The developmental origins of health and disease and intergenerational inheritance: a scoping review of multigenerational cohort studies.

Epidemiologic research has increasingly acknowledged the importance of developmental origins of health and disease (DOHaD) and suggests that prior exposures can be transferred across generations. Multigenerational cohorts are crucial to verify the intergenerational inheritance among human subjects. We carried out this scoping review aims to summarize multigenerational cohort studies' characteristics, issues, and implications and hence provide evidence to the DOHaD and intergenerational inheritance. We adopted a comprehensive search strategy to identify multigenerational cohorts, searching PubMed, EMBASE, and Web of Science databases from the inception of each dataset to June 20th, 2022, to retrieve relevant articles. After screening, 28 unique multigenerational cohort studies were identified. We classified all studies into four types: population-based cohort extended three-generation cohort, birth cohort extended three-generation cohort, three-generation cohort, and integrated birth and three-generation cohort. Most cohorts (n = 15, 53%) were categorized as birth cohort extended three-generation studies. The sample size of included cohorts varied from 41 to 167,729. The study duration ranged from two years to 31 years. Most cohorts had common exposures, including socioeconomic factors, lifestyle, and grandparents' and parents' health and risk behaviors over the life course. These studies usually investigated intergenerational inheritance of diseases as the outcomes, most frequently, obesity, child health, and cardiovascular diseases. We also found that most multigenerational studies aim to disentangle genetic, lifestyle, and environmental contributions to the DOHaD across generations. We call for more research on large multigenerational well-characterized cohorts, up to four or even more generations, and more studies from low- and middle-income countries.

Secondary Analysis of the Salt Substitute and Stroke Study (SSaSS): Effects of Potassium-Enriched Salt on Cardiac Outcomes.

BACKGROUND: The SSaSS (Salt Substitute and Stroke Study) has shown that use of a potassium-enriched salt lowers the risk of stroke, total cardiovascular events, and premature death. The effects on cause-specific cardiac outcomes are reported here. METHODS: SSaSS was an unblinded, cluster-randomised trial assessing the effects of potassium-enriched salt compared with regular salt among 20 995 Chinese adults with established stroke and older age and uncontrolled hypertension. Post hoc efficacy analyses were performed using an intention-to-treat method and a hierarchical Poisson regression model adjusting for clustering to obtain rate ratios and 95% CIs. We assessed acute coronary syndrome, heart failure, arrhythmia, and sudden death. RESULTS: Over a mean 4.74 years follow-up, there were 695 acute coronary syndrome events, 454 heart failure events, 230 arrhythmia events, and 1133 sudden deaths recorded. The rates of events were lower in potassium-enriched salt group for all outcomes but CIs were wide for most: acute coronary syndrome (6.32 versus 7.65 events per 1000 person-years; rate ratio, 0.80 [95% CI, 0.65-0.99]); heart failure (9.14 versus 11.32 events per 1000 person-years; rate ratio, 0.88 [95% CI, 0.60-1.28]); arrhythmia (4.43 versus 6.20 events per 1000 person-years; rate ratio, 0.59 [95% CI, 0.35-0.98]); and sudden death (11.01 versus 11.76 events per 1000 person-years; rate ratio, 0.94 [95% CI, 0.82-1.07]; all P>0.05 with adjustment for multiple comparisons). CONCLUSIONS: These results suggest that use of potassium-enriched salt is more likely to prevent than cause cardiac disease but the post hoc nature of these analyses precludes definitive conclusions. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02092090.

Resting heart rate and risk of dementia: a Mendelian randomization study in the international genomics of Alzheimer's Project and UK Biobank.

Background: Observational studies have demonstrated that a higher resting heart rate (RHR) is associated with an increased risk of dementia. However, it is not clear whether the association is causal. This study aimed to determine the causal effects of higher genetically predicted RHR on the risk of dementia. Methods: We performed a two-sample Mendelian randomization analysis to investigate the causal effect of higher genetically predicted RHR on Alzheimer's disease (AD) using summary statistics from genome-wide association studies. The generalized summary Mendelian randomization (GSMR) analysis was used to analyze the corresponding effects of RHR on following different outcomes: 1) diagnosis of AD (International Genomics of Alzheimer's Project), 2) family history (maternal and paternal) of AD from UK Biobank, 3) combined meta-analysis including these three GWAS results. Further analyses were conducted to determine the possibility of reverse causal association by adjusting for RHR modifying medication. Results: The results of GSMR showed no significant causal effect of higher genetically predicted RHR on the risk of AD (ßGSMR = 0.12, P = 0.30). GSMR applied to the maternal family history of AD (ßGSMR = -0.18, P = 0.13) and to the paternal family history of AD (ßGSMR = -0.14, P = 0.39) showed the same results. Furthermore, the results were robust after adjusting for RHR modifying drugs (ßGSMR = -0.03, P = 0.72). Conclusion: Our study did not find any evidence that supports a causal effect of RHR on dementia. Previous observational associations between RHR and dementia are likely attributed to the correlation between RHR and other cardiovascular diseases.

Evaluating the accuracy of the Ophthalmologist Robot for multiple blindness-causing eye diseases: a multicentre, prospective study protocol.

INTRODUCTION: Early eye screening and treatment can reduce the incidence of blindness by detecting and addressing eye diseases at an early stage. The Ophthalmologist Robot is an automated device that can simultaneously capture ocular surface and fundus images without the need for ophthalmologists, making it highly suitable for primary application. However, the accuracy of the device's screening capabilities requires further validation. This study aims to evaluate and compare the screening accuracies of ophthalmologists and deep learning models using images captured by the Ophthalmologist Robot, in order to identify a screening method that is both highly accurate and cost-effective. Our findings may provide valuable insights into the potential applications of remote eye screening. METHODS AND ANALYSIS: This is a multicentre, prospective study that will recruit approximately 1578 participants from 3 hospitals. All participants will undergo ocular surface and fundus images taken by the Ophthalmologist Robot. Additionally, 695 participants will have their ocular surface imaged with a slit lamp. Relevant information from outpatient medical records will be collected. The primary objective is to evaluate the accuracy of ophthalmologists' screening for multiple blindness-causing eye diseases using device images through receiver operating characteristic curve analysis. The targeted diseases include keratitis, corneal scar, cataract, diabetic retinopathy, age-related macular degeneration, glaucomatous optic neuropathy and pathological myopia. The secondary objective is to assess the accuracy of deep learning models in disease screening. Furthermore, the study aims to compare the consistency between the Ophthalmologist Robot and the slit lamp in screening for keratitis and corneal scar using the Kappa test. Additionally, the cost-effectiveness of three eye screening methods, based on non-telemedicine screening, ophthalmologist-telemedicine screening and artificial intelligence-telemedicine screening, will be assessed by constructing Markov models. ETHICS AND DISSEMINATION: The study has obtained approval from the ethics committee of the Ophthalmology and Optometry Hospital of Wenzhou Medical University (reference: 2023-026 K-21-01). This work will be disseminated by peer-review publications, abstract presentations at national and international conferences and data sharing with other researchers. TRIAL REGISTRATION NUMBER: ChiCTR2300070082.

Table Correction: Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis.

[This corrects the article DOI: 10.2196/45111.].

Trends in Health Service Use for Dry Eye Disease From 2017 to 2021: A Real-World Analysis of 369,755 Outpatient Visits.

Purpose: We aimed to analyze the trends and patterns in outpatient health service treatment of dry eye disease (DED) using real-world data from Yinzhou District in China. Methods: The Yinzhou Health Information System is a comprehensive database including electronic medical records from 277 medical institutions representing over 1.64 million residents. We extracted outpatient records from January 1, 2017, to December 31, 2021, that included the first diagnosis of DED according to the International Classification of Diseases, 10th Revision (H04.101, H04.103, H11.104, H16.202, or H18.803). We analyzed the trends and patterns of DED outpatient visits using the Mann-Kendall trend test and Cochran-Armitage trend test. Results: We identified a total of 369,755 outpatient visits from 145,712 patients with DED of all ages (60.37% female; 54.10% 50 years or older). Primary medical institutions had the largest number of DED outpatient visits (42%), followed by tertiary medical institutions (35%). Over the 5-year period, the number of DED outpatient visits increased from 59,260 to 90,807 (53.23%). We observed significant consecutive annual proportion increases in females (from 61.09% to 62.01%; P = 0.001), patients 50 years or older (from 55.10% to 60.08%; P < 0.001), and outpatient visits in primary medical institutions (from 33.19% to 48.75%; P < 0.001). Conclusions: Our study found an increase in outpatient health service use for DED in Yinzhou from 2017 to 2021, with higher proportions and increases among females, patients 50 years or older, and primary medical institutions. Translational Relevance: The rapid growth in the prevalence of DED indicates high eye healthcare needs in patients.

Assessing COVID-19 pandemic's impact on essential diabetes care in Manila, the Philippines: A mixed methods study.

The COVID-19 pandemic directly increased mortality and morbidity globally. In addition, it has had extensive indirect ill effects on healthcare service delivery across health systems worldwide. We aimed to describe how patient access to diabetes care was affected by the pandemic in Manila, the Philippines. We used an explanatory, sequential mixed method approach including a cross-sectional survey (n = 150) and in-depth interviews of patients (n = 19), focus group discussions of healthcare workers (n = 22), and key informant interviews of health facility administrators (n = 3) from October 2021 to January 2022. Larger proportions of patients reported absence of livelihood (67.3%), being in the lowest average monthly household income group (17.3%), and disruptions in diabetes care (54.0%) during the pandemic. They identified the imposition of lockdowns, covidization of the healthcare system, and financial instability as contributors to the reduced availability, accessibility, and affordability of diabetes-related consultations, medications, and diagnostics. At least a quarter of the patients experienced catastrophic health expenditures across all areas of diabetes care during the pandemic. Most healthcare workers and administrators identified telemedicine as a potential but incomplete tool for reaching more patients, especially those deemed lost to follow-up. In the Philippines, the pandemic negatively impacted access to essential diabetes care.

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update.

Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

Residential proximity to major roadways and hearing impairment in Chinese older adults: a population-based study.

BACKGROUND: With rapid urban sprawl, growing people are living in the vicinity of major roadways. However, little is known about the relationship between residential proximity to major roadways and hearing impairment (HI). METHODS: We derived data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, and included 13,775 participants aged 65 years or older. Multivariate logistic regressions were employed to examine the association between residential proximity to major roadways and HI. The effects of corresponding potentially modifiable factors were studied by three-way interaction analyses. Sensitivity analyses were performed to verify the robustness of the results. RESULTS: The prevalence of HI was 38.3%. Participants living near major roadways were more likely to have a higher socioeconomic status. An exposure-response relation between residential proximity to major roadways and HI was observed (Ptrend < 0.05). Compared with individuals living > 300 m away from major roadways, the adjusted odds ratios (OR) were 1.07 (95% CI: 0.96-1.24), 1.15 (95% CI: 1.07-1.34), and 1.12 (95% CI: 1.01-1.31) for those living 101-200 m, 50-100 m, and < 50 m away from the roadways, respectively. Particularly, the association was more pronounced among individuals exposed to carbon monoxide (CO) pollution or opening windows frequently (Pinteraction < 0.05). Three-way interaction analyses confirmed that participants exposed to CO pollution and frequently leaving windows open had the highest OR of 1.73 (95% CI: 1.58-1.89). CONCLUSIONS: This nation-wide cohort study suggested that residential proximity to major roadways was significantly associated with an increased exposure-response risk of HI in Chinese older adults. Exposure to CO pollution and opening windows frequently might strengthen the relations.

Community Efficacy for Non-Communicable Disease Management and Medication Adherence: The Sequential Mediating Role of Self-Efficacy and Depressive Symptoms.

Purpose: We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age. Patients and Methods: Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis. Results: Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males. Conclusion: Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.

Changes in physical activity and all-cause mortality in the oldest old population: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

BACKGROUND: Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80 years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80 years or older) population using the Chinese Longitudinal Healthy Longevity Survey. METHODS: Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n = 14,287), 2) remaining physically active (n = 5411), 3) shifting from being inactive to active (n = 1364), and 4) shifting from being active to inactive (n = 1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups. RESULTS: A total of 15,707 participants died during follow-up (median duration of follow-up = 3.0 years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata. CONCLUSION: Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.

Association between individual resilience and depression or anxiety among general adult population during COVID-19: a systematic review.

BACKGROUND: The coronavirus disease (COVID-19) pandemic exacerbated depression and anxiety worldwide. Resilience is important to maintain mental health during uncertain times, but limited study has systematically reviewed its association with depression or anxiety with an emphasis on the general population. METHODS: We searched PubMed and Embase for quantitative or mixed-methods studies on the general adult population published between 1 January 2020 and 31 April 2022 (PROSPERO ID: CRD 42022340935). National Institute of the Health quality assessment tools was used to assess the risk of bias. We qualitatively synthesized findings by outcome and study design. RESULTS: A total of 2945 studies were screened and 35 studies were included in the narrative analysis (5 on depression, 9 on anxiety, and 21 on both). Overall, 21 studies identified statistically significant inverse associations between resilience and depression, while 24 studies found statistically significant inverse associations between resilience and anxiety. Eight studies reported no statistically significant relationships between resilience with depression or anxiety. CONCLUSIONS: Resilience was found to be inversely associated with depression and anxiety during the COVID-19 pandemic. The findings highlight the importance of resilience-enhancing intervention in migrating the global mental health burden from outbreaks of infectious diseases.

Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis.

BACKGROUND: Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. OBJECTIVE: This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. METHODS: We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. RESULTS: A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI -0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). CONCLUSIONS: Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. TRIAL REGISTRATION: PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104.

Evaluating the effectiveness and cost-effectiveness of free influenza vaccination policy for older adults in Yinzhou, China: Study protocol of a real-world analyses.

BACKGROUND: Influenza causes excessive morbidity and mortality among older adults. While influenza vaccine provides protection against its infection, the vaccination coverage in China among older adults has been very low. Previous evidence on the cost-effectiveness of government-sponsored free influenza vaccination programs in China was primarily based on literature data, which might not always reflect real-world patient populations. The Yinzhou Health Information System (YHIS) is a regional database that captures electronic health records, insurance claims data, etc. for all residents in Yinzhou district, Zhejiang province, China. We will use YHIS to study the effectiveness, influenza-related direct medical cost and cost-effectiveness analysis (CEA) of the free influenza vaccination program for older adults. In this paper, we describe the study design and innovations in detail. METHODS: We will establish a retrospective cohort of permanent older residents aged 65 and over, using YHIS between 2016 and 2021. We will estimate the vaccine coverage rate, influenza incidence rate and influenza-related direct medical cost from 2016 to 2021. Regression discontinuity will be used to estimate vaccine effectiveness for the 2020/2021 season. We will build a decision tree model to compare the cost-effectiveness of three influenza vaccination options (free trivalent influenza vaccine, free quadrivalent influenza vaccine, and no policy) from both societal and health system perspectives. Parameter inputs will be gathered from both YHIS and published literature. We will calculate the incremental cost-effectiveness ratio with cost and quality-adjusted life years (QALYs) discounted at 5 % annually. DISCUSSION: Our CEA solidifies multiple sources including regional real-world data and literature for a rigorous evaluation of the government-sponsored free influenza vaccination program. The results will provide real-world evidence from real-world data on the cost-effectiveness of a real-world policy. Our findings are expected to support evidence-based policy making and to promote health for older adults.

Intake of sugary beverages with chronic conditions and multimorbidity: a prospective cohort study of UK Biobank.

BACKGROUND: The burden of chronic conditions associated with sugary beverages is increasing but little is known about the role of different types of sugary beverages in the co-occurrence of multiple chronic conditions ('multimorbidity'). To inform future sugar-reduction guidelines, we aimed to examine the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and natural juices (NJ) with multimorbidity. METHODS: This prospective cohort study included 184 093 UK Biobank participants aged 40-69 years at baseline who completed at least one occasion of 24-h dietary recall between 2009 and 2012. Daily consumptions of SSB, ASB and NJ were assessed using 24-h dietary recall. Participants were followed from the first 24-h assessment until the onset of two or more new chronic conditions, or the end of follow-up (31 March 2017), whichever occurred first. Logistic regression models, Cox proportional hazard models and quasi-Poisson mixed effects models were used to estimate the association of beverages intakes with chronic conditions and multimorbidity. RESULTS: A total of 19 057 participants had multimorbidity at baseline and 19 968 participants developed at least two chronic conditions during follow-up. We observed dose-response relationships of SSB and ASB consumptions with the prevalence and incidence of multimorbidity. For example, the adjusted hazard ratios (HRs) and 95% CIs of the incidence of developing at least two chronic conditions ranged from 1.08 (1.01-1.14) for SSB intake of 1.1-2 units/day to 1.23 (1.14-1.32) for >2 units/day compared with 0 units/day. Also, the adjusted HRs (95% CIs) of ASB consumption ranged from 1.08 (1.03-1.13) for 0.1-1 unit/day to 1.28 (1.17-1.40) for >2 units/day compared with non-consumers. Conversely, moderate consumption of NJ was associated with a smaller risk of the prevalence and incidence of multimorbidity. Moreover, higher intakes of SSB and ASB were positively associated whereas moderate intake of NJ was inversely associated with increased number of new-onset chronic conditions during follow-up. CONCLUSIONS: Higher SSB and ASB intakes were positively associated whereas moderate NJ intake was inversely associated with the higher risk of multimorbidity and increased number of chronic conditions. Current and intended policy options to decrease the burden of chronic conditions and multimorbidity need a formulation of SSB and ASB reduction strategies.

An economic evaluation of a primary care-based technology-enabled intervention for stroke secondary prevention and management in rural China: a study protocol.

Introduction: Secondary prevention of stroke is a leading challenge globally and only a few strategies have been tested to be effective in supporting stroke survivors. The system-integrated and technology-enabled model of care (SINEMA) intervention, a primary care-based and technology-enabled model of care, has been proven effective in strengthening the secondary prevention of stroke in rural China. The aim of this protocol is to outline the methods for the cost-effectiveness evaluation of the SINEMA intervention to better understand its potential economic benefits. Methods: The economic evaluation will be a nested study based on the SINEMA trial; a cluster-randomized controlled trial implemented in 50 villages in rural China. The effectiveness of the intervention will be estimated using quality-adjusted life years for the cost-utility analysis and reduction in systolic blood pressure for the cost-effectiveness analysis. Health resource and service use and program costs will be identified, measured, and valued at the individual level based on medication use, hospital visits, and inpatients' records. The economic evaluation will be conducted from the perspective of the healthcare system. Conclusion: The economic evaluation will be used to establish the value of the SINEMA intervention in the Chinese rural setting, which has great potential to be adapted and implemented in other resource-limited settings.

Trends in global health research among universities in China: a bibliometric analysis.

BACKGROUND: There has been considerable progress in developing global health education and research in China. Nevertheless, evidence of the progress of Chinese universities' contributions to global health research is limited. More efforts are needed to depict the progress Chinese universities have collectively made in advancing the field of global health. This study aimed to examine Chinese universities' collective contributions to global health research by describing the longitudinal trends in global health research publications, uncovering research themes in global health, and exploring collaboration patterns. METHODS: A comprehensive bibliometric analysis was conducted for original research studies of the ten founding members of the China Consortium of Universities for Global Health, one of the largest networks of global health research and education in China. RESULTS: We found that (1) the number of research publications in the field of global health has steadily increased from 2014 to 2020, (2) non-communicable disease was the most popular research topic, accounting for over one-third of total publications, followed by maternal and child health and neurological and mental disorders and diseases, (3) less than one-fifth of papers involved primary data collection, with the majority of the study populations from low-income and lower-middle-income countries in Asia and Africa, and (4) a sizable collaboration network has been established with co-authors from over 200 oversea universities or organizations, with about one third from the US. CONCLUSIONS: Despite a variety of challenges and barriers, Chinese universities have been playing an increasingly important role in global health research as assessed by peer-reviewed publications over the last decade. More concerted efforts by multiple stakeholders, including government, private sectors, funding agencies, academic institutions, and researchers, are needed to advance the development of global health research in China.

Stroke and activity limitation in Chinese adults 65 Years or older.

BACKGROUND: Differences in activity limitations between stroke survivors and people with other chronic conditions and how their levels of activity limitation vary by sociodemographic characteristics have not been well quantified. OBJECTIVE: To quantify activity limitations experienced by Chinese older adult stroke survivors and explore stroke effects in specific subgroups. METHODS: We used Chinese Longitudinal Healthy Longevity Survey 2017-2018 data (N = 11,743) to produce population-weighted estimates of activity limitations using the Activities of Daily Living (ADL) and the Instrumental ADL (IADL) scales for older adults (age 65 and older) stroke survivors compared to those with non-stroke chronic conditions and those without chronic conditions. Multinomial logistic regressions were run with outcomes "no activity limitation," "IADL only limitation," and "ADL limitation." RESULTS: The weighted marginal prevalence of ADL limitation was higher in the stroke group (14.8%) than in those with non-stroke chronic condition (4.8%) or no chronic conditions (3.6%) (p < 0.01). The corresponding prevalence of IADL limitation for the three groups was 36.0%, 31.4%, and 22.2%, respectively (p < 0.01). Stroke survivors aged ≥ 80 years had a higher prevalence of ADL/IADL limitation than those aged 65-79 years (p < 0.01). Formal education was associated with a lower prevalence of ADL/IADL limitation in each chronic condition group (p < 0.01). CONCLUSIONS: Prevalence and severity of activity limitation among Chinese older adult stroke survivors were several times higher than those without chronic conditions and those with non-stroke chronic conditions. Stroke survivors, particularly those aged ≥80 years and those without formal education, might be predisposed to more severe activity limitation and require more support to compensate.