Trends and Distribution of Infertility - Asia Pacific Region, 1990-2021.

What is already known about this topic?: Infertility represents a significant global public health concern, impacting approximately 15% of couples of reproductive age worldwide. Despite this, data on infertility prevalence in the demographically diverse Asia-Pacific region remains sparse. What is added by this report?: This study examines the trends and distribution of infertility in the Asia-Pacific region from 1990 to 2021, revealing a significant increase in female infertility. The growth rate of secondary infertility has exceeded that of primary infertility. Additionally, an increase in the prevalence of polycystic ovary syndrome (PCOS) may be a significant contributor. The research also highlights geographical variations in the prevalence and trends of infertility across different countries. What are the implications for public health practice?: The findings emphasize the significance of sexual and reproductive health services and rights in safeguarding fertility.

Sensory impairment, loneliness, and the discordance between subjective and objective cognitive function among older adults: A multi-cohort study.

OBJECTIVES: This study aimed to examine the association between sensory impairment and the discordance between subjective/objective cognitive function among older adults and test the mediating effect of loneliness. METHODS: We used data from four cohort studies conducted in 16 countries (N = 19,119). Sensory impairment and subjective cognitive impairment were self-reported. Objective cognitive impairment was measured in three dimensions. Generalized estimating equations were conducted to examine the association between sensory impairment and discordance in subjective/objective cognitive function. Cross-lagged panel model and a bootstrap method with 2,000 samples were employed to verify the mediating effect. RESULTS: Sensory impairment was related to an increased risk of subjective cognitive impairment (OR = 4.70, 95 % CI 4.33-5.10), objective impairment (OR = 1.51, 95 %CI 1.31-1.74), as well as the discordance in subjective/objective cognitive function (OR = 1.35, 95 %CI 1.06-1.71 for older adults with normal subjective cognitive function). In contrast, sensory impairment was associated with a decreased risk of discordant subjective/objective cognitive function among those with subjective cognitive impairment (OR = 0.79, 95 %CI 0.66-0.94). Moreover, loneliness mediated the association between sensory impairment and subjective cognitive impairment (standardized indirect effect = 0.002, 95 %CI 0.001-0.004), objective cognitive impairment (standardized indirect effect = 0.005, 95 %CI 0.003-0.007) as well as the discordance in subjective/objective cognitive function (standardized indirect effect = 0.001, 95 %CI 0.001-0.003 for older adults with normal subjective cognitive function). CONCLUSIONS: Significant association between sensory impairment and discordance in subjective/objective cognitive function and the mediating role of loneliness were revealed, varying by subjective cognitive function. Early screening on sensory impairment and targeted interventions on loneliness should be considered in future policies on cognitive impairment.

The Role of Smoking, Obesity, and Physical Inactivity in Cognitive Performance and Decline: A Multicohort Study.

BACKGROUND: Unhealthy lifestyles are recognized contributors to cognitive decline, yet limited evidence focuses on their roles in cognitive decline rate. This study examined the role of smoking, obesity, and physical inactivity in cognitive performance and rate of cognitive decline by birth cohort on a global scale. METHODS: Utilizing data from 4 prospective cohort studies (China Health and Retirement Longitudinal Study, English Longitudinal Study on Ageing, Health and Retirement Study, and Survey of Health, Ageing and Retirement in Europe) across 14 countries, a multicohort study was performed. Eligible participants were aged 50 years and older. Linear mixed models were employed to detect the role of smoking, obesity, and physical inactivity in cognitive function domains (epidemic memory, working memory, and time orientation). RESULTS: Higher scores of cognitive functions were found in participants who engaged in more vigorous physical activity, were noncurrent smokers, and maintained underweight (eg, for episodic memory scores in females at 60 years, vigorous physical activity: 0.47, 95% CI: 0.46, 0.49). In addition, a slower rate of cognitive decline was also found in individuals who engaged in moderate or vigorous physical activity, were noncurrent smokers, and maintained not being underweight (eg, for episodic memory scores changing from 50 to 70 years old in females, vigorous physical activity: from 0.54 (95% CI: 0.51, 0.57) to 0.40 (95% CI: 0.37, 0.44) and in males from 0.33 (95% CI: 0.30, 0.36) to 0.11 (95% CI: 0.08, 0.14). CONCLUSIONS: We confirmed the beneficial impact of healthy lifestyles in preventing cognitive decline and promoting healthy aging. Urgent measures are needed to identify and encourage healthy lifestyles, such as strengthening tobacco control, developing policy on physical activity promotion, and preventing underweight, to minimize worldwide levels of cognitive decline.

Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study.

BACKGROUND: Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association. METHODS: We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores. FINDINGS: The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, ß=-0·15 [95% CI -0·17 to -0·13]; two diseases, ß=-0·37 [-0·40 to -0·34]; three diseases, ß=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (ß=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888). INTERPRETATION: These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people. FUNDING: Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

The shattered "Iron Rice Bowl": effects of Chinese state-owned enterprise reform on depressive symptoms in later life.

OBJECTIVES: The SOE reform was the first time that economic insecurity was introduced since 1949 in China, with hundreds of million employees affected by the laid off. This study took the State-Owned Enterprises (SOE) reform in China as a natural experiment to explore the impact of economic insecurity on depressive symptoms in later life. METHODS: Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. CHARLS used the probabilities proportional to size (PPS) sampling method and involved 450 villages/resident committees, 150 counties/districts and 12,400 households. A total of 5113 urban dwellers born earlier than 1971 (aged 25 years old and above at the start of the SOE reform, 1995) were involved. Using the province-level  economic loss from the layoffs, we examined the impact of economic insecurity exposure on the score of depressive symptoms using a difference-in-differences model (DID). RESULTS: Individuals with economic insecurity exposure had a significantly increased risk of higher depressive symptoms scores, in which a 1 percentage point increase in expected economic loss would increase the CESD-10 score by 0.10. For an individual at the median distribution (CESD-10 = 5), this implies a shift to the 58th percentile (CESD-10 = 6). Given that the average intensity of expected economic loss is 10.22% and the mean CESD-10 is 6.92, exposure to the SOE reform led to an average increase in the CESD-10 score by 1.02 and by at least 14.74%. The heterogeneity analyses showed that the role of SOE reform in depressive symptoms scores was robust in both female and male groups and groups with different educational attainment. CONCLUSIONS: Economic insecurity exposure increased the depressive symptoms score later in life in the context of China. Programs, such as adequate unemployment insurance benefits, can protect individuals against the risk of financial loss, thereby reducing their negative impact on depressive symptoms. Providing mental symptoms surveillance and psychological counseling to those experienced at a time of great uncertainty is important for preventing depression in times of economic insecurity.

Sex differences in cognitive aging and the role of socioeconomic status: Evidence from multi-cohort studies.

BACKGROUND: Sex differences exist in cognitive function, and socioeconomic status (SES) may play a role in changing these discrepancies. This study investigated the role of SES in contributing to sex differences in cognitive function. METHODS: We conducted a pooled multi-cohort study on the basis of four comparative cohort studies from the UK, the US, Europe and China to assess sex differences and the role of SES in cognitive decline by birth cohort (1930-1938, 1939-1945, 1946-1968). Cognitive function was measured in three domains based on the mean and SD of the corresponding tests: episodic memory, working memory, and time orientation. SES was the summed scores of education and household wealth. FINDINGS: 61,019 individuals were involved. Cognitive function of women declined faster than those of men as growing old (particularly after 80 years old). As SES increased, cognitive function increased more for women than for men in most cases among later-born cohorts (1930-1938, 1939-1945, 1946-1968) (e.g., episodic memory scores at 60 years old: women exhibited an increase from -0.09 [95%CI -0.12, -0.07] in low SES to 0.89 [0.86, 0.92] in high SES; men from -0.16 [-0.19, -0.14] to 0.59 [0.56, 0.62]). However, sex-specific cognitive benefits were absent in the oldest birth cohort (1895-1929). INTERPRETATION: These findings highlight the importance of considering the role of SES in the discrepancy of sex difference in cognitive aging.

Characteristics and treatment patterns of autism spectrum disorder in China, 2020.

This study aimed to investigate the characteristics of children diagnosed with ASD in China and to estimate ASD treatment patterns in 2020. This study used data from the 2020 Survey on Family Circumstance and Demand Support and Resources among Autistic Children in China. The study sample included 4,557 children diagnosed with ASD aged 2-16 years old. Data were collected through questionnaires completed by parents. Of the 4,557 children with ASD, there was a male-to-female ratio of 5.75:1, and the average age when ASD risk symptoms were first reported was 27.97(SD=10.83) months. Higher proportions of families with highly educated parents (college and above; around 58%) and advanced parental age at childbirth (≥35 years; over 50%) were found among autistic children. Additionally, about 41.05% of autistic children had an immediate family member diagnosed with mental/intellectual disorders. In terms of the treatment patterns for autistic children, 84.82% had received behavioral and developmental treatments and 77.74% had received therapy-based treatments, whereas 3% children had not received any treatment. Higher odds of non-treatment were found among children who were male (OR=1.69, 95% CI: 1.01,3.03) and had ASD diagnosed later on (OR= 1.02, 95% CI:1.01,1.03), as compared to their counterparts. Future studies will need to explore the etiology of the disparities of ASD, and policy efforts are critically needed to understand and address the barriers for children with ASD to receive appropriate treatments.

Urbanization and depressive symptoms among middle-aged and older adults in China.

Aims: Urbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration. Methods: Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms. Results: Our final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions. Conclusions: Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

Mechanistically understanding adsorption of methyl orange, indigo carmine, and methylene blue onto ionic/nonionic polystyrene adsorbents.

The involved interaction information concerning adsorbate-adsorbate and adsorbate-adsorbent is indispensable for developing and optimizing adsorption treatment of dye wastewater. Single and bi-solute adsorption of methyl orange (MO), indigo carmine (IC), and methylene blue (MB) on polystyrene anion exchanger (PsAX), defunctionalized version of PsAX (DF-PsAX), and hyper-cross-linked polystyrene adsorbent (MN200) were investigated to obtain a mechanistic understanding. Under acidic condition, higher adsorption efficiencies of PsAX due to extra intermolecular interactions of MO between the protonated tertiary amine group and the sulfate groups were observed, while strong alkaline condition is favorable for the adsorption of IC and MB by PsAX. MN200 exhibited much larger adsorption capacity toward MB than that toward MO or IC, because the fused-rings structure of MB is more polarizable and can form stronger nonionic intermolecular attractions with the matrix structure of polystyrene adsorbents. Bi-solute adsorption reveals that MO has obvious competitive effect toward IC adsorption at low concentrations, but it is not the case for the adsorption at high concentrations, where IC molecules can form intermolecular H-bonding interactions to defend the competition. the thermodynamic parameters confirm the endothermic and spontaneous nature of MO adsorption by PsAX, and ≈ 48 KJ mol-1 of the enthalpy change (∆H) imply the adsorption is not just physical absorption. Additionally, water/ethanol mixture solution of NaCl can almost thoroughly regenerate the exhausted PsAX, whereas only aqueous solution without ethanol is invalid.

Identification of a Key Gene Involved in Branched-Chain Short Fatty Acids Formation in Natto by Transcriptional Analysis and Enzymatic Characterization in Bacillus subtilis.

Natto as a fermented soybean product has many health benefits for human due to its rich nutritional and functional components. However, the unpleasant odor of natto, caused by the formation of branched-chain short fatty acids (BCFAs), prohibits the wide acceptance of natto products. This work is to identify the key gene of BCFAs formation and develop the guidance to reduce natto odor. Transcriptional analysis of BCFAs synthesis pathway genes was conducted in two Bacillus subtilis strains with obvious different BCFAs synthesis abilities. The transcriptional levels of bcd, bkdAA, and ptb in B. subtilis H-9 were 2.7-fold, 0.7-fold, and 8.9-fold higher than that of B. subtilis H-4, respectively. Therefore, the ptb gene with the highest transcriptional change was considered as the key gene in BCFAs synthesis. The ptb encoded enzyme Ptb was further characterized by inducible expression in Escherichia coli. The recombinant Ptb protein (about 32 kDa) was verified by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis analysis. The catalysis functions of Ptb were confirmed on substrates of isovaleryl-CoA and isobutyryl-CoA, and the higher catalysis efficiency of Ptb on isovaleryl-CoA explained the higher level of isovaleric acid in natto. The optimal activities of Ptb were observed at 50 °C and pH 8.0, and the enzymatic activity was inhibited by Ca2+, Zn2+, Ba2+, Mn2+, Cu2+, SDS, and EDTA. Collectively, this study reports a key gene responsible for BCFAs formation in natto fermentation and provides potential strategies to solve the odor problem.