Association of longitudinal trajectories of general and abdominal adiposity during middle age with mental health and well-being in late life: A prospective analysis

Single measures of adiposity markers, such as body mass index (BMI) and waist circumference (WC), are associated with adverse mental health outcomes; however, long-term patterns of adiposity and their health effects remain unclear. The current study assessed adiposity trajectories during a 14-year span beyond middle age and their relevance to mental well-being in late life, and the contribution of genetic and lifestyle factors to the trajectories. Based on a nationally representative sample with longitudinal anthropometric measures, adiposity trajectories were identified by latent mixture modeling, and logistic regression model was used to estimate their associations with mental well-being, with adjustment for confounders. Of the 3491 eligible participants included (mean [SD] age, 69.5 [8.9] years), five discrete BMI and four WC trajectory patterns were identified over 14 years. Compared with the low-stable BMI group (range, 22.8 to 22.9 kg/m²; representing stable healthy body weight), the high-stable group (range, 34.3 to 35.4 kg/m²; stable obese) was associated with increased risk of depression (odds ratio [OR], 1.63; 95 % CI, 1.28-2.07) and low subjective well-being (OR, 1.35; 95 % CI, 1.02-1.79). Compared with the low-stable WC group (range, 75 to 79 cm healthy WC), the high-increasing group (range, 114 to 121 cm) was associated with increased risk of depression (odds ratio [OR], 1.64; 95 % CI, 1.19-2.25) and low well-being (OR, 1.48; 95 % CI, 1.01-2.16). The adiposity trajectories, especially the high-stable/increasing groups, were driven by genetic factors in a dose-response manner, whereas the high/moderate-increasing groups were also behaviorally related. This longitudinal cohort study reveals that stably high trajectory patterns of central and general adiposity during middle age were associated with higher risk of depression and low well-being in late life. The findings indicate the importance of weight management beyond middle age, such as adherence to a healthy lifestyle, in promoting mental health and well-being.

Socioeconomic, Health Services, and Multimorbidity Disparities in Chinese Older Adults

INTRODUCTION

As one of the world's most populous countries, China persistently confronts a significant multimorbidity burden. This study aimed to elucidate the multimorbidity burden experienced by Chinese older adults, explore its interplay with socioeconomic disparity, and investigate potential correlations between these provincial disparities and health services availability.

METHODS

The fourth wave of China's national Urban and Rural Elderly Population study, conducted in 2015, was used to construct a multimorbidity index and elucidate the geographic differences in the multimorbidity burden. Incorporating macrolevel indicators about socioeconomic and health services availability, quantile regression and Spearman correlation analyses were employed to investigate the relationship between multimorbidity and socioeconomic disparities and examine the potential linkages between these provincial disparities and health services availability. Analyses were performed in 2023.

RESULTS

The final analysis included a total of 213,857 older adults. At the provincial level, significant geographic disparities in multimorbidity burden were identified. After adjusting for individual social determinants of health, an independent association was found between the human development index and a higher multimorbidity index (coefficient= -0.22; 95% CI= -0.24, -0.19). Furthermore, a significant positive correlation emerged between human development index and both population and geographic densities of health services availability. Notably, geographic density displayed greater inequality (Gini coefficients=0.45-0.48) than population density (Gini coefficients=0.03-0.10).

CONCLUSIONS

This study demonstrates that multimorbidity burden in China is linked to provincial socioeconomic disparities and that inequality in health services availability may account for this, which would advocate for a need to reduce disparities in health services availability.

Long-term variations of urban-Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study

BACKGROUND

An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities.

METHODS AND FINDINGS

This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility.

CONCLUSIONS

A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

Long-term risk of psychiatric disorder and psychotropic prescription after SARS-CoV-2 infection among UK general population

Despite evidence indicating increased risk of psychiatric issues among COVID-19 survivors, questions persist about long-term mental health outcomes and the protective effect of vaccination. Using UK Biobank data, three cohorts were constructed: SARS-CoV-2 infection (n = 26,101), contemporary control with no evidence of infection (n = 380,337) and historical control predating the pandemic (n = 390,621). Compared with contemporary controls, infected participants had higher subsequent risks of incident mental health at 1 year (hazard ratio (HR): 1.54, 95% CI 1.42-1.67; P = 1.70 × 10-24; difference in incidence rate: 27.36, 95% CI 21.16-34.10 per 1,000 person-years), including psychotic, mood, anxiety, alcohol use and sleep disorders, and prescriptions for antipsychotics, antidepressants, benzodiazepines, mood stabilizers and opioids. Risks were higher for hospitalized individuals (2.17, 1.70-2.78; P = 5.80 × 10-10) than those not hospitalized (1.41, 1.30-1.53; P = 1.46 × 10-16), and were reduced in fully vaccinated people (0.97, 0.80-1.19; P = 0.799) compared with non-vaccinated or partially vaccinated individuals (1.64, 1.49-1.79; P = 4.95 × 10-26). Breakthrough infections showed similar risk of psychiatric diagnosis (0.91, 0.78-1.07; P = 0.278) but increased prescription risk (1.42, 1.00-2.02; P = 0.053) compared with uninfected controls. Early identification and treatment of psychiatric disorders in COVID-19 survivors, especially those severely affected or unvaccinated, should be a priority in the management of long COVID. With the accumulation of breakthrough infections in the post-pandemic era, the findings highlight the need for continued optimization of strategies to foster resilience and prevent escalation of subclinical mental health symptoms to severe disorders.

The trends of mental disorders mortality in China over a 33-year period

OBJECTIVES

We investigated the variations in the trends of mental disorders mortality by age, period, and cohort, over a 33-year period from 1987 to 2020, to reveal the relationship between age, period, cohort, and mental disorders mortality, as well as providing guidance for resource allocation to prevent mental disorders-related deaths in vulnerable target populations.

METHODS

The data of mental disorders mortality 1987-2020 were from five administrative organizations, which collected from the National Health Commission in China with national monitoring by sex and age, covering 31 provinces in China. The International Classification of Diseases (ICD), its 9th Revision (ICD-9) and its 10th Revision were used to code the mental diseases. From 1987-2002, ICD-9 was used, and ICD-10 was used from 2003 to 2020. The age standardized mortality rates (ASMRs) were calculated using the World Standard Population as the reference. We used joinpoint models to assess the trends of mental disorders mortality in China for the period 1987-2020. And the age-period-cohort models were employed to estimate the age-period-cohort effect on mental disorders mortality.

RESULTS

The age-standardized overall mental disorders mortality rate (ASMR) showed a downward trend from 1987 to 2020. Further, the ASMR of individuals in urban was higher than that in rural from 1987 to 2001, but, post-2002, this urban-rural disparity in ASMR showed a less clear pattern, with urban areas occasionally surpassing rural areas and vice versa. ASMR is less prevalent among females compared to males overall. The contribution of age effects to mental disorders mortality gradually increases with advancing age, the period effects of mental disorders mortality gradually decrease over time. The cohort effect's contribution to mental disorders mortality decreases in the newly born population, while in the older birth cohorts, the cohort effect's contribution to the mortality rate of mental disorders increases.

CONCLUSIONS

The ASMR exhibits a decreasing trend from 1987 to 2020, and these change trend showed urban-rural and sex differences. The primary factors contributing to this overall decline are period effects and cohort effects. Our results provide valuable information for shaping mental health policies, designing targeted interventions, and preparing for future changes in disease mortality rates. The focus on different demographic factors allows for a nuanced and tailored approach to mental health promotion and intervention strategies.

Predicting recurrence and survival in patients with non-metastatic renal-cell carcinoma after nephrectomy: a prospective population-based study with multicenter validation

BACKGROUND

Accurate prognostication of oncological outcomes is crucial for the optimal management of patients with renal cell carcinoma (RCC) after surgery. Previous prediction models were developed mainly based on retrospective data in the Western populations, and their predicting accuracy remains limited in contemporary, prospective validation. We aimed to develop contemporary RCC prognostic models for recurrence and overall survival (OS) using prospective population-based patient cohorts and compare their performance with existing, mostly utilized ones.

METHODS

In this prospective analysis and external validation study, the development set included 11  128 consecutive patients with non-metastatic RCC treated at a tertiary urology center in China between 2006 and 2022, and the validation set included 853 patients treated at 13 medical centers in the USA between 1996 and 2013. The primary outcome was progression-free survival (PFS), and the secondary outcome was OS. Multivariable Cox regression was used for variable selection and model development. Model performance was assessed by discrimination [Harrell's C-index and time-dependent areas under the curve (AUC)] and calibration (calibration plots). Models were validated internally by bootstrapping and externally by examining their performance in the validation set. The predictive accuracy of the models was compared with validated models commonly used in clinical trial designs and with recently developed models without extensive validation.

RESULTS

Of the 11  128 patients included in the development set, 633 PFS and 588 OS events occurred over a median follow-up of 4.3 years [interquartile range (IQR) 1.7-7.8]. Six common clinicopathologic variables (tumor necrosis, size, grade, thrombus, nodal involvement, and perinephric or renal sinus fat invasion) were included in each model. The models demonstrated similar C-indices in the development set (0.790 [95% CI 0.773-0.806] for PFS and 0.793 [95% CI 0.773-0.811] for OS) and in the external validation set (0.773 [0.731-0.816] and 0.723 [0.731-0.816]). A relatively stable predictive ability of the models was observed in the development set (PFS: time-dependent AUC 0.832 at 1 year to 0.760 at 9 years; OS: 0.828 at 1 year to 0.794 at 9 years). The models were well calibrated and their predictions correlated with the observed outcome at 3, 5, and 7 years in both development and validation sets. In comparison to existing prognostic models, the present models showed superior performance, as indicated by C-indices ranging from 0.722 to 0.755 (all P <0.0001) for PFS and from 0.680 to 0.744 (all P <0.0001) for OS. The predictive accuracy of the current models was robust in patients with clear-cell and non-clear-cell RCC.

CONCLUSIONS

Based on a prospective population-based patient cohort, the newly developed prognostic models were externally validated and outperformed the currently available models for predicting recurrence and survival in patients with non-metastatic RCC after surgery. The current models have the potential to aid in clinical trial design and facilitate clinical decision-making for both clear-cell and non-clear-cell RCC patients at varying risk of recurrence and survival.

HLA-C*07:01 and HLA-DQB1*02:01 protect against white matter hyperintensities and deterioration of cognitive function: A population-based cohort study

BACKGROUND

Neuroinflammation and aberrant immune regulation are increasingly implicated in the pathophysiology of white matter hyperintensities (WMH), an imaging marker of cerebrovascular pathologies and predictor of cognitive impairment. The role of human leukocyte antigen (HLA) genes, critical in immunoregulation and associated with susceptibility to neurodegenerative diseases, in WMH pathophysiology remains unexplored.

METHODS

We performed association analyses between classical HLA alleles and WMH volume, derived from MRI scans of 38 302 participants in the UK Biobank. To identify independent functional alleles driving these associations, we conducted conditional forward stepwise regression and lasso regression. We further investigated whether these functional alleles showed consistent associations with WMH across subgroups characterized by varying levels of clinical determinants. Additionally, we validated the clinical relevance of the identified alleles by examining their association with cognitive function (n = 147 549) and dementia (n = 460 029) in a larger cohort.

FINDINGS

Four HLA alleles (DQB1*02:01, DRB1*03:01, C*07:01, and B*08:01) showed an association with reduced WMH volume after Bonferroni correction for multiple comparisons. Among these alleles, DQB1*02:01 exhibited the most significant association (β = -0.041, 95 % CI: -0.060 to -0.023, p = 1.04 × 10-5). Forward selection and lasso regression analyses indicated that DQB1*02:01 and C*07:01 primarily drove this association. The protective effect against WMH conferred by DQB1*02:01 and C*07:01 persisted in clinically relevant subgroups, with a stronger effect observed in older participants. Carrying DQB1*02:01 and C*07:01 was associated with higher cognitive function, but no association with dementia was found.

INTERPRETATION

Our population-based findings support the involvement of immune-associated mechanisms, particularly both HLA class I and class II genes, in the pathogenesis of WMH and subsequent consequence of cognitive functions.

Composite healthy lifestyle, socioeconomic deprivation, and mental well-being during the COVID-19 pandemic: a prospective analysis

The adverse psychological and social impacts of COVID-19 pandemic are well characterized, but the role of composite, modifiable lifestyle factors that may interact to mitigate these impacts is not. The effect of socioeconomic deprivation on these lifestyle risks also remains unclear. Based on a nationally representative, longitudinal cohort, we assessed the association between a combination of pre-pandemic lifestyle factors and mental health conditions during pandemic, and the contribution of deprivation to it. Composite lifestyle factors included BMI, smoking status, alcohol consumption, physical activity, sedentary time, sleep duration, and fruit and vegetable intake, with lifestyle scores and lifestyle categories calculated for each participant. Symptoms of depression and anxiety, and personal well-being were assessed by validated scales during the pandemic. Socioeconomic deprivation was characterized by both individual-level (income, wealth, and education) and group-level factors (Index of Multiple Deprivation). Of the 5049 eligible participants (mean [SD] age, 68.1 [10.9] years; 57.2% were female) included in the study, 41.6% followed a favorable lifestyle, 48.9% followed an intermediate lifestyle, and 9.5% followed an unfavorable lifestyle. Compared with favorable lifestyle category, participants in the intermediate and unfavorable lifestyle category were at increased risk of mental health conditions, with the hazard ratio (HR) for trend per increment change towards unfavorable category of 1.17 (95% CI 1.09-1.26) for depression, 1.23 (1.07-1.42) for anxiety, and 1.39 (1.20-1.61) for low well-being. A significant trend of lower risk for mental health conditions with increasing number of healthy lifestyle factors was observed (P < 0.001 for trend). There were no significant interactions between lifestyle factors and socioeconomic deprivation for any of the outcomes, with similar HRs for trend per one increment change in lifestyle category observed in each deprivation group. Compared with those in the least deprived group with favorable lifestyle, participants in the most deprived group adherent to unfavorable lifestyle had the highest risk of mental health outcomes. These results suggest that adherence to a broad combination of healthy lifestyle factors was associated with a significantly reduced risk of mental health conditions during the COVID-19 pandemic. Lifestyle factors, in conjunction with socioeconomic deprivation, independently contribute to the risk of mental health issues. Although further research is needed to assess causality, the current findings support public health strategies and individual-level interventions that provide enhanced support in areas of deprivation and target multiple lifestyle factors to reduce health inequalities and promote mental well-being during the ongoing COVID-19 pandemic.

Changing Patterns in Digestive Diseases Mortality in Urban and Rural Areas - China, 1987-2021

What is already known about this topic?

Digestive diseases (DDs) are a global health concern with a substantial epidemiological and economic impact, given their high prevalence.

What is added by this report?

This study investigated the trends in mortality related to DDs in China from 1987 to 2021, focusing on the urban-rural divide. Additionally, it aimed to determine the specific impacts of age, period, and cohort on DDs mortality.

What are the implications for public health practice?

There is a need to prioritize and allocate more resources toward the future management of DDs in order to effectively address the challenges posed by urbanization and aging populations.

Changing Patterns of Mortality in Diabetes Mellitus Among Older Adults - China, 1987-2021

What is already known about this topic?

Diabetes mellitus poses a significant public health concern for older adults in China, resulting in increased mortality rates.

What is added by this report?

This study investigates the evolving pattern of mortality associated with diabetes mellitus and analyzes the contributions of age, period, and cohort effects from 1987 to 2021. The results demonstrate a consistent rise in diabetes mellitus mortality over the last 30 years, notably in rural regions.

What are the implications for public health practice?

This research offers valuable insights to aid policymakers in developing targeted intervention strategies that address the specific needs of higher-risk populations, such as women, older adults, and individuals in rural areas.

Zero-Dimensional Hybrid Antimony Chloride with Near-Unity Broad-Band Orange-Red Emission toward Solid-State Lighting

Zero-dimensional (0D) hybrid metal halides are attractive owing to their distinctive structure as well as photoluminescence (PL) characteristics. To discover 0D hybrid metal halides with high photoluminescence quantum yield and good stability is of great significance for white light-emitting diodes (LEDs). Herein, a novel hybrid antimony chloride (CTP)2SbCl5 is synthesized, which shows a bright broad-band orange-red emission peaking at 620 nm under the low energy excitation (365 nm), achieving an excellent photoluminescence quantum yield of 96.8%. In addition, (CTP)2SbCl5 shows an additional emission peaking at 470 nm when excited at high energy (323 nm). PL spectra and density functional theory results demonstrate that the observed dual-band emission originates from the singlet and triplet self-trapped excitons confined in isolated [SbCl5]2- square pyramids. Moreover, (CTP)2SbCl5 presents relatively superior air stability, and the PL intensity still maintains 78% of the initial PL intensity when exposed to the air for above 2 weeks. Benefiting from high-efficiency PL emission and good stability of (CTP)2SbCl5, a stable warm white LED device with a 92.3% color rendering index was prepared by coating blue phosphor BaMgAl10O17:Eu2+, green (Sr,Ba)2SiO4:Eu2+, and orange-red (CTP)2SbCl5 on a 365 nm LED chip. This work provides an efficient luminescent material and also demonstrates the potential application of 0D hybrid antimony chloride in solid-state lighting.

Relationship of retinal capillary plexus and ganglion cell complex with mild cognitive impairment and dementia

OBJECTIVE

To investigate relationship of the retinal capillary plexus (RCP) and ganglion cell complex (GCC) with mild cognitive impairment (MCI) and dementia in a community-based study1.

METHODS

This cross-sectional study incorporated the participants of the Jidong Eye Cohort Study. Optical coherence tomography angiography was performed to obtain RCP vessel density and GCC thickness with detailed segments. The Mini-mental State Examination and Montreal Cognitive Assessment were used to assess cognitive status by professional neuropsychologists. Participants were thus divided into three groups: normal, mild cognitive impairment, and dementia. Multivariable analysis was used to measure relationship of ocular parameters with cognitive impairment.

RESULTS

Of the 2678 participants, the mean age was 44.1 ± 11.7 years. MCI and dementia occurred in 197 (7.4%) and 80 (3%) participants, respectively. Compared to the normal group, the adjusted odds ratio (OR) with the 95% confidence interval was 0.76 (0.65-0.90) for the correlation of lower deep RCP with MCI. We found the following items significantly associated with dementia compared with the normal group: a superficial (OR, 0.68 [0.54-0.86]) and deep (OR, 0.75 [0.57-0.99]) RCP, as well as the GCC (OR, 0.68 [0.54-0.85]). Compared to the MCI group, those with dementia had decreased GCC (OR, 0.75 [0.58-0.97]).

CONCLUSIONS

Decreased deep RCP density was associated with MCI. Decreased superficial and deep RCP and the thin GCC were correlated with dementia. These implied that the retinal microvasculature may develop into a promising non-invasive imaging marker to predict severity of cognitive impairment.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BACKGROUND

This study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors.

METHODS

A total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance.

RESULTS

The DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow.

LIMITATION

This study may exist recall bias and lacks causal explanation.

CONCLUSIONS

Significant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

Trends and Patterns of Respiratory Tuberculosis Mortality in Rural and Urban - China, 1987-2021

What is already known about this topic?

In China, an estimated 780,000 individuals contract tuberculosis (TB) every year. With TB ranked as the second most prevalent disease in terms of the morbidity and mortality rates for legally infectious diseases, it imparts a substantial disease burden on families and society.

What is added by this report?

This study identifies specific periods and cohort effects related to trends in respiratory TB mortality in both rural and urban regions of China. The mortality rates have been found to decrease at an annual rate of 5.5% in urban regions and 6.6% in rural ones, with a more marked decline evident in rural areas. These findings represent a significant milestone in the prevention and treatment of respiratory TB in China, especially in its rural locales.

What are the implications for public health practice?

This research contributes to policymakers' comprehension, assisting in the early formulation of cogent optimization policies, thereby further supporting the United Nations Sustainable Development Goals (SDGs) and the Endeavor to End Respiratory TB Strategy. It is recommended that policymakers prioritize key groups such as children, young adults aged 20-30 in rural areas, and older men (60 years and over) in urban areas when developing these astute optimization policies.

Epidemiological Shifts in Infectious Diseases in China: Implications and Policy Recommendations

In recent decades, China has experienced significant alterations in its landscape of infectious diseases, with noteworthy reductions in historically prevalent illnesses such as tuberculosis and viral hepatitis. At the same time, emerging pathogens like severe acute respiratory syndrome (SARS), Influenza A virus subtype H7N9 (H7N9), and SARS coronavirus 2 (SARS-CoV-2) pose new challenges. These epidemiological shifts, fueled by fast economic development, urbanization, modifications in the healthcare system, and an aging population, present considerable obstacles to the country's public health infrastructure and policy frameworks. This article provides a comprehensive review of these changes, underscoring the driving forces behind them and the resultant impact on health policy and infrastructure. It stresses the challenges and calls for an intensification of surveillance efforts, the establishment of collaborative partnerships both nationally and internationally, the encouragement of worldwide cooperation, and the reinforcement of public health education as pivotal strategies for managing China's changing spectrum of infectious diseases.

Changing Patterns of Mortality in Viral Hepatitis - China, 1987-2021

What is already known about this topic?

Viral hepatitis continues to present a major global public health challenge, with China shouldering the heaviest burden of this disease worldwide.

What is added by this report?

This study examined evolving trends and assessed the impacts of age, period, and cohort on viral hepatitis mortality from 1987 to 2021 in both urban and rural settings across China.

What are the implications for public health practice?

This research provides critical insights, enabling policymakers to develop precise and effective intervention strategies that are specifically tailored to address the needs of high-risk older adults.

Simulating human walking: a model-based reinforcement learning approach with musculoskeletal modeling

Introduction

Recent advancements in reinforcement learning algorithms have accelerated the development of control models with high-dimensional inputs and outputs that can reproduce human movement. However, the produced motion tends to be less human-like if algorithms do not involve a biomechanical human model that accounts for skeletal and muscle-tendon properties and geometry. In this study, we have integrated a reinforcement learning algorithm and a musculoskeletal model including trunk, pelvis, and leg segments to develop control modes that drive the model to walk.

Methods

We simulated human walking first without imposing target walking speed, in which the model was allowed to settle on a stable walking speed itself, which was 1.45 m/s. A range of other speeds were imposed for the simulation based on the previous self-developed walking speed. All simulations were generated by solving the Markov decision process problem with covariance matrix adaptation evolution strategy, without any reference motion data.

Results

Simulated hip and knee kinematics agreed well with those in experimental observations, but ankle kinematics were less well-predicted.

Discussion

We finally demonstrated that our reinforcement learning framework also has the potential to model and predict pathological gait that can result from muscle weakness.

Sleep time and quality associated with depression and social anxiety among children and adolescents aged 6-18 years, stratified by body composition

BACKGROUND

Sleep has been suggested as risk factors for depression and social anxiety in children and adolescents, but little is known about the role of individual body composition on these association.

METHOD

We conducted a cross-sectional survey of children and adolescents aged 6-18 years in Beijing, China, in 2020, and assessed body composition by using iDXA dual-energy X-ray bone densitometer. Generalized liner model (GLM) and restricted cubic spline (RCS) were employed to analyze the associations between sleep and depression and social anxiety with different body composition. The attributable fraction (AFs) to assess the benefits of improvements of sleep in reducing depression and social anxiety odds.

RESULTS

Depression and social anxiety accounted for 13.1 % and 30.3 % of the study population. Sleep time was significantly associated with depression (HR = 2.35[1.58, 3.50]), and social anxiety (HR = 1.65[1.24, 2.20]); and sleep quality was significantly associated with depression (HR = 7.27[4.87, 10.84]), and social anxiety (HR = 2.54 [1.99, 3.25]) among children and adolescents. The exposure to both insufficient sleep time and poor sleep quality were associated with a higher odd of depression and social anxiety, but lower BF%, higher muscle rate and FFM/FM alleviated the adverse effects of sleep quality on depression and social anxiety.

LIMITATIONS

Conclusions about causality remain speculative because of the cross-sectional design.

CONCLUSION

Insufficient sleep time, poor sleep quality, high BF%, low muscle rate and FFM/FM can jointly associate with anxiety and depression. This study provides new evidence support for accurate prevention and control of mental diseases in children and adolescents with different body types.

Long-term Trends in Healthy and Unhealthy Life Expectancy Among Adults Aged 60 - A Global Perspective, 1990-2019

What is already known about this topic?

Traditionally, life expectancy has served as a pivotal measure for assessing population health. However, there is an increasing focus on distinguishing healthy years of life from those characterized by illness, particularly among the elderly population.

What is added by this report?

This study conducts an exhaustive global analysis of the trends in healthy and unhealthy life expectancy among adults aged 60 and over from 1990 to 2019. These trends are further correlated with socio-demographic indicators and health services metrics.

What are the implications for public health practice?

Comprehending the dynamics between healthy and unhealthy life years can equip policymakers with the necessary insights to prioritize interventions. These interventions can thereby secure both quality and longevity of life for the increasingly aging population.

Disparity in spectrum of infectious diseases between in-school and out-of-school children, adolescents, and youths in China: findings from a successive national surveillance from 2013 to 2021

Background

An accelerated epidemiological transition, economic development and urbanization have brought rapid reductions but a potential disparity in infectious diseases burdens in-school and out-of-school children, adolescents, and youths in China. This paper assesses the disparity in spectrum of infectious diseases between two groups, and described disparity's variation by age, year and province, and determined the priority diseases.

Methods

A total of 7,912,274 new incident cases (6,159,021 in school and 1,753,253 out of school) aged 6-21 years across 43 notifiable infectious diseases have been collected based on China's Notifiable Infectious Disease Surveillance System from 2013 to 2021. All infectious diseases are categorized into seven categories: vaccine preventable, bacteria, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. We used the index of incidence rate ratio (IRR) of by specific disease, category, year, and age to assess the disparity between those out-of-school and in-school, and determine their separate priority diseases.

Findings

From 2013 to 2021, a small disparity of notifiable infectious diseases existed with higher average yearly incidence for out-of-school children, adolescents, and youth than that in-school (327.601 v.s. 319.677 per 100,000, IRR = 1.025, 95%CI: 1.023-1.027, standardized IRR = 1.169, 95%CI: 1.155-1.183), and it gradually narrowed by surveillance years with IRR from 1.351 in 2013 to 1.015 in 2021 due to large decreased disparity in compulsory education stage group. Such disparity was mainly driven by sexually transmitted and bloodborne diseases, bacteria diseases, vectorborne diseases, quarantinable diseases and zoonotic diseases. However, vaccine preventable diseases, gastrointestinal and enterovirus diseases showed higher incidence of infectious diseases for those in-school than that out-of-school, particularly for seasonal influenza, mumps and hand-foot-and-mouth disease. Meanwhile, such disparity is obvious in most of ages and in eastern and coastal regions of China, and the narrowing trend is attributed to six categories diseases, except for sexually transmitted and bloodborne diseases with gradually widened disparity between two groups with surveillance years with IRR from 22.939 in 2013 to 23.291 in 2021 due to large disparity for those who have completed compulsory education.

Interpretation

A huge achievement has been achieved in reducing the burden and disparity of infectious diseases between out-of-school and in-school children, adolescents, and youths in China, particularly for the compulsory education stage population. The priorities for the coming decades will be to extend successful strategies to a broad scope and promote education, particularly for the investment of social health resources and the improvement of personal health literacy in the non-compulsory education stage. This should involve extending the years of compulsory school, improving sex health education, strengthening monitoring, expanding immunization programs coverage and prioritizing the prevention and control of sexually transmitted diseases and tuberculosis among out-of-school population.

Funding

National Natural Science Foundation of China and Beijing Natural Science Foundation.

Widening rural-urban gap in life expectancy in China since COVID-19

INTRODUCTION

Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural-urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.

METHODS

We used monthly death counts from death registration systems. Rural-urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.

RESULTS

The rural-urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural-urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural-urban gap since 1987 were positively correlated with the rural-urban disparity in public health expenditures, especially among ages <60 (p values <0.005).

CONCLUSIONS

Our findings identified a widening rural-urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.

Long-Term Patterns of Meningitis Mortality: A Continual Downward Trend and a Vulnerable Infant Population - China, 1987-2021

What is already known about this topic?

Meningitis, a life-threatening disease, presents a significant public health challenge. Its rate of progress in burden reduction notably lags behind other diseases that can be prevented through vaccination.

What is added by this report?

This research explored the changes in the mortality rate of meningitis in China over a span of 35 years. The study further identified the effects of age, period, and cohort on the mortality trends.

What are the implications for public health practice?

In the context of minimal disparities between urban and rural settings, it is crucial to focus on and implement targeted prevention programs for meningitis within the infant population.

Effect modifications of BMI transition and trajectory in the associations of adverse childhood experiences with new-onset dementia and its subtypes in older US adults

Background

Adverse childhood experiences (ACEs) and dementia are associated and comorbid with obesity. However, according to emerging research, the role of obesity in the association between ACEs and dementia seems controversial.

Aims

This analysis aimed to explore the associations between ACEs and different dementia subtypes and the effect modification of long-term body mass index (BMI).

Methods

Data were obtained from the US Health and Retirement Study. Six ACEs were categorised as 0, 1 and 2 or more. All-cause dementia, Alzheimer's disease (AD) and other dementias were defined by self-reported or proxy-reported physician diagnosis. Cox proportional hazards regression was used to explore the associations of ACEs with new-onset all-cause dementia, AD and other dementias from 2010 to 2020. Effect modification of BMI in 2010 and BMI transition and trajectory (fitted by group-based trajectory modelling) from 2004 to 2010 were assessed.

Results

15 282 participants with a mean age of 67.0 years (58.0-75.0) were included in the 2010 data analysis. Significant interactions of ACEs with baseline BMI, BMI transition and BMI trajectory in their associations with new-onset all-cause dementia and AD were observed (all p<0.05). For instance, positive associations of two or more ACEs (vs none) with all-cause dementia and AD were found in those with a BMI trajectory of maintaining ≥30 kg/m2 (maintain obesity) rather than a decline to or maintaining <25 kg/m2 (decline to or maintain normal weight), with hazard ratios (HRs) of 1.87 (95% confidence interval (CI): 1.45 to 2.42) and 1.85 (95% CI: 1.22 to 2.80), respectively.

Conclusions

ACEs were associated with dementia and AD in US adults with long-term abnormally elevated BMI but not with long-term normal or decreasing BMI. Integrated weight management throughout life could prevent dementia among those with childhood adversity.

Air pollution, genetic susceptibility, and the risk of atrial fibrillation: A large prospective cohort study

To date, no study has explored the extent to which genetic susceptibility modifies the effects of air pollutants on the risk of atrial fibrillation (AF). This study was designed to investigate the separate and joint effects of long-term exposure to air pollutants and genetic susceptibility on the risk of AF events. This study included 401,251 participants without AF at baseline from UK Biobank. We constructed a polygenic risk score and categorized it into three categories. Cox proportional hazards models were fitted to assess the separate and joint effects of long-term exposure to air pollutants and genetics on the risk of AF. Additionally, we further evaluated the effect modification of genetic susceptibility. The hazard ratios and corresponding 95% confidence intervals of incident AF for per interquartile range increase in particulate matter with an aerodynamic diameter smaller than 2.5 µm (PM2.5) or 10 µm (PM10), nitrogen dioxide (NO2), and nitrogen oxide (NOx) were 1.044 (1.025, 1.063), 1.063 (1.044, 1.083), 1.061 (1.042, 1.081), and 1.039 (1.023, 1.055), respectively. For the combined effects, participants exposed to high air pollutants levels and high genetic risk had approximately 149.2% (PM2.5), 181.7% (PM10), 170.2% (NO2), and 157.2% (NOx) higher risk of AF compared to those with low air pollutants levels and low genetic risk, respectively. Moreover, the significant additive interactions between PM10 and NO2 and genetic risk on AF risk were observed, with around 16.4% and 35.1% of AF risk could be attributable to the interactive effects. In conclusion, long-term exposure to air pollutants increases the risk of AF, particularly among individuals with high genetic susceptibility.

Ambient air pollution, genetic risk and telomere length in UK biobank

BACKGROUND

Telomere length (TL) is a biomarker of genomic aging. The evidence on the association between TL and air pollution was inconsistent. Besides, the modification effect of genetic susceptibility on the air pollution-TL association remains unknown.

OBJECTIVE

We aimed to evaluate the association of ambient air pollution with TL and further assess the modification effect of genetic susceptibility.

METHODS

433,535 participants with complete data of TL and air pollutants in UK Biobank were included. Annual average exposure of NO2, NOx, PM10 and PM2.5 was estimated by applying land use regression models. Genetic risk score (GRS) was constructed using reported telomere-related SNPs. Leukocyte TL was measured by quantitative polymerase chain reaction (qPCR). Multivariable linear regression models were employed to conduct associational analyses.

RESULTS

Categorical exposure models and RCS models both indicated U-shaped (for NO2 and NOx) and L-shaped (for PM10 and PM2.5) correlations between air pollution and TL. In comparison to the lowest quartile, the 2nd and 3rd quartile of NO2 (q2: -1.3% [-2.1%, -0.4%]; q3: -1.2% [-2.0%, -0.3%], NOx (q2: -1.3% [-2.1%, -0.5%]; q3: -1.4% [-2.2%, -0.5%]), PM2.5 (q2: -0.8% [-1.7%, 0.0%]; q3: -1.3% [-2.2%, -0.5%]), and the third quartile of PM10 (q3: -1.1% [-1.9%, -0.2%]) were inversely associated with TL. The highest quartile of NO2 was positively correlated with TL (q4: 1.0% [0.0%, 2.0%]), whereas the negative correlation between the highest quartile of other pollutants and TL was also attenuated and no longer significant. In the genetic analyses, synergistic interactions were observed between the 4th quartile of three air pollutants (NO2, NOx, and PM2.5) and genetic risk.

IMPACT STATEMENT

Our study for the first time revealed a non-linear trend for the association between air pollution and telomere length. The genetic analyses suggested synergistic interactions between air pollution and genetic risk on the air pollution-TL association. These findings may shed new light on air pollution's health effects, offer suggestions for identifying at-risk individuals, and provide hints regarding further investigation into gene-environment interactions.

Investigating the Microscopic Mechanism of Ultrasonic-Vibration-Assisted-Pressing of WC-Co Powder by Simulation

The ultrasonic-vibration-assisted pressing process can improve the fluidity and the uneven distribution of density and particle size of WC-Co powder. However, the microscopic mechanism of ultrasonic vibration on the powder remains unclear. In this paper, WC particles with diameter 5 μm and Co particles with diameter 1.2 μm were simulated by three-dimensional spherical models with the aid of the Python secondary development. At the same time, the forming process of the powder at the mesoscale is simulated by virtue of the finite element analysis software ABAQUS. In the simulation process, the vibration amplitude was set to 1, 2, and 3 μm. Their influence on the fluidity, the filling density, and the stress distribution of WC-Co powder when the ultrasonic vibration was applied to the conventional pressing process was investigated. The simulation results show that the ultrasonic vibration amplitude has a great influence on the density of the compact. With an increase in the ultrasonic amplitude, the compact density also increases gradually, and the residual stress in the billet decreases after the compaction. From the experimental results, the size distribution of the billet is more uniform, the elastic after-effect is reduced, the dimensional instability is improved, and the density curves obtained by experimentation and simulation are within a reasonable error range.

Activities of Daily Living-Related Functional Impairment Among Population Aged 65 and Older - China, 2011-2050

What is already known about this topic?

The elevated prevalence of functional impairment among elderly individuals in China contributes to an increased burden of care.

What is added by this report?

This report presents a comprehensive evaluation of trends in functional impairment related to activities of daily living (ADL) among the elderly population in China. Furthermore, it offers insights for future projections of these trends in this demographic group.

What are the implications for public health practice?

Addressing the care needs and functional impairment issues among the aging population in China necessitates interdepartmental collaboration.

Medical service utilization and costs of autism spectrum disorder: Evidence from hospital records in Beijing, China

As more and more people are diagnosed with autism spectrum disorder (ASD), it is necessary to better understand their costs. Detailed information on medical service utilization and costs could aid in designing equitable, effective policies to support individuals with ASD and their families. In this retrospective analysis, individuals with a hospital encounter (outpatient visit or inpatient admission) were collected from Beijing Municipal Health Big Data and Policy Research Center (BMHBD), from January 1, 2017 to December 31, 2021. We analyzed the costs, hospital visits/admissions and their changing trends over 5 years. Poisson regression and logit regression were conducted to analyze the influencing factors of visits, admissions and costs. The study population consisted of 26,826 users of medical services (26,583 outpatients and 243 inpatients; mean age: 4.82 ± 3.47 years for outpatients; 11.62 ± 6.74 years for inpatients). 99.1% were outpatients (mean ± standard deviation (SD) costs per year: $422.06 ± $11.89), while 0.9% were inpatients (mean ± SD costs per year: $4411.71 ± $925.81). More than 50% of outpatients received medication and diagnostic testing services. Among those with an inpatient admission, 91% received treatment services. Medication costs were the major contributor to medical costs for adults. Diagnostic test and treatment costs were the major contributors for children and adolescents. The findings demonstrated a significant economic burden for those diagnosed with ASD and highlighted opportunities for improving the care of this vulnerable group. This study adds to the literature by focusing on age differences among health-care utilization in individuals with ASD.

Enhancing the effectiveness of infectious disease health education for children and adolescents in China: a national multicenter school-based trial

BACKGROUND

Infectious diseases pose a significant risk to the health and well-being of children and adolescents, and can even be life-threatening. Thus, our study aimed to explore the effectiveness of health education based on the social-ecological model in improving the knowledge of infectious diseases among this vulnerable population.

METHODS

This study was a school-based intervention conducted in seven Chinese provinces in 2013, involving a total of 26,591 children and adolescents in the intervention group and 24,327 in the control group. The intervention group received a comprehensive health intervention based on the social-ecological model (SEM) over six months, which included a supportive environment, health education on infectious diseases, guidance on self-monitoring infectious disease-related behaviors, and other measures. Data on infectious disease-related knowledge and other characteristics were collected through questionnaires. The main outcome measure will be the difference in the effectiveness of health education regarding infectious diseases in children and adolescents between baseline and post-intervention. A mixed-effects regression model was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) to assess the impact of infectious disease-related interventions on the participants.

RESULTS

We utilized a socioecological model as the foundation for a six-month health education program on infectious diseases targeting children and adolescents in the intervention group. At the individual and community levels, the correct rate of health behavior related to infectious diseases in the intervention group was higher than that in the control group (P < 0.05), the ORs (95% CI) were 0.94 (0.90-0.99) and 0.94 (0.89-0.99), respectively. But the intervention effect was not significant at the interpersonal level. The intervention effect at the organizational level was obvious, with an increase in opportunities for children and adolescents to acquire knowledge of infectious diseases from courses and lectures, teachers, and doctors, (all P < 0.05), with the ORs (95% CI) of 0.92 (0.87-0.97) and 0.86 (0.83-0.94), respectively. However, there was no significant difference between the intervention group and the control group in school infectious disease health education policy.

CONCLUSION

Enhancing health education regarding infectious diseases is crucial in promoting comprehensive prevention and control measures among children and adolescents. Nevertheless, it remains imperative to reinforce health education on infectious diseases at the interpersonal and policy levels. This holds significant reference value for mitigating childhood infectious diseases in the post-COVID-19 era.

Effect of bionic hexagonal texture on squeezing films inside soft contacts with high adhesion and high friction

To understand the mechanisms of high friction and high adhesion in bioinspired textured surfaces under wet conditions, the evolution behavior of squeezing films across lubricated interfaces is experimentally investigated using optical interferometry. The results show that the splitting of the continuous large-scaled liquid film into numerous isolated micro zones is an important function of the hexagonal texture. Both the orientation and the size of the hexagonal texture have noticeable effects on the drainage rate: either downscaling the hexagonal texture or orienting the texture with two sides of each micro-hexagon parallel to the inclining direction could accelerate the draining process. While the draining process is completed, residual micro-droplets turn out to be entrapped within the contact regions of single hexagonal micro-pillars. The entrapped micro-droplets gradually shrink as the hexagonal texture downsizes. Moreover, a novel geometrical shape for the micro-pillared texture is proposed to improve the drainage efficiency.

Study and design of amino acid-based radical enzymes using unnatural amino acids

Radical enzymes harness the power of reactive radical species by placing them in a protein scaffold, and they are capable of catalysing many important reactions. New native radical enzymes, especially those with amino acid-based radicals, in the category of non-heme iron enzymes (including ribonucleotide reductases), heme enzymes, copper enzymes, and FAD-radical enzymes have been discovered and characterized. We discussed recent research efforts to discover new native amino acid-based radical enzymes, and to study the roles of radicals in processes such as enzyme catalysis and electron transfer. Furthermore, design of radical enzymes in a small and simple scaffold not only allows us to study the radical in a well-controlled system and test our understanding of the native enzymes, but also allows us to create powerful enzymes. In the study and design of amino acid-based radical enzymes, the use of unnatural amino acids allows precise control of pKa values and reduction potentials of the residue, as well as probing the location of the radical through spectroscopic methods, making it a powerful research tool. Our understanding of amino acid-based radical enzymes will allow us to tailor them to create powerful catalysts and better therapeutics.

Thermally stable red-emitting oxide ceramics for laser lighting

Laser-driven phosphor-converted white light sources are highly desirable for their unprecedented energy efficiency and lighting quality. However, important challenges remain due to a lack of efficient and stable red-emitting materials. Here we explore Eu²⁺ -activated oxide-based double perovskites as red emitters with thermally stable photoluminescence. Sr₃ TaO_5.5 :Eu²⁺ ceramics exhibit a red emission band peaking at 620 nm upon blue laser pumping owing to the Eu²⁺ occupation at highly ordered substitutional lattice sites. A constructed laser-driven white light wheel under an incident power density of 19.2 W/mm² presents a record luminous flux of 1115 lm with an excellent color rendering indexof 90. Our study invigorates the development of Eu²⁺ -activated oxide-based ceramics with thermally stable luminescence for laser pumped lighting and display applications. This article is protected by copyright. All rights reserved.

Long-term exposure to PM2.5 and O3 with cardiometabolic multimorbidity: Evidence among Chinese elderly population from 462 cities

Cardiometabolic multimorbidity (CMM) refers to the presence of multiple cardiovascular and metabolic diseases (CMDs), such as hypertension, diabetes, and cardio-cerebrovascular diseases (CCVD), in the same individual, and has emerge as a significant global health concern due to population aging. Although previous research has demonstrated the association between cardiovascular and metabolic diseases and air pollutants, evidence on the link between CMM and air pollution exposure among Chinese older adults is limited. To address this research gap, we conducted a national representative survey of 222,179 adults aged 60 and older to investigate the epidemiology of CMM and its association with long-term exposure to PM_2.5 and O₃ in China's elderly population. We found that the prevalence of CMM among Chinese older adults was 16.9%, and hypertension and CCVD were the most common CMM cluster (10.8%). After adjusting for confounding variables, we observed a significant positive association between PM_2.5 exposure and the prevalence of hypertension, diabetes, and CCVD, with a respective excess risk increase of 3.2%, 3.6%, and 5.5% for every 10-unit increase. Moreover, every 10-unit increase in PM_2.5 was linked to a higher risk of hypertension and diabetes (2.2%), hypertension and CCVD (5.4%), diabetes and CCVD (5.6%), and hypertension, diabetes, and CCVD combined (7.6%). We also found a U-shaped curve relationship between O₃ exposure and the occurrence of hypertension, diabetes, and CCVD, as well as different subtypes of CMM, with the lowest risk of O₃ exposure was observed near 75-80 μg/m³. Furthermore, we identified that female and rural residents are more vulnerable to the health risks of air pollution than male and urban residents. Given the increasing aging of the population and rising prevalence of multimorbidity, policymakers should focus more attention on the female and rural elderly population to prevent and control CMM. This study provides compelling evidence that reducing air pollution levels can be an effective strategy to prevent and manage CMM among older adults.

Changing Patterns of Heart Disease Mortality in Rural and Urban Areas - China, 1987-2021

What is already known about this topic?

The burden of heart disease is increasing rapidly due to the aging population and changing lifestyles in China.

What is added by this report?

This study investigated the evolution of mortality rates due to heart disease in urban and rural areas of China over the past 35 years, and identified the age-period-cohort effects on mortality changes.

What are the implications for public health practice?

Healthcare providers should prioritize attention to heart disease among older males living in rural areas.

Association between multimorbidity and memory-related diseases among middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study

Objectives

This study aimed to examine the cross-sectional and longitudinal association between multimorbidity and memory-related diseases (MDs) among Chinese middle-aged and older adults.

Methods

This study included 8,338 subjects who participated in the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression and Cox proportional hazards regression models were used to explore the association and effect of multimorbidity on MDs.

Results

The overall prevalence of MDs was 2.52%, and the mean multimorbidity number was 1.87. In a cross-sectional analysis, compared with the no multimorbidity group, groups of multimorbidity with four or more non-communicable diseases (NCDs) were more likely to have MDs (OR: 6.49, 95%CI: 4.35–9.68). Within 2.7 years of follow-up, 82 cases of MDs (1.12%) were reported, and participants with multimorbidity were more likely to have new-onset MDs than participants without multimorbidity (HR: 2.93, 95%CI: 1.74–4.96).

Conclusion

Multimorbidity is associated with MDs among Chinese middle-aged and older adults. This relationship gradually strengthens with the severity of multimorbidity, which indicates that early prevention for people with multimorbidity may reduce the risk of MDs.

Exposure to various ambient air pollutants and 9 cardiovascular conditions among individuals with diabetes: A prospective analysis of the UK Biobank

BACKGROUND AND AIMS

The adverse effects of air pollutants on the risk of most cardiovascular diseases (CVDs) are well-established, but the risk of CVDs such as deep vein thrombosis, pulmonary embolism, or aortic valve stenosis have been underappreciated, especially in the diabetic population. This study aimed to evaluate associations between long-term air pollutants exposure and the risk of incident CVDs among participants with diabetes.

METHODS

This study included 27,827 participants with baseline diabetes from the UK Biobank. We then estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVDs associated with chronic air pollutant exposure in the diabetic population by fitting the Cox proportional hazards model. Moreover, we investigated the cardiovascular effects of air pollutants at concentrations below WHO guideline limits.

RESULTS

After multivariable adjustment, long-term NO₂ and NO_x exposures were positively associated with the development of 8 and 6 types of CVDs in participants with diabetes, respectively. In term of particulate matters, the effect estimates ranged from 1.51 (1.13, 2.03) (coronary artery disease) to 4.65 (2.73, 7.92) (peripheral arterial disease) per 10 μg/m³ increase in PM_2.5. Whereas, the effect estimates ranged from 1.15 (1.04, 1.27) (arterial hypertension) to 2.28 (1.40, 3.69) (pulmonary embolism) per 10 μg/m³ increase in PM₁₀. In addition, our study discovered that for most of the cardiovascular events (8 of 9), the deleterious effects of air pollutants persisted even when participants were exposed to air pollutants concentrations below WHO guideline limits.

CONCLUSIONS

Long-term exposure to ambient NO₂, NO_x, PM_2.5, and PM₁₀, either at normal or low level, increased risk of various cardiovascular outcomes in the diabetic population.

Chronic Disease in China: Geographic and Socioeconomic Determinants Among Persons Aged 60 and Older

OBJECTIVES

This study aimed to reveal the epidemic characteristics of chronic diseases among the Chinese older population and provide empirical strategies for the prevention and management of chronic diseases in the seniors in China.

DESIGN

A national cross-sectional study.

SETTING AND PARTICIPANTS

A total of 224,640 Chinese residents aged 60 and older were invited, and 222,179 (98.9%) participated in our survey.

METHODS

Standardized questionnaires were used to collect socioeconomic information and self-reported physician-diagnosed chronic diseases. The associations between individual socioeconomic status and chronic diseases were estimated using generalized linear mixed-effects models.

RESULTS

The national prevalence of any chronic diseases was 81.1% (95% CI 80.9-81.2), representing 179.9 million Chinese older adults. The prevalence increased with aging and peaked at 80 to 84 years old (87.2, 95% CI 86.7-87.7), this is consistent with studies in developing countries. Women (84.2, 84.0-84.4), rural residents (82.6, 82.4-82.8), and ethnic minorities (82.2, 81.5-82.8) had a higher prevalence than men (77.7, 77.4-77.9), urban residents (79.7, 79.5-79.9), and people of Han ethnicity (81.0, 80.8-81.2), respectively. For provincial prevalence, Tibet had the highest prevalence of chronic diseases (91.8, 91.5-92.0), and Fujian had the lowest (72.7, 72.5-72.9). The absolute differences between the highest and lowest provinces for the specific chronic condition ranged from 2.78% for cancer to 36.3% for cardiovascular diseases.

CONCLUSIONS AND IMPLICATIONS

Chronic diseases were highly prevalent among older adults in China and varied geographically. Advanced socioeconomic status appeared to have double-edged impacts on the prevalence of chronic diseases. Our findings support that reducing gender and geographic disparities should be prioritized in China's chronic disease prevention and management, and an affordable long-term care services system for older adults should be established urgently in China.

Changes in Shape Discrimination Sensitivity Under Glare Conditions After Orthokeratology in Myopic Children: A Prospective Study

Purpose

To investigate changes in shape discrimination under mesopic conditions with and without glare after orthokeratology in myopic children.

Methods

This prospective study included 79 eyes of 79 myopic children (ages: 8-16 years). Shape discrimination thresholds (SDTs) were measured using radial frequency patterns, with a radial frequency of 4 cycles/360°, a peak spatial frequency of 3 cycles per degree, a contrast of 20%, and a mean radius of 1.5 degrees. SDT under mesopic conditions with and without glare was measured before orthokeratology and again at 1 week and 1 month after orthokeratology. Changes in the SDTs and their relationships to baseline ocular parameters were analyzed.

Results

SDTs with glare decreased significantly at 1 week (-0.08 ± 0.15 log(arcsec), P < 0.001) and 1 month (-0.09 ± 0.15 log(arcsec), P < 0.001) after orthokeratology. SDTs without glare remained stable (P = 0.81 and P = 1.00, respectively). The difference between SDTs with and without glare also decreased significantly at 1 week (-0.10 ± 0.17 log(arcsec), P < 0.001) and at 1 month (-0.08 ± 0.18 log(arcsec), P = 0.001) after orthokeratology. Based on a multivariate analysis, the greater decrease in SDT with glare after 1 month of orthokeratology was associated with a higher baseline spherical equivalent refraction.

Conclusions

Orthokeratology resulted in improved shape discrimination in myopic children under mesopic conditions but only when measured in the presence of glare.

Developmental Gerontology and Active Population Aging in China

Population aging is an irreversible process in the development of modern society, which brings challenges to comprehensive modernized social governance. Population aging is a "dualistic" development issue that not only leads to aging of the labor force structure but also creates new demographic dividends. This study describes the core thoughts of developmental gerontology (DG), which provides new insight into the relationship between active aging and comprehensive governance for modernized society. The development of DG will provide a feasible and sustainable path to integrate and coordinate the relationship between population aging, society, and economy.

Confronting COVID-19 and Prioritizing Aging Population

Over the past three years, China has implemented rapid, vigorous, and coordinated control measures to limit the spread of coronavirus disease 2019 (COVID-19) effectively. These measures include active containment, graded management, rational resource allocation, rapid contact tracing and disposal, and targeted vaccination of key populations. These efforts have contributed to the prompt and effective control of outbreaks, protecting the health and well-being of older adults. This review provides a comprehensive summary of the changes in China's COVID-19 prevention and control experiences and other public health measures since the outbreak of the pandemic, and assesses their impact on older adults. It may serve as a valuable reference for future epidemic prevention and control efforts.

Age- and sex-related differences in the retinal capillary plexus in healthy Chinese adults

BACKGROUND

To assess age- and sex-related changes in the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in healthy Chinese adults.

METHODS

In this cross-sectional study, all data were derived from the community-based Jidong Eye Cohort Study. Participants underwent optical coherence tomography angiography (OCTA) and other ocular and systemic examinations. The vessel densities of the whole measured area, parafovea, and four quadrants in the SCP and DCP were measured.

RESULTS

We recruited 1036 eyes of 1036 healthy participants; the mean age was 40.4 ± 9.8 years, and 449 (43.3%) participants were males. The SCP and DCP vessel densities in all regions, except for temporal and nasal regions in the SCP, non-linearly decreased with age. The DCP vessel densities began to decrease at approximately 35 years of age, while the SCP vessel densities began to decrease at approximately 40 years of age. The DCP vessel densities decreased more rapidly than the SCP vessel densities at 35-50 years of age. The DCP vessel densities remained stable or slightly decreased after the age of 50 years in females, while those decreased linearly in most regions in males.

CONCLUSIONS

The retinal vessel density decreased earlier and more rapidly in the DCP than in the SCP, and the effect of aging on the DCP vessel density was sex-dependent. Our findings suggest that age and sex should be considered when interpreting clinical quantitative OCTA data.

Public concern for animal welfare and its correlation with ethical ideologies after coronavirus disease (COVID-19) in China

The outbreak of coronavirus disease (COVID-19) represents a major public health challenge and a serious threat to sustainable social development. A consideration of animal welfare is clearly justified, given the potential contribution of animals to the spread of the disease. The present study, therefore, sought to investigate the concern the Chinese people have for animal welfare (PCAW) and how their 'ethical ideology' (idealism and relativism) determines PCAW after COVID-19, through comparison with the same study, carried out in China in 2015. Our results demonstrated a significant improvement in Chinese PCAW after COVID-19. The adverse impact of COVID-19 may have resulted in a lowered idealism score and this decreased score served to neutralise significant correlations between idealism and PCAW, compared to the 2015 results. The global pandemic did not increase people's relativism score and a significant correlation was found between relativism and PCAW. Gender, age, educational level, public perception of animals after COVID-19, zoo and aquarium visiting were all shown to be predictor variables for PCAW. This study is one of the first to investigate Chinese PCAW after COVID-19 and can therefore provide knowledge that will potentially increase Chinese PCAW.

Highly Distorted Antimony(III) Chloride [Sb2 Cl8 ]2- Dimers for Near-Infrared Luminescence up to 1070 nm

Zero-dimensional (0D) hybrid metal halides with unique compositional and structural tunability appear as an emerging class of luminescent materials, but near-infrared (NIR) emitters therein are largely unexplored to date. This study presents three novel 0D hybrid antimony chlorines with edge-sharing [Sb₂ Cl₈ ]^2- dimers, showing unusual room-temperature broadband NIR emission with the maximum emission wavelength up to 1070 nm. Photoluminescence studies and density functional theory calculation demonstrate that the emissions originate from the highly localized excitons, and that the confined [Sb₂ Cl₈ ]^2- dimers in these structures show low symmetry and a large degree of structural freedom. These hybrid antimony chlorines with [Sb₂ Cl₈ ]^2- dimers expand the range of new NIR materials in 0D metal halides.

Association of self-reported snoring with decreased retinal thickness and vessel density

Purpose: Self-reported snoring has been reported to influence nerves and vessels. However, there are few direct evidences of snoring related to nerves and microvessels defects. Therefore, we evaluated the association of self-reported snoring with retinal structure and microcirculation.

Methods: A total of 2,622 participants were recruited from the Jidong eye cohort study (JECS). Physical examinations, laboratory tests, and questionnaires were recorded. We also used optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to assess the retinal structure and microvascular network. Snoring was defined as “never,” “occasionally,” and “frequently or more severe” according to self-reported frequency.

Results: The prevalence of snoring were 84.6% (n = 983) and 45.0% (n = 657) in males and females, respectively. Compared with never snoring group, the retinal thickness increased in “occasionally” (p &lt; 0.001) and “frequently or more severe” groups (p = 0.001), while no difference was found between snoring groups (p = 0.14). Superficial retinal capillary plexus (RCP) vessel density was lower in “frequently or more severe” group than in “never” (p &lt; 0.001) and “occasionally” snoring groups (p &lt; 0.001). After adjusting for confounders, “frequently or more severe” snoring was significantly associated with thinner total retinal thickness [β = −2.79 (95% CI: −5.27, −0.30)] and lower superficial RCP vessel density [β = −0.71 (95% CI: −1.19, −0.23)].

Conclusion: Our research showed self-reported snoring was associated with thinner retinal thickness and lower superficial RCP vessel density. The findings of our study emphasize the need for self-reported snoring assessments in determining retinal structure and microcirculation impairment.

Decreased Vessel Density in Retinal Capillary Plexus and Thinner Ganglion Cell Complex Associated With Cognitive Impairment

Background

To determine the association of the retinal capillary plexus (RCP) and ganglion cell complex (GCC) with cognitive impairment using optical coherence tomography angiography (OCTA).

Methods

A cross-sectional, community-based study utilizing data from the participants enrolled between August 2019 and January 2020 in the Jidong Eye Cohort Study. We assessed the vessel density in RCP and GCC thickness using OCTA, and cognitive testing using the Montreal Cognitive Assessment (MoCA). Cognitive impairment in this study was defined as MoCA score &lt; 24. We used multivariable analysis to evaluate the association of RCP and GCC with cognitive impairment after adjusting for confounders.

Results

This study analyzed 1555 participants. The mean age of participants was 52.3 (8.4) years, and 861 (55.4%) were women. Cognitive impairment was observed in 268 (17.2%) participants. The adjusted odds ratio (OR) with 95% confidence interval (95% CI) for parafovea vessel density in the deep RCP with cognitive impairment was 1.20 (1.03–1.39). For vessel area and length density surrounding foveal avascular zone with cognitive impairment, the ORs with 95% CIs were 1.23 (1.07–1.41) and 1.30 (1.13–1.49), respectively. For thickness in the superior GCC with cognitive impairment, the OR with 95% CI was 1.16 (1.01–1.32).

Conclusion

Lower vessel density in the RCP and thinner GCC were associated with cognitive impairment. Our results suggest that alterations in the RCP and GCC could provide further evidence when assessing the cognitive function and may even be potentially useful biomarkers in the detection of cognitive impairment.

Association of cigarette smoking with retinal capillary plexus: an optical coherence tomography angiography study

PURPOSE

To investigate the association between cigarette smoking and retinal capillary plexus (RCP) using optical coherence tomography angiography (OCTA) and to examine whether potential vascular risk factors could impact their association.

METHODS

This is a cross-sectional, community-based study. The Jidong Eye Cohort Study included participants aged ≥18 years in the Jidong community (Tangshan city, northern China) from August 2019 to January 2020. All participants underwent comprehensive ophthalmic examination and completed detailed smoking questionnaires. Retinal vessel density in the superficial and deep RCP was automatically measured using OCTA.

RESULTS

Of the 2598 participants included in the study, 2026 (78.0%) never smoked and 572 (22.0%) had a history of smoking (494 [19.0%] current smokers and 78 [3.0%] former smokers). The median (interquartile range) age was 41 (34-52) years for the non-smoking group and 45 (35-54.5) years for the smoking group. Multivariable analysis showed that smoking history is associated with a low deep RCP vessel density in the parafovea (β, -0.53; 95% confidence interval [CI], -0.82 to -0.24) and four quadrants. Increased smoking pack-years were associated with reduced deep RCP vessel density in the parafovea (p for trend <0.001) and four quadrants. The significant interaction between diabetes and smoking only was found for superficial RCP vessel density in the parafovea (p for interaction = 0.014) and four quadrants except for the temporal quadrants.

CONCLUSIONS

Cigarette smoking is an independent risk factor for reduced deep RCP vessel density. Our findings imply the potential detrimental effect of smoking on the occurrence of ocular diseases.

The bipolar charge plasma spectrometer (BCPS) based on the 2π-field-of-view double-channel electrostatic analyzer

In this paper, we propose a bipolar charge plasma spectrometer based on the double-channel electrostatic analyzer for simultaneously measuring thermal ions and electrons with a 2π hemispherical field-of-view. Both ions and electrons within the wide field-of-view enter the spectrometer, pass through the variable geometric factor channel, and are then separated by the double-channel electric fields. Two microchannel plates are accommodated at the exit of the analyzer for ion and electron detection. The main performance of the spectrometer has been obtained from on-ground calibration. With the electrostatic deflectors and the cylindrically symmetric structure, the spectrometer provides simultaneous measurements of thermal ion and electron velocity distributions with a shared field-of-view of 360° (azimuth angle) by 90° (elevation angle) and a broad energy range for both ions and electrons. The ion analyzer constant and the electron analyzer constant are 11.1 and 9.7, respectively. The detecting energy range of 33.3-44.4 keV for ions and 29.1-38.8 keV for electrons can be obtained by using the sweeping electrostatic analyzer voltage range of 3-4000 V. The ion and electron energy resolutions are 9.6% and 6.1%, respectively. The variable geometric factor function provides a large geometric factor adjusting range for both ion and electron measurements by two orders of magnitude, which fulfills the requirements of a large dynamic flux range for simultaneous measurements of space thermal plasma in the solar wind and magnetosphere.