Greenness, air pollution, and mortality risk: a retrospective cohort study of patients with lung cancer in China.

The association between long-term exposure to air pollution and mortality from lung cancer has been established, yet evaluations of the potential mitigating effects of greenness on this impact are scarce. We conducted a cohort study in Pingyi County. A two-level Cox proportional hazards regression model was used to examine the associations among long-term exposure to air pollution, residential greenness, and lung cancer mortality. Among the examined pollutants, nitrogen dioxide exhibited the most significant adverse effects and highest risk of lung cancer mortality, with hazard ratio (HR) = 2.783 (95% confidence interval [CI]: 1.885-4.107) for all-cause mortality, HR = 2.492 (95%CI: 1.659-3.741) for tumour-related mortality, and HR = 2.431 (95%CI: 1.606-3.678) for lung cancer mortality. Higher greenness values were associated with a reduced risk of lung cancer mortality. These findings suggest the importance of implementing strategies for increasing greenness to reduce the health impacts of air pollution.

Toward tuberculosis elimination by understanding epidemiologic characteristics and risk factors in Hainan Province, China.

BACKGROUND: The disease burden of tuberculosis (TB) was heavy in Hainan Province, China, and the information on transmission patterns was limited with few studies. This atudy aims to further explore the epidemiological characteristics and influencing factors of TB in Hainan Province, and thereby contribute valuable scientific evidences for TB elimination in Hainan Province. METHODS: The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System, along with socio-economic data. The spatial-temporal and population distributions were analyzed, and spatial autocorrelation analysis was conducted to explore TB notification rate clustering. In addition, the epidemiological characteristics of the cases among in-country migrants were described, and the delay pattern in seeking medical care was investigated. Finally, a geographically and temporally weighted regression (GTWR) model was adopted to analyze the relationship between TB notification rate and socio-economic indicators. The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR. RESULTS: From 2013 to 2022, 64,042 cases of TB were notified in Hainan Province. The estimated annual percentage change of TB notification rate in Hainan Province from 2013 to 2020 was - 6.88% [95% confidence interval (CI): - 5.30%, - 3.69%], with higher rates in central and southern regions. The majority of patients were males (76.33%) and farmers (67.80%). Cases among in-country migrants primarily originated from Sichuan (369 cases), Heilongjiang (267 cases), Hunan (236 cases), Guangdong (174 cases), and Guangxi (139 cases), accounting for 53%. The majority (98.83%) of TB cases were notified through passive case finding approaches, with delay in seeking care. The GTWR analysis showed that gross domestic product per capita, the number of medical institutions and health personnel per 10,000 people were main factors affecting the high TB notification rates in some regions in Hainan Province. Different regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region. CONCLUSIONS: The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions. Particular attention should be paid to the prevalence of TB among males, farmers, and out-of-province migrant populations. The notification rate was also influenced by economic development and medical conditions, indicating the need of more TB specialized hospitals, active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study.

BACKGROUND: Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified. OBJECTIVE: This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China. METHODS: Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA. RESULTS: The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA). CONCLUSIONS: Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA

Association between social integration and loneliness among the female migrant older adults with children: the mediating effect of social support.

BACKGROUND: The number of migrant older adults with children (MOAC) in China has been increasing in recent years, and most of them are women. This study aimed to explore the mediating effect of social support between social integration and loneliness among the female MOAC in Jinan, China. METHODS: In this study, 418 female MOAC were selected using multi-stage cluster random sampling in Jinan, Shandong Province, China. Loneliness was measured by the eight-item version of the University of California Los Angeles Loneliness Scale (ULS-8), and social support was measured by The Social Support Rating Scale (SSRS). Descriptive analyses, t-tests, ANOVA, and structural equation modeling (SEM) were used to illustrate the relationship between social integration, social support, and loneliness. RESULTS: The average scores of ULS-8 and SSRS were 12.9 ± 4.0 and 39.4 ± 5.9 among female MOAC in this study. Social integration and social support were found to be negatively related to loneliness, and the standardized direct effect was -0.20 [95% CI: -0.343 to -0.068] and -0.39 [95% CI: -0.230 to -0.033], respectively. Social support mediated the relationship between social integration and loneliness, and the indirect effect was -0.16 [95% CI: -0.252 to -0.100]. CONCLUSION: The female MOAC's loneliness was at a relatively lower level in this study. It was found that social integration was negatively associated with loneliness, and social support mediated the relationship between them. Helping female MOAC integrate into the inflow city and improving their social support could be beneficial for alleviating their loneliness.

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study.

OBJECTIVES: Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome, is characterized by slow gait and subjective cognitive complaints among older adults. This study assessed the relationship between multimorbidity, its patterns, and MCR. METHODS: Data for this study were obtained from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Participants who were aged 60 years and older and had complete data at baseline as well as complete data about MCR at follow-up were selected. Patients without MCR at baseline were selected for further analyses. Longitudinal associations between multimorbidity, its patterns, and MCR were examined using a Cox proportional hazards model. Multimorbidity patterns were classified using latent class analysis. RESULTS: A total of 4923 respondents were included at baseline, 43.47% of whom had multimorbidity. Additionally, the prevalence of MCR at baseline was 12.61%. After adjusting for covariates, multimorbidity was positively associated with MCR (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.06-1.68). A higher number of multimorbidity was also significantly associated with an increased risk of developing MCR (HR = 1.10, 95% CI = 1.02-1.19). Three multimorbidity patterns were selected: relatively healthy pattern, respiratory pattern, and cardiovascular pattern. Older adults with the cardiovascular pattern were 1.57 times more likely to develop MCR than those with the relatively healthy pattern (HR = 1.57, 95% CI = 1.16-2.13). There was no significant difference between the relatively healthy pattern and the respiratory pattern (HR = 1.31, 95% CI = 0.91-1.92). CONCLUSIONS: MCR is highly prevalent among older Chinese adults. MCR may be exacerbated by multimorbidity. For older adults with multimorbidity (especially cardiovascular multimorbidity), attention should be paid to MCR to achieve early detection, diagnosis, and treatment.

East Asian summer rainfall stimulated by subseasonal Indian monsoonal heating.

The responses of the East Asian summer monsoon (EASM) to the Indian summer monsoon (ISM) have been the subject of extensive investigation. Nevertheless, it remains uncertain whether the ISM can serve as a predictor for the EASM. Here, on the basis of both observations and a large-ensemble climate model experiment, we show that the subseasonal variability of abnormal diabatic heating over India enhances precipitation over central East China, the Korean Peninsula, and southern Japan in June. ISM heating triggers Rossby wave propagation along the subtropical jet, promoting southerly winds over East Asia. The southerly winds helps steer anomalous mid-tropospheric warm advection and lower-tropospheric moisture advection toward East Asia, providing conditions preferential for rainband formation. Cluster analysis shows that, depending on jet structures, ISM heating can serve as a trigger as well as a reinforcer of the rainband.

The chain mediation model of social support and life satisfaction among migrant older adults with children: The role of mental health and sleep quality.

INTRODUCTION: Few studies have examined the life satisfaction of migrant older adults with children (MOAC), who emerged due to rapid urbanization and population aging in China. This study aimed to explore the chain mediating effect of mental health and sleep quality on the association between social support and life satisfaction among MOAC in Weifang, China. METHODS: A cross-sectional study was conducted using multi-stage cluster random sampling, and 613 participants were included. The Social Support Rating Scale, Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index, and Scale with Life Satisfaction were used to measure the social support, mental health, sleep quality, and life satisfaction of MOAC, respectively. Descriptive statistics, t-tests, and ANOVA were used to explore the relationship between sociodemographic variables and life satisfaction. Pearson's correlation analysis and structural equation modeling (SEM) were conducted to investigate the association between social support, mental health, sleep quality, and life satisfaction. RESULTS: The mean total SWLS score was 27.87±5.58. SEM analysis demonstrated that social support had a positive effect on life satisfaction (ß= 0.197). Mental health and sleep quality partially mediated the association between social support and life satisfaction (95% CI: 0.083-0.193), and the mediating effect accounted for 39.198% of the total effect. CONCLUSION: Life satisfaction was relatively high, and mental health and sleep quality partially mediated the association between social support and life satisfaction. Policy suggestions were provided based on these results.

Association between self-reported oral health and cognitive function among the community-dwelling elderly in Jinan, China: the mediating effect of life satisfaction.

Background: Deterioration of self-reported oral health and decline in cognitive function are two main adverse health outcomes experienced by the older adults. Little evidence was found on the psychosocial mechanism between self-reported oral health and cognitive function. This study explores the association between self-reported oral health and cognitive function and examines the mediating effect of life satisfaction among the community-dwelling elderly in Jinan, China. Methods: A total of 512 older individuals (60+) were included in the study. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination scale (MMSE), and self-reported oral health was measured using the Chinese version of the Geriatric Oral Health Assessment Index (GOHAI). Pearson correlation analysis was used to determine the relationship between self-reported oral health, life satisfaction, and cognitive function. Multivariate linear regression analysis was conducted to explore the possible effect of covariates. Structural equation modelling and Bootstrap analyses were conducted to verify the mediating role of life satisfaction. Results: The mean MMSE score was 25.65 ± 4.42. Better self-reported oral health was significantly associated with a higher level of life satisfaction, and those with higher life satisfaction experienced better cognitive function. Age, educational level and source of living expenses were found to be cofounding variables. Life satisfaction partially mediated the effect of self-reported oral health on cognitive function (95% confidence interval [CI]: 0.010 to 0.075). The mediating effect of life satisfaction accounted for 24% of the total effect. Conclusion: The level of cognitive function was relatively high. Self-reported oral health was positively associated with cognitive function, and the mediating effect of life satisfaction was proven to exist in the community-dwelling older individuals. Early screening for oral diseases and a greater focus on life satisfaction are recommended.

Gender-Specific Association Between Perceived Stigma Toward Tuberculosis and Acceptance of Preventive Treatment Among College Students With Latent Tuberculosis Infection: Cross-Sectional Analysis.

BACKGROUND: With the increasing enrollment scale of colleges, the number of students on campus has risen sharply in China. The number of students with tuberculosis (TB) and rifampicin-resistant TB in colleges has increased significantly. Preventive treatment of latent tuberculosis infection (LTBI) is an important means for TB prevention and control in colleges. At present, the acceptance of LTBI treatment among college students remains unclear. In addition, evidence shows stigma may be one of the key factors affecting acceptance of LTBI treatment. To date, there is little direct evidence on the gender-specific association between perceived stigma toward TB and acceptance of LTBI treatment among college students. OBJECTIVE: This study aimed to describe the acceptance of LTBI treatment among college students in an eastern province of China to explore the association between perceived stigma toward TB and acceptance of LTBI treatment and to examine the moderating effect of gender on the association. METHODS: Data were derived from the project on the evaluation of LTBI treatment and its effectiveness among college students in Shandong, China. In total, 1547 college students were included in the analysis. We considered covariates at the individual and family levels. Multilevel mixed-effects logistic regression was used to examine the moderating role of gender and also explore the association between perceived stigma toward TB and acceptance of LTBI treatment. RESULTS: The acceptance rate of LTBI treatment among the diagnosed college students was 46.7% (n=723). The proportion of female students (n=361, 51.5%) accepting LTBI treatment was higher than that of male students (n=362, 42.8%; P=.001). There was an interaction between perceived stigma toward TB and gender (OR 0.93, 95% CI 0.87-1.00; P=.06). Among college students with LTBI, perceived stigma toward TB was positively associated with acceptance of preventive treatment (OR 1.03, 95% CI 1.00-1.08, P=.05). Perceived stigma toward TB was positively associated with accepting LTBI treatment only among male students (OR 1.07, 95% CI 1.02-1.12; P=.005). CONCLUSIONS: The acceptance rate of preventive treatment among college students with LTBI was low. Contrary to our expectations, perceived stigma toward TB was positively associated with acceptance of preventive treatment. Gender moderated this association; high perceived stigma toward TB was associated with acceptance of preventive treatment only in male gender. Gender-specific strategies are effective in improving the acceptability of LTBI treatment in colleges.

The relationships of preventive behaviors and psychological resilience with depression, anxiety, and stress among university students during the COVID-19 pandemic: A two-wave longitudinal study in Shandong Province, China.

Introduction: Studies have shown that the psychological impact of the COVID-19 pandemic may lead to long-term health problems; therefore, more attention should be paid to the mental health of university students. This study aimed to explore the longitudinal effects of preventive behaviors and psychological resilience on the mental health of Chinese college students during COVID-19. Methods: We recruited 2,948 university students from five universities in Shandong Province. We used a generalized estimating equation (GEE) model to estimate the impact of preventive behaviors and psychological resilience on mental health. Results: In the follow-up survey, the prevalence of anxiety (44.8% at T1 vs 41.2% at T2) and stress (23.0% at T1 vs 19.6% at T2) decreased over time, whereas the prevalence of depression (35.2% at T1 vs 36.9% at T2) increased significantly (P < 0.001). Senior students were more likely to report depression (OR = 1.710, P < 0.001), anxiety (OR = 0.815, P = 0.019), and stress (OR = 1.385, P = 0.011). Among all majors, medical students were most likely to report depression (OR = 1.373, P = 0.021), anxiety (OR = 1.310, P = 0.040), and stress (OR = 1.775, P < 0.001). Students who wore a mask outside were less likely to report depression (OR = 0.761, P = 0.027) and anxiety (OR = 0.686, P = 0.002) compared to those who did not wear masks. Students who complied with the standard hand-washing technique were less likely to report depression (OR = 0.628, P < 0.001), anxiety (OR = 0.701, P < 0.001), and stress (OR = 0.638, P < 0.001). Students who maintained a distance of one meter in queues were less likely to report depression (OR = 0.668, P < 0.001), anxiety (OR = 0.634, P < 0.001), and stress (OR = 0.638, P < 0.001). Psychological resilience was a protective factor against depression (OR = 0.973, P < 0.001), anxiety (OR = 0.980, P < 0.001), and stress (OR = 0.976, P < 0.001). Discussion: The prevalence of depression among university students increased at follow-up, while the prevalence of anxiety and stress decreased. Senior students and medical students are vulnerable groups. University students should continue to follow relevant preventive behaviors to protect their mental health. Improving psychological resilience may help maintain and promote university students' mental health.

The association of weight control attempts with suicidality: The role of objective weight status and weight perception among adolescents of United States.

BACKGROUND: The evidence for the association of weight control attempts with suicidality by objective weight status, subjective weight perception, and distorted weight perception among adolescents was limited. METHODS: Data were extracted from a national representative sample of Youth Risk Behavior Surveys in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of weight control attempts, objective weight status, and weight perception with suicidality. FINDINGS: The adolescents attempting to lose weight had higher weighted prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment compared with other attempts of weight control. Totally, attempting to lose weight was significantly associated with increased risk of suicidal ideation (OR: 1.17, 95%CI: 1.05-1.30) and suicide attempt (OR: 1.26, 95%CI: 1.10-1.46) when adjusting objective weight status, weight perception and all other covariates. In the subgroup analyses, attempting to lose weight was significantly associated with increased risk of suicidality in the adolescents of normal weight, underweight, perceived normal weight, perceived underweight, right estimation of objective weight status. LIMITATIONS: Uncertain causal relationship existed because of cross-sectional design. CONCLUSIONS: The risk of suicidality associated with weight control attempts varied among different subgroups. The findings in this study suggest that not only objective weight status but also weight perception should be with consideration when performing weight control attempts.

Factors associated with refusal of preventive therapy after initial willingness to accept treatment among college students with latent tuberculosis infection in Shandong, China.

BACKGROUND: Preventive therapy of latent tuberculosis infection (LTBI) is an important component of tuberculosis (TB) control. Research on acceptance of TB preventive therapy (TPT) is an important topic. Current studies focus on acceptability and compliance. However, it is unclear whether LTBI patients will start TPT after accepting treatment. The study assessed the factors associated with TPT refusal after initial willingness to accept treatment. METHODS: Data were derived from a baseline survey of prospective study of LTBI treatment among college students in Shandong Province, China. A total of 723 students initially willing to accept TPT were included in the analysis. Stepwise logistic regression was used to explore the individual- and family-level characteristic variables that factors associated with TPT refusal after initial willingness to accept treatment. RESULTS: Of the 723 LTBI college students who initially had acceptance willingness, 436 (60.3%) finally refused TPT. At the individual level, non-medical students were more likely to refuse TPT [odds ratio (OR) = 4.87, 95% confidence interval (CI): 3.10-7.67)], as were students with moderate physical activity (OR = 1.45, 95% CI: 1.04-2.04). Students with boarding experience (OR = 0.49, 95% CI: 0.31-0.78) and a high level of knowledge about TB (OR = 0.97, 95% CI: 0.95-0.99) were less likely to refuse TPT. At the family level, those with high father's educational level (OR = 1.50, 95% CI: 1.07-2.10) or high household income (OR = 1.80, 95% CI: 1.20-2.71) were more likely to refuse TPT after initially accepting treatment. CONCLUSIONS: Factors associated with TPT refusal after initial willingness to accept treatment, such as personal (type of students, physical activity, boarding experiences, knowledge of TB) and family characteristics (father's education level, household income) among college student with LTBI, might help identify persons for whom tailored interventions could improve the start of LTBI treatment.

"Urban Respiration" Revealed by Atmospheric O2 Measurements in an Industrial Metropolis.

Urban regions, which "inhale" O2 from the air and "exhale" CO2 and atmospheric pollutants, including harmful gases and fine particles, are the largest sinks of atmospheric O2, yet long-term O2 measurements in urban regions are currently lacking. In this study, we report continuous measurements of atmospheric O2 in downtown Lanzhou, an industrial metropolis in northwestern China. We found declines in atmospheric O2 associated with deteriorated air quality and robust anticorrelations between O2 and gaseous oxides. By combining O2 and pollutants measurements with a Lagrangian atmospheric transport model, we quantitatively break down "urban respiration" (ΔO2URB) into human respiration (ΔO2RES) and fossil fuel combustion (ΔO2FF). We found increased ΔO2FF contribution (from 66.92% to 72.50%) and decreased ΔO2RES contribution (from 33.08 to 27.50%) as O2 declines and pollutants accumulate. Further attribution of ΔO2FF reveals intracity transport of atmospheric pollutants from industrial sectors and suggests transportation sectors as the major O2 sink in downtown Lanzhou. The varying relationships between O2 and pollutants under different conditions unfold the dynamics of urban respiration and provide insights into the O2 and energy consumption, pollutant emission, and intracity atmospheric transport processes.

Prevalence and risk factors of latent tuberculosis infection among college students: a systematic review and meta-analysis.

OBJECTIVES: College students are at increased risk of tuberculosis (TB), which increases their likelihood of developing latent tuberculosis infections (LTBI). This study aimed to estimate the pooled prevalence of LTBI and identify its risk factors. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang and CBM databases (10 March 2022) for studies published in any language. The pooled prevalence of LTBI was estimated using random effects methods. Factors associated with LTBI were evaluated by determining standardised mean difference (SMD) with 95% confidence interval (CI). All analyses were performed using the Stata 15.1. RESULTS: A total of 50 studies from 18 countries were included, with 44 tuberculin skin test (n = 623,732) and 19 interferon gamma release assay (n = 38,266) estimates. The prevalence of a positive tuberculin skin test was 20% (95% CI: 17-23%), and the prevalence of a positive interferon gamma release assay was 9% (95% CI: 7%-11%) among college students. Older age (SMD: 1.67, 95% CI: 1.31-2.13), no Bacillus Calmette-Guérin vaccination/scar (SMD: 1.51, 95% CI: 1.06-2.16), contact with TB cases (SMD: 1.34, 95% CI: 1.11-1.62), clinical training (SMD: 1.93, 95% CI: 1.65-2.26) and overweight/obesity (SMD: 1.17, 95% CI: 1.06-1.30) were associated with a higher prevalence of LTBI. Sex was not associated with LTBI prevalence. CONCLUSION: College students have an increased risk of LTBI, although it varies by geographical area. This meta-analysis provides evidence of risk factors for LTBI in college students. Infection control measures should be conducted for college students with LTBI.

The Effect of Chronic Disease and Mental Health on Sleep Quality among Migrant Elderly Following Children in Weifang City, China.

Few studies have focused on the sleep quality among migrant elderly following children (MEFC). This study aimed to investigate the effects of chronic disease and mental health on the sleep quality of MEFC in Weifang, China. A cross-sectional study was conducted by multi-stage cluster random sampling, and in total 613 participants were enrolled. Sleep quality and mental health were assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Depression, Anxiety, and Stress Scale (DASS-21), respectively. Chronic disease was assessed by the question "how many chronic diseases do you have?" A descriptive analysis and chi-square test were used to describe participants' sociodemographic variables, chronic disease, mental health, and sleep quality. The relationship between chronic disease, mental health, and sleep quality was explored by establishing binary logistic regression models. The results showed that 18.3% of MEFC's sleep quality was poor. MEFCs who were male were more likely to report good sleep quality. MEFCs who have similar monthly family income compared with others around, with multimorbidity, depression, and anxiety were more likely to report poor sleep quality. Nearly 1/5 of MEFCs were having poor sleep quality in this study. Results indicated that chronic diseases, depression, and anxiety were risk factors for the sleep quality of MEFC. Implications for the government, communities, and families of MEFC were given for improving their sleep quality.

Effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the migrant older with children to Jinan, China.

Due to the acceleration of China's urbanization, the number of migrant older with children (MOC) continued to increase. This study aimed to clarify the effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the MOC to Jinan, China. A cross-sectional study included 656 MOC (36.3% men and 63.7% women) using multi-stage cluster random sampling in Jinan, China. Childcare disagreement was evaluated by the differences between parents and grandparents on the diet, dressing, education, and childcare consumption. Social support was assessed using the social support rating scale (SSRS). Descriptive analysis, chi-squared test, and binary logistic regression were applied to analyze the association between childcare disagreement with children, social support, health status, and unmet healthcare-seeking behavior of the MOC. Approximately 41.3% of participants had unmet healthcare-seeking behavior. Logistic regression analysis showed that the MOC whose health status compared to last year get better were more likely to have unmet healthcare-seeking behavior, while who were women, had partial will of migration, hired a nanny, had smaller childcare disagreement with children on dressing, had smaller childcare disagreement with children on consumption, and had moderate social support, were less likely to experience unmet healthcare-seeking behavior. Recommendations were given to the government and family members to improve the health services-seeking behavior of the MOC.

Mediating effect of family support on the relationship between acculturation and loneliness among the migrant elderly following children in Jinan, China.

The total number of migrant elderly following children (MEFC) has gradually increased along with population aging and urbanization in recent decades in China. The purpose of this study was to investigate the mediating effect of family support on the relationship between acculturation and loneliness among the MEFC in Jinan, China. A total of 656 MEFC were selected by multistage cluster random sampling. Loneliness was measured using the short-form UCLA Loneliness Scale (ULS-8), while acculturation and family support were assessed using a self-designed questionnaire. Descriptive analysis, univariate analysis, and the structural equation model (SEM) were conducted to illustrate the relationship between the above indicators and loneliness. The average ULS-8 score of the MEFC was 12.82 ± 4.05 in this study. Acculturation of the MEFC exerted a negatively direct effect on loneliness and a positively direct effect on family support simultaneously, while family support exerted a negatively direct effect on loneliness. Family support partially mediated the relationship between acculturation and loneliness [95% CI: -0.079 to 0.013, p < 0.001], while the mediating effect of family support accounted for 14.0% of the total effect. The average ULS-8 score of 12.82 ± 4.05 implied a low level of loneliness in the MEFC in Jinan, China. Acculturation was found to be correlated with loneliness, while the mediating role of family support between acculturation and loneliness was established. Policy recommendations were provided to reduce loneliness and improve the acculturation and family support of the MEFC according to the findings above.

The Effects of Living Environment, Health Status of Family Members, and Migrant Elderly following Children's Attitude about Care on Grandchildren's Health Status in Weifang, China.

As urbanization is growing quickly in China, many migrant elderly following children (MEFC) migrate to big cities to care for their grandchildren (grandchildren of MEFC=GMEFC). This study aimed to explore the effects of the living environment, health statuses of family members, and MEFC's attitude regarding the care of their children (children of MEFC=CMEFC) for their GMEFC on GMEFC's health statuses in Weifang, China. Multistage cluster random sampling was used to select the participants, and 613 MEFC were included in total. Descriptive analysis, univariate analysis and binary logistic regression were used to investigate the association between the related variables and GMEFC's health statuses. It was found that 74.9% of the GMEFC had excellent health statuses. The GMEFC who had siblings, the CMEFC with excellent health statuses, and the MEFC with excellent health statuses were more likely to have excellent health statuses. Moreover, the GMEFC who were female, elevators occasionally malfunctioned, the MEFC who were dissatisfied with the CMEFC's time spent on caring, and the MEFC who did not understand or forgive the CMEFC's limited time on caring were less likely to have GMEFC with excellent health statuses. The results indicated that a better living environment, better health statuses of family members, and a positive attitude of the MEFC regarding the care of CMEFC for GMEFC would result in a better health status of GMEFC.

The Relationship Between CDC Personnel Subjective Socioeconomic Status and Turnover Intention: A Combined Model of Moderation and Mediation.

A stable and motivated CDC workforce is critical for Chinese public health system improvement in the post-pandemic period of COVID-19. Meanwhile, the lack of career development prospects, low income, low status and the widespread and increasingly serious job burnout of employees CDC staff is a complex and difficult problem for the government. Therefore, this study explored the relationship between CDC personnel subjective socioeconomic status and turnover intention using a sample of 2,502 grass-roots CDC personnel who were administered with a subjective socioeconomic status scale, turnover intention scale, job burnout scale, and payment questionnaire. The results showed that: (1) subjective socioeconomic status had a significant association with job burnout and turnover intention; (2) all three dimensions of job burnout played a mediating role in the relationship between subjective socioeconomic status and turnover intention; (3) expected salary change played a moderating role between subjective socioeconomic status and turnover intention. The effect was stronger for workers with low expected salary change, which means due to the multidimensional comparative and complex mechanism of salary change, which had limited effect on turnover intention. These findings provide a basis for the relationship between turnover intention and socioeconomic status of grass-roots CDC personnel, and also provide ideas for reducing job burnout and staff turnover.

Soft drink consumption and depressive symptoms among the adolescents of United States: The mediating role of aggressive behaviors.

BACKGROUND: There is limited evidence for the association among soft drink consumption, aggressive behaviors, and depressive symptoms among the adolescents. METHODS: Data were derived from a national representative sample of Youth Risk Behavior Surveys of United States during 2011 to 2019. Binary logistic regression models with complex sampling design were used to estimate the effect of soft drink consumption on aggressive behaviors and depressive symptoms. Mediating analysis was used to explore the association between soft drink consumption and depressive symptoms by aggressive behaviors. FINDINGS: The total prevalence of depressive symptoms was 3l.2 % (30.3 %-32.0 %). Compared with none of soft drink consumption, <1 time/day (OR: 1.29, 95%CI: 1.19-1.41), 1-2 times/day (OR: 1.49, 95%CI: 1.33-1.67), and ≥3 times/day (OR: 1.95, 95%CI: 1.70-2.24) were significantly associated with increased risk of aggressive behaviors. High levels of soft drink consumption (1-2 times/day, OR: 1.19, 95%CI: 1.07-1.32; ≥3 times/day, OR: 1.61, 95%CI: 1.42-1.81) and aggressive behaviors (OR: 1.98, 95%CI: 1.84-2.13) were found to be significantly associated with increased risk of depressive symptoms. A linear dose-response relationship of soft drink consumption with aggressive behaviors and depressive symptoms was found in this study (all p < 0.001). Aggressive behaviors partially mediated the association between soft drink consumption and depressive symptoms and each pathway was statistically significant. LIMITATIONS: The causal relationship was not able to certain because of the cross-sectional design. CONCLUSIONS: The mediating role of aggressive behaviors on the association of high levels of soft drink consumptions with depressive symptoms should be paid more attention among the adolescents.