Trajectories of depressive symptoms and their predictors in Chinese older population: Growth Mixture model.

BACKGROUND: Given the rapidly rising proportion of the older population in China and the relatively high prevalence of depressive symptoms among this population, this study aimed to identify the trajectories of depressive symptoms and the factors associated with the trajectory class to gain a better understanding of the long-term course of depressive symptoms in this population. METHODS: Data were obtained from four wave's survey of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3646 participants who aged 60 years or older during baseline survey, and completed all follow-ups were retained in this study. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Growth mixture modelling (GMM) was adopted to identify the trajectory classes of depressive symptoms, and both linear and quadratic functions were considered. A multivariate logistic regression model was used to calculate the adjusted odds ratios (ORs) of the associated factors to predict the trajectory class of participants. RESULTS: A four-class quadratic function model was the best-fitting model for the trajectories of depressive symptoms in the older Chinese population. The four trajectories were labelled as increasing (16.70%), decreasing (12.31%), high and stable (7.30%), and low and stable (63.69%), according to their trends. Except for the low and stable trajectory, the other trajectories were almost above the threshold for depressive symptoms. The multivariate logistic regression model suggested that the trajectories of chronic depressive symptoms could be predicted by being female, living in a village (rural area), having a lower educational level, and having chronic diseases. CONCLUSIONS: This study identified four depressive symptom trajectories in the older Chinese population and analysed the factors associated with the trajectory class. These findings can provide references for prevention and intervention to reduce the chronic course of depressive symptoms in the older Chinese population.

Network connectivity between benevolent childhood experiences and uncertainty stress among Chinese university students.

Background: The purpose of this study was to explore the association between benevolent childhood experiences (BCEs) and uncertainty stress among Chinese university students by network analysis. Methods: A total of 1,830 university students from three Chinese cities were recruited. Respondents' BCEs and uncertainty stress were self-reported using online questionnaire. The structure of the BCEs-uncertainty stress and related centrality indicators were examined for this sample. Results: The overall network model showed that "no ways to suit the important changes in life" was the most influential, followed by "all things are not going well," "feel that there is nothing to do," and "worry about the future." And in this network, the most influential bridge symptom was "having a positive self-concept." Conclusion: The central symptoms of the BCEs-uncertainty stress network should be prioritized as targets in interventions and prevention efforts to reduce uncertainty stress among Chinese university students. Improving university students' positive self-concept is important to alleviate the level of uncertainty stress among Chinese university students.

Relationship between obesity indicators and hypertension-diabetes comorbidity among adults: a population study from Central China.

OBJECTIVE: To identify the relationship between obesity indicators and hypertension-diabetes comorbidity (HDC) among adults in central China. DESIGN AND SETTING: A cross-sectional study was conducted from 1 June 2015 to 30 September 2018 in 11 districts of Hubei Province, China. PARTICIPANTS: A total of 29 396 participants aged 18 years or above were enrolled in the study. 2083 subjects with missing data were excluded. Eventually, 25 356 participants were available for the present analysis. MAIN OUTCOME MEASURES: Data were subjected to univariable and multivariable logistic regression to examine the association between obesity indicators (body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR)) and HDC prevalence. Crude odds ratio and adjusted OR (AOR) with associated 95% CI were calculated. RESULTS: Overall, 2.8% of the respondents had HDC. The odds of HDC prevalence increased with the BMI of the participants (18.5≤BMI (kg/m2)≤23.9-1; 24≤BMI (kg/m2)≤26.9-AOR: 5.66, 95% CI: 4.25 to 7.55; BMI (kg/m2)≥27-AOR: 7.96, 95% CI: 5.83 to 10.87). The risk of HDC also increased with the WHtR of participants (WHtR≤P25-1; P25≤WHtR≤P50-AOR: 1.73, 95% CI: 1.10 to 2.71; P50 ≤WHtR≤P75-AOR: 2.51, 95% CI: 1.60 to 3.92; WHtR≥P75-AOR: 3.22, 95% CI: 2.01 to 5.16). Stratified analysis by gender showed that high BMI and WHtR were risk factors of HDC in males and females. However, the odds of HDC prevalence increased only when WHtR≥P75 in males, whereas the probability of HDC increased when WHtR≥ P25 in females. CONCLUSION: High BMI and WHtR can increase the risk of HDC among Chinese adults. Reasonable control of BMI and WHtR may be beneficial in preventing HDC. Females should focus on maintaining an optimal WHtR earlier.

Impact of the coronavirus disease 2019 lockdown on Schistosoma host Oncomelania hupensis density in Wuhan.

BACKGROUND: Snails that host the parasitic worm Schistosoma were once controlled or eliminated in Wuhan, China. However, safety measures associated with the outbreak of novel coronavirus disease 2019 (COVID-19) halted snail detection and extermination efforts. The impact of the COVID-19 pandemic on urban schistosomiasis transmission remains unclear. This study aimed to investigate snail density and the associated risk of a schistosomiasis outbreak in Wuhan. METHODS: The density and infection status of snails were monitored by global positioning system satellites, and outbreak risk was calculated by adjusting the Kaiser model. SigmaPlot was used to create a three-dimensional risk matrix. RESULTS: The living snail frame occurrence rate was 1.48%, and the average living snail density was 0.054/0.11 m2 in 2020, indicating an increase relative to the respective 2019 values (0.019/0.11 m2). No infectious snails were observed in the survey area. The possibility, harmfulness, and uncontrollability indicator values were 0.842, 0.870, and 0.866, respectively. The areas at greatest risk were the northern bank of Tianxingzhou and the Tianxingzhou and Hongshan districts overall. The existing snail sites in the northern bank of Tianxingzhou exhibited the highest risk scores, followed by those in Pak Sha Chau, with the highest risk score found in Yangsiji Village. The events likely to occur in Hongshan District were also likely to have high severity. CONCLUSIONS: During the COVID-19 outbreak, the risk of schistosomiasis increased due to snail colonies returning to their sites of origin in Wuhan, suggesting a need for strengthened infection control and prevention measures.

Applicability of the Smart Vision Screening Instrument among Chinese Primary School Students.

BACKGROUND: A smart vision screening instrument was applied for screening low eyesight in primary school students in Wuhan, China. We aimed to compare the differences in test results between this instrument and lamp-box visual acuity charts, assess the validity of the screening results, and perform a preliminary comparison of the cost inputs of the two approaches. METHODS: In this cross-sectional study conducted in Wuhan, China in 2017, vision tests were performed on the same day among enrolled primary school students by using the two approaches. The t-test and kappa test were performed to compare the differences, and the indicators of validity were calculated and receiver operating characteristic (ROC) curves were drawn. Existing cost-input data were collected and the budget was analyzed. RESULTS: In total, 1001 schoolchildren were included, and the prevalence of low eyesight was 21.18% (95% CI: 18.71-23.87%). The test results of the two approaches were not statistically different (t=1.929, P>0.05) and showed moderate consistency (kappa=0.519, P<0.001). Sensitivity and specificity of the instrument were 84.90% (95% CI: 79.21-89.30%) and 91.63% (95% CI: 89.42-91.64%), respectively; positive predictive value was 73.17% (95% CI: 67.10-78.51%); and negative predictive value was 95.76% (95% CI: 94.00-97.04%). Area under the ROC curve was 0.883 (95% CI: 0.853-0.913) and significantly differed from 0.5 (P<0.001). The budget when using the instrument decreased 48.07% compared to that when using lamp-box visual acuity charts. CONCLUSION: The test result of the instrument is reliable, and using it to conduct screening is cost-saving. Therefore, it might be popularized for vision monitoring in schoolchildren.

A Specialized Clinical Laboratory Center for the Coronavirus Disease 2019 (COVID-19) in Wuhan Leishenshan Hospital During the COVID-19 Outbreak.

Responding to the extreme scarcity of medical resources during the early outbreak of the coronavirus disease (COVID-19) in Wuhan, China, an emergency specialist hospital of Leishenshan started to construct on January 26, 2020, and accommodate patients on February 6, 2020. The clinical laboratory center of Leishenshan Hospital (CLCLH) was constructed at the same time within 11 days to support the treatment of inpatients in Leishenshan Hospital and the testing of suspected patients from different fever clinics in Wuhan. The CLCLH could perform a total of 320 clinic, 299 biochemistry, 31 microorganism, and 47 infection and immunity examinations per day. It could also complete an average of 239 nucleic acid tests and 118 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody examinations per day. No suspected cases were documented among the health care workers during the operation of the CLCLH. The construction and operation experiences of the CLCLH is provided in this study and might be used by other countries as reference. The content of this study is divided into 4 parts: (1) the establishment of the CLCLH, including its layout and medical resource allocation; (2) the major testing items; (3) the specific procedure of COVID-19 indicator examination; and (4) the standardized personal protection measures.

Factors associated with depressive symptoms among the elderly in China: structural equation model.

OBJECTIVES: To establish a structural equation model for exploring the direct and indirect relationships of depressive symptoms and their associated factors among the Chinese elderly population. DESIGN: A cross-sectional research. The 2015 data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted. SETTING: CHARLS is an ongoing longitudinal study assessing the social, economic, and health status of nationally representative samples of middle-aged and elderly Chinese residents. PARTICIPANTS: A total of 5791 participants aged 60 years and above were included. MEASUREMENTS: Depressive symptoms were used as the study outcome. Sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were used as predictors. Confirmatory factor analysis was first conducted to test the latent variables. Structural equation model was then utilized to examine the associations among latent variables and depressive symptoms. RESULTS: The mean age of the participants was 68.82 ± 6.86 years, with 55.53% being males. The total prevalence of depressive symptoms was 37.52%. The model paths indicated that sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration were directly associated with depressive symptoms, and the effects were 0.281, 0.509, -0.067, and -0.162, respectively. Sociodemographic characteristics, unhealthy habits, and sleep duration were indirectly associated with depressive symptoms, mediating by poor health status. Their effects on poor health status were -0.093, 0.180, and -0.279, respectively. All paths of the model were significant (P < 0.001). The model could explain 40.9% of the variance in the depressive symptoms of the Chinese elderly population. CONCLUSIONS: Depressive symptoms were significantly associated with sociodemographic characteristics, poor health status, unhealthy habits, and sleep duration among Chinese elderly population. The dominant predictor of depressive symptoms was poor health status. Targeting these results might be helpful in rationally allocating health resources during screening or other mental health promotion activities for the elderly.

Dose-response relationship between intergenerational contact frequency and depressive symptoms amongst elderly Chinese parents: a cross-sectional study.

BACKGROUND: Given the high prevalence of depressive symptoms amongst the elderly Chinese population and the significance of intergenerational contact in this demographic group, the purpose of this study was to examine the association and dose-response relationship between the frequency of intergenerational contact and depressive symptoms. METHODS: Data were obtained from the third wave of the China Health and Retirement Longitudinal Study. A total of 5791 participants at age 60 or older were included in this study. Depressive symptoms were defined by the 10-item version of the Centre for Epidemiologic Studies Depression Scale. Intergenerational contact included in-person meeting and remote connecting, and they were analysed separately. Intergenerational contact frequency was classified into ten categories and then treated as a continuous variable for analysis. We performed univariate and multivariate logistic regressions to identify risk covariables. Restrictive cubic spline analysis was used to examine the dose-response relationship between intergenerational contact frequency and the outcome of depressive symptoms. RESULTS: Both the frequency of meeting and the frequency of connecting with children were independently associated with depressive symptoms in the elderly, and the odds ratios for depressive symptoms increased with decreasing frequencies (P < 0.01). There was a negative dose-response relationship between intergenerational contact frequency and depressive symptoms. The odds of depressive symptoms steadily decreased with increasing frequency of meeting with their children. Following an initial increase, the odds rapidly decreased as the frequency of connecting with children increased with an inflection point at once a monthly. Both associations were nonlinear (P < 0.001). CONCLUSIONS: Our findings revealed a negative dose-response relationship between intergenerational contact frequency and depressive symptoms in the elderly Chinese population. Thus, future health interventions should consider cultural norms in shaping the mental well-being of Chinese elderly persons.

Prevalence and co-infection of schistosomiasis/hepatitis B among rural populations in endemic areas in Hubei, China.

BACKGROUND: Both hepatitis B virus (HBV) infection and schistosomiasis are important public health problems in China. Concurrent infection between HBV and schistosomiasis is often observed in areas where schistosomiasis is endemic. The aim of this study was to determine the prevalence of schistosomiasis and HBV in schistosomiasis-affected areas, to explore whether schistosomiasis patients are more susceptible to HBV and to determine if the prevalence of HBV in high-endemic areas of schistosomiasis is higher than in low-endemic areas. METHODS: A total of 6526 participants from 13 villages in Hubei province were included in a cross-sectional study and blood samples were collected and examined. Qualitative variables were compared between groups using Pearson's chi-squared test or Fisher's exact test as appropriate. RESULTS: Of the 6526 participants, the overall prevalence was 8.27% for schistosomiasis and 2.67% for HBV. The prevalence of hepatitis B among participants who were Schistosoma antibody positive (25.37%) was higher than the prevalence in participants who were Schistosoma antibody negative (0.62%; χ2=1169.358, p<0.001, odds ratio 54.659). We also observed that there was no difference in the prevalence of hepatitis B between males and females in areas where schistosomiasis was endemic (χ2=1.827, p=0.177), but the prevalence of hepatitis B in middle-aged people was higher than in other age groups (χ2=47.877, p<0.001). CONCLUSIONS: There was an association between schistosomiasis and HBV infection. However, more work is needed to find the causal relationship between schistosomiasis and HBV infection.

Physical and behavioural factors, negative emotion and cognitive function among near-centenarians and centenarians in China.

OBJECTIVE: To investigate the association among demographic, physical, behavioural parameters, psychosocial and cognitive function in near-centenarians and centenarians. METHODS: The present study data originated from the 2014 wave of the largest nationwide longitudinal survey of the population aged 95 and above in China (N = 175). The aim of this study was to systematically identify the relationship among physical and behavioural variables, negative emotions and cognitive function. Cognitive function was evaluated by the modified Mini-Mental State Examination (mMMSE) Chinese version. Structured responses were obtained for the analysis of physical and behavioural factors and negative emotions. RESULTS: The average age of the sample was 98.78 years (SD = 4.00, range: 95-112 years). The average score of the mMMSE was 20.71 (SD = 3.48), average activities of daily living (ADL) total score was 17.21 (SD = 1.72), average instrumental activities of daily living (IADL) total score was 17.90 (SD = 5.57), and average negative emotion score was 8.77 (SD = 2.69). In the combined multiple linear regression model, the quality of sleep, IADL and negative emotion of centenarians were significantly associated with cognitive function (P < 0.05). CONCLUSION: The cognitive function of centenarians was significantly associated with the quality of sleep, IADL and negative emotion. Improving physical functioning and social resources can help emotional health and improve the overall cognition of centenarians.

Sleep quality, sleep duration, and their association with hypertension prevalence among low-income oldest-old in a rural area of China: A population-based study.

OBJECTIVE: The relationship among sleep quality, sleep duration and hypertension prevalence is controversial in different age groups and genders. This study aimed to investigate sleep quality, sleep duration and their association with hypertension prevalence among low-income oldest-old in a rural area of China. METHODS: A cross-sectional survey was conducted in a representative sample of 1066 adults aged 80-99 years in 2017. Logistic regression analysis was performed. RESULTS: Among males, sleep durations of <6 h and 6-<7 h were significantly associated with hypertension prevalence, with odds ratios (ORs) of 3.15 (95% confidence interval (CI) 1.37 to 7.23) and 2.38 (95% CI 1.22 to 4.63), respectively. Among females, only the sleep duration of <6 h was associated with increased OR of hypertension of 3.49 (95% CI 1.50 to 8.09). Poor sleep quality was associated with hypertension for both genders (ORmen 1.67, 95% CI 1.12 to 2.49; ORwomen 1.91, 95% CI 1.29 to 2.82). For women, a combination of poor sleep quality and any group of sleep duration, except for 7-<8 h, was associated with higher hypertension prevalence. For men, only the combination of poor sleep quality and short sleep duration (<7 h) was associated with high hypertension prevalence. CONCLUSION: Short sleep duration and poor sleep quality are associated with hypertension prevalence of oldest-old. The prevention of hypertension in older adults should be investigated from the perspective of sleep improvement.

Factors associated with health literacy in rural areas of Central China: structural equation model.

BACKGROUND: Health literacy is a strong predictor of health status. This study develops and tests a structural equation model to explore the factors that are associated with the health literacy level of rural residents in Central China. METHODS: The participants were recruited from a county-level city in Central China (N = 1164). Face-to-face interviews were conducted to complete the self-designed questionnaire of each participant. The questionnaire included items for the (1) demographic information, (2) socioeconomic status, and (3) health literacy of the participants. Mplus analyses were performed to evaluate the proposed model. RESULTS: The final model showed good fit for the data, and both demographic characteristics (i.e., age, BMI, and residence) and socioeconomic status (i.e., monthly income, occupation, and education level) were significantly associated with health literacy level. The effects of these two variables were - 0.277 (P < 0.05) and 0.615 (P < 0.001), respectively, and the model explained 70.2% of the variance in health literacy. CONCLUSIONS: Health literacy was significantly associated with age, BMI, distance between residence and nearest medical institution, monthly income, occupation, and education level, whereas socioeconomic status was a dominant predictor of health literacy level. Targeting these factors might be helpful in allocating health resources rationally when performing health promotion work.

Analysis of Scientific Collaboration Networks among Authors, Institutions, and Countries Studying Adolescent Myopia Prevention and Control: A Review Article.

BACKGROUND: Studies related to the prevention and control of myopia in adolescents have increased rapidly, but only a few have measured the levels of scientific collaboration among authors, institutions and countries in this field. Thus, in this study, we aimed to reveal the status and levels of scientific collaboration in this field. METHODS: The research population included all published papers in the field of adolescent myopia prevention and control indexed in the Web of Science databases from 1997-2016. The co-authorship networks were drawn using SATI (Statistical Analysis Toolkit for Informetrics), Ucinet and VOS viewer (Visualisation of Similarities viewer). Active authors and some measures of co-author network, including degree centrality, closeness, betweenness, density and diameter, were also assessed. RESULTS: Overall, 610 records were obtained, and a number of publications developed through an increase in different collaboration types, with cooperation among authors and institutions as the most apparent ones. The top ten active authors and institutions were identified. The density of cooperative networks of the top 70 authors and the first 69 institutions were 0.043 and 0.011, respectively, with corresponding diameters of five and six, respectively. Seven distinct clusters formed the cooperation network among 38 countries. The top three clusters were centered in China, the United States and Australia, also identified as the most productive countries. CONCLUSION: The flow of information is slow and the collaboration among authors and institutions in the network are not close enough. Thus, multiple collaboration types should be encouraged in this field, especially among countries.

Sleep Quality and Its Associated Factors among Low-Income Adults in a Rural Area of China: A Population-Based Study.

BACKGROUND: There is limited population-based research focusing on sleep quality among low-income Chinese adults in rural areas. This study aimed to assess sleep quality among low-income adults in a rural area in China and identify the association between sleep quality and sociodemographic, lifestyle and health-related factors. METHODS: The study was conducted from September to November in 2017 using a cross-sectional survey questionnaire. A total of 6905 participants were recruited via multistage, stratified cluster sampling. Data were collected using the Chinese versions of Pittsburgh Sleep Quality Index and Food Frequency Questionnaire, while we also determined the sociodemographic profiles of the participants. RESULTS: The mean age of the sample was 58.71 ± 14.50 years, with 59.7% being male, while the mean duration of daily sleep was 5.95 ± 1.31 h, with 56.7% reportedly experiencing poor sleep quality. Multiple regression analysis revealed that older age, unemployment, lower income, disability and chronic disease comorbidities were significant factors associated with an increased risk of poor sleep quality for both genders. Moreover, married and higher education level were associated with decreased risk of poor sleep quality for females, while a meat-heavy diet and illness during the past two weeks increased the risk of poor sleep quality for males. CONCLUSIONS: Sociodemographic, lifestyle and health-related factors had an impact on the frequently poor sleep quality of low-income Chinese adults in rural areas. Thus, comprehensive measures must be developed to address the modifiable predictive factors that can possibly enhance sleep quality.

Establishment of first engineering specifications for environmental modification to eliminate schistosomiasis epidemic foci in urban areas.

Snail control is a key link in schistosomiasis control, but no unified methods for eliminating snails have been produced to date. This study was conducted to explore an engineering method for eliminating Oncomelania hupensis applicable to urban areas. The engineering specifications were established using the Delphi method. An engineering project based on these specifications was conducted in Hankou marshland to eliminate snails, including the transformation of the beach surface and ditches. Molluscicide was used as a supplement. The snail control effect was evaluated by field investigation. The engineering results fulfilled the requirements of the design. The snail density decreased to 0/0.11m2, and the snail area dropped to 0m2 after the project. There was a statistically significant difference in the number of frames with snails before and after the project (P<0.05). Snails were completely eliminated through one year of continuous monitoring, and no new snails were found after a flood disaster. This study demonstrates that engineering specifications for environmental modification were successfully established. Environmental modification, mainly through beach and ditch remediation, can completely change the environment of Oncomelania breeding. This method of environmental modification combined with mollusciciding was highly effective at eliminating snails.