Association of sleep duration and risk of frailty among the elderly over 80 years old in China: a prospective cohort study / 中华预防医学杂志

Objective: To explore the association between sleep duration and the risk of frailty among the elderly over 80 years old in China. Methods: Using the data from five surveys of the China Elderly Health Influencing Factors Follow-up Survey (CLHLS) (2005, 2008-2009, 2011-2012, 2014, and 2017-2018), 7 024 elderly people aged 80 years and above were selected as the study subjects. Questionnaires and physical examinations were used to collect information on sleep time, general demographic characteristics, functional status, physical signs, and illness. The frailty state was evaluated based on a frailty index that included 39 variables. The Cox proportional risk regression model was used to analyze the correlation between sleep time and the risk of frailty occurrence. A restricted cubic spline function was used to analyze the dose-response relationship between sleep time and the risk of frailty occurrence. The likelihood ratio test was used to analyze the interaction between age, gender, sleep quality, cognitive impairment, and sleep duration. Results: The age M (Q1, Q3) of 7 024 subjects was 87 (82, 92) years old, with a total of 3 435 (48.9%) patients experiencing frailty. The results of restricted cubic spline function analysis showed that there was an approximate U-shaped relationship between sleep time and the risk of frailty. When sleep time was 6.5-8.5 hours, the elderly had the lowest risk of frailty; Multivariate Cox proportional risk regression model analysis showed that compared to 6.5-8.5 hours of sleep, long sleep duration (>8.5 hours) increased the risk of frailty by 13% (HR: 1.13; 95%CI: 1.04-1.22). Conclusion: There is a nonlinear association between sleep time and the risk of frailty in the elderly.

Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China / 生物医学与环境科学（英文）

Objective@#Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment.@*Methods@#This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment.@*Results@#Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted @*Conclusion@#A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.

Associations of Sarcopenia, Handgrip Strength and Calf Circumference with Cognitive Impairment among Chinese Older Adults / 生物医学与环境科学（英文）

Objective@#To evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults.@*Methods@#Totally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment.@*Results@#The prevalence of cognitive impairment was 34.36%. The adjusted odds ratio ( @*Conclusion@#Sarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.

Effects of estimated glomerular filtration rate on all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China / 中华流行病学杂志

Objective@#To investigate the association between estimated glomerular filtration rate (eGFR) and all-cause mortality in the elderly aged 65 years and older in longevity areas in China.@*Methods@#Data used in this study were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, 1 802 elderly adults were collected in the study during 2012-2017/2018. In this study, the elderly were classified into 4 groups, moderate-to-severe group [<45 ml·min-1·(1.73 m2)-1], mild-to-moderate group [45- ml·min-1·(1.73 m2)-1], mild group [60- ml·min-1·(1.73 m2)-1] and normal group [≥90 ml·min-1·(1.73 m2)-1] according to their eGFR levels.@*Results@#After 6 years of follow-up, 852 participants died, with a mortality rate of 47.3%. Multivariate Cox regression analysis showed that the levels of eGFR were negatively correlated with all-cause mortality risk in the elderly (the HR of elderly was 0.993 and the 95%CI was 0.989-0.997 for every unit of eGFR increased, P=0.001), while compared with the group with normal eGFR, the HRs (95%CI) of the elderly in the moderate-to-severe group, mild-to-moderate group, and mild group were 1.690 (1.224-2.332, P=0.001), 1.312 (0.978-1.758, P=0.070), 1.349 (1.047-1.737, P=0.020) respectively [trend test P<0.001].@*Conclusion@#The decrease in eGFR was associated with higher mortality risk among the elderly in longevity areas in China.

Influence of visual impairment on mortality in the elderly aged 65 years and older in 8 longevity areas in China / 中华流行病学杂志

Objective@#To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China.@*Methods@#The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted.@*Results@#A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3%. The 5-year mortality rate was 76.7% in the group with visual impairment, and 47.6% in the group without visual impairment (P<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (HR=1.30, 95%CI: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (HR=1.48, 95%CI:1.20-1.84). However, vision status was not associated with the risk for mortality in males (HR=1.02, 95%CI: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (HR=1.39, 95%CI: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (HR=1.37, 95%CI: 0.61-3.07; HR=0.95, 95%CI: 0.61-1.48).@*Conclusion@#In the elderly people in China, visual impairment is a risk factor for mortality.

Influence of visual impairment on mortality in the elderly aged 65 years and older in 8 longevity areas in China / 中华流行病学杂志

To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China. The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted. A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3. The 5-year mortality rate was 76.7 in the group with visual impairment, and 47.6 in the group without visual impairment (<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (=1.30, 95: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (=1.48, 95:1.20-1.84). However, vision status was not associated with the risk for mortality in males (=1.02, 95: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (=1.39, 95: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (=1.37, 95: 0.61-3.07; =0.95, 95: 0.61-1.48). In the elderly people in China, visual impairment is a risk factor for mortality.

Effects of estimated glomerular filtration rate on all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China / 中华流行病学杂志

To investigate the association between estimated glomerular filtration rate (eGFR) and all-cause mortality in the elderly aged 65 years and older in longevity areas in China. Data used in this study were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, 1 802 elderly adults were collected in the study during 2012-2017/2018. In this study, the elderly were classified into 4 groups, moderate-to-severe group [<45 ml·min(-1)·(1.73 m(2))(-1)], mild-to-moderate group [45- ml·min(-1)·(1.73 m(2))(-1)], mild group [60- ml·min(-1)·(1.73 m(2))(-1)] and normal group [≥90 ml·min(-1)·(1.73 m(2))(-1)] according to their eGFR levels. After 6 years of follow-up, 852 participants died, with a mortality rate of 47.3. Multivariate Cox regression analysis showed that the levels of eGFR were negatively correlated with all-cause mortality risk in the elderly (the of elderly was 0.993 and the 95 was 0.989-0.997 for every unit of eGFR increased, =0.001), while compared with the group with normal eGFR, the (95) of the elderly in the moderate-to-severe group, mild-to-moderate group, and mild group were 1.690 (1.224-2.332, =0.001), 1.312 (0.978-1.758, =0.070), 1.349 (1.047-1.737, =0.020) respectively [trend test <0.001]. The decrease in eGFR was associated with higher mortality risk among the elderly in longevity areas in China.

Knowledge, attitudes, and practices related to COVID-19 pandemic among residents in Hubei and Henan Provinces / 南方医科大学学报

OBJECTIVE@#To survey the residents for their understanding of Coronavirus Disease 2019 (COVID-19)-related knowledge, attitude and practices (KAP) in two hard hit provinces of China to facilitate the governmental decisions on strategies against the disease.@*METHODS@#We invited the participants from Hubei and Henan Provinces of China for an internetbased survey starting from 12:00 on February 21, 2020 to 12:00 on February 23. The survey included the general conditions, KAP of COVID-19, psychological status and living conditions of the residents.@*RESULTS@#The effective response rate of the questionnaire was 98.9%. The mean (P25, P75) age of the participants was 19 (16, 40) years, and 54.3% of them were students. Social media were the most important source of information concerning the pandemic of the respondents. The respondents had a high awareness of person-to-person transmission of the virus through the respiratory tract or droplets but showed a relatively low level of awareness of the population susceptible to COVID-19 and its specific symptoms. The results of multivariate analysis showed that women, undergraduate students (including college students) and higher degree holders had better knowledge of COVID-19 ( < 0.05); the proportion of respondents who expressed to have different levels of psychological stressed such as worry, anxiety and panic reached 77.2%; 16.7% of the responders considered psychological interventions necessary for their psychological conditions; 63.6% of the respondents confessed a bias against the people returning from Hubei and Henan provinces, while 22.4% worried that they might be biased because of their residence in Hubei and Henan. The rate of personal protective equipment shortage was as high as 69.4%; the rates of the responders who would "covering the mouth and nose when coughing or sneezing", "properly use masks in accordance with regulations", "maintain proper hand hygiene ", "avoid gatherings with relatives and friends" and "refrain from going to public places" were 92.4%, 95.9%, 93.5%, 88.8% and 93.1%, respectively. Women and groups with good knowledge of the disease reported better protective behaviors against the diseases ( < 0.05).@*CONCLUSIONS@#The residents in Hubei and Henan Provinces have generally good KAP related to COVID-19, and the online platforms plays a positive role to in circulating epidemic-related information. It is essential to further increase the supply of the protective materials and pay more attention to the mental health of the residents during the pandemic, and psychological counseling and psychological protection should be provided if necessary.

Association of plasma albumin and hypersensitive C-reactive protein with 5-year all-cause mortality among Chinese older adults aged 65 and older from 8 longevity areas in China / 中华预防医学杂志

Objective@#To investigate the relationship of plasma albumin and hypersensitive C-reactive protein (Hs-CRP) with 5-year all-cause mortality among Chinese older adults aged 65 and older.@*Method@#Data was collected in 8 longevity areas of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) study conducted by Chinese Center for Disease Control and Prevention and Peking University at baseline survey in 2012 and 2014, the participants enrolled in 2012 was followed-up in 2014 and 2017, the participants enrolled in 2014 was followed-up in 2017 only. Finally, 3 118 older adults aged 65 and older with complete information on albumin, Hs-CRP and body mass index (BMI) were included in this study. Plasma samples of older adults were collected for the detection of albumin and Hs-CRP at baseline survey. Survival status and follow-up time was recorded for all participants. All older adults were divided into 4 groups according to the levels of plasma albumin and Hs-CRP, and Cox proportional hazard models were constructed to assess their influence on the risk of all-cause mortality.@*Results@#Among 3 118 older adults included, the prevalence of hypoalbuminemia was 10.1% (316/3 118), and was 22.8% (711/3 118) for elevated Hs-CRP. During 10 132 person-years of follow-up, 1 212 participants died. Participants with hypoalbuminemia had increased risk of all-cause mortality, with an hazard ratio (HR) and 95% confidential interval (CI) of 1.18 (1.01-1.38), compared to participants with normal plasma albuminemia; participants with elevated Hs-CRP had increased risk of all-cause mortality, with an HR (95%CI) of 1.18 (1.04-1.35), compared to participants with normal plasma Hs-CRP. Participants with normal plasma albumin and elevated Hs-CRP, with hypoalbuminemia and normal Hs-CRP, with hypoalbuminemia and elevated Hs-CRP also had increased risk of all-cause mortality when compared to those with normal plasma albumin and normal Hs-CRP, the HR (95%CI) were 1.16 (1.01-1.34), 1.11 (0.91-1.37) and 1.43 (1.11-1.83), respectively.@*Conclusion@#Hypoalbuminemia and elevated Hs-CRP were responsible for increased risk of 5-year all-cause mortality among Chinese older adults from 8 longevity areas.

The relationship between hazard ratio and median survival time / 中华预防医学杂志

The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.

Block randomization in clinical trials / 中华预防医学杂志

Randomization is the key to ensure the balance of confounders between the comparison groups in clinical trials, and it is the statistical basis for making the study results comparable. A simple randomization in a clinical trial with large sample-size allows for a balanced comparison of the number of subjects and confounding factors between groups, but in a clinical trial with small sample-size, it is necessary to use a restricted randomization method (the blocked randomization). Block randomization ensures that the number of subjects between groups is basically equal, maximize the effectiveness of clinical trials as the standard error of the treatment-effect estimate is decreased, which affords big rewards in scientific accuracy and credibility.

Historical perspective of progress and achievement on epidemiology in the past 70 years in China / 中华流行病学杂志

Epidemiology is a discipline developed in the practice of preventing diseases and promoting health and is the key of public health and preventive medicine. Since the founding of the People’s Republic of China, with the changing of disease pattern in populations, the applications of epidemiology now have expanded from infectious diseases to chronic non-communicable diseases, injuries and health related events. The discipline has made remarkable achievements in the field of disease prevention and control, scientific research and teaching, institution building and academic journals. In this paper we briefly review the history and achievements of epidemiology in China in the past 70 years, and explore the future development of the discipline, which may leave a trace of history for the development of epidemiology in China.

Prospect of systematic review: strengths and limitations / 中华疾病控制杂志

As the core method of evidence-based medicine, systematic review comprehensively summarizes all the evidence of a particular problem. It enables clinicians, scientific researchers, and health policy makers to quickly obtain a great deal of comprehensive, accurate, and reliable information in a short time, and are crucial tools for them to keep up with rapidly evolving areas of medicine. Adequate systematic reviews integrate the evidence that is accumulating in a particular field to narrate the distance between research evidence and medical practice. However, in recent years, people are always questioning and criticizing systematic review. In this situation, we introduce the origin and concept of the system review briefly and elaborate the strengths and limitations of the system review in detail. Finally, on the basis of application and current situation of the systematic review, we describe the prospect of the systematic review. Even though the methodology of the systematic review has some limitations, it is still the most authoritative method for synthesizing all research evidence in a given field, because we have no better way. If the results of a systematic review of all studies are unreliable, there is no reason to say that the results of one or several of them are impartial or unbiased.

The use and pitfalls of large randomized controlled trials / 中华流行病学杂志

Modern epidemiology is the art and science of investigating quantitatively regularities or general laws regarding applied healthcare issues.The validity of epidemiological studies is primarily determined by the study design and the precision by the sample size.Large randomized controlled trial (RCT) is thus the most rigorous and most precise epidemiological study design.Due to ethical concerns,RCTs can however be used only to evaluate medical interventions.Rigorousness of study design and sample size required for a study are inversely related to the anticipated size of effect to be evaluated:the smaller the effect,the more rigorous the study design and larger the sample size are required.Thus,large RCTs are necessary and called upon when and only when the effectiveness to be proved is relatively small;large effectiveness can be verified with small or medium-sized RCTs or even observational studies.In the stages of scientific research,large RCTs are confirmatory rather than original investigations on new hypotheses,whereas the value of a study is ultimately determined by the importance and novelty of the research question rather than methodology and the P value.Overemphasis on large RCTs has been causing:1) overemphasis on interventions of small or moderate effect;2) overemphasis on confirmatory studies and on size of study and funding and weakening original creative work;3) increasing the risk of research resources,medical activities,and patients' well-being being hijacked by pharmaceutical companies.

The use and pitfalls of large randomized controlled trials / 中华流行病学杂志

Modern epidemiology is the art and science of investigating quantitatively regularities or general laws regarding applied healthcare issues.The validity of epidemiological studies is primarily determined by the study design and the precision by the sample size.Large randomized controlled trial (RCT) is thus the most rigorous and most precise epidemiological study design.Due to ethical concerns,RCTs can however be used only to evaluate medical interventions.Rigorousness of study design and sample size required for a study are inversely related to the anticipated size of effect to be evaluated:the smaller the effect,the more rigorous the study design and larger the sample size are required.Thus,large RCTs are necessary and called upon when and only when the effectiveness to be proved is relatively small;large effectiveness can be verified with small or medium-sized RCTs or even observational studies.In the stages of scientific research,large RCTs are confirmatory rather than original investigations on new hypotheses,whereas the value of a study is ultimately determined by the importance and novelty of the research question rather than methodology and the P value.Overemphasis on large RCTs has been causing:1) overemphasis on interventions of small or moderate effect;2) overemphasis on confirmatory studies and on size of study and funding and weakening original creative work;3) increasing the risk of research resources,medical activities,and patients' well-being being hijacked by pharmaceutical companies.

Association of sleep and behavioral problems in Nanjing preschool children / 中华实用儿科临床杂志

Objective To investigate the prevalence of sleep and behavioral problems in a large sample of Nanjing preschoolers,and explore the relationship between them.Methods A total of 1327 children from 6 kindergartens of 2 districts in Nanjing,aged 3-6 years,were included in the study by using a stratified random sample survey method.Parents of these children completed a questionnaire including sleep habits and social characteristics of the children and their family.Behavioral problem scores were measured by the Achenbach children behavior checklist for children aged 1.5-5.0 years.The relationship between sleep and behavioral problems was tested using multivariate Logistic regression models to control for potentially confounding factors.Results Overall,52.68％ of the children were found to have sleep problems.The prevalence of sleep problems in boys was 56.11％,which was significantly higher than that (48.60％) in girls (P =0.006).The prevalence of total behavioral problems was 10.40％.Children with sleep problems had significantly higher prevalence and scores of total behavioral problems,internalizing syndrome and externalizing syndrome compared with those of children without sleep problems,and the differences were significant (P ＜ 0.05).In Logistic regression models,the children sleep problems were significantly contributed to total behavioral problems(OR =2.08,P ＜ 0.001).Conclusion The children sleep problems are common and as a risk factor for behavioral problems in Nanjing preschoolers.

Construction of quantified appraisal system of imported risk of dengue fever / 中华疾病控制杂志

Objective To select the indexes from the related literatures to form an appraising table sheet,and to provide the surveillance of imported dengue fever with a scientific,useful,easy operating and quantified appraising tool.Methods Delphi model was adopted to concentrate the advices of the experts specializing in the field of dengue fever.The engaged experts scaled all of the indexes,and gave the importance value to each index by the importance grade value of 5,3,and 1.Results According to the advices of the experts,9 indexes were eliminated from the 59 given third grade indexes,and 50(84.7%) of them were retained.The experts put the importance of the average weight value of 3.50 to the whole appraising table sheet,3.85 to the first grade indexes,3.56 to the second grade indexes,and 3.44 to the third grade indexes.The harmony coefficient on the indexes system was 0.33(P

Analysis on safety of combination therapy with amlodipine plus terazosin in middle aged and old male patients with essential hypertension / 中华疾病控制杂志

Objective To evaluate the safety of combination therapy with amlodipine and terazosin in middle aged and old male patients with essential hypertension.Methods Randomized,prospective,parallel study was carried out in middle aged and old male patients with essential hypertension in Anqing between August 2005 and February 2006.In this article,508 patients were chosen to appraise safety of the combination therapy.Results ①After 4 weeks,the heart rate of combination group changed from 68.9?7.7 to 67.7?6.9.There was no significant difference before and after treatment.②The combination group didn't affect the levels of blood glucose,lipid,electrolyte and the function of kidney and liver.③As regards tolerability,adverse experiences were observed in 4.1%,12.3%,and 13.2% of patients,respectively.Orthostatic hypertension did not happen in three groups during treatment.Conclusions The combination of amlodipine and Terazosin have no influence on the levels of blood glucose,lipid and the function of kidney and liver.Moreover,the combination was tolerated as well as its components.Through the adjustment of drug dosage,orthostatic hypotension did not happen in three groups during treatment.

Efficacy and Safety of Combination Therapy with Amlodipine Plus Terazosin in Patients with Essential Hypertension / 中华高血压杂志

Objective To evaluate the short-term efficacy and safety of combination therapy with amlodipine and terazosin in middle aged and old male patients with essential hypertension.Methods Randomized,prospective,parallel study was carried out in middle aged and old male patients with essential hypertension in Anqing community between August 2005 and February 2006.Antihypertensive efficacy and safety of the combination therapy were evaluated in 508 patient who completed the study.Results After 4 weeks treatment,the average reduction of SBP were 4.0?15.0,17.5?15.8 and 20.0?15.9 mm Hg in Terazosin group,amlodipine group and combination group,respectively(P