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OBJECTIVE@#This study aims to evaluate the association between lower grip strength and mortality hazard.@*METHODS@#We selected 10,280 adults aged 45 to 96 years old from the China Health and Retirement Longitudinal Study and used multivariate Cox proportional hazard models to assess the association of grip strength with mortality hazard. In addition, we explored the possibility of a nonlinear relationship using a 4-knot restricted spline regression.@*RESULTS@#We found that elevated grip strength was associated with lower mortality up to a certain threshold. The baseline quartile values of grip strength were 30, 37, and 44 kg for males and 25, 30, and 35 kg for females. After adjusting for confounders, with category 1 as the reference group, the adjusted HRs were 0.58 (0.42-0.79) in males and 0.70 (0.48-0.99) in females (category 4). We also found a linear association between grip strength values and all-cause death risk (males, P = 0.274; females, P = 0.883) using restricted spline regression. For males with a grip strength < 37 kg and females with a grip strength < 30 kg, grip strength and death were negatively associated.@*CONCLUSION@#Grip strength below a sex-specific threshold is inversely associated with mortality hazard among middle-aged and older Chinese adults with chronic diseases.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Chronic Disease , East Asian People , Hand Strength , Longitudinal StudiesABSTRACT
To systematically evaluate the clinical efficacy and safety of Lianhua Qingwen in the treatment of adult pneumonia. The randomized controlled trial of Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia were retrieved from PubMed, EMbase, Wanfang database, VIP database, and CNKI from the establishment of database to March 2020. Two researchers independently conducted literature screening and data extraction, and the third researcher was in charge of arbitration in case of any disagreement. Outcome indicators included total clinical effective rate, symptom improvement time, and incidence of adverse events. R 3.6.1 was used for Meta-analysis, and RevMan 5.3 was used for quality evaluation. Twenty-two studies were included, with a total of 2 007 patients, including 1 017 patients in the experimental group and 990 patients in the control group. The results showed that the total clinical effective rate of the experimental group was higher than that of the control group(RR=1.11, 95%CI[1.08, 1.15], P<0.001), and the antifebrile time(MD=-1.81, 95%CI[-2.42,-1.21], P<0.001), cough duration(MD=-2.32, 95%CI[-2.89,-1.76], P<0.001), rale duration(MD=-2.19, 95%CI[-2.74,-1.63], P<0.001), imaging recovery time(MD=-2.17, 95%CI[-2.76,-1.58], P<0.001) and post-treatment CRP(MD=-4.07, 95%CI[-6.39,-1.75], P<0.001] were all significantly lower than those of the control group. However, it did not proved that the experimental group was safer than the control group(RR=0.84, 95%CI[0.57, 1.24], P=0.382). The results confirmed that Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia could improve the clinical treatment efficiency, shorten the time of fever, cough, rale disappearance and imaging recovery, improve CRP index and accelerate the recovery of pneumonia patients. However, the literatures included in this study had a low quality, and the conclusions still need to be further confirmed by more high-quality, multi-center, rigorously designed randomized controlled trial.
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Adult , Humans , Cough , Drugs, Chinese Herbal/adverse effects , Pneumonia/drug therapy , Treatment OutcomeABSTRACT
Objective To explore the immunization of category B vaccine and its influencing factors among children aged 0 to 6 in Hangzhou City. Method We carried out an investigation with 685 parents of children aged 0 to 6 from January to February in 2017 by using stratified random sampling method. Statistical method was used to analyze the knowledge, behaviors and attitudes towards category B vaccine, and logistic regression was applied to explore the determinant factors of category B vaccine behavior. Results 670 parents were under actual survey, 467 children have been vaccinated at least one kind of category B, which accounts for 69.70％ and the rates of five main types of vaccine were lower than 30％. Logistic regression showed that people of citizen (OR=1.54, 95％ CI: 1.14-2.38) , able to distinguish category A or B vaccine (OR=2.05, 95％ CI: 1.26-3.33) , positive attitude towards category B vaccine (OR=2.46, 95％CI: 1.43-4.23), and higher affordable price (OR=3.15, 95％CI:2.07-4.80) were determinant factors of category B vaccine behavior . Conclusion The rate of category B vaccine behavior of children aged 0 to 6 is on a moderate level. The cognition and attitude of children' s parents on category A vaccine and category B vaccine have effect on the immunization status of category B vaccine among children aged 0 to 6 in Hangzhou.
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Objective To learn the current status of health literacy of residents in Wenling City, and to explore the relationship between health literacy and socioeconomic status. Methods A total of 3200 residents aged 15-69 years old from 6 townships were selected by stratified multi-stage random sampling method and probability proportionate to size sampling (PPS) method, and a questionnaire surveyed was conducted. Results Totally 3189 questionnaires were effective and the overall level of health literacy of residents was 19.79％ (631/3189) . The percentages of residents who had the basic health knowledge and concept, healthy lifestyle and behavior, health related skills were 23.27％、 24.21％ and 23.83％, respectively. About 55.47％ of residents had the literacy of safety and first-aid, which was the highest, followed by 38.66％ with scientific health belief, 32.77％ with literacy for disease prevention, 26.12％ with health information, 14.14％ with primary medical care and 7.49％ with the literacy for chronic disease prevention. Logistic regression model showed that the health literacy level with institutions class was 2.25 times of manual workers class, and the health literacy level of people have bachelor degree or above was 6.93 times less literate or illiterate, and the health literacy level of family income of 200 thousand Yuan and above was 7.70 times of 0～50 thousand Yuan. The health literacy were different among different socioeconomic status residents (P<0.01) . Conclusion There are obvious gaps in health literacy among different socioeconomic status groups. Health education should be strengthened among residents, especially among the manual workers class, low education class and low income class.
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Objective To assess the current status of knowledge, attitude and practice (KAP) towards antibiotic use among community residents in Hangzhou, and to explore the correlations among them. Methods A total of 449 permanent residents in Hangzhou were randomly selected using a multistage stratified random sampling method. Self-reported data on basic demographic factors, and relevant KAP information were collected by the questionnaire survey. Differences in KAP scores according to each demographic factor were assessed by the t test or ANOVA test, and AMOS 21.0 was used for the path analysis. Results Scores for knowledge, attitude and practice regarding antibiotic use were (6.17±2.45), (6.45±0.99) and (6.21±1.02) respectively. Results of the path analysis showed that education level and age had effects on the knowledge (coefficients: 0.57 and -0.38 respectively) . Age, gender and knowledge had effects on the attitude (coefficients: -0.27, 0.12 和 0.02 respectively), and attitudes, gender, monthly income and the level of education had effects on the practice (coefficients: 0.48、 0.37、 0.06 and 0.02 respectively) . Conclusion Community residents in Hangzhou lack relevant knowledge, and there are some irrational attitudes and practices regarding antibiotic use. There is a correlation between knowledge and attitudes, as well as between attitudes and practices, but the knowledge and practices are not correlated.
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Objective To investigate the immunization status of the left-behind/non-left-behind children in the rural areas of Zhejiang Province. Methods Multi-stage cluster random sampling was adopted to recruit 0-6 years old children and their guardians in a rural mountainous county in Lishui District of Zhejiang Province. Household survey was conducted using structured questionnaires. Records of vaccination were obtained and verified in the local disease control and prevention center. Results A total of 420 questionnaires were issued, with a number of 416 were complete and valid. The Valid responsive rate was 99.05% . Among them, 97 were left-behind and 319 were non-left-behind children. The immunization coverage rates did not differ significantly between the left-behind and non-left-behind children. The timely immunization rates of the third shot of hepatitis B vaccine and the first shot of encephalitis vaccine differed significantly between left-and non left-behind children (P=0.049 and P=0.044, respectively) . Conclusion Immunization status of the left-behind children in the rural areas of Zhejiang province was in a good condition in general. The local disease control and prevention center should strengthen the communication, to promote immunization knowledge and to improve family supervision of the left-behind children.
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Objective To understand the association between people under impaired glucose regulation (IGR) with poor quality of sleep and the occurrence of diabetes.Methods Based on a cohort of 1136 persons with IGR,the present study would include information on the duration of sleep and severity of insomnia.The cohort was followed for two years and the outcomes of impaired glucose regulation were summarized.Poisson regression was employed to analyze the relationship between the quality of sleep and the occurrence of diabetes.Results After the confounders were adjusted,when compared with 7-9 h sleep duration,the less than 7 h sleep duration showed a RR value of 1.77 (P＜0.001) while more than 9 h sleep duration had a RR value of 1.45 (P=0.067).When compared data from people having less than 14 scores of the Insomnia Severity Index (ISI),those people with more than 14 scores had a RR value of 1.58 (P＜0.001).Conclusion Causal relationship between the quality of sleep and the occurrence of diabetes did exist among the IGR population while the poor quality of sleep might increase the risk of diabetes at the end of the two-year following-up program.
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Objective To explore the factors influencing the premarital medical examination in Chinese population and to discuss the related possible intervention strategies.Methods Data were collected through self-designed questionnaires on 2572 newly married respondents,selected under a stratified randomized sampling method,at Marriage Registration Office in 12 counties in Zhejiang province.Predictive factors were derived from the integrating complementary constructs of Health Belief Model,Theory of Reasoned Action as well as individual demographic characteristics.Multiple logistic multilevel analyses was used as the main statistical method,with individuals as the ' low' and counties as the 'high' levels.Results Behaviors on premarital medical examination showed a clustering trait at the county level (P=0.018) and variance partition coefficients (VPC) of each variables was between 15.40％ and 17.58％.There were no statistical significances found in the rates of premarital medical examination among gender,age,residence of Household Registration,education,income,health insurance and history of premarital medical examination.However,significant correlation was seen on occupation of the respondents.The rate of premarital medical examination among the respondents who had not attended medical examination during the last six moths was 1.31times (95％ confidence intervals,1.05 -1.65 ) more than those who had,with OR (odds ratio) as 1.51 (95％CI:1.14-2.00) for the pregnant respondents in their first marriage and 0.35 (95％CI:0.23-0.51 )for remarried respondents,compared with women at first marriage but remained unpregnant.Regarding premarital medical examination,the respondents reported greater benefits,less barriers,greater positive behavioral attitudes and normative beliefs to it,with an ORs as 2.32 (95％ CI:1.18-4.60),0.71 (95％CI:0.57-0.90),1.69 (95％CI:1.10-2.58) and 1.72 (95％CI:1.34-2.20)respectively,but with no significant association with perceived susceptibility,perceived severity and motivation to comply.Conclusion Factors such as individual perceived benefits,barriers,attitudes and normative beliefs etc.,were determinants of premarital medical examination accompanied by minor (16％) influence coming from the geographical environment.
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Through the multi-stage hierarchical Bayesian model and Markov Chain Monte Carlo methods, Bayesian statistics can be used in dependent spatial data analysis, including disease mapping in small areas, disease clustering, and geographical correlation studies. Recently, Bayesian spatial models have been developed with many types, which have made considerable progress in data analysis. This paper introduces several approaches that have been fully developed and applied, such as BYM model,joint model, semi-parameter model, moving average model and so on. Recently,many studies focused on the comparison work through Deviance Information criterion. Those results show that BYM model and MIX model of semi-parameter model could obtain better results. As more research going on, Bayesian statistics will have more space in applications of spatial epidemiology.
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Humans , Bayes Theorem , Epidemiologic Methods , Epidemiology , Markov Chains , Models, Statistical , Monte Carlo MethodABSTRACT
Objective To evaluate the validity and reliability of a Chinese version on the Short-Form Health Survey Scale (SF-36) among elderly population. Methods Questionnaire including SF-36 Chinese version was administered in a cross-sectional study from October to December 2007. 4241 elderly people over 60 years old from rural and urban area in Zhejiang province were face-to-face interviewed by welltrained investigators, and then analyses on correlation, reliability, factors, t-test and one-way ANOVA were made to evaluate on reliability and validity of the scale. Results The SF-36 Chinese version had good split-half reliability (r=0.91, P<0.001 ) and all the internal consistency Cronbach's alpha coefficients exceeded 0.8 except for VT (α=0.65), SF(α=0.65) and MH (α=0.40). The correlative coefficients between each item and its domain were all greater than the 0.4 thresholds except item 9-2, and they were greater than the correlation between the item and other domains for all but item 9-8. These results demonstrated that the SF-36 Chinese version had good convergent validity and discriminant validity. The distribution of 35 items in 6 public factors (the cumulative variance=67.04 %) extracted from them was consistent with the basic conceived concept. All domains except MH had good validity to discriminate different categories. Conclusion The SF-36 Chinese version had good reliability and validity. It was acceptable for the evaluation on quality of life in elderly population, but the reliability and validity of MH were relative low and the items such as 9-2, 9-8 in MH and 3-1 in PF were not suitable for Chinese elderly population.