Association between lifestyle factors and suboptimal health status among Chinese college freshmen: a cross-sectional study

Intrarelationships between suboptimal health status and anxiety symptoms: A network analysis

BACKGROUND

Suboptimal health status is a global public health concern of worldwide academic interest, which is an intermediate health status between health and illness. The purpose of the survey is to investigate the relationship between anxiety statuses and suboptimal health status and to identify the central symptoms and bridge symptoms.

METHODS

This study recruited 26,010 participants aged <60 from a cross-sectional study in China in 2022. General Anxiety Disorder-7 (GAD-7) and suboptimal health status short form (SHSQ-9) were used to quantify the levels of anxiety and suboptimal health symptoms, respectively. The network analysis method by the R program was used to judge the central and bridge symptoms. The Network Comparison Test (NCT) was used to investigate the network differences by gender, place of residence, and age in the population.

RESULTS

In this survey, the prevalence of anxiety symptoms, SHS, and comorbidities was 50.7 %, 54.8 %, and 38.5 %, respectively. "Decreased responsiveness", "Shortness of breath", "Uncontrollable worry" were the nodes with the highest expected influence. "Irritable", "Exhausted" were the two symptom nodes with the highest expected bridge influence in the network. There were significant differences in network structure among different subgroup networks.

LIMITATIONS

Unable to study the causal relationship and dynamic changes among variables. Anxiety and sub-health were self-rated and may be limited by memory bias.

CONCLUSIONS

Interventions targeting central symptoms and bridge nodes may be expected to improve suboptimal health status and anxiety in Chinese residents. Researchers can build symptom networks for different populations to capture symptom relationships.

Evaluating the association between effort-reward imbalance and suboptimal health status among hospital nurses: a cross-sectional study

OBJECTIVES

Occupational stress is a common complaint in nurses, who perceived more sense of effort-reward imbalance (ERI). Suboptimal health status (SHS) is a state between health and disease. However, the correlation between ERI and SHS is unclear. Therefore, the aim of this study was to examine the prevalence of SHS and ERI and evaluate the relationship between ERI and SHS in clinical nurses by a cross-sectional study.

MATERIAL AND METHODS

The current cross-sectional study was conducted through an online survey at Dongping People's Hospital in China. A total of 633 completed surveys were received. Effort-reward imbalance was measured by subscales of the ERI questionnaire. SHS was measured by the Suboptimal Health Status Questionnaire - 25 (SHSQ-25). The relationship between ERI and SHS in nurses was subsequently assessed by Spearman's correlation coefficient and logistic regression model.

RESULTS

The mean age of the optimal health status (OHS) group (M±SD 26.3±7.3 years) was younger than the SHS group (M±SD 30.3±6.9 years). The prevalence of SHS was 54.5% (345/633). Female nurses aged ≥30 years, a junior college or university graduate educational level, smokers, and nurses without regular exercise were at a higher risk of SHS. In Spearman's correlation analysis, ERI reflected by the effort-reward ratio was correlated with SHSQ-25 score (r = 0.662, p < 0.001). In logistic regression, ERI was strongly associated with SHS after potential confounding factors adjusting (OR 27.924, 95% CI 22.845-34.132).

CONCLUSIONS

The prevalence of SHS was significantly high in clinical nurses. Administrators should pay more attention to health status of female nurses aged ≥30 years, with a junior college or bachelor's degree, smoking, and without regular exercise to reduce the SHS and ERI. Int J Occup Med Environ Health. 2024;37(2):166-75.

The mediating effect of perceived stress on the relationship between big five personality traits and suboptimal health status in Chinese population: a nationwide survey in the framework of predictive, preventive, and personalized medicine

Background

The effects of psychological factors on suboptimal health status (SHS) have been widely described; however, mechanisms behind the complex relationships among the Big Five personality traits and SHS are unclear. Identifying people with specific traits who are susceptible to SHS will help improve life quality and reduce the chronic disease burden under the framework of predictive, preventive, and personalized medicine (PPPM / 3PM). This study investigated the relationships among personality traits and SHS. It also explored whether perceived stress plays a mediating role in SHS development.

Method

A nationwide cross-sectional survey based on multistage random sampling was conducted in 148 cities in China between June 20 and August 31, 2022. Personality traits, perceived stress, and SHS were evaluated using the Big Five Inventory-10 (BFI-10), the 4-item Perceived Stress Scale (PSS-4), and the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF), respectively. Pearson's correlation analysis was employed to examine the associations between personality traits, perceived stress, and SHS. Structural equation modeling (SEM) was used to discern the mediating role of perceived stress in the relationships among personality traits and SHS.

Result

A total of 22,897 participants were enrolled in this study, among whom the prevalence of SHS was 52.9%. SHS was negatively correlated with three trait dimensions (i.e., extraversion, agreeableness, and conscientiousness) but positively correlated with neuroticism. Meanwhile, stress was negatively correlated with extraversion, agreeableness, conscientiousness, and openness, whereas it was positively correlated with neuroticism. The SEM results showed that, when adjusting for covariates (i.e., gender, age, BMI, educational level, current residence, marital status, and occupational status), higher agreeableness (β =  - 0.049, P < 0.001) and conscientiousness (β =  - 0.103, P < 0.001) led to lower SHS prevalence, higher neuroticism (β = 0.130, P < 0.001), and openness (β = 0.026, P < 0.001) caused SHS to be more prevalent. Perceived stress played a partial mediating role in the relationships among personality traits and SHS, respectively, contributing 41.3%, 35.9%, and 32.5% to the total effects of agreeableness, conscientiousness, and neuroticism on SHS. Additionally, the mediating impact of stress was significant even though extraversion had no direct effect on SHS.

Conclusion

This study revealed a high prevalence of SHS in Chinese residents. Personality traits significantly influenced SHS rates, which perceived stress tended to mediate. From a PPPM perspective, early screening and targeted intervention for people with neuroticism (as well as stress alleviation) might contribute to health enhancement and chronic disease prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00349-x.

A motivational approach to understanding problematic smartphone use and negative outcomes in university students

Considering the rising integration of smartphones into classrooms, the purpose of this research was to explore the relationship between problematic smartphone use (PSU) and negative outcomes through the lens of self-determination theory. This study examined 1,039 students' reported academic motivation, PSU, anxiety, insomnia, and perceived stress. The first objective of this study was to examine how motivational orientations could predict PSU. Then, we examined how motivational orientations and PSU, when used as a mediating variable, could be modeled to predict negative student mental health outcomes (anxiety, insomnia, and perceived stress). As predicted, statistically significant results suggested that autonomous academic motivation was associated with less PSU (β = -0.16), as well as less anxiety (β = -0.12), insomnia (β = -0.16), and stress (β = -0.10). In contrast, higher levels of controlled academic motivation were associated with more PSU (β = 0.37), as well as higher levels of anxiety (β = 0.49) and insomnia (β = 0.41). Amotivation was also positively related to PSU (β = 0.17), anxiety (β = 0.36), insomnia (β = 0.62), and stress (β = 0.22). All indirect effects (mediation effects) were statistically significant and in the predicted direction: the impact of autonomous motivation on negative outcomes was mediated by lower levels of PSU while controlled motivation and amotivation were mediated by higher levels of PSU. Overall, this study advanced the understanding of PSU in university classrooms by demonstrating a link with academic motivation and mental health outcomes.

Shinrin-Yoku (Forest Bathing): A Scoping Review of the Global Research on the Effects of Spending Time in Nature

Background

This Scoping review (ScR) builds upon the 2017 review conducted by Hansen et al which contributed to evidence base shinrin-yoku (SY), also known as forest bathing (FB), has many positive health effects and is becoming a prescribed dose (specific time spent in nature) by health care providers. Practice and research regarding SY, has been historically based in Asian countries with a recent increase in Europe. The need and call for more research worldwide continues to further the evidence of SY as a health promotion modality. Through this ScR the authors identified programmatic components, health information monitored and screened, time spent in nature, geographical regions, trends, and themes in SY research worldwide.

Methods

Following PRISMA-ScR guidelines we searched across 7 electronic databases for SY or FB research articles from 2017 through 2022. PubMed, CINAHL, PsycInfo, ScienceDirect, SCOPUS, Embase, JSTOR were included due to the interdisciplinary nature of SY or FB research. Each database provided unique strengths ensuring a capture of a wide range of articles. The resulting articles were screened and extracted through Covidence.

Results

Database searches returned 241 results, with 110 references removed during the deduplication process, 131 were initially screened in the title and abstract review stage. Resulting in 82 unique results deemed relevant and screened in full text. During the final stage of the review, 63 articles met all inclusion criteria and were extracted for data.

Conclusions

The practice of SY has physiological (PHYS) and psychological (PSYCH) benefits across age groups. Research findings indicate either the natural or the virtual environment (VW) has significant health benefits. Continued research is encouraged globally for short- and long-term health outcomes for all individuals. The connection with nature benefits the mind, body and soul and is supported by Henry David Thoreau's philosophy: "Our livesneed the relief of where the pine flourishes and the jay still scream."

Influence of lifestyle on suboptimal health: Insights from a national cross-sectional survey in China

Background

Suboptimal health status (SHS) is a non-clinical or pre-disease state between optimal/ideal health and disease. While its etiology remains unclear, lifestyle is considered one of the most important risk factors. We aimed to examine the effects of lifestyles on SHS through a nationwide survey in China.

Methods

We conducted a cross-sectional survey in 148 cities across China between 20 June and 31 August 2022, on 30 505 participants from rural and urban communities gathered through stratified quota sampling. We measured SHS with the Short-Form Suboptimal Health Status Questionnaire (SHSQ-SF). We gathered information on participants' lifestyles (ie, smoking, alcohol consumption, breakfast habits, weekly food delivery frequency, intermittent fasting, sleep duration and physical activities) through face-to-face interview. We determined the relationship between lifestyle and SHS logistic regression analysis by based on odds ratios (ORs) and 95% confidence intervals (CIs).

Results

We included 22 897 participants (female: 13 056, male: 9841), 12 108 (52.88%) of whom reported exposure to SHS. After adjusting for demographic characteristics, individuals who currently smoked (OR = 1.165; 95% CI = 1.058-1.283) and those who drank alcohol (OR = 1.483; 95% CI = 1.377.1.596) were at a higher risk of SHS than those who have never done either. In a dose-response way, takeaway food consumption was associated with a higher risk of SHS, while increased frequency of breakfast and mild-intensity exercise conversely reduced said risk. Individuals with shorter sleep duration had a higher risk of SHS when compared to those who slept for more than seven hours per day.

Conclusions

We observed a relatively high prevalence of SHS across China, highlighting the importance of lifestyle in health promotion. Specifically, adopting healthy dietary habits, engaging in regular physical activity, and ensuring high-quality sleep are key in preventing SHS.

Registration

Chinese Clinical Trial Registry (ChiCTR2200061046).

Measurement properties of the EQ-5D-5L in sub-health: evidence based on primary health care workers in China

BACKGROUND

Sub-health which is the state between health and disease is a major global public health challenge. As a reversible stage, sub-health can work as a effective tool for the early detection or prevention of chronic disease. The EQ-5D-5L (5L) is a widely used, generic preference-based instrument while its validity in measuring sub-health is not clear. The aim of the study was thus to assess its measurement properties in individuals with sub-health in China.

METHODS

The data used were from a nationwide cross-sectional survey conducted among primary health care workers who were selected on the basis of convenience and voluntariness. The questionnaire was composited of 5L, Sub-Health Measurement Scale V1.0 (SHMS V1.0), social-demographic characteristics and a question assessing the presence of disease. Missing values and ceiling effects of 5L were calculated. The convergent validity of 5L utility and VAS scores was tested by assessing their correlations with SHMS V1.0 using Spearman's correlation coefficient. The known-groups validity of 5L utility and VAS scores was assessed by comparing their values between subgroups defined by SHMS V1.0 scores using the Kruskal-Wallis test. We also did an analysis in subgroups according to different regions of China.

RESULTS

A total of 2063 respondents were included in the analysis. No missing data were observed for the 5L dimensions and only one missing value was for the VAS score. 5L showed strong overall ceiling effects (71.1%). The ceiling effects were slightly weaker on the "pain/discomfort" (82.3%) and "anxiety/depression" (79.5%) dimensions compared with the other three dimensions (nearly 100%). The 5L weakly correlated with SHMS V1.0: the correlation coefficients were mainly between 0.2 and 0.3 for the two scores. 5L was yet not sensitive in distinguishing subgroups of respondents with different levels of sub-health, especially the subgroups with adjacent health status (p > 0.05). The results of subgroup analysis were generally consistent with those of the full sample.

CONCLUSIONS

It appears that the measurement properties of EQ-5D-5L in individuals with sub-health are not satisfactory in China. We thus should be cautious to use it in the population.

Sharif R, Suleman G, Das G, Alam MK, Ahmed N. The Association of Socioeconomic and Lifestyle Factors with the Oral Health Status in School-Age Children from Pakistan: A Cross-Sectional Study

The data on how lifestyle factors of school-going children affect their oral health are not sufficient; therefore, there is a need to analyze the adverse effects of poor lifestyle habits and the role of mothers' education on oral health. The aim of this study was to analyze the association of socioeconomic and lifestyle factors with the oral health status of school-going children through a structured questionnaire and oral examination. Ninety-five (26.5%) children were from class 1. One hundred eighty-seven (52.1%) mothers were educated while 172 (47.9%) were uneducated. Two hundred seventy-six (76.9%) children had never visited the dentist. The results indicate that dental health behavior is associated with lifestyle factors as well as socio-demographic variables. Parent education and awareness regarding oral health plays a major role in determining the oral health of children.

Translation and cross-cultural validation of a precision health tool, the Suboptimal Health Status Questionnaire-25, in Korean

BACKGROUND

Suboptimal health status (SHS) is a reversible stage between health and illness that is characterized by health complaints, low energy, general weakness, and chronic fatigue. The Suboptimal Health Status Questionnaire-25 (SHSQ-25) has been validated in three major populations (African, Asian, and Caucasian) and is internationally recognized as a reliable and robust tool for health estimation in general populations. This study focused on the development of K-SHSQ-25, a Korean version of the SHSQ-25, from its English version.

METHODS

The SHSQ-25 was translated from English to Korean according to international guidelines set forth by the World Health Organization (WHO) for health instrument translation between different languages. A subsequent cross-sectional survey involved 460 healthy South Korean participants (aged 18-83 years; 65.4% females) to answer the 25 questions focusing on the health perspectives of 5 domains, 1) fatigue, 2) cardiovascular health, 3) digestive tract, 4) immune system and 5) mental health. The K-SHSQ-25 was further validated using tests for reliability, internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS

The version of K-SHSQ-25 achieved linguistic, cultural, and conceptual equivalence to the English version. The intraclass correlation coefficient (ICC) of test-retest reliability for individual items ranged from 0.88 to 0.99. Reliability estimates based on internal consistency reached a Cronbach's α of 0.953; the Cronbach's α for each domain ranged from 0.76 to 0.94. Regarding construct validity, the EFA of the K-SHSQ-25 generally replicated the multidimensional structure (fatigue, cardiovascular, digestive, immune system, and mental health) and 25 questions. The CFA revealed that the root mean square error of approximation (RMSEA), goodness-of-fit index (GFI) and adjusted goodness of fit index (AGFI) were excellent (RMSEA = 0.069<0.08, GFI = 0.929>0.90, AGFI = 0.907>0.90). The five domains of the K-SHSQ-25 showed significant correlations with each other (r = 0.59-0.81, P<0.001). The cut-off point of K-SHSQ-25 for SHS was determined as an SHS score of 25. The prevalence of SHS in this study was 60.0% (276/460), with 47.8% (76/159) for males and 58.5% for females (176/301).

CONCLUSIONS

Our results indicate that the Korean version of SHSQ-25, K-SHSQ-25, is a transcultural equivalent, robust, valid, and reliable assessment tool for evaluating SHS in the Korean-speaking population.

The Interactions of Media Use, Obesity, and Suboptimal Health Status: A Nationwide Time-Trend Study in China

Obesity and suboptimal health status (SHS) have been global public health concerns in recent decades. A growing number of works have explored the relationships between media use and obesity, as well as SHS. This study aimed to examine the time trend of the associations between media use (including traditional media and new media) and obesity, as well as SHS. The data were derived from three national random samples of the Chinese General Social Survey (CGSS), which was separately conducted in 2013, 2015, and 2017. In total, 34,468 respondents were included in this study, consisting of 16,624 males and 17,844 females, and the average age was 49.95 years old (SD = 16.72). It found that broadcast use and television use were positively associated with obesity and showed an increasing trend over time. Cellphone use emerged as a risk factor for obesity in 2017 and showed an increasing trend. By contrast, newspaper use, television use, and internet use were negatively associated with SHS, and television use showed a decreasing trend in the association with SHS, while internet and newspaper use showed an increasing trend. In conclusion, media use was positively associated with obesity while negatively associated with SHS. It showed a decreasing trend in the associations between traditional media use and obesity, while revealing an increasing trend in the associations between new media use and obesity, as well as SHS. The practical implications of the findings are discussed.

All around suboptimal health - a joint position paper of the Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine

First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person. This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.

The status of health promotion lifestyle and its related factors in Shandong Province, China

OBJECTIVES

This study aims to explore the status of Shandong Province, China residents' health promotion lifestyle and its influencing factors, especially to explore how health attitude affects health promotion lifestyle, thus can make targeted recommendations for health promotion in China and similar areas.

METHODS

1800 adults were selected from urban and rural areas of Shandong Province, China, using multistage stratified, cluster random sampling method. A survey was conducted face-to-face from March to May, 2018, using Health Promotion Lifestyle Profile and Health Attitude Questionnaire. The between-group measured data were compared by One-way ANOVA or t-tests. The correlation between the health attitude and health promotion lifestyle was examined by Pearson correlation. Logistic regression model was used to examine the related factors influencing health promotion lifestyle. Health promotion lifestyle is the dependent variable, and gender, education level, annual family per capita income and health attitude are the independent variables.

RESULTS

The mean (SD) of HPLP-IICR total score of the participants was 82.12(16.63). 54.50% of the participants had poor or average health promotion lifestyle, while 45.50% had good or excellent health promotion lifestyle. Significant differences existed in health promotion lifestyle among different gender, education level, income level, marital status, and health attitude (Ps < 0.001). Multivariable Logistic regression model found that male (OR = 0.35, 95% CI: 0.12-0.34), high school education level (OR = 0.57, 95% CI:0.17-0.41), junior middle school & below (OR = 0.42; 95% CI:0.12-0.33), annual family per capita income with < 10,000 CNY (OR = 2.53, 95% CI:1.24-2.06; OR = 2.14, 95% CI:1.08-3.12), low health affection (OR = 0.39, 95% CI:2.15-4.22), and low health behavioral intention (OR = 0.21; 95% CI: 2.33-5.29) were statistically significant correlates of average or poor health promotion lifestyle.

CONCLUSIONS

The health lifestyle needs to be further promoted in Shandong Province, China. The government and social sectors are encouraged to make more efforts to improve the accessibility and quality of health services. Meanwhile, individual responsibility cannot be ignored as well. More affective factors and operable measures should be added to enhance health affection and health behavioral intention, so as to enhance health promotion lifestyle.

Associated Factors of Suboptimal Health Status Among Adolescents in China: A Cross-Sectional Study

PURPOSE

Suboptimal health status (SHS) is a state between health and disease, has several adverse effects, although, its main underlying mechanism is still unclear. This study aimed to investigate SHS and its associated factors of adolescents.

METHODS

A community-based cross-sectional study was conducted in the three different geographic locations of China (Shanxi, Guangzhou, and Tibet). A multidimensional sub-health questionnaire of adolescent (MSQA) is used to evaluate SHS. Independent two-sample K-S test was performed for the quantitative data as the non-parametric test, whereas Chi-square test method was applied to explore the difference of discrete variables data between groups. Then finally, multiple logistic regression analysis was applied to analyze the influential factors of SHS.

RESULTS

Among 1461 respondents (between 15 and 18 years old), females proportion (56.47%) was higher than males (43.53%) where SHS was higher in Shanxi followed by Tibet and then Guangdong. The rural area, grade, lack of sleep time, home visit in a week, lack of exercise, a heavy burden of study, smoking, drinking, and fewer friends were the risk factors of SHS, while families living status, seeking help and extroversion were the protective factors.

CONCLUSION

SHS is significantly associated with behavior and lifestyle-related factors. For comprehensively prevention and control of the SHS, it is urgently needed to reduce the risk factors and enhance the protective factors among adolescents.

Reliability and validity of SHMS v1.0 for suboptimal health status assessment of Tianjin residents and factors affecting sub-health: A cross-sectional study

ABSTRACT

The study aimed to explore the reliability and validity of the Sub-Health Measurement Scale version 1.0 (SHMS v1.0) for the assessment of the suboptimal health status (SHS) of Tianjin residents.This was a cross-sectional study that surveyed 2640 urban residents in Tianjin from June 2016 to January 2018. Demographic and clinical characteristics were collected. Each subject completed the SHMS v1.0 and Short Form-36 (SF-36) scale assessments.The retest coefficient was 0.675. The overall Cronbach's α coefficient was 0.921. The correlation between SHMS v1.0 and SF-36 was 0.781 (P < .01). The SHS frequency increased with age, from 62.4% in participants ≤25 years of age to 72.8% in those ≥ 56 years of age. The multivariable analysis showed that female sex (P < .001), age >25 years old (P = .009), bachelor degree or above (P < .001), obesity (P < .0), regular smoking (P = .043), frequent drinking (P = .045), sleep time < 6 hours (P = .006), working time >10 hours (P < .001), physical exercise <5 times/mo (P < .001), and adverse events >9 (P < .001) were associated with SHS.The prevalence of SHS is high among urban residents in Tianjin.

Chronotype, Sleep, and Depressive Symptoms Among Chinese College Students: A Cross-Sectional Study

Objective: To describe the prevalence of chronotype and depressive symptoms among Chinese college students and to examine the association between chronotype and depressive symptoms.

Methods: From April to May 2019, a cross-sectional survey was conducted among 1,179 Chinese college students from 2 universities in Anhui and Jiangxi provinces. A total of 1,135 valid questionnaires were collected, the valid response rate was 98.6%. The questionnaire investigated age, gender, major, height, weight, only child status, living place, self-reported family economy, and self-reported study burden. The chronotype was assessed by the Morning and Evening Questionnaire (MEQ). Depressive symptoms and sleep quality were evaluated by the Patient Health Questionnaire 9 (PHQ-9) and the Pittsburgh Sleep Quality Index (PSQI), respectively. A Chi-square test was used to examine the proportion of depressive symptoms among Chinese college students with different demographic characteristics. The generalized linear model was used to analyze the relationships between chronotype and depressive symptoms.

Results: The proportion of morning types (M-types), neutral types (N-types), and evening types (E-types) of college students were 18.4, 71.1, and 10.5%, respectively. The proportion of mild depression, moderate depression, and moderate to severe depression of participants were 32.4, 6.0, and 4.2%, respectively. Compared to the M-types, after controlled for age, gender, major, sleep quality, self-reported study burden, father's education level, and self-reported family economy, depressive symptoms were positively correlated with E-types (OR = 2.36, 95% CI: 1.49–3.73).

Conclusions: There was a significant association between chronotype and depressive symptoms among Chinese college students. Further longitudinal studies were needed to clarify the causal relationship between chronotype and depressive symptoms.

Psychological symptoms in Chinese nurses may be associated with predisposition to chronic disease: a cross-sectional study of suboptimal health status

BACKGROUND

Suboptimal health status (SHS) is a reversible state between ideal health and illness and it can be effectively reversed by risk prediction, disease prevention, and personalized medicine under the global background of predictive, preventive, and personalized medicine (PPPM) concepts. More and more Chinese nurses have been troubled by psychological symptoms (PS). The correlation between PS and SHS is unclear in nurses. The purpose of current study is to investigate the prevalence of SHS and PS in Chinese nurses and the relationship between SHS and PS along with predisposing factors as well as to discuss the feasibility of improving health status and preventing diseases according to PPPM concepts in Chinese nurses.

METHODS

A cross-sectional study was conducted with the cluster sampling method among 9793 registered nurses in Foshan city, China. SHS was evaluated with the Suboptimal Health Status Questionnaire-25 (SHSQ-25). Meanwhile, the PS of depression and anxiety were evaluated with Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) self-assessment questionnaires. The relationship between PS and SHS in Chinese nurses was subsequently analyzed.

RESULTS

Among the 9793 participants, 6107 nurses were included in the final analysis. The prevalence of SHS in the participants was 74.21% (4532/6107) while the symptoms of depression and anxiety were 47.62% (2908/6107) and 24.59% (1502/6107) respectively. The prevalence of SHS in the participants with depression and anxiety was significantly higher than those without the symptoms of depression (83.3% vs 16.7%, P < 0.001) and anxiety (94.2% vs 5.8%, P < 0.0001). The ratio of exercise habit was significantly lower than that of non-exercise habit (68.8% vs 78.4%, P < 0.001) in SHS group.

CONCLUSIONS

There is a high prevalence of SHS and PS in Chinese nurses. PS in Chinese nurses are associated with SHS. Physical exercise is a protective factor for SHS and PS so that the exercise should be strongly recommended as a valuable preventive measure well in the agreement with PPPM philosophy. Along with SDS and SAS, SHSQ-25 should also be highly recommended and applied as a novel predictive/preventive tool for the health measures from the perspectives of PPPM in view of susceptible population and individual screening, the predisposition to chronic disease preventing, personalization of intervention, and the ideal health state restoring.

Disclosure of suboptimal health status through traditional Chinese medicine-based body constitution and pulse patterns

OBJECTIVES

Suboptimal health status (SHS) is a dynamic state wherein people have not been diagnosed with a disease but tend to develop diseases. People with SHS often experience fatigue and other nonspecific symptoms, which are related to a deviated body constitution in traditional Chinese medicine (TCM). However, the correlation between TCM constitution and SHS has not been adequately investigated. Furthermore, no study has explored the radial pulse analysis-an assistive objective indicator of TCM constitution-in healthy people and people with SHS.

DESIGN

A cross-sectional study.

SETTINGS/LOCATION

Center for Traditional Medicine, Taipei Veterans General Hospital, Taiwan.

SUBJECTS

Sixty-six adults (27 healthy participants and 39 participants with SHS) who were aged 20-39 years.

OUTCOME MEASURES

The body constitution questionnaire (BCQ) scores, suboptimal health status questionnaire-25 (SHSQ-25) scores, and radial pulse waves detected using sphygmography were recorded. Pulse wave analyses are presented as the ratio of frequency below 10 Hz to that above 10 Hz (SER10), which represent energy changes in organ blood flow.

RESULTS

Participants with SHS had significantly higher Yang-Xu, Yin-Xu, and stasis scores of BCQ compared with healthy participants. The SHSQ-25 scores of the participants with SHS were moderately correlated with their Yang-Xu, Yin-Xu, and stasis scores (r = 0.65, 0.66, and 0.72, respectively; all p < 0.001), but weak correlations were discovered for healthy participants. The participants with SHS had significantly higher SER10 at the left guan (the "liver" system in TCM) than did the healthy participants.

CONCLUSIONS

SHS is moderately correlated with TCM-based constitution and those with SHS had increased SER10 at the leftguan of the radial pulse.

Mediating effect of health consciousness in the relationship of lifestyle and suboptimal health status: a cross-sectional study involving Chinese urban residents

OBJECTIVE

Suboptimal health status (SHS), a third state between good health and disease, can easily develop into chronic diseases, and can be influenced by lifestyle and health consciousness. No study has surveyed the intermediation of health consciousness on the relationship between lifestyle and SHS. This study aimed to analyse the association of lifestyle and SHS, and intermediation of health consciousness in Chinese urban residents.

DESIGN

A cross-sectional face-to-face survey using a four-stage stratified sampling method.

PARTICIPANTS

We investigated 5803 Chinese urban residents aged 18 years and over. We measured SHS using the Sub-Health Measurement Scale V1.0. We adopted a structural equation model to analyse relationships among lifestyle, health consciousness and SHS. We applied a bootstrapping method to estimate the mediation effect of health consciousness.

RESULTS

Lifestyle had stronger indirect associations with physical (β -0.185, 95% CI -0.228 to -0.149), mental (β -0.224, 95% CI -0.265 to -0.186) and social SHS (β -0.216, 95% CI -0.257 to -0.179) via health consciousness than direct associations of physical (β -0.144, 95% CI -0.209 to -0.081), mental (β -0.146, 95% CI -0.201 to -0.094) and social SHS (β -0.130, 95% CI -0.181 to -0.077). Health consciousness has a strong direct association with physical (β 0.360, 95% CI 0.295 to 0.427), mental (β 0.452, 95% CI 0.392 to 0.510) and social SHS (β 0.434, 95% CI 0.376 to 0.490). Ratio of mediating effect of health consciousness to direct effect of lifestyle with physical, mental and social SHS was 1.28, 1.53 and 1.66, respectively.

CONCLUSIONS

Health consciousness was more important in preventing physical, mental and social SHS than lifestyle. Therefore, it might be useful in changing unhealthy lifestyle and reducing the influence of poor lifestyle on physical, mental and social SHS.

Associations of physical activity and screen time with suboptimal health status and sleep quality among Chinese college freshmen: A cross-sectional study

This study aimed to investigate the associations of physical activity (PA) and screen time (ST) with physiological, psychological, and social health-particularly regarding effects on sleep quality-among Chinese college freshmen. A cross-sectional survey was conducted at Renmin University of China, in Beijing. A total of 5,233 students were surveyed in September 2015. Participants completed a self-report questionnaire on their demographic characteristics, tobacco and alcohol use, PA, ST, sleep quality, and health status. Multivariate logistic regression was performed to examine the independent and interactive associations between PA and ST with sleep quality and suboptimal health status. In total, 10.43%, 13.18%, and 13.26% of the 5,233 students had physiological, psychological, and social suboptimal health status, respectively. The prevalence of poor sleep quality was 37.94%. High ST and high PA were significantly associated with physiological suboptimal health status (aOR = 1.39, 95% CI: 1.16-1.68, and aOR = 0.55, 95% CI: 0.45-0.71), psychological suboptimal health status (aOR = 1.43, 95% CI: 1.21-1.69, and aOR = 0.57, 95% CI: 0.47-0.69), social suboptimal health status (aOR = 1.27, 95% CI: 1.08-1.50, and aOR = 0.63, 95% CI: 0.52-0.77), and poor sleep quality (aOR = 1.20, 95% CI: 1.03-1.39, and aOR = 0.64, 95% CI: 0.55-0.76). Additionally, low ST and high PA were interactively negatively associated with poor sleep quality (aOR = 0.56, 95% CI: 0.45-0.70), physiological suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59), psychological suboptimal health status (aOR = 0.48, 95% CI: 0.39-0.58), and social suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59). These findings suggested there are independent and interactive associations of low ST and high PA with poor sleep quality and suboptimal health status among Chinese college freshmen.

Prevalence and Associated Lifestyle Factors of Suboptimal Health Status among Chinese Children Using a Multi-Level Model

Chinese children are facing health challenges brought by chronic non-communicable diseases, such as physical problems and psychological related health problems. Childhood represents a critical life period when the long-term dietary and lifestyle behaviors are formed. It is necessary to survey the prevalence of suboptimal health status (SHS) among Chinese children and to research the relationship between SHS and lifestyles. This study aimed to examine the prevalence of SHS among Chinese children using a large-scale population survey sample covering school students and nonstudent children, and clarified the relationships between SHS and lifestyle factors using multi-level models controlled for the cluster effect of location and the confounding effect of demographics. Multi-level generalized estimating equation models were used to examine the relationships between SHS and lifestyle factors. Prevalence ratios (PR) and 95% confidence intervals (CI) were used to assess the strength of these relationships. Of the 29,560 children, 14,393 reported one or more SHS symptoms, giving a SHS prevalence of 48.69%. The prevalence of SHS for boys (46.07%) was lower than that for girls (51.05%). After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, lifestyle factors associated with SHS were: less sleep duration, current smokers (PR = 1.085, 95%CI: 1.027–1.147), current drinkers (PR = 1.072, 95%CI: 1.016–1.131), children’ parents suffering from chronic diseases (PR = 1.294, 95%CI: 1.179–1.421), poor sleep quality (PR = 1.470, 95%CI: 1.394–1.550), stress (PR = 1.545, 95%CI: 1.398–1.707), negative life events (PR = 1.237, 95%CI: 1.088–1.406), hypertension (PR = 1.046, 95%CI: 1.009–1.084), unhealthy diet choice (PR = 1.091, 95%CI: 1.051–1.133) and irregular meal time (PR = 1.210, 95%CI: 1.163–1.259). Children who could exercise regularly (PR = 0.897, 95%CI: 0.868–0.927) and those with regular medical checkup (PR = 0.891, 95%CI: 0.854–0.929) were associated with lower prevalence probability of SHS. SHS has become a serious public health challenge for Chinese children. Unhealthy lifestyles were closely associated with SHS. Implementation of preventative strategies are needed to reduce the potential SHS burden associated with these widespread high-risk unhealthy lifestyle behaviors.

Prevalence of Suboptimal Health Status and the Relationships between Suboptimal Health Status and Lifestyle Factors among Chinese Adults Using a Multi-Level Generalized Estimating Equation Model

This study examined the prevalence of suboptimal health among Chinese adults based on a large-scale national survey and clarified the relationship between suboptimal health and lifestyle factors. We used multi-level generalized estimating equation models to examine the relationships between suboptimal health and lifestyle factors. Of the 48,978 respondents, 34,021 reported one or more suboptimal health symptoms, giving a suboptimal health status prevalence of 69.46%. After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, factors associated with suboptimal health were: current smoking (odds ratio (OR) = 1.083, 95% confidence interval (CI): 1.055-1.111), drinking alcohol (OR = 1.075, 95% CI: 1.025-1.127), family history of disease (OR = 1.203, 95% CI: 1.055-1.111), sleeping <6 h per day (OR = 1.235, 95% CI: 1.152-1.256), poor sleep quality (OR = 1.594, 95% CI: 1.515-1.676), stress (OR = 1.588, 95% CI: 1.496-1.686), negative life events (OR = 1.114, 95% CI: 1.045-1.187), unhealthy diet choices (OR = 1.093, 95% CI: 1.033-1.156), and not regularly having meals at fixed hours (OR = 1.231, 95% CI: 1.105-1.372). Respondents who exercised regularly had lower odds of having suboptimal health status (OR = 0.913, 95% CI: 0.849-0.983). Suboptimal health has become a serious public health challenge in China. The health status of the population could be effectively improved by improving lifestyle behaviors.

Suboptimal health status as an independent risk factor for type 2 diabetes mellitus in a community-based cohort: the China suboptimal health cohort study

Background

The prevalence of diabetes, constituted chiefly by type 2 diabetes mellitus (T2DM), is a global public health threat. Suboptimal health status (SHS), a physical state between health and disease, might contribute to the progression or development of T2DM.

Methods

We conducted a prospective cohort study, based on the China Suboptimal Health Cohort Study (COACS), to understand the impact of SHS on the progress of T2DM. We examined associations between SHS and T2DM outcomes using multivariable logistic regression models and constructed predictive models for T2DM onset based on SHS.

Results

A total of 61 participants developed T2DM after an average of 3.1 years of follow-up. Participants with higher SHS scores had more T2DM outcomes (p = 0.036). Moreover, compared with the lowest quartile of SHS scores, participants with fourth, third, and second quartile SHS scores were found to be associated with a 1.7-fold, 1.6-fold, and 1.5-fold risk of developing T2DM, respectively. The predictive model constructed with SHS had higher discriminatory power (AUC = 0.848) than the model without SHS (AUC = 0.795).

Conclusions

The present study suggests that a higher SHS score is associated with a higher incidence of T2DM. SHS is a new independent risk factor for T2DM and has the capability to act as a predictive tool for T2DM onset. The evaluation of SHS combined with the analysis of modifiable risk factors for SHS allows the risk stratification of T2DM, which may consequently contribute to the prevention of T2DM development. These findings might require further validation in a longer-term follow-up study.

Suboptimal health status and psychological symptoms among Chinese college students: a perspective of predictive, preventive and personalised health

Background

Suboptimal health status (SHS) is an intermediate health status between health and illness, a syndrome characterised by the perception of health complaints, general weakness and low energy. This study aimed to investigate the prevalence of SHS and the correlation between SHS and psychological symptoms among Chinese college students and to identify the SHS-related risk factors from the perspective of predictive, preventive and personalised medicine (PPPM).

Methods

A cross-sectional study was conducted among 4119 college students who were enrolled from Taishan Medical University and Baoji Vocational and Technical College in the eastern and western areas of China. SHS levels of the participants were measured by an established self-reporting Suboptimal Health Status Questionnaire-25 (SHSQ-25). Psychosomatic conditions were estimated by the self-rating Symptom Checklist-90 (SCL-90) scale. Spearman correlation analysis was applied to analyse the relationship between SHSQ-25 scores and SCL-90 estimates. Logistic regression analysis was applied for multivariate analysis.

Results

The prevalence of SHS was 21.0% (864/4119), with 23.3% (701/3005) for female students and 14.6% (163/1114) for male students. The prevalence of general positive psychological symptom was 14.2% (586/4119), with 15.6% (470/3005) for female students and 10.4% (116/1114) for male students. A strong correlation was identified between SHS score and SCL-90 estimates, with the correlation coefficient (r) of 0.719. Logistic regression showed that variables significantly associated with SHS were somatisation (adjusted odds ratio (aOR) = 3.185, 95% confidence interval [CI] = 2.048-4.953), obsessive-compulsive (aOR = 3.518, 95% CI = 2.834-4.368), interpersonal sensitivity (aOR = 1.883, 95% CI = 1.439-2.463) and depression (aOR = 1.847, 95% CI = 1.335-2.554).

Conclusions

Our findings confirm that there is a high prevalence of SHS among college students and there is a strong association between SHS and psychological symptoms among Chinese college students. High susceptibility of SHS occurs particularly in vulnerable groups: female students, sophomore students, medical students and students from rural area. Identification of SHS and prompt application of personalised psychological health-supporting activities will promote college students' health status.