[Declining Rate of Neural Tube Defects and Outcomes of Defective Infants in Shaanxi Province from 2003 to 2022].

Objective To evaluate the changes in the incidence of neural tube defects (NTDs) in Shaanxi province from 2003 to 2022,investigate the diagnosis time and outcomes of defective infants,and predict the incidence of NTDs in Shaanxi province from 2023 to 2025,thereby providing a basis for improving the birth defects surveillance system. Methods Data were collected from all the perinatal infants from 28 weeks of gestation to 7 days after birth in all the hospitals with obstetrical department in Shaanxi province during 2003-2022.The changes in the incidence of NTDs from 2003 to 2022 were analyzed based on the birth defects surveillance system. Results A total of 1 106 483 perinatal infants in Shaanxi province from 2003 to 2022 were surveyed,among which NTDs occurred in 848 perinatal infants,with an incidence of 7.66/10 000.The incidence was the highest (48.02/10 000) in 2005 and the lowest (0.57/10 000) in 2022.The NTDs in Shaanxi province were mainly spina bifida (55.90%),which was followed by anencephaly (25.71%) and encephalocele (18.40%).The incidences of the three declined with fluctuations (P<0.001).The results of the Joinpoint analysis showed that the incidence of NTDs decreased slowly with the annual percentage change of -4.04 from 2003 to 2014 and declined rapidly with the annual percentage change of -28.05 from 2014 to 2022.From 2003 to 2022,the average proportion of prenatal diagnosis of NTDs in Shaanxi province was 72.88%.Dead fetus (61.91%) was the main birth outcome,followed by live birth (26.77%),stillbirth (8.73%),and death within seven days after birth (2.59%).The incidence of NTDs in Shaanxi province from 2023 to 2025 were predicted by the GM (1,1) model as 0.49/10 000,0.41/10 000,and 0.35/10 000,respectively. Conclusion The incidence of NTDs in Shaanxi province declined significantly during 2003-2022,especially in a rapid manner after 2014.Dead fetus was the primary outcome of perinatal infants with NTDs,followed by live birth.

[Interaction of hypertensive comorbidity patterns and social participation on depressive symptoms].

OBJECTIVE: To explore the relationship between hypertensive comorbidity patterns and social participation and depressive symptoms in middle-aged and elderly hypertensive patients. METHODS: Using the data from the 2015, 2018 and 2020 of the China Health and Retirement Longitudinal Study, 2786 middle and elderly adults aged 45 and above with hypertension were included. Data analysis was performed in Stata 17.0 statistical software, using frequency and percentage to describe baseline characteristics. The generalized estimation equation(GEE) was used to to analyze the data, and GEE was constructed with the depressive symptoms of middle and elderly people as the dependent variable. The unifactorial and multifactorial analysis of the effects of hypertensive comorbidity patterns and social participation on depressive symptoms, and the influence of the interaction between hypertensive comorbidity patterns and social participation on depressive symptoms were analyzed. RESULTS: Among the baseline characteristics of 2786 middle and older adults with hypertension, 2319(83.24%) had hypertensive comorbidity and 1558(55.92%) had social participant. The result of unifactorial GEE analysis of depressive symptoms in middle and older adults showed that the risk of depressive symptoms was higher in hypertensive comorbidity than in hypertension without comorbidity(OR=2.31, 95%CI 1.97-2.71, P<0.01), and lower in middle and older adults with social participation than in those without social participation(OR=0.71, 95%CI 0.64-0.78, P<0.01). The result of multifactorial GEE analysis of depressive symptoms in middle and older adults showed that the risk of depressive symptoms was higher in hypertensive comorbidity than in hypertension without comorbidity(OR=2.06, 95%CI 1.75-2.41, P<0.01), and lower in middle and older adults with social participation than in those without social participation(OR=0.78, 95%CI 0.70-0.87, P<0.01). Analysis of the interaction of hypertensive comorbidity and social participation on depressive symptoms in middle and older adults showed that middle and older adults with hypertensive comorbidity and no social participation had a 2.20 times higher risk of depressive symptoms than those with hypertension without comorbidity and no social participation(OR=2.20, 95%CI 1.78-2.72, P<0.01). CONCLUSION: Comorbidity is severe in the hypertensive population, and social participation in the hypertensive comorbidity population may reduce the risk of developing depressive symptoms.

Trends in total cholesterol control among American adults with hypercholesterolemia, 1988-2018.

BACKGROUND AND AIMS: Cholesterol control and management in patients with hypercholesterolemia are significant for the primary and secondary prevention of atherosclerotic cardiovascular disease. This study analyzed the trend of serum total cholesterol (TC) control (<240 mg/dL and <200 mg/dL) in American adults with hypercholesterolemia and thereby make some effective recommendations for the public health measures. METHODS AND RESULTS: Basing on the National Health and Nutrition Examination Survey (NHANES) data from 1988 to 2018 (12 cycles), we calculated the weighted and representative rate of patients with hypercholesterolemia who had controlled TC, and then described the trend. Among the adults with hypercholesterolemia, the age-adjusted rate of those whose TC was less than 240 mg/dL increased from 7.67% (95%CI: 5.94%-9.40%) in 1988-1991 to 58.52% (95%CI: 55.89%-61.15%) in 2013-2014 and then remained stable; and the age-adjusted rate of those whose TC was less than 200 mg/dL increased from 2.49% (95%CI: 1.48%-3.50%) in 1988-1991 to 44.58% (95%CI: 40.00%-49.16%) in 2017-2018. CONCLUSION: We concluded that the rate of controlling TC below 200 mg/dL among all patients had shown an increasing trend from 1988 to 2018 in America, while the rate of controlling TC below 240 mg/dL remained stable in recent years after an increasing.

The relationship between cadmium and cognition in the elderly: a systematic review.

Context: The relationship between cadmium (Cd) and the cognition of the elderly is indistinct.Objective: To summarise the studies on the relationship between the cognition of the elderly and Cd.Methods: Literatures were searched in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wan fang database on April 25, 2022. The entries in the STROBE statement were used to evaluate the literature quality; all the quantitative studies that met the requirements were systematically summarised.Results: Blood Cd was negatively correlated with the cognitive ability of the elderly, corresponding to different cognitive ability assessment methods, the regression coefficients were: -0.11 (-0.20, -0.03), -0.46 (-0.71, -0.21), -0.54 (-0.90, -0.17), -0.19 (-0.37, -0.01), and -2.29 (-3.41, -1.16). The regression coefficients between urinary Cd level and cognition score were -1.42 (-2.38, -0.46), and 0.76 (-1.28, -0.23). When dietary Cd increased by 1 µg/kg, the composite z-score decreased by 3.64 (p = 0.001). There was no significant correlation between drinking water Cd, fingernail Cd and cognition (p > 0.05).Conclusion: We concluded that blood Cd (including whole blood and plasma), urine Cd and dietary Cd were negatively correlated with the cognition of the elderly, but the relationship between Cd in drinking water and fingernails and cognition was not statistically significant.

Assessing the psychometric properties of the Chinese return-to-work self-efficacy questionnaire using Rasch model analysis.

BACKGROUND: Self-efficacy is a significant predictor of return to work and affects the confidence of survivors to return to work after illness. The Return-to-work self-efficacy (RTW-SE) questionnaire is a self-report questionnaire to assess confidence in returning to work with good reliability and validity. The aim of this study was to translate and cross-culturally adapt the RTW-SE questionnaire into Chinese and examine the psychometric properties among young and middle-aged stroke survivors using Rasch model analysis. METHODS: The cross-cultural adaptation and translation procedures followed a dual-translation approach. The psychometric properties of the RTW-SE questionnaire were examined using Rasch model analysis by Winsteps software. The unidimensionality and local independence were analyzed by principal component analysis of the residuals (PCAR) and standardized residual correlations.Category diagnostics were performed for scale function, and the item fit, reliability, and separation were also validated. Item-person maps were used to examine the distribution and matching of item's location and person ability. Finally, the differential item functioning (DIF) was used to measure gender-related group equivalence. RESULTS: A total of 366 participants aged 23-59 years were recruited from three communities in Zhengzhou. The RTW-SE questionnaire demonstrated unidimensionality and a 5-point Likert rating scale was more appropriate to investigate young and middle-aged stroke survivors'self-efficacy. There was a good fit for the items with both person and item reliabilities greater than 0.8 and separation indices of 3.75 and 3.94, respectively. The item location was identified from the item-person map as not covering person ability, but the scale did not have an age-related DIF. CONCLUSIONS: The results confirm evidence of appropriate psychometric properties of the RTW-SE questionnaire and can be used as a reliable and validated instrument for measuring self-efficacy to return to work in young and middle-aged Chinese patients with stroke.

Effects of sea buckthorn (Hippophae rhamnoides L.) on factors related to metabolic syndrome: A systematic review and meta-analysis of randomized controlled trial.

The purpose of this meta-analysis is to explore whether the supplement of sea buckthorn affects the factors related to metabolic syndrome. The related RCTs from five databases were systematically searched and comprehensively random effects model was used to calculate SMD and 95% CI. The Cochrane deviation risk tool was used to evaluate the deviation risk. Fifteen studies were involved in the meta-analysis. First, sea buckthorn supplementation reduced triglycerides [-0.722 (-1.129, -0.316); p < .001], total cholesterol [-0.345 (-0.639, -0.051); p = .021], low density lipoprotein cholesterol [-0.396 (-0.755, -0.037); p = .031], and increased high density lipoprotein cholesterol [0.370 (0.056, 0.684); p = .021] in overall subjects. Second, subgroup analysis showed that sea buckthorn supplementation reduced lipids only in people with abnormal lipid metabolism. Third, sea buckthorn had no effect on blood sugar, blood pressure, and BMI of the overall subjects. Sea buckthorn may affect the lipid metabolism in circulation, but it cannot affect blood glucose, blood pressure, and BMI. These indicators are closely associated with metabolic syndrome. This study may contribute to the development and utilization of sea buckthorn, and may provide a new and safer way for the prevention and treatment of metabolic syndrome. The limitation of this study is high heterogeneity, even if subgroup analysis is used. However, more clinical studies are needed to determine the real effect of sea buckthorn on metabolic syndrome.

The lipid accumulation product (LAP) association with hyperuricemic hypertension in the China Health and Nutrition Survey: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Previous studies have explored the relationship between lipid accumulation product (LAP) and hypertension or hyperuricemia. However, the association between LAP and hypertension with hyperuricemia (HWH) is inconclusive. Therefore, we aimed to evaluate the association between LAP and HWH. METHODS AND STUDY DESIGN: A total of 7897 participants aged 18 to 75 years from the 2009 wave of the China Health and Nutrition Survey were included in this study. General linear regression models were built to assess the association of LAP with systolic blood pressure (SBP), diastolic blood pressure (DBP), and uric acid (UA) concentrations. Logistic regression models were used to estimate the association between LAP and HWH risk, restricted cubic splines (RCS) were used to analyze the dose-response relationship between them. RESULTS: The prevalence of HWH was significantly higher in men (7.63%) than in women (1.99%) (X2=142; p<0.001). After adjustment for potential confounders, LAP scores were positively correlated with SBP, DBP, and UA concentrations in both genders (all p-trend <0.01). Compared with participants in the lowest quartile of LAP, those in the highest quartile had a higher risk of HWH [OR (95% CI)=12.2 (7.22-20.5) for men, OR (95% CI)=14.5 (3.50- 60.2) for women]. The RCS results suggested a nonlinear relationship between the continuous change of LAP and HWH risk after adjustment for confounding factors in each gender (p for nonlinearity <0.001). CONCLUSIONS: Our findings suggest that higher LAP scores was strongly associated with greater HWH risk in Chinese adults.

The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis.

AIMS AND OBJECTIVES: To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. BACKGROUND: Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. DESIGN: A cross-sectional descriptive study. METHODS: In total, 208 stroke survivors (70.25 ± 9.08 years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. RESULTS: The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. CONCLUSIONS: The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. RELEVANCE TO CLINICAL PRACTICE: Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

[Multiple Correspondence of Abnormal Birth History with Genetic and Environmental Risk Factors].

Objective To investigate the multiple correspondence of genetic and environmental risk factors with abnormal birth history and provide a scientific basis for improving the birth defects surveillance system and reducing the incidence of birth defects. Methods Data were collected from all the perinatal infants from 28-week-old fetuses to 7-day-old infants born in all the hospitals with obstetrical department in Xi'an from 2003 to 2015. Results A total of 1 236 937 perinatal infants were surveyed,including 10 619 with birth defects.The average incidence rate of birth defects was 0.86% (0.70%-1.15%).Multiple correspondence analysis showed that the women who had had 1 or 2 children with birth defects were associated with the history of spontaneous abortion,family history of birth defects,and history of exposure to toxic and harmful substances.The women who had had 3 or more children with birth defects showed stronger association with family history of birth defects.The birth defects in women with history of spontaneous abortion (257/10 619) was ranked in the order of congenital heart disease,polydactyly,neural tube defects,congenital hydrocephalus,cleft lip with cleft palate,and simple cleft lip.The birth defects in women who had given birth to children with birth defects (135/10 619) followed the order of cleft lip with cleft palate,anencephaly,hydrocephalus,neural tube defects,cleft lip,and talipes equinovarus. Conclusions Abnormal birth history is associated with family history of birth defects and history of exposure to environmental risk factors.Giving birth to three or more children with birth defects is highly correlated with the family history of birth defects.

The causal association between body mass index and type 2 diabetes mellitus-evidence based on regression discontinuity design.

OBJECTIVE: This study aimed to investigate and determine the precise causal association between body mass index (BMI) and type 2 diabetes mellitus (T2DM) using a regression discontinuity design (RDD). METHODS: The cross-sectional data of 8550 participants were from the China Health and Nutrition Survey (CHNS) in 2015. Influencing factors with statistically significant were selected with logistic regression analysis, and a risk prediction model was established to obtain the risk of individuals suffering from T2DM. RDD was performed with BMI as the grouping variable and the risk of individuals suffering from T2DM as the outcome variable. RESULTS: The predictive factors in the T2DM risk prediction model were age, gender, BMI, habitation, education, physical activity level, preference for sugary beverages, walking, self-evaluation health status and history of hypertension. The AUC (area under receiver operating characteristic curve) of the T2DM risk prediction model was 0.849 (95% CI: 0.833, 0.866). BMI was an independent risk factor for T2DM (OR = 1.109, p < 0.001); at BMI = 31 kg/m2 , the risk of T2DM increased sharply by 5.03% (p = 0.006). CONCLUSIONS: There was a positive causal association between BMI and T2DM; when BMI = 31 kg/m2 , the risk of individuals suffering from T2DM was sharply increased.

Post-traumatic growth and influencing factors among frontline nurses fighting against COVID-19.

OBJECTIVE: To explore the level and influencing factors of frontline nurses' post-traumatic growth (PTG) during COVID-19 epidemic. METHODS: A cross-sectional survey was conducted in February 2020 in three hospitals in China. The Post-traumatic Growth Inventory (PTGI) was used to investigate the PTG of frontline nurses. Data on related factors, including demographic characteristics and subjective variables, were collected. The Event-Related Rumination Inventory was used to assess rumination. Pearson's or Spearman's correlation was calculated for bivariate analysis. Independent sample t-tests or one-way analysis of variance and multiple linear regression analysis were used to examine the related factors. RESULTS: A total of 179 frontline nurses were recruited, and 167 were included in the analyses. The mean PTG score was 70.53±17.26. The bivariate analyses showed that deliberate rumination was modestly positively correlated with PTG (r=0.557, p<0.01), while intrusive rumination had a modest negative correlation with PTG (r=-0.413, p<0.01). Multiple linear regression demonstrated that working years, self-confidence in frontline work, awareness of risk, psychological intervention or training during the epidemic and deliberate rumination were the main influencing factors of PTG among frontline nurses and accounted for 42.5% of the variance (F=31.626, p<0.001). CONCLUSIONS: The PTG of frontline nurses was at a medium to high level and was influenced by working years, self-confidence in frontline work, awareness of risk, psychological intervention or training and deliberate rumination. It is necessary to strengthen psychological guidance and training for frontline nurses and promote their deliberate rumination on epidemic events to improve their PTG.

Timing of do-not-resuscitate orders and health care utilization near the end of life in cancer patients: a retrospective cohort study.

PURPOSE: The objectives are to explore the prevalence of DNR orders, the factors influencing them, and the association between DNR signing and health care utilization among advanced cancer patients. METHODS: This was a retrospective cohort study. Data from cancer decedents in three hospitals in China from January 2016 to December 2017 during their last hospitalization before death were obtained from the electronic medical records system. RESULTS: In total, 427 cancer patients were included; 59.0% had a DNR order. Patients who had solid tumors, lived in urban areas, had more than one comorbidity, and had more than five symptoms were more likely to have DNR orders. The cut-off of the timing of obtaining a DNR order was 3 days, as determined by the median number of days from the signing of a DNR order to patient death. Patients with early DNR orders (more than 3 days before death) were less likely to be transferred to the intensive care unit and undergo cardiopulmonary resuscitation, tracheal intubation, and ventilation, while they were more likely to be given morphine and psychological support compared with those with late (within 3 days before death) and no orders. CONCLUSIONS: Advanced cancer patients with solid tumors living in urban areas with more symptoms and comorbidities are relatively more likely to have DNR orders. Early DNR orders are associated with less aggressive procedures and more comfort measures. However, these orders are always signed late. Future studies are needed to better understand the timing of DNR orders.

Linear association between grip strength and all-cause mortality among the elderly: results from the SHARE study.

BACKGROUND: Grip strength had become a potential tool for clinical assessments, while the predictive value of the grip strength of community-based populations had some limitations. AIMS: To identify the shapes of the association between grip strength and all-cause mortality in the Survey of Health, Ageing and Retirement in Europe (SHARE) cohort. METHODS: Based on the SHARE cohort, 13,231 subjects aged 65 years and older were included in this study. Cox models with penalized splines (P-splines) were employed to characterize the shapes of the association between grip strength and all-cause mortality with the adjustment of covariates including sociodemographic characteristics, health characteristics, behavioral habits, and illness status. Then grip strength was analyzed as a categorical variable in quintile to examine the impact of low grip strength on all-cause mortality. RESULTS: Inversely linear associations were found between grip strength and mortality both in males and females after adjustment for covariates. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for each 5 kg decrease in grip strength to all-cause mortality were 1.11 (1.06-1.18) in males and 1.17 (1.08-1.28) in females. In comparison with subjects in the fifth quintile, the adjusted HRs and 95% CIs of all-cause mortality in the first quintile was 2.39 (1.79-3.19) in males and 1.84 (1.34-2.51) in females. Which were statistically significant in the second quintile compared with the fifth quintile [Males: 2.06 (1.56, 2.74), Females: 1.83 (1.35, 2.48)]. CONCLUSIONS: Grip strength is inversely linear association with all-cause mortality and the low grip strength at the first and second quintile are a robust predictor of all-cause mortality.

Does obesity based on body mass index affect semen quality?-A meta-analysis and systematic review from the general population rather than the infertile population.

Whether obesity affects the quality of semen has become the focus of research. However, there are some deficiencies in the past research, because the vast majority of known infertile patients were included in the study samples. Taking infertile men as the research object to analyse the impact of obesity on semen quality, which cannot accurately prove that the impact on semen quality is caused by obesity, because the impact on semen quality may also be caused by other factors. Therefore, we selected ordinary obese men rather than infertile patients to conduct a systematic review and meta-analysis of the effects of obesity on semen parameters. The results showed that obesity had no effect on sperm concentration (SMD: -0.15, 95% CI: -0.32 ~ 0.02, p = .088) and percentage of normal sperm morphology (SMD: -0.17, 95% CI: -0.66 ~ 0.32, p = .487), but decreased semen volume (SMD: -0.32, 95% CI: -0.52 ~ -0.12, p = .002), total sperm number (SMD: -0.77, 95% CI: -1.31 ~ -0.23, p = .005), percentage of forward progression (SMD: -0.95, 95% CI: -1.7 ~ -0.19, p = .014) and percentage of viability (SMD: -0.812, 95% CI: -1.532 ~ -0.093, p = .027). Therefore, obesity affects semen quality to a certain extent, and maintaining normal weight may be one of the effective ways to improve male fertility.

Body mass index increases the lymph node metastasis risk of breast cancer: a dose-response meta-analysis with 52904 subjects from 20 cohort studies.

BACKGROUND: Since body mass index (BMI) is a convincing risk factor for breast cancer, it is speculated to be associated with lymph node metastasis. However, epidemiological studies are inconclusive. Therefore, this study was conducted to investigate the effect of BMI on the lymph node metastasis risk of breast cancer. METHODS: Cohort studies that evaluating BMI and lymph node metastasis in breast cancer were selected through various databases including PubMed, PubMed Central (PMC), Web of science, the China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals (VIP) and Wanfang Data Knowledge Service Platform (WanFang) until November 30, 2019. The two-stage, random effect meta-analysis was performed to assess the dose-response relationship between BMI and lymph node metastasis risk. Between-study heterogeneity was assessed using I2. Subgroup analysis was done to find possible sources of heterogeneity. RESULTS: We included a total of 20 studies enrolling 52,904 participants. The summary relative risk (RR) (1.10, 95%CI: 1.06-1.15) suggested a significant effect of BMI on the lymph node metastasis risk of breast cancer. The dose-response meta-analysis (RR = 1.01, 95%CI: 1.00-1.01) indicated a positive linear association between BMI and lymph node metastasis risk. For every 1 kg/m2 increment of BMI, the risk of lymph node metastasis increased by 0.89%. In subgroup analyses, positive linear dose-response relationships between BMI and lymph node metastasis risk were observed among Asian, European, American, premenopausal, postmenopausal, study period less than 5 years, and more than 5 years groups. For every 1 kg/m2 increment of BMI, the risk of lymph node metastasis increased by 0.99, 0.85, 0.61, 1.44, 1.45, 2.22, and 0.61%, respectively. CONCLUSION: BMI significantly increases the lymph node metastasis risk of breast cancer as linear dose-response reaction. Further studies are needed to identify this association.

Biomarkers of environmental manganese exposure and associations with childhood neurodevelopment: a systematic review and meta-analysis.

BACKGROUND: Although prior studies showed a correlation between environmental manganese (Mn) exposure and neurodevelopmental disorders in children, the results have been inconclusive. There has yet been no consistent biomarker of environmental Mn exposure. Here, we summarized studies that investigated associations between manganese in biomarkers and childhood neurodevelopment and suggest a reliable biomarker. METHODS: We searched PubMed and Web of Science for potentially relevant articles published until December 31th 2019 in English. We also conducted a meta-analysis to quantify the effects of manganese exposure on Intelligence Quotient (IQ) and the correlations of manganese in different indicators. RESULTS: Of 1754 citations identified, 55 studies with 13,388 subjects were included. Evidence from cohort studies found that higher manganese exposure had a negative effect on neurodevelopment, mostly influencing cognitive and motor skills in children under 6 years of age, as indicated by various metrics. Results from cross-sectional studies revealed that elevated Mn in hair (H-Mn) and drinking water (W-Mn), but not blood (B-Mn) or teeth (T-Mn), were associated with poorer cognitive and behavioral performance in children aged 6-18 years old. Of these cross-sectional studies, most papers reported that the mean of H-Mn was more than 0.55 µg/g. The meta-analysis concerning H-Mn suggested that a 10-fold increase in hair manganese was associated with a decrease of 2.51 points (95% confidence interval (CI), - 4.58, - 0.45) in Full Scale IQ, while the meta-analysis of B-Mn and W-Mn generated no such significant effects. The pooled correlation analysis revealed that H-Mn showed a more consistent correlation with W-Mn than B-Mn. Results regarding sex differences of manganese associations were inconsistent, although the preliminary meta-analysis found that higher W-Mn was associated with better Performance IQ only in boys, at a relatively low water manganese concentrations (most below 50 µg/L). CONCLUSIONS: Higher manganese exposure is adversely associated with childhood neurodevelopment. Hair is the most reliable indicator of manganese exposure for children at 6-18 years of age. Analysis of the publications demonstrated sex differences in neurodevelopment upon manganese exposure, although a clear pattern has not yet been elucidated for this facet of our study.

[Multi-correspondence analysis of the status and related factors of chronic diseases multimorbidity in middle-aged and elderly people in China in 2009].

OBJECTIVE: To study the status of chronic disease multimorbidity of middle-aged and elderly people over 45 years old in China, and to analyze the influencing factors. METHODS: Using the data of the"China Health and Nutrition Survey(CHNS)", this survey has been carried out in 10 rounds nationwide since 1989. Multi-stage cluster random sampling was used to investigate rural and urban areas in 9 provinces and cities in China. In this study, the general socio-demographic characteristics, disease history, living habits and other information in the 2009 database were used to analyze the subjects who were collected blood samples. The prevalence of 8 common chronic diseases and multimorbidity such as hypertension, mixed-hyperlipidemia and hyperuricemia were described respectively. The Venn diagram in the R software package was used to calculate the multimorbidity of the disease. The χ~2 test and multiple correspondence analysis were used to explore the influencing factors of chronic disease multimorbidity in the middle-aged and elderly people in China. RESULTS: Among the 5316 subjects, the highest prevalence among 8 chronic diseases was hypertension(2143, 40. 3%). The lowest prevalence was myocardial infarction(87, 1. 4%). There were all together 1498 patients who had two kinds or more than two kinds of chronic diseases with a detection rate of 28. 18%. The most common multimorbidity were hypertension+hyperuricemia(199, 13. 30%), followed by hypertension + mixed-hyperlipidemia(191, 12. 77%). Hypertension+hyperuricemia+mixed-hyperlipidemia was the most common combination of the three chronic diseases(103, 6. 89%). Age(Kendull=0. 158, P<0. 001), region(χ~2=30. 129, P<0. 001), BMI(Kendull=0. 344, P<0. 001) and marital status(χ~2=21. 923, P<0. 001) were associated with the number of multimorbidities. Correspondence analysis showed that subjects aged 65 to 74, living in cities and sleeping less than 7 hours were more likely to have multimorbidity. CONCLUSION: The prevalence of chronic disease multimorbidity among middle-aged and elderly residents in China is high. Older age, unmarried, overweight and obesity, too little or too much sleep may increase the risk of multimorbidity.

Neck circumference may be a valuable tool for screening individuals with obesity: findings from a young Chinese population and a meta-analysis.

BACKGROUND: Central obesity and overweight/obesity can result in various chronic non-communicable diseases, such as cardiovascular disease, metabolic syndrome, and diabetes mellitus. Waist circumference (WC) and body mass index (BMI) are widely used to measure obesity despite their limitations. For example, WC and BMI cannot be measured in pregnant women and subjects with abdominal ascites or masses. Therefore, this study aims to determine the efficacy of neck circumference (NC) as a tool for screening central obesity and overweight/obesity. METHODS: A total of 1169 undergraduates aged 18-25 years were studied by a cross-sectional survey in China, 2016. Questionnaires and physical examinations were used to collect data. Receiver operator characteristic (ROC) curve was performed to determine the best threshold of NC for screening central obesity and overweight/obesity. Meanwhile, a meta-analysis was conducted to estimate the efficacy of NC for screening central obesity and overweight/obesity synthetically. RESULTS: NC was moderately correlated with WC and BMI. The ROC analysis showed that 37.1 cm for male and 32.6 cm for female were the best thresholds for central obesity, and 37.4 cm and 32.2 cm for overweight/obesity, respectively. The sensitivity, specificity, area under receiver operating curve (AUC) of central obesity and overweight/obesity were higher. In the meta-analysis, the pooled sensitivity, specificity, AUC and their 95%CI of NC for screening central obesity were 0.72 (0.68~ 0.75), 0.87 (0.74~ 0.94), 0.77 (0.73~ 0.80) for male and 0.73 (0.65~ 0.80), 0.80 (0.71~ 0.86), 0.82 (0.79~ 0.86) for female. For overweight/obesity, the pooled sensitivity, specificity, AUC and corresponding 95%CI were 0.83 (0.70~ 0.91), 0.77 (0.66~ 0.85), 0.86 (0.83~ 0.89) for male and 0.82 (0.71~ 0.90), 0.84 (0.61~ 0.95), 0.89 (0.86~ 0.92) for female. CONCLUSION: NC may not be a good tool for screening individuals with central obesity. But it may be a simple and valuable tool for screening individuals with overweight/obesity, especially in females.

[Relationship between serum magnesium concentration and obesity in Chinese adults].

OBJECTIVE: To explore the relationship between concentration of serum magnesium with overweight/obesity and abdominal obesity in Chinese adults. METHODS: Data from China Health and Nutrition Survey investigated in 2009 was analyzed. Rank correlation analysis, univariate analysis and binary Logistic regression analysis were performed to analyze influence of serum magnesium concentrations, regions and gender on the prevalence of overweight/obesity and abdominal obesity. RESULTS: The prevalence of overweight/obesity was 40. 2%. The concentration of serum magnesium in people withoverweight/obesity was higher than that in people with non-overweight/obesity( 0. 95 mmol/L vs. 0. 93 mmol/L, t = 7. 021, P < 0. 001). The prevalence of overweight/obesity was 33. 2%. The concentration of serum magnesium in people with abdominal obesity was higher than that in people with non-abdominal obesity( 0. 95 mmol/L vs. 0. 93 mmol/L, t = 5. 712, P < 0. 001). The serum magnesium concentration, prevalence of overweight/obesity and abdominal obesity were higher in magnesium-rich area than in the nonmagnesium-rich areas, which showed significant differences between two groups( serum magnesium: t = 8. 012, P < 0. 001; overweight/obesity: χ~2= 138. 252, P < 0. 001;abdominal obesity: χ~2= 134. 999, P < 0. 001). The rank correlation coefficients between serum magnesium concentration and prevalence of overweight/obesity and abdominal obesity were 0. 952 and 0. 796 in male, and 0. 794 and 0. 903 in female, respectively. Serum magnesium concentration was divided into four grades according to quartiles. The risk of overweight/obesity increased by 1. 207 times( 95% CI 1. 138-1. 281) when the serum magnesium increased a level, and the risk of abdominal obesity increased by 1. 187 times( 95% CI 1. 114-1. 266). CONCLUSION: Higher serum magnesium concentration may be a risk factor for overweight/obesity and abdominal obesity. Serum magnesium concentration is moderately and even highly correlated with prevalence of obesity, and there is a gender difference in this relationship.

Body mass index had different effects on premenopausal and postmenopausal breast cancer risks: a dose-response meta-analysis with 3,318,796 subjects from 31 cohort studies.

BACKGROUND: There is sufficient evidence supporting a relationship between increased body mass index (BMI) and an increased risk for breast cancer among postmenopausal women. However, most studies have found a decreased risk for premenopausal breast cancer. This study was conducted to find out the different effects of BMI on the risk of breast cancer among premenopausal and postmenopausal women, and explore the potential factors that influence the associations. METHODS: A dose-response meta-analysis with 3,318,796 participants from 31 articles was conducted. Cohort studies that included BMI and corresponding breast cancer risk were selected through various databases including PubMed, Medline, Web of Science, the China National Knowledge Infrastructure (CNKI) and Chinese Scientific Journals (VIP). Random effects models were used for analyzing the data. RESULTS: The summary relative risks (RRs) were 1.33 (95%CI: 1.20-1.48) and 0.94(95%CI: 0.80-1.11) among postmenopausal and premenopausal women, respectively. The dose-response meta-analysis indicated a positive non-linear association between BMI and breast cancer risk among postmenopausal women, and compared to the mean level of the normal BMI category (21.5 kg/m2) the RR in total postmenopausal women were1.03 (95% CI: 1.02-1.05) per 1 kg/m2 increment. However, no statistically significant association among total premenopausal women was detected. In subgroup analysis among European premenopausal women, the summary RR was 0.79(95%CI: 0.70-0.88). The non-linear relationship showed a negative non-linear association between BMI and breast cancer risk among European premenopausal women. When compared to the mean level of the normal BMI category, the RRs were 0.98 (95%CI: 0.96-1.00) per 1 kg/m2 increment, respectively. CONCLUSIONS: In line with previous studies BMI had different effects on pre-menopausal and postmenopausal breast cancer risk. However, contrary to previous studies, a high BMI was not associated with decreased risk in total pre-menopausal women. More research is needed to better understand these differences.