Blood Profiles of Community-Dwelling People with Sarcopenia: Analysis Based on the China Health and Retirement Longitudinal Study.

INTRODUCTION: Routine blood factors can be economical and easily accessible candidates for sarcopenia screening and monitoring. The associations between sarcopenia and routine blood factors remain unclear. This study aimed to examine sarcopenia and blood factor associations based on a nation-wide cohort in China. METHODS: A total of 1,307 participants and 17 routine blood indices were selected from two waves (year 2011 and year 2015) of the China Health and Retirement Longitudinal Study (CHARLS). The diagnosis of sarcopenia was based on the criteria proposed by the Asian Working Group for Sarcopenia (AWGS 2019). Generalized mixed-effects models were performed for association analyses. A logistic regression (LR) model was conducted to examine the predictive power of identifying significant blood factors for sarcopenia. RESULTS: A higher sarcopenia risk was cross-sectionally associated with elevated blood concentrations of high-sensitivity C-reactive protein (hsCRP) (OR = 1.030, 95% CI [1.007, 1.053]), glycated hemoglobin (HbA1c) (OR = 1.407, 95% CI [1.126, 1.758]) and blood urea nitrogen (BUN) (OR = 1.044, 95% CI [1.002, 1.089]), and a decreased level of glucose (OR = 0.988, 95% CI [0.979, 0.997]). A higher baseline hsCRP value (OR = 1.034, 95% CI [1.029, 1.039]) and a greater over time change in hsCRP within 4 years (OR = 1.034, 95% CI [1.029, 1.039]) were associated with a higher sarcopenia risk. A higher BUN baseline value was related to a decreased sarcopenia risk over time (OR = 0.981, 95% CI [0.976, 0.986]), while a greater over time changes in BUN (OR = 1.034, 95% CI [1.029, 1.040]) and a smaller over time change in glucose (OR = 0.992, 95% CI [0.984, 0.999]) within 4 years were also related to a higher sarcopenia risk. LR based on significant blood factors (i.e., hsCRP, HbA1c, BUN, and glucose), and sarcopenia status in year 2015 yielded an area under the curve of 0.859 (95% CI: 0.836-0.882). CONCLUSION: Routine blood factors involved in inflammation, protein metabolism, and glucose metabolism are significantly associated with sarcopenia. In clinical practice, plasma hsCRP, BUN, blood sugar levels, sex, age, marital status, height, and weight might be helpful for sarcopenia evaluation and monitoring.

Association between socioeconomic status and hypertension among adults in Fujian province and the mediating effect of BMI and cooking salt intake: a cross-sectional study.

OBJECTIVES: This study aimed to investigate the association between socioeconomic status (SES) and the prevalence of hypertension in Fujian province, China, and to evaluate the mediating effect of body mass index (BMI) and cooking salt intake between SES and hypertension. DESIGN: Community-based cross-sectional survey was conducted between June 2018 and December 2019. SETTING: Fujian province, China. PARTICIPANTS: A total of 26 500 participants aged >18 years completed the survey. OUTCOME MEASURES: The primary outcome was the prevalence of hypertension. Education, income and occupation were used as SES indicators. Meanwhile, certain health behaviours and metabolic risk factors were used as secondary indicators of SES. RESULTS: The prevalence of hypertension was relatively high among participants who finished primary education (34.8%), had the lowest annual income (46.0%), were unemployed or retired (34.7%). Education and income levels were negatively associated with the prevalence of hypertension (p<0.05). Regular smoking, alcohol consumption, BMI and high cooking salt intake were also significantly associated with the prevalence of hypertension (p<0.05). Cooking salt intake was identified as a partial mediator between income and hypertension, mediating 3.45% of the association. Both BMI and cooking salt intake were partial mediators between education and hypertension, mediating 5.23% and 1.93% of the association, respectively. CONCLUSIONS: SES was associated with the prevalence of hypertension among adults in Fujian province, China. BMI and cooking salt intake were partial mediators of the association between SES and hypertension.

The association of spousal depressive symptoms and cognitive function among older adults: mediation and moderated mediation analyses.

OBJECTIVES: To test whether contagious depressive symptoms mediate the association between spousal depressive symptoms (spousal-DS) and the other spouse's cognitive function, and test the moderated mediation of social activities engagement and sleep quality. STUDY DESIGN: A total of 3,230 adults aged ≥60 and one of his/her close relatives were interviewed in 2016 in Xiamen, China. METHODS: Cognitive function and depressive symptoms were measured by MoCA and GDS-15/CES-D-10, respectively. Social activities engagement and sleep quality were self-reported. Mediation and moderated mediation were tested by PROCESS macro with 5000 bootstrapping re-samples. RESULT: Among all, 1,193 pairs were husband-wife with complete information and were included. The mean ages of older adults and their spouses were 68.35 ± 6.53 and 66.53 ± 7.91 years, respectively. The mean MoCA and GDS-15 scores for older adults were 22.21 ± 5.45 and 1.73 ± 2.17, respectively. The average score of CES-D-10 for spouses was 14.18 ± 4.77. Spousal-DS were associated with cognitive functions of older adults via the contagious depressive symptoms (indirect effect: -0.048, 95% confidence interval (CI): (-0.075, -0.028)). Such mediation can be buffered by attending social activities (interaction: -0.062, 95% CI: (-0.111, -0.013)) and improving sleep quality (interaction: -0.034, 95% CI: (-0.057, -0.012)). CONCLUSION: Cognitive function of older adults was associated with his/her spouse's depressive symptoms, and the association was mediated by contagious depressive symptoms and moderated by social activities as well as sleep quality.

Exploring the Spatial Distribution of Rheumatic Diseases and Its Correlation With Temperature and Humidity Among Middle-Aged and Elderly Adults in China.

Objectives: This study aimed to analyze the prevalence of rheumatic diseases and its correlation with temperature and humidity among middle-aged and elderly adults in China from a spatial perspective. Methods: Data on rheumatic diseases among middle-aged and elderly adults were sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Moran's I was applied to explore the spatial autocorrelation of rheumatic diseases. Spatial lag model (SLM) was established to probe the correlation between rheumatic diseases and temperature and humidity. Results: The age-standardized prevalence of rheumatic diseases was 33.2% for middle-aged and elderly adults in China, varying from 12.0% to 51.4% depending on regions. The Global Moran's I was 0.506 (p = 0.001). Average temperature had negative correlation while average relative humidity had positive correlation with age-standardized prevalence of rheumatic diseases in the SLM. Conclusion: The age-standardized prevalence of rheumatic diseases of middle-aged and elderly adults showed spatial autocorrelation in China. We recommend taking measures to prevent rheumatic diseases for the middle-aged and elderly adults, especially for those living in cold and humid regions.

Socioeconomic Disparities in Disability-Free Life Expectancy and Life Expectancy Among Older Chinese Adults From a 7-Year Prospective Cohort Study.

Objectives: We examined the magnitude and determinants of socioeconomic disparities in disability-free life expectancy and life expectancy at age 65 (DFLE65 and LE65) in China. Methods: Data from Chinese Longitudinal Healthy Longevity Survey collected during 2011-2018 (8,184 participants aged ≥65) were used. Socioeconomic status (SES) was measured by economic status (ES), and education, respectively. Multistate Markov models and microsimulations were fitted to estimate DFLE65 and LE65. Results: LE65 between high- and low-ES groups differed by 2.20 years for males and 2.04 years for females. The DFLE65 disparity in ES was 1.51 and 1.29 years for males and females, respectively. Not undergoing physical examinations, inadequate fruit/vegetable intake, and stress contributed to 35.10% and 57.36% of DFLE65 disparity in ES, as well as 26.36% and 42.65% of LE65 disparity for males and females, respectively. These disparities in education and ES were of a similar magnitude, while the above factors contributed little to education disparity. Conclusion: Socioeconomic disparities in DFLE65 and LE65 existed in China. Physical examination, fruit/vegetable intake and stress partly explained these disparities.

Association of long-term exposure to PM2.5 with hypertension and diabetes among the middle-aged and elderly people in Chinese mainland: a spatial study.

BACKGROUND: Epidemiological evidence has shown an association between long-term exposure to fine particulate matter (PM2.5) and hypertension and diabetes, but few studies have considered the spatial properties of the samples. This study aimed to investigate the long-term effect of PM2.5 exposure on hypertension and diabetes among middle-aged and elderly people in China based on a spatial study. METHODS: We conducted a national cross-sectional study of the most recently launched wave 4 2018 data of the China Health and Retirement Longitudinal Study (CHARLS) to calculate the prevalence of hypertension and diabetes. The exposure data of annual average PM2.5 concentrations were estimated combined with satellite observations, chemical transport modeling, and ground-based monitoring. A shared component model (SCM) was used to explore the association of PM2.5 with hypertension and diabetes, in which these two diseases borrowed information on spatial variations from each other. Then, we evaluated the effect variations in PM2.5 in different periods and smoking status on changes in outcomes. RESULTS: The prevalence of hypertension and diabetes was 44.27% and 18.44%, respectively, among 19,529 participants. The annual average PM2.5 concentration in 31 provinces ranged from 4.4 µg/m3 to 51.3 µg/m3 with an average of 27.86 µg/m3 in 2018. Spatial auto-correlations of the prevalence of hypertension and diabetes and PM2.5 concentrations were seen (Moran's I = 0.336, p = 0.01; Moran's I = 0.288, p = 0.03; Moran's I = 0.490, p = 0.01). An interquartile range (IQR: 16.2 µg/m3) increase in PM2.5 concentrations was significantly associated with a higher prevalence of hypertension and diabetes with odds ratios (ORs) of 1.070 [95% credible interval (95% CrI): 1.034, 1.108] and 1.149 (95% CrI: 1.100, 1.200), respectively. Notably, the effect of PM2.5 on both hypertension and diabetes was relatively stronger among non-smokers than smokers. CONCLUSION: Our nationwide study demonstrated that long-term exposure to PM2.5 might increase the risk of hypertension and diabetes, and could provide guidance to public policymakers to prevent and control hypertension and diabetes according to the spatial distribution patterns of the above effects in China.

Design and evaluation of a cognitive health education pilot program according to the RE-AIM framework.

OBJECTIVE: Most formats of currently used community-based health education for cognitive impairment prevention are limited to one-way communication, such as distributing leaflets, pasting posters, or holding a lecture, and they lack comprehensive evaluation. Here we aim to design, test, and evaluate a novel pilot cognitive health education program combined with psychosocial interventions (CHECPI). METHODS: We designed the CHECPI program and tested it among adults aged 60 and over in an aging-friendly community in 2018. Multidimensional cognitive functions were measured by the Montreal Cognitive Assessment (MoCA) before and three months after the CHECPI program. Quantitative and qualitative analyses were performed based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the program. Wilcoxon signed-rank tests were used to assess changes in multidimensional cognitive functions. RESULTS: The CHECPI program was comprised of 12 courses and introduced 5 kinds of psychosocial interventions. Reach: 28 older adults participated in the program, of whom most were female (n = 22) and younger elderly with an average age of 65.32 years. Effectiveness: 19 participants finished≥6 courses as well as the follow-up survey. Although their MoCA scores did not improve significantly, they had increased their visuospatial ability significantly (with the average score increasing by 0.42). Adoption: the community officers, lecturers, and participants highly recommended the program, but they agreed that the lack of professional instructors may hinder its popularization. Implementation: the program was implemented in full accordance with the pre-program design. Maintenance: three months after the program, 17 participants had maintained at least one of the seven healthy behaviors that were introduced in the program. CONCLUSIONS: Younger female elderly were more willing to participate in the program. It enhanced participants' visuospatial ability, but a sufficient number of professional instructors are crucial for large-scale promotion.

The Relevance of Regenerating Gene 1a Polymorphisms to Radiation Sensitivity and Survival of Nasopharyngeal Carcinoma Receiving Radiotherapy in a Southern Chinese Population.

OBJECTIVE: Gene polymorphism is closely related to tumor development, therapeutic response and prognosis. The relationship between regenerating gene 1A (Reg1A) polymorphism and nasopharyngeal carcinoma (NPC) is unclear. This retrospective study aimed to analyze the association between Reg1a polymorphisms and metastasis, radiation sensitivity and survivals in patients with NPC. METHODS: A total of 308 patients who had received radiotherapy at the Affiliated Xinhua Hospital, Hainan Medical College, between January 2010 and December 2018 with NPC, were enrolled for assessment of Reg1a polymorphisms through direct DNA sequencing. RESULTS: In the polymorphism of gene REG1A, patients with rs10165462 20CC genotype had later T stages (OR = 4.051, 95% CI: 1.775-9.244, P = 0.001), whereas carriers with rs12072 2922CC genotype had earlier T stages (OR = 1.891, 95% CI: 1.018-3.514, P = 0.044) after adjustments for age and gender, respectively. Among rs10165462 20 C/T polymorphism, 20TT wild-type was associated with better radiation response (P = 0.0019), and multivariate analysis showed that it was the only genotype of polymorphism that was significantly associated with better radiation response (OR = 0.265, 95% CI: 0.096-0.727, P = 0.01). Patients with the 20TT wild-type had a better five-year overall survival (60.9%) rate and five-year progression-free survival (60.8%) than those with the 20CC genotype (41.8% and 39.4%, P = 0.01 and P = 0.004, respectively). Patients with variant alleles (CC + CT) had significantly poorer OS (45.2%) and PFS (41.8%) compared with wild-type (TT) carriers (60.9% and 60.8%; P = 0.037 and P = 0.015, respectively). As for rs12072, patients with variant alleles (TT + TC) had significantly adverse OS and PFS compared with wild-type (CC) carriers (62.5% vs 44.8% and 62.5% vs 42.9%; P = 0.024 and P = 0.027, respectively). Cox regression showed that rs10165462 20CT was the only prognostic factor for OS (HR = 1.642, 95% CI 1.038-2.598, P = 0.034) and PFS (HR = 1.705, 95% CI 1.080-2.692, P = 0.022). CONCLUSION: Reg1a polymorphisms may be a predictor of radiation response, local invasion, OS and PFS in patients with NPC who undergo radiotherapy treatment.

Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals.

BACKGROUND: The global burden of disability continues to increase. Understanding the hierarchical structure of activities of daily living (ADL) and the trajectories of disability of elderly individuals is pivotal to developing early interventions. PURPOSE: To determine the hierarchical structure of the ability of Chinese elderly individuals to perform ADL and further describe the trajectories of disability prior to death. METHODS: Longitudinal item response theory model (LIRT) was constructed for 28,345 elderly participants in the Chinese Longitudinal Healthy Longevity Survey, in which ADL were measured using the Katz scale from 1998 to 2018, until the participants' death. Two difficulty parameters (κ-partial and κ-total) were used in the LIRT defining the thresholds for hierarchical structure in ADL (κ-partial: no limitation to partial limitation, κ-total: partial limitation to totally limited). Disability values estimated from the LIRT were fitted to a mixed-effects model to examine the manner in which the trajectories of disability varied with different subject characteristics. RESULTS: The findings confirmed the earliest loss in the capability to perform ADL (bathing(κ-partial = - 1.396), toileting(κ-partial = - 0.904)) at the level of partial limitation, with an overlap of partial and totally limited (total bathing, partial dressing, partial transferring, total dressing, partial feeding, partial continence), and finally a total loss of capability for toileting, feeding, transferring, and continence (κ-total = 3.647). Disability trajectories varied with sex (ß = 0.041, SE = 0.001), place of residence (ß = 0.010, SE = 0.001), and marital status (ß = 0.144, SE = 0.001). Females, individuals living in urban areas, and those who lived without a spouse had a poorer disability status. CONCLUSION: The loss in the ability to perform ADL has a hierarchical structure. Subject characteristics affect trajectories of disability in the elderly Chinese population.

Mediation and moderated mediation in the relationships among income condition, depression, cognition and residence among older adults in China.

AIM: A better income condition has always been associated with better cognition; however, studies that have demonstrated the pathway of this relationship are limited. We aim to evaluate the mediation effect of depression in this association, and whether this mediation is moderated by the place of residence. METHODS: We conducted a face-to-face study, including 3230 older adults aged >60 years in Xiamen, China, in 2016. The income condition of participants was categorized into three groups: income less than expenditure, income equals expenditure and income more than expenditure. Depression was measured using the Geriatric Depression Scale and cognition was evaluated using the Montreal Cognitive Assessment tool. We first examined a simple mediation model where depression was a mediator between income condition and cognition. Furthermore, residence was systematically integrated into the model as a moderator, and the model was adjusted for age, gender, number of year of education, hypertension and diabetes. All mediation and moderated mediation effects were estimated by the plug-in "PROCESS" in SPSS. RESULTS: In total, 2852 participants were finally included. Depression partially mediated the relationship between income condition and cognition (indirect effect = 0.25, total effect = 0.72). Moderated mediation analyses indicated that a direct effect only existed among urban older adults (B = 0.92; 95% confidence interval [CI]: [0.47-1.38]), whereas an indirect effect was stronger for individuals in urban (B = 0.28; 95% CI: [0.18-0.41]) rather than rural environments (B = 0.17; 95% CI: [0.11-0.26]). CONCLUSIONS: A better income condition is a protective factor for cognition and it partially benefits work through milder depressive symptoms, particularly in older adults in urban residences. Geriatr Gerontol Int 2020; 20: 860-866.

Hypothetical Interventions on Risk Factors for Cognitive Impairment among Chinese Older Adults: An Application of the Parametric G-Formula.

The effects of psychosocial and dietary interventions on risk of cognitive impairment is not known. The aim of this study was to estimate the 10-year risks of cognitive impairment under hypothetical interventions of psychosocial factors and dietary intake among Chinese older adults. A sample of 7377 respondents aged 65 and over was drawn from the last four waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2011/2012. The parametric g-formula was used to estimate the risk of cognitive impairment under independent hypothetical interventions of social engagement, psychological well-being (PWB), dietary intake, and the joint interventions of their different combination. The observed risk of cognitive impairment was 20.08% (95% confidence interval (CI): 18.81, 21.07). The risk ratios (RR) of cognitive impairment under the hypothetical interventions on higher social engagement, eating fruits at least sometimes, eating vegetables at least sometimes, positive PWB were 0.72 (95% CI: 0.65, 0.82), 0.93 (95% CI: 0.89, 0.95), 0.98 (95% CI: 0.89, 1.00) and 0.99 (95% CI: 0.98, 0.99), respectively. The RR of joint intervention was 0.64 (95% CI: 0.58, 0.73). Hypothetical interventions on psychosocial factors such as social engagement and PWB, as well as fruits and vegetable intake, were beneficial to protect older adults from cognitive impairment.

Spatial Characteristics of Life Expectancy and Geographical Detection of Its Influencing Factors in China.

Life expectancy (LE) is a comprehensive and important index for measuring population health. Research on LE and its influencing factors is helpful for health improvement. Previous studies have neither considered the spatial stratified heterogeneity of LE nor explored the interactions between its influencing factors. Our study was based on the latest available LE and social and environmental factors data of 31 provinces in 2010 in China. Descriptive and spatial autocorrelation analyses were performed to explore the spatial characteristics of LE. Furthermore, the Geographical Detector (GeoDetector) technique was used to reveal the impact of social and environmental factors and their interactions on LE as well as their optimal range for the maximum LE level. The results show that there existed obvious spatial stratified heterogeneity of LE, and LE mainly presented two clustering types (high-high and low-low) with positive autocorrelation. The results of GeoDetector showed that the number of college students per 100,000 persons (NOCS) could mainly explained the spatial stratified heterogeneity of LE (Power of Determinant (PD) = 0.89, p < 0.001). With the discretization of social and environmental factors, we found that LE reached the highest level with birth rate, total dependency ratio, number of residents per household and water resource per capita at their minimum range; conversely, LE reached the highest level with consumption level, GDP per capita, number of college students per 100,000 persons, medical care expenditure and urbanization rate at their maximum range. In addition, the interaction of any two factors on LE was stronger than the effect of a single factor. Our study suggests that there existed obvious spatial stratified heterogeneity of LE in China, which could mainly be explained by NOCS.

Association of regenerating gene 1A single-nucleotide polymorphisms and nasopharyngeal carcinoma susceptibility in southern Chinese population.

OBJECTIVE: Nasopharyngeal carcinoma (NPC) is a common malignancy in Southern China and Southeast Asia. Genetic susceptibility is a major contributing factor in determining the individual risk of NPC in these areas. To test the association between NPC and variants in regenerating gene 1A (REG1A), we conducted a hospital-based case-control study in a Cantonese-speaking population from Guangdong province. METHODS: We endeavored to determine whether genetic variants of the REG1A gene were associated with the risk of NPC amidst the Cantonese population in a hospital-based case-control study using polymerase chain reaction-restriction and direct sequencing analysis in 211 NPC patients and 150 healthy controls. The association between NPC risk and the 14C/T, 20C/T, 369G/T, 1201A/G, and 2922C/T polymorphisms was examined after adjustment for age and sex. RESULTS: We found an increased risk of developing NPC in individuals with REG1A 2922C/T variant genotype (p = 0.003, OR 0.419, 95% CI 0.235-0.746), and after adjustment for sex and age (p = 0.003, OR 0.406, 95% CI 0.226-0.732). No association between other polymorphisms (14C/T, 20C/T, 369G/T, and 1201A/G) and the risk of NPC was observed, before or after adjustment for age and sex. CONCLUSION: Our findings suggest that the REG1A 2922C/T polymorphism is associated with an increased risk of developing NPC in a Cantonese population from Guangdong province. Larger studies are required to confirm our findings and unravel the underlying mechanisms.

Social Engagement and Cognitive Impairment in Older Chinese Adults: The Mediating Role of Psychological Well-Being.

Objective: The objective of this study was to explore the association between social engagement and cognitive impairment with psychological well-being (PWB) as a mediator in older Chinese adults and to further test the gender differences in this association. Method: Data were drawn from the Chinese Longitudinal Healthy Longevity Survey of older Chinese adults, aged 65 and older (N = 6,998). The total effect was decomposed into direct and indirect effects by logistic regression based on the Karlson, Holm, and Breen method. Results: Higher social engagement was significantly associated with lower odds of cognitive impairment, odds ratio (OR) = 0.89, 95% confidence interval (CI) = [0.82, 0.97]. Moreover, a better PWB would decrease the odds of cognitive impairment (OR = 0.96, 95% CI = [0.94, 0.98]). The mediating effect was 15.4% in the full sample and 13.1% in the men subsample. However, mediation was not significant in the women subsample. Discussion: Higher social engagement was associated with a decreased odds of cognitive impairment in older men, and this association was mediated by PWB.

The impact of medical insurance on medical expenses for older Chinese: Evidence from the national baseline survey of CLHLS.

With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal-Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.

The Association of Social Isolation With the Risk of Stroke Among Middle-Aged and Older Adults in China.

Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.

Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China.

Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents' acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents' intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between "cues to action" and "perceived susceptibility" and/or "perceived severity." A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents' intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents' perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.

Factors affecting parental intention to vaccinate kindergarten children against influenza: A cross-sectional survey in China.

BACKGROUND: The impact of influenza in children under 5 can be severe and fatal. However, the influenza vaccination uptake in China remains suboptimal. The objectives of this study were to investigate parents' perceptions on influenza vaccination and to assess vaccination promotional factors. METHODS: A cross-sectional survey among 1506 parents with children in kindergarten was conducted in two areas with different policies: self-paid vaccination and free vaccination. The questionnaire was based on the structure of the Health Belief Model (HBM). Multiple logistic regression was used to analyze the determinants of parental vaccination intention. Odds ratios (OR) and respective 95% confidence intervals (95% CI) are reported. RESULTS: Within the free policy group versus the non-free group, vaccination intention rates were 76.3% versus 83.4%, and vaccination rates were 34.2% versus 3.1%. Results from multivariate analysis showed that parents with high scores for perceived susceptibility (OR = 1.44; 95% CI: 1.09-1.91), perceived benefits (OR = 1.80; 95% CI: 1.30-2.50) and cues to action (OR = 3.32; 95% CI: 2.47-4.46) were more likely to get their children vaccinated, while those perceived more barriers (OR = 0.50; 95% CI: 0.37-0.68) had lower vaccination intention. More knowledge (OR = 1.74; 95% CI: 1.18-2.56) and preferable attitudes (higher perceived necessity: OR = 1.84; 95% CI: 1.53-2.22; less safety worry: OR = 1.35; 95% CI: 1.10-1.66) were associated with significantly higher vaccination intention. Adjusted for parents' gender, age, education, income and children's age, the same significant factors were found. Parental intention was found to be influenced by different vaccination policies. Under a free policy, past influenza vaccination uptake (OR = 4.52; 95% CI: 1.07-19.02) greatly promoted parents' willingness to vaccinate their children. CONCLUSION: Parents had high intention to get their kindergarten children vaccinated with the influenza vaccine in spite of the low uptake rate. Our results indicate that offering free influenza vaccines and parental education over the next years may increase the influenza vaccination rate.

Associations between modifiable lifestyle factors and multidimensional cognitive health among community-dwelling old adults: stratified by educational level.

ABSTRACTBackground:Cognition is multidimensional, and each domain plays a unique and crucial part in successful daily life engagement. However, less attention has been paid to multi-domain cognitive health for the elderly, and the role of lifestyle factors in each domain remains unclear. METHODS: We conducted a cross-sectional study of 3,230 older adults aged 60+ years in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) was used to measure general cognition and six specific sub-domains. To account for educational effects, we adjusted the MoCA score and divided respondents into three education-specific groups (low, moderate, and high education groups with ≤5, 6~8, and ≥9 years of education, respectively). A series of proportional odds models were used to detect the associations between two categories of lifestyle factors - substance abuse (cigarette and alcohol) and leisure activity (TV watching, reading, smartphone use, social activity, and exercise) - and general cognition and the six sub-domains in those three groups. RESULTS: Among the 3,230 respondents, 2,617 eligible participants were included with a mean age of 69.05 ± 7.07 years. Previous or current smoking/drinking was not associated with MoCA scores in the whole population, but unexpectedly, the ex-smokers in the low education group performed better in general cognition (OR = 2.22) and attention (OR = 2.05) than their never-smoking counterparts. Modest TV watching, reading, and smartphone use also contributed to better cognition among elderly participants in the low education group. For the highly educated elderly, comparatively longer reading (>3.5 hours/week) was inversely associated with general cognition (OR = 0.53), memory (OR = 0.59), and language (OR = 0.54), while adequate exercise (5~7 days/week) was positively related to these factors with OR = 1.48, OR = 1.49, and OR = 1.53, respectively. For the moderately educated elderly, only modest reading was significantly beneficial. CONCLUSIONS: Lifestyle factors play different roles in multidimensional cognitive health in different educational groups, indicating that individual intervention strategies should be designed according to specific educational groups and different cognitive sub-domains.