The Relationship Between Alcohol Consumption and Frailty Among Older Adults in China: Results From the Chinese Longitudinal Healthy Longevity Survey.

INTRODUCTION: Alcohol consumption has an impact on the frailty, but current research in China lacks a detailed classification of alcohol use. This study aimed to explore the relationship between different drinking patterns and frailty in older adults. METHODOLOGY: The data came from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) study, which included older adults (aged ≧ 60). Their demographic data, drinking status, and frailty index were collected in CLHLS. Through logistic regression models to analyze the correlation between alcohol consumption and frailty. RESULTS: A total of 14,931 participants were included in the analysis. The prevalence of frailty was 29.1%, 35.2%, and 14.9% among risk-free, past risky, and now risky drinkers, respectively. After adjusting for covariates, past risky drinking was a risk factor for frailty (p = .003). DISCUSSION: High-risk alcohol consumption is positively correlated with frailty. Prevention and reduction of risky drinking in older adults may help protect them from developing frailty.

Evaluating the quality of home care in community health service centres: A machine learning approach.

AIMS: The aim of the study is to develop a model using a machine learning approach that can effectively identify the quality of home care in communities. DESIGN: A cross-sectional design. METHODS: In this study, we evaluated the quality of home care in 170 community health service centres between October 2022 and February 2023. The Home Care Service Quality Questionnaire was used to collect information on home care structure, process and outcome quality. Then, an intelligent and comprehensive evaluation model was developed using a convolutional neural network, and its performance was compared with random forest and logistic regression models through various performance indicators. RESULTS: The convolutional neural network model was built upon seven variables, which encompassed the qualification of home nursing staff, developing and practicing emergency plan to cope with different emergency rescues in home environment, being equipped with medication and supplies for first aid according to specific situations, assessing nutrition condition of home patients, allocation of the number of home nursing staff, cases of new pressure ulcers and patient satisfaction rate. Remarkably, the convolutional neural network model demonstrated superior performance, outperforming both the random forest and regression models. CONCLUSION: The successful development and application of the convolutional neural network model highlight its ability to leverage data from community health service centres for rapid and accurate grading of home care quality. This research points the way to home care quality improvement. IMPACT: The model proposed in this study, coupled with the aforementioned factors, is expected to enhance the accuracy and efficiency of a comprehensive evaluation of home care quality. It will also help managers to take purposeful measures to improve the quality of home care. REPORTING METHOD: The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The application of this model has the potential to contribute to the advancement of high-quality home care, particularly in lower-middle-income communities.

Prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China: A cross-sectional Study.

AIMS: To examine the prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China. DESIGN: A cross-sectional study. METHOD: From January to July 2017, using the convenience sampling method, a total of 503 maintenance haemodialysis patients from six hospitals in Lianyungang, China, were recruited for this study. The participants' socio-demographic, lifestyle factors and health information were assessed using a general information questionnaire. Frailty was evaluated based on the Fried frailty phenotype. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population, including age, sex, living alone, employment, educational level, body mass index, per capita monthly household income, smoking status, exercise status, primary diagnosis, dialysis age, frequency of dialysis, vascular access, congestive heart failure, other cardiac diseases, cerebrovascular disease, peripheral blood diseases, pain, albumin level and haemoglobin level. RESULTS: Among the 503 participants with an average age of 53.02 years (standard deviation 14.99), 178 had pre-frailty (35.3%) and were mostly young and middle-aged. The prevalence of pre-frailty among participants <60 years old was more than 40%. Regression analysis showed that lack of exercise, dialysis age ≤12 months, congestive heart failure and other cardiac diseases were positively associated with pre-frailty. Two hundred and eighteen participants were frail (43.3%), most of whom were aged ≥60. The prevalence of frailty in participants ≥60 was 71.4%. Regression analysis showed that advanced age, being female, obesity, low per capita monthly household income, lack of exercise, diabetes as the primary disease, dialysis age ≤12 months, congestive heart failure, other cardiac diseases, pain and low albumin level, were positively associated with frailty. In addition, more than half of the participants hardly exercised (64.6%), while lack of exercise was a risk factor for pre-frailty and frailty. A third of the participants had pain (33.4%), while pain was an independent risk factor for pre-frailty and frailty in these participants. CONCLUSION: Pre-frailty and frailty are common in patients with maintenance haemodialysis. Most of the elderly maintenance haemodialysis patients are frail, and most of the young and middle-aged patients are pre-frail. Clinicians should actively screen the pre-frailty and frailty among patients with maintenance haemodialysis, especially those with dialysis age ≤12 months. Many factors affect pre-frailty and frailty in this population. Tailored intervention measures should be designed and implemented based on these factors, giving priority to exercise guidance and pain management for patients to help them prevent or reverse pre-frailty and frailty.

Frailty knowledge level and its influencing factors among older adults in China.

Raising older adults' frailty knowledge level and encouraging them to actively engage in the prevention and treatment of frailty is essential to promote healthy aging. This cross-sectional study investigated frailty knowledge level and its influencing factors in community-dwelling older adults in China. A total of 734 older adults were included in the analysis. About half of them misjudged their frailty state (42.50%), and 17.17% obtained frailty knowledge in the community. Those who were female, lived in rural areas, lived alone, had not attended school, had a monthly income <3,000RMB, were at risk for malnutrition, were depressed, and were socially isolated were more likely to have lower frailty knowledge level. Those with advanced age and pre-frailty or frailty stage were more knowledgeable about frailty. The group with the highest proportion of low frailty knowledge level was those who had never attended school or completed primary school and had loose friend ties (98.7%). It is crucial to develop tailored intervention to raise frailty knowledge level in older adults in China.

Investigating oral health-related quality of life in patients with ischaemic stroke in China.

OBJECTIVE: The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model. BACKGROUND: Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. MATERIALS AND METHODS: Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model. RESULTS: Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. CONCLUSION: The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

Experiences and needs of older adults at different stages of cerebral infarction based on trajectory theory-A qualitative study.

BACKGROUND: In recent years, stroke has become the second leading cause of death worldwide, and the incidence and mortality of ischemic stroke have increased significantly. This study mainly aimed to explore the experiences and needs of older adults at different stages of cerebral infarction based on the chronic illness trajectory theory. METHODS: Data were collected from 22 older adults experiencing the onset, acute, and stable stages of stroke through semi-structured interviews and were analyzed using Colaizzi's descriptive phenomenological approach. RESULTS: Multiple themes and subthemes emerged on the experiences and needs of older adults at different stages of cerebral infarction based on the three dimensions of the long-term disease trajectory theory: illness-related work, biographical work, and everyday life work. Seven themes were extracted for illness-related work, six for biographical work, and eight for everyday life work. DISCUSSIONS: The treatment, nursing, and rehabilitation of cerebral infarction are complex. This study indicated that patients after cerebral infarction have different experiences and needs for illness-related work. They also have distinctive and dynamically changing demands for biographical work and everyday life work. CONCLUSIONS: The experiences and needs of older patients with cerebral infarction changed dynamically at different stages of the disease. Healthcare professionals should develop effective interventions targeting these needs at various disease stages, provide patients with continuous support to shape their disease trajectories, and maintain patients' stability.

The willingness and influencing factors to choose smart senior care among old adults in China.

BACKGROUND: Population aging has become an escalating issue in China resulting in increasing healthcare demand. Smart senior care has the potential to help older adults live independently and relieve the pressure of healthcare including home-based care. This study aimed to explore Chinese older adults' preferred access models and service content of smart senior care and factors affecting their willingness to choose smart senior care. METHODS: This was a cross-sectional study. A total of 760 community-dwelling older adults from Xuzhou, China were included in this study. Their demographics, family support, health status, smart senior care use, and willingness to choose smart senior care were collected. The Chi-square test was used for single factor analysis of each variable. The statistically significant variables were included in the logistics regression model to analyze factors influencing older adults' willingness to choose smart senior care. The chi-square goodness of fit test was used to analyze the preferred content and access models of smart senior care; the Bonferroni method was used to correct the results. RESULTS: The finding indicated that participants' age, number of children, frequency of children visiting parents, adequate senior care, self-reported health, chronic diseases, smartphone use, and attitude toward smart senior care were significantly associated with their willingness to choose the smart senior care (p < 0.05). For smart senior care access models, participants preferred the remote monitoring model, telephone call model, and the community site model over the health smart home model and the smart application platform model. There was no statistical difference among these three preferred access models (p' > 0.005). Regarding service content, participants desired medical care service the most (p' < 0.005). CONCLUSIONS: Chinese older adults' willingness to choose smart senior care is affected by personal, family, health, and other factors. To develop China's senior care, we should consider their demand and preference for smart senior care. It is important to enrich the content of smart senior care, especially on medical care services, and maintain the dynamic balance between supply and demand using a diverse supply approach.

Where Are We and What Shall We Do Next? A Qualitative Study of the Quality of Home Care in Shanghai, China.

Introduction: With the increasing need for home care in Shanghai, China, it is crucial to ensure its quality. This study aimed to explore quality-related issues of home care in Shanghai, China, and identify strategies for improvement. Method: This is a descriptive qualitative study. Semistructured interviews were conducted among 27 individuals, including home care managers (n = 8), nurses (n = 10), and patients and/or their caregivers (n = 9). Colaizzi's seven-step analysis method was used to guide data analysis. Results: Three themes emerged regarding the quality of home care in China: unsatisfactory structure quality, unsatisfactory process quality, and imperfect outcome quality evaluation system. Recommended strategies for quality improvement included issuing standards for home care evaluation, refining structure quality and process quality, and establishing an outcome quality evaluation system. Conclusions: Concerns about the quality of home care in China were identified by providers and patients. More research especially studies quantifying the care quality and its influencing factors are needed.

Evaluating the Quality of Home Care in China Using the Home Care Quality Assessment Tool.

INTRODUCTION: This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). METHOD: We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. RESULTS: On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p = .018). DISCUSSION: Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts.

Smoking and Cognitive Function Among Middle-Aged Adults in China: Findings From the China Health and Retirement Longitudinal Study Baseline Survey.

BACKGROUND: Smoking is prevalent among people in China. In this study, we examined the association between smoking and cognitive function in a representative sample of adults aged 45 years and older in China. METHODS: We analyzed the baseline data of 16,892 participants from the China Health and Retirement Longitudinal Study. We measured smoking based on smoking status (never, former, and current smokers) and pack years (one pack year equals 20 cigarettes per day for 1 year). We assessed cognitive function for visuospatial ability, episodic memory, orientation/attention, and overall cognitive function. Multivariate linear and logistic regressions were used to examine the independent association between smoking and cognitive function, controlling for sociodemographic factors, domestic partner status, physical health status, and depressive symptoms. RESULTS: The study participants were, on average, 60 years old. The prevalence of former and current smoking in this population was 8.4% and 28.8%, respectively. Compared with nonsmokers, former and current smokers had better cognitive function (p < .0001). After controlling for covariates, only former smokers, compared with nonsmokers, have better orientation and attention (p = .04) and overall cognitive function (p = .01). Moreover, pack years are positively associated with orientation, attention (p = .04), and overall cognitive function among all participants (p = .02). CONCLUSIONS: This study identified that, among middle-aged and older Chinese adults, former smokers had the highest cognitive function, especially attention and orientation, followed by never smokers and current smokers. When screening for cognition impairment among Chinese middle-aged and older adults, we should encourage them to quit smoking.

NLRP3 Inflammasome Is Involved in Q-VD-OPH Induced Necroptosis Following Cerebral Ischemia-Reperfusion Injury.

Necroptosis is a manner of caspase-independent cell death,which accounts for delayed ischemic cerebral injury, and can be used as a novel tool to expand the treatment time window in ischemic cerebral injury. Q-VD-OPH, a novel pan caspase inhibitor, has been identified as an inducer of necroptosis. In this study, we determined the optimal dose of Q-VD-OPH, which induces necroptosis in rats by the middle cerebral artery occlusion, followed by reperfusion. Furthermore, we report that the NLRP3 inflammasome is involved in necroptosis, with levels of NLRP3 inflammasome proteins as well as inflammatory cytokines, such as IL-1ß, being elevated. We also demonstrated that NLRP3 was not only expressed in microglia and vascular endothelial cell, but also in neurons when necroptosis is induced with Q-VD-OPH. Inhibition of NLRP3 by glyburide strongly suppressed the expression of NLRP3 inflammasome proteins and IL-1ß, and markedly reduced brain tissue damage. Our findings provide evidence that pretreatment with Q-VD-OPH suppresses apoptosis and induces necroptosis in the cerebral ischemia-reperfusion model. We also identified that the NLRP3 inflammasome plays an important role in neuronal necroptosis, and that NLRP3 inflammasome deficiency reduces brain tissue damage after cerebral ischemia-reperfusion injury in rats.

The development of quality indicators for home care in China.

OBJECTIVES: To develop a comprehensive system of quality indicators for home care in China. DESIGN: A modified Delphi technique and analytic hierarchy process. PARTICIPANTS: Twenty experts were invited to participate in the Delphi expert consultation. METHODS: Experts rated the perceived importance of 92 potential indicators through two rounds of e-mail surveys in November and December 2016. The analytic hierarchy process was used to determine the relative importance of the quality indicators identified through the Delphi expert consultation. RESULTS: The average authoritative coefficient was 0.815 ± 0.0432 (range: 0.75-0.90). After two rounds of Delphi expert consultation, 77 quality indicators were identified as important in the Chinese home care setting. The mean importance ratings ranged from 4.35 to 4.95 on a 5-point scale, with variation coefficients ranging from 0.04 to 0.15. The percentage of experts giving the maximum possible score on each item ranged from 45% to 95%. In the second round, the Kendall's W coefficients ranged from 0.363 to 0.570. As for relative importance, the weights were 0.198-0.490, 0.029-0.047 and 0.037-0.66 for first-level, secondary-level and third-level quality indicators, respectively, with all consistency ratio values less than 0.1. CONCLUSION: The absolute and relative importance of 77 indicators identified as potentially valid measures of the quality of Chinese home care was determined. This instrument is the first set of home care quality indicators developed specifically for mainland China, and it should be useful in evaluating and improving the quality of Chinese home care.

Cytotoxic melodinus-type alkaloids from the ethanol extract of Melodinus fusiformis.

A chemical investigation of the ethanol extract of the aerial parts of Melodinus fusiformis led to the isolation of six new melodinus-type alkaloids, melofusines A-E (1-6), along with one known compound, melodinine B. Structural elucidation of all the compounds was performed by spectral methods such as 1D and 2D NMR, IR, UV and HRESIMS. The isolated compounds were tested in vitro for cytotoxic potential against six tumor cell lines (Hep-2, SCL-1, CAL-27, UMSCC-1, Detroit-562 and TCA-83). As a result, compound 1 exhibited significant cytotoxic activities against all tested tumor cell lines with IC50 values <5µM.

Protective effects of silibinin and its possible mechanism of action in mice exposed to chronic unpredictable mild stress.

Silibinin, a natural flavonoid antioxidant isolated from extracts of the milk thistle herb, has recently been identified as having anti-hepatotoxic and anticancer properties. In this paper, we investigated the effects of silibinin on behavior and neuroplasticity in mice subjected to chronic unpredictable mild stress (CUMS). After 5 consecutive weeks of CUMS, the mice were treated with silibinin (100 mg/kg, 200 mg/kg and 400 mg/kg by oral gavage) for 3 consecutive weeks. The results showed that silibinin administration significantly alleviated the CUMS-induced depressive-like behavior, including the total number of squares crossed and the frequency of rearing in the open field test, the immobility time in the tail suspension test and the forced swimming test. Furthermore, silibinin treatment increased the levels of brain-derived neurotrophic factor (BDNF), serotonin (5-HT) and norepinephrine (NE) in the prefrontal cortex and hippocampus. Our study provides new insight into the protective effects of silibinin on the depressive status of CUMS mice, specifically by improving neuroplasticity and neurotransmission.

Assessment of clinical effect of therapy combining disease with syndrome on rheumatoid arthritis.

OBJECTIVE: To observe the effectiveness and safety of a therapy combining disease with syndrome on rheumatoid arthritis. METHODS: Eighty patients with rheumatoid arthritis belonging to syndrome of damp-heat obstruction were randomly divided into a treatment group and a control group according to stratified blocked randomization method. Forty cases in the control group orally took Loxoprofen Sodium Tablet and Leifumite Tablet and the other 40 cases in the treatment group orally took a Chinese medicine for 12 weeks as a course of treatment. ACR therapeutic effect was used as the standard for evaluating the total therapeutic effect. RESULTS: After 12 weeks of treatment, there was a statistical difference (P < 0.01) in the improvement of VAS score, morning stiffness time, number of swelling joints, index of swelling joints, number of joints with tenderness, index of joints with tenderness, average grip strength of both hands, DSA28 score, HAQ, patient's assessment, physician's assessment, ESR, CRP and RF in both groups. The improvement of morning stiffness time, number of swelling joints, index of swelling joints, grip strength, HAQ and patient's assessment in the treatment group was much better than that in the control groups with statistical difference (P < 0.05). ACR20, ACR50 and ACR70 was 27.5% (11/40), 37.5% (15/40) and 22.5% (9/40) respectively in the treatment group and 40% (16/40), 27.5% (11/42) and 10.0% (4/40) respectively in the control group with statistical difference (P < 0.05) in the superiority of the treatment group over the control group. The incidence of adverse reaction in the control group was higher than that in the treatment group (P < 0.05). CONCLUSION: Definite therapeutic effect and high safety can be achieved in using the therapy combining disease with syndrome to treat rheumatoid arthritis belonging to syndrome of damp-heat obstruction.