Objectives:Current findings from cohort studies examining the association between obesity and cognitive impairment are inconsistent, particularly with regard to central obesity. This study aimed to investigate the prospective associations of Body Mass Index (BMI), Waist Circumference (WC), and Waist-Hip Ratio (WHR) with the risk of cognitive impairment among Chinese elderly. Methods:We used data from the Zhejiang Healthy Aging Cohort Study (ZHACS), which included 8,443 participants. BMI, WC, and WHR were assessed using a baseline questionnaire that was initiated in 2014. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) at baseline and three waves of follow-up (2015, 2016, and 2019-2021), with cognitive impairment based on thresholds tailored to participants' educational backgrounds. Log-binomial regression models adjusted for numerous covariates were used to examine the associations and calculate relative risks (RRs). Results:After 6 years of follow-up, 3,006 participants (35.60%) showed cognitive impairment at least once, according to the MMSE. BMI-defined underweight was positively associated with cognitive impairment (RR = 1.15; 95%CI: 1.05-1.27). Conversely, inverse associations were identified for central obesity defined by WC and WHR, with estimated effect sizes of 14% (RR = 0.86; 95%CI: 0.81-0.91) and 9% (RR = 0.91; 95%CI: 0.86-0.97), respectively. Participants with both BMI-defined overweight/obesity and WC/WHR-defined central obesity had a significant inverse association with cognitive impairment, whereas those with both BMI-defined underweight and WC/WHR-defined central obesity did not. Stratified analyses indicated that the association of BMI-defined underweight and WHR-defined central obesity with cognitive impairment was more evident among women participants and individuals aged ≥70 years. Conclusion:Among Chinese older adults, BMI-defined underweight was significantly positively associated with cognitive impairment, whereas WC-defined and WHR-defined central obesity was inversely associated with cognitive impairment, particularly among older adults (≥70 years) and women.

Epidemiological studies suggest that proxies of lifetime estrogen exposure are associated with the risk of Alzheimer's disease (AD). However, results remain limited and inconsistent. This study aimed to examine whether menstrual and reproductive factors, proxies of estrogen exposure, are associated with the risk of AD in Chinese postmenopausal women. Information on menstrual and reproductive factors was obtained through the baseline survey of the Zhejiang Ageing and Health Cohort Study. During the three follow-up waves, AD diagnoses were conducted. We excluded participants with prevalent cognitive impairment or incomplete data of cognitive assessment at baseline, and incident cases of cognitive impairment without AD diagnosis across follow-up. Log-binomial model and the generalized additive model (GAM), controlled for a wide range of potential confounders, were generated to examine the association. Finally, 5606 women were included, and 597 developed AD during follow-up. The age of participants ranged from 60 to 95 years (mean = 65.7 years, SD = 6.5) at baseline. Women with a longer reproductive lifespan (> 34 years, compared with 32-34 years) had a lower risk of AD (RR = 0.81, 95% CI 0.67-0.98). Menopause due to ovariectomy was associated with a higher risk of AD (RR = 2.17, 95% CI 1.16-4.08), compared to those with natural menopause. The shorter length of menstrual cycles (≤ 27 days, compared with 28-30 days) was associated with an increased risk of AD (RR = 1.47, 95% 1.15-1.87), and shorter length of menstrual period (≤ 3 days, compared with 4-6 days) was associated with a decreased risk of AD (RR = 0.73, 95% 0.59-0.90). Women with 2 or more parity showed a higher risk of AD, while women with 2 or more miscarriages and abortions had a lower risk of AD. Older age at first childbirth (> 22 years, compared with 21-22 years) was associated with a decreased risk of AD (RR = 0.47, 95% CI 0.38-0.58). A U-shaped association was identified between mean breastfeeding duration and AD. Oral contraceptive use was also associated with an increased risk of AD. Our results show that menstrual and reproductive factors are statistically significantly associated with the risk of AD in Chinese postmenopausal women.

The monitoring and identification of mosquito vectors are crucial for controlling the transmission of mosquito-borne diseases. Traditional mosquito morphological identification and surveillance methods, such as human landing catches, human-baited double net traps and BG-Sentinel mosquito traps, require a large amount of manpower but can only provide fragmented data. We utilized the MS-300, an internet-based vector mosquito monitor, to continuously capture and upload real-time data to cloud services across ten monitoring sites located in seven cities in Zhejiang Province, China from May to December 2023. A new multiplex PCR system was developed for amplifying the internal transcribed spacer 2 region, followed by employing both multiplex PCR and DNA barcoding techniques for detecting wild mosquitoes. A comprehensive monitoring of 9749 mosquitoes was conducted. The mosquito density gradually increased from May 2023, peaked around June 22nd, and then declined in a wave-like pattern. The mosquitoes have two peak activity times, the peak times may vary depending on different locations and seasons. The study showed the high specificity of a multiplex PCR system in distinguishing six mosquito species: Aedes albopictus, Aedes aegypti, Culex pipiens pallens, Armigeres subalbatus, Anopheles sinensis and Anopheles anthropophagus. Notably, the sensitivity of detecting An. anthropophagus reached an impressive 1fg/µL. With the exception of Ae. aegypti and An. anthropophagus, all four other mosquito species have been identified in Zhejiang Province, with Cx. p. pallens being the predominant population. The results were highly consistent with DNA barcoding technology. The MS-300 continuously and automatically monitors mosquito population density and activity, providing effective guidance for mosquito control based on the environment and reducing labor costs. Our newly established multiple PCR system enables precise identification of crucial vector mosquitoes, facilitating a comprehensive understanding of population structures across diverse regions for selecting effective control measures.

BACKGROUND:Hepatitis significantly increases the global disease burden and has become a major public health issue worldwide. China is a high-risk area for viral hepatitis, which is also a serious public health problem. METHODS:The scaling relationship between various types of hepatitis and population size was explained by a scaling law. Fixed-effects and random-effects meta-analyses were used to calculate a combined index of β based on the single-scale index from 2004 to 2023. Furthermore, the X11 process was employed to identify the structural components of the time series of various types of hepatitis. RESULTS:In the past 20 years, the proportion of patients with viral hepatitis in Zhejiang Province has changed significantly, and hepatitis B remains the main type of hepatitis, accounting for approximately 70% of all hepatitis cases. The proportion of hepatitis C and E cases has been increasing, whereas the proportion of hepatitis A cases has been decreasing since 2004 and has remained at a low level (approximately 3%) since 2010. The combined scaling exponents of hepatitis A, hepatitis B, hepatitis C, hepatitis E and unclassified hepatitis based on the random effects model were 0.88 (95% confidence interval(CI): 0.78 to 0.98), 0.78 (95% CI: 0.70 to 0.86), 1.18 (95% CI: 1.11 to 1.26), 0.91 (95% CI: 0.86 to 0.97) and 0.89 (95% CI: 0.79 to 1.00), respectively. CONCLUSION:In the past 20 years, the epidemic situation of hepatitis A, hepatitis B and unclassified hepatitis has shown a significant downward trend, whereas the proportions of hepatitis C and hepatitis E among those with viral hepatitis have increased annually. The combined scaling exponent and development trends of the five types of hepatitis show significant heterogeneity. Overall, hepatitis C exhibits superlinear characteristics, whereas other types of hepatitis exhibit sublinear characteristics. Different types of hepatitis exhibit distinct epidemic characteristics and require targeted prevention and control measures.

What is already known about this topic?:Large language models (LLMs) have demonstrated considerable potential in clinical applications. However, their performance in field epidemiology, particularly within Chinese-language contexts, remains largely unexplored. What is added by this report?:This study evaluates six leading LLMs (ChatGPT-o4-mini-high, ChatGPT-4o, DeepSeek-R1, DeepSeek-V3, Qwen3-235B-A22B, and Qwen2.5-Max) using examination questions from the Zhejiang Field Epidemiology Training Program. For multiple-choice questions, all models except DeepSeek-V3 scored below the 75th percentile of junior field epidemiologists, while for case-based questions, LLMs generally outperformed that percentile. However, LLMs demonstrated significant limitations when addressing questions requiring specialized knowledge. Notably, LLMs may generate inaccurate or fabricated references, presenting substantial risks for inexperienced practitioners. What are the implications for public health practice?:LLMs demonstrate promising potential for supporting epidemiological investigations. Nevertheless, current LLMs cannot replace human expertise in field epidemiology. Their practical implementation faces considerable challenges, including ensuring output accuracy and reliability. Future efforts should prioritize optimizing performance through verified knowledge databases and establishing robust regulatory frameworks to enhance their effectiveness in public health applications.

Introduction:This study presents empirical evidence from the implementation of an automated infectious disease warning system utilizing multi-source surveillance and multi-point triggers in Yuhang District, Hangzhou City, Zhejiang Province, so as to provide reference for more extensive practice of infectious disease surveillance and early warning in the future. Methods:The data were obtained from the Health Emergency Intelligent Control Platform of Yuhang District from January 1 to April 30, 2024, encompassing warning signal issuance and response documentation. Descriptive epidemiological method was used to analyze the early warning signals. Results:From January 1 to April 30, 2024, the Health Emergency Intelligent Control Platform in Yuhang District generated 4,598 valid warning signals, with a warning signal positive rate of 36.43%. The early warning system detected 71 infectious disease outbreaks reported through the Intelligent Control Platform, including 24 single-source early warning and 47 multi-source early warning. The sensitivity was 78.02%, demonstrating improved performance compared to existing infectious disease surveillance and warning systems. Conclusions:This represents the first domestic publication evaluating an automated multi-source surveillance and multi-point trigger warning system. By integrating and correlating multi-source data, the system can efficiently and accurately detect warning signals of infectious disease incidents, which has significant practical implications for early surveillance, warning, and management of infectious diseases.

By the end of the 20th century, China had transitioned into an aging society. With the aging population, the health problems of older adults have become a central concern for both families and society. Identifying and addressing these health issues is of paramount importance. The main objective of this study was to investigate the health and well-being of Chinese older adults aged ≥ 60 years. A cross-sectional design was employed, and 16,276 participants from 11 non-randomly selected counties in Zhejiang Province were enrolled in the Zhejiang Healthy Aging Cohort Study. The analysis included a wide range of variables, such as demographic characteristics, family status, social support, medical history, health behaviors, dietary habits, depressive symptoms, activities of daily living, and cognitive function. The results highlighted several significant health challenges among older adults, including a high prevalence of abdominal obesity, limited educational attainment, low income, insufficient physical activity, and inadequate nutritional intake. Additionally, 38.9

Background:The emergence of advanced diagnostic techniques and improved disease surveillance have led to increased recognition of psittacosis cases in recent years. This study aimed to characterize the epidemiological patterns and spatiotemporal distribution of psittacosis in Zhejiang Province, China, and to identify high-risk clusters through predictive modeling. Methods:We conducted a comprehensive analysis of reported psittacosis cases in Zhejiang Province from January 2019 to June 2024. Demographic characteristics and seasonal trends were systematically analyzed. Spatial epidemiological methods, including spatiotemporal distribution mapping, spatial autocorrelation analysis, and Kriging interpolation, were employed to identify disease hotspots and predict risk areas. Results:During the study period, 315 psittacosis cases were reported, with an annual average incidence rate of 0.0914 per 100,000 population, showing a significant increasing trend. The geographic distribution of cases expanded over time. More cases were reported in winter. Cases demonstrated a male predominance (sex ratio 1.1:1) with a median age of 64 years. Occupational analysis revealed farmers as the most affected group (52.4%). Spatial analysis identified significant clustering (Moran's I = 0.5428, P < 0.001), with high-incidence areas concentrated in western and central regions. Kriging interpolation predicted the highest disease risk in western Zhejiang, followed by central, southwestern and parts of northern regions. Western and southwestern regions had high risks of cluster. Conclusions:Our findings demonstrate a concerning upward trend in psittacosis incidence with expanding geographic distribution in Zhejiang Province. The identification of high-risk clusters in western, central, and northern regions provides critical evidence for targeted public health interventions, including enhanced surveillance in agricultural communities and seasonal prevention campaigns during winter months.

Determining the durability of immunity after SARS-CoV-2 infection or vaccination is critical for understanding immune protection upon reinfection and optimizing vaccine design. We measured SARS-CoV-2-specific antibodies and T-cell responses in COVID-19 convalescent patients up to 14 months after infection and COVID-19 convalescents who received two doses of BBIBP-CorV at 6-month intervals. We observed that most convalescents had durable neutralizing antibody and T-cell responses against the SARS-CoV-2 Wuhan strain at least 14 months after infection. Administering a booster dose to convalescent patients significantly increased neutralizing antibodies against the Wuhan strain, but neutralization activity against Omicron BA.1, BA.2, BA.2.12.1, and BA.4/BA.5 was significantly decreased. Six months after the first dose vaccination, the neutralizing antibody levels significantly declined and were not further enhanced by a second dose. Omicron BA.1-specific T-cell responses were detectable in most convalescent patients and were not significantly affected by vaccination. These analyses provide insights into the durability of the immune response after infection and hybrid immunization and may be relevant for future vaccine strategies.

BACKGROUND:Avian influenza is an infectious disease of birds caused by the influenza A virus, which can infect a variety of domestic,wild birds and even cross the species barrier and infect humans.To understand the contamination of avian influenza virus in the external environment of poultry in Huzhou City from 2017 to 2023 and to assess the risk of human infection with avian influenza. METHODS:A total of 3,400 environmental specimens from five types of venues in Huzhou City were collected and tested for influenza A virus nucleic acid using fluorescent reverse transcription polymerase chain reaction (RT-PCR). RESULTS:From 2017 to 2023, with 15.44% overall positive rate of influenza A virus. The predominant subtype of avian influenza virus was H9 (accounting for 54.67%). The peak of positive influenza virus detection rates occurred in winter and spring seasons every year. The venue with highest positive rate was poultry slaughtering and processing plants (41.83%), followed by urban and rural live poultry markets (35.48%); among all types of specimens, the highest positive rate was detected in swab specimens from the surfaces of poultry slaughtering or display tables (47.37%), followed by wastewater from poultry washing (45.83%), and surfaces of cages (27.65%). CONCLUSION:The contamination of avian influenza virus in the poultry environment in Huzhou City is relatively severe, with diverse subtypes. There is a potential risk of human infection with avian influenza virus, and real-time monitoring of avian influenza virus in the poultry environment needs to be strengthened.

Objective To describe the trends in the incidence of hand, foot and mouth disease (HFMD) before, during, and after China's Coronavirus Disease (COVID) control policies, and to interpret the influence on HFMD incidence at different control stages in Zhejiang Province.Methods We collected data on HFMD cases in Zhejiang between 2014 and 2023. We compared the constituent ratios of cases at different COVID control stages by sex, age, child groups, and pathogens and weekly seasonal indices to observe seasonal variations in the incidence of HFMD. An interrupted time-series segmented regression analysis was applied to estimate the influence on HFMD incidence at different control stages. Stratified and sensitivity analyses were conducted to validate the findings.Results A considerable proportion of cases occurred among children living separately. The proportions of children in kindergartens or nurseries and children aged 2-4 years were relatively low at the strict control stage compared to the other three stages. Enteroviruses other than enterovirus 71 and coxsackie virus A16 were the dominant HFMD pathogens, and the proportion showed an increasing trend. The usual spring-summer peak in HMFD incidence did not occur in 2020, and the periodicity of the biennial peak was disrupted for a year. The summer peak in 2023 was higher than that in the other years, and was delayed by 3 weeks. The trend changes in weekly HFMD cases during the strict control and regular control stages were - 15% (IRR: 0.85, 95% CI: 0.81-0.89) and 17% (IRR: 1.17, 95% CI: 1.12-1.23), respectively. However, the change was not statistically significant during the reopening stage (IRR: 1.41, 95% CI: 0.34-5.88). The expected number of cases increased by 1.12 times (95% CI: 243.17, 53.45%) during the reopening stage compared to what would have occurred if the zero-COVID policy had continued in 2023.Conclusion Non-pharmaceutical interventions (NPIs) for COVID-19 control can mitigate HFMD. However, after the dynamic zero-COVID policy ended, the HFMD incidence returned to historical levels. Strict NPIs such as traffic restrictions and kindergarten closures cannot be sustained long-term. NPIs such as improving personal hygiene for routine prevention are highly recommended.

IntroductionDepressive symptoms are often experienced by patients with arthritis and are correlated with poor health outcomes. However, the association between depressive symptoms and multidimensional factors (sociodemographic characteristics, health conditions, health behaviors, and social support) among older patients with arthritis in China remains poorly understood. This study aimed to explore the prevalence of depressive symptoms in older patients with arthritis in eastern China and identify the associated factors.MethodsWe analyzed data of 1,081 older patients with arthritis using secondary data from 2014 to 2020 from a community-based ongoing study initiated in 2014 in eastern China. The prevalence of depressive symptoms was calculated, and univariate and multilevel logistic regression analyses were used to identify the associated factors.ResultsThe mean age of older patients with arthritis was 69.16 ± 7.13 years; 42.92% were men and 57.08% were women. The prevalence of depressive symptoms in older patients with arthritis was 14.99% (95% confidence interval: 12.91–17.26%), about 1.8 times higher than that in older adults without arthritis (8.49%, p < 0.001). Multilevel logistic regression identified perception of poor economic status (odds ratio [OR] = 5.52, p < 0.001), multimorbidity (OR = 1.96, p = 0.001), limitations in activities of daily living (OR = 2.36, p = 0.004), and living alone (OR = 3.13, p = 0.026) as factors positively associated with depressive symptoms. Patients diagnosed with arthritis at an older age had lower odds of experiencing depressive symptoms (OR = 0.67, p = 0.046).ConclusionScreening for depressive symptoms is essential among older patients with arthritis, especially those who perceive themselves as having a poor economic status, are diagnosed at an earlier age, have multimorbidity, have limitations in activities of daily living, and live alone. The associations of age at arthritis diagnosis and dietary behaviors with depressive symptoms require further research.

Fine particular matter (PM2.5) has been associated with dementia, but limited information is available regarding the association between PM2.5 components and dementia. We aimed to identify the major components of PM2.5 that affect cognitive function to further investigate its mechanism of action, and develop a prevention strategy for dementia. In this study, we included 7804 participants aged ≥ 60 years recruited from seven counties in Zhejiang province, eastern China. The participants completed the baseline survey between 2014 and 2015, and were followed up until the end of 2020. We adopted single-component robust Poisson regression models for analyses, and estimated relative risks and 95

BackgroundChina is one of the main epidemic areas of scrub typhus, and Zhejiang Province, which is located in the coastal area of southeastern China, is considered a key region of scrub typhus. However, there may be significant bias in the number of reported cases of scrub typhus, to the extent that its epidemiological patterns are not clearly understood. The purpose of this study was to estimate the possible incidence of scrub typhus and to identify the main driving components affecting the occurrence of scrub typhus at the county level.MethodsData on patients with scrub typhus diagnosed at medical institutions between January 2016 and December 2023 were collected from the China Disease Control and Prevention Information System (CDCPIS). The kriging interpolation method was used to estimate the possible incidence of scrub typhus. Additionally, a multivariate time series model was applied to identify the main driving components affecting the occurrence of scrub typhus in different regions.ResultsFrom January 2016 to September 2023, 2,678 cases of scrub typhus were reported in Zhejiang Province, including 1 case of reported death, with an overall case fatality rate of 0.04%. The seasonal characteristics of scrub typhus in Zhejiang Province followed an annual single peak model, and the months of peak onset in different cities were different. The estimated area with case occurrence was relatively wider. There were 41 counties in Zhejiang Province with an annual reported case count of less than 1, while from the estimated annual incidence, the number of counties with less than 1 case decreased to 21. The average annual number of cases in most regions fluctuated between 0 and 15. The numbers of cases in the central urban area of Hangzhou city, Jiaxin city and Huzhou city did not exceed 5. The estimated random effect variance parameters σλ2, σϕ2, and σν2 were 0.48, 1.03 and 3.48, respectively. The endemic component values of the top 10 counties were Shuichang, Cangnan, Chun’an, Xinchang, Pingyang, Xianju, Longquan, Dongyang, Yueqing and Qingyuan. The spatiotemporal component values of the top 10 counties were Pujiang, Anji, Pan’an, Dongyang, Jinyun, Ninghai, Yongjia, Xiaoshan, Yinwu and Shengzhou. The autoregressive component values of the top 10 counties were Lin’an, Cangnan, Chun’an, Yiwu, Pujiang, Longquan, Xinchang, Luqiao, Sanmen and Fuyang.ConclusionThe estimated incidence was higher than the current reported number of cases, and the possible impact area of the epidemic was also wider than the areas with reported cases. The main driving factors of the scrub typhus epidemic in Zhejiang included endemic components such as natural factors, but there was significant heterogeneity in the composition of driving factors in different regions. Some regions were driven by spatiotemporal spread across regions, and the time autoregressive effect in individual regions could not be ignored. These results that monitoring of cases, vectors, and pathogens of scrub typhus should be strengthened. Furthermore, each region should take targeted prevention and control measures based on the main driving factors of the local epidemic to improve the accuracy of prevention and control.

Abstract Purpose Smoking is a risk factor for sarcopenia. Nevertheless, few studies analyzed the independent effects of various smoking dimensions (duration, intensity, cumulative dose) on sarcopenia risk. This is a cross-sectional study based on an older population in Zhejiang Province to determine which smoking dimensions are mainly important for sarcopenia risk and to explore the dose–response relationship between them. Methods Our study included 783 patients with sarcopenia and 4918 non-sarcopenic individuals. Logistic regression and restricted cubic with logistic regression (for nonlinear dose effects) were used to obtain odds ratios (ORs) and 95% confidence intervals as well as restricted cubic splines (RCS) curves. Results Compared with never-smokers, current smokers had an increased risk of sarcopenia (OR = 1.786; 95% CI 1.387–2.301) after adjusting for confounders such as age, sex, education, alcohol consumption, disease history, etc. There was no significant association between smoking intensity and sarcopenia after more than 20 cigarettes per day (OR = 1.484; 95% CI 0.886–2.487), whereas the risk of sarcopenia increased significantly with increasing duration of smoking after more than 40 years (OR = 1.733; 95% CI 1.214–2.473). Meanwhile, there was a significant non-linear dose–response relationship between smoking duration or intensity and the risk of sarcopenia. However, the risk of sarcopenia increased linearly with the number of pack-years of smoking, which is not a significant nonlinear dose–response relationship. Conclusions This study indicated the association between smoking and sarcopenia. Both smoking duration and cumulative dose were significantly and positively associated with sarcopenia. These findings reflect the important role of the number of years of smoking in increasing the risk of sarcopenia and provide scientific evidence that different smoking dimensions may influence the risk of the sarcopenia.

目的 分析自2022年3月以来浙江省本土新型冠状病毒感染(新冠)聚集性疫情流行病学特征.方法 收集2022年3月3日至5月8日浙江省本土新冠聚集性疫情的流行病学调查资料,采用描述性流行病学方法进行分析.结果 262起疫情波及11个市的71个县(市、区),累计报告确诊病例668例,无症状感染者866例.局部空间自相关分析显示,嘉善县、平湖市、海宁市、临平区、余杭区、拱墅区、上城区和婺城区存在热点聚集性.本次疫情由上海市输入并导致关联疫情占72.90％;50例以上规模疫情持续时间为7～15 d,10 d左右控制动态基本再生数(Rt)＜1.结论 本轮疫情主要发生在嘉兴市和杭州市,大部分是外省输入病例引起的关联疫情;疫情R,控制在1以下的时间越早,规模越小,疫情持续时间越短.

Background Accumulating evidence showed that dietary habits might modify the risk of depression. This study aimed to evaluate the longitudinal association of egg consumption with depressive symptoms in the Chinese elderly. Methods We analyzed the data from Zhejiang Ageing and Health Cohort Study including 8289 participants. The Patient Health Questionnaire-9 scale (PHQ-9) was used to assess depressive symptoms at baseline and three waves of follow-up (2015, 2016, and 2019–2020). A PHQ-9 cut-off score ≥ 5 was used to define depressive symptoms. The participants with depressive symptoms at baseline were excluded. Egg consumption was evaluated through the diet habits section of the baseline questionnaire. Self-reported egg consumption was measured as the number of eggs per week and categorized into three categories. Log-binomial regression models with Generalized Estimating Equations were utilized to evaluate the association of egg consumption with depressive symptoms and estimate relative risks (RRs). Results The mean age of included participants was 68.6 years. After 6 years of follow-up, 1385 (16.7%) participants were indicated with depressive symptoms by PHQ-9 at least once. Compared with non-consumers or less-than-weekly consumers, participants consuming < 3 eggs/week and ≥ 3 eggs/week had 30% (RR = 0.70, 95%CI 0.62–0.80) and 38% (RR = 0.62, 95%CI 0.54–0.71) lower risks of depressive symptoms, respectively. A linear association was confirmed (P for trend < 0.01), and each egg increment per week was associated with a 4% lower risk of depressive symptoms (RR = 0.96, 95%CI 0.93–0.99). Sensitivity analyses yielded consistent results to the main analyses. Conclusions Egg consumption is prospectively related to a lower risk of depressive symptoms in the Chinese elderly. More prospective studies are needed to verify the association.

BackgroundSyphilis has caused epidemics for hundreds of years, and the global syphilis situation remains serious. The reported incidence rate of syphilis in Zhejiang Province has ranked first in the province in terms of notifiable infectious diseases for many years and is the highest in China. This study attempts to use the scaling law theory to study the relationship between population size and different types of syphilis epidemics, while also exploring the main driving factors affecting the incidence of syphilis in different regions.MethodsData on syphilis cases and affected populations at the county level were obtained from the China Disease Control and Prevention Information System. The scaling relationship between different stages of syphilis and population size was explained by scaling law. The trend of the incidence from 2016 to 2022 was tested by the joinpoint regression. The index of distance between indices of simulation and observation (DISO) was applied to evaluate the overall performance of joinpoint regression model. Furthermore, a multivariate time series model was employed to identify the main driving components that affected the occurrence of syphilis at the county level. The p value less than 0.05 or confidence interval (CI) does not include 0 represented statistical significance for all the tests.ResultsFrom 2016 to 2022, a total of 204,719 cases of syphilis were reported in Zhejiang Province, including 2 deaths, all of which were congenital syphilis. Latent syphilis accounted for 79.47% of total syphilis cases. The annual percent change (APCs) of all types of syphilis, including primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis, were − 21.70% (p < 0.001, 95% CI: −26.70 to −16.30), −16.80% (p < 0.001, 95% CI: −20.30 to −13.30), −8.70% (p < 0.001, 95% CI: −11.30 to −6.00), −39.00% (p = 0.001, 95% CI: −49.30 to −26.60) and − 7.10% (p = 0.008, 95% CI: −11.20 to −2.80), respectively. The combined scaling exponents of primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis based on the random effects model were 0.95 (95% CI: 0.88 to 1.01), 1.14 (95% CI: 1.12 to 1.16), 0.43 (95% CI: 0.37 to 0.49), 0.0264 (95% CI: −0.0047 to 0.0575) and 0.88 (95% CI: 0.82 to 0.93), respectively. The overall average effect values of the endemic component, spatiotemporal component and autoregressive component for all counties were 0.24, 0.035 and 0.72, respectively. The values of the autoregressive component for most counties were greater than 0.7. The endemic component of the top 10 counties with the highest values was greater than 0.34. Two counties with value of the spatiotemporal component higher than 0.1 were Xihu landscape county and Shengsi county. From 2016 to 2022, the endemic and autoregressive components of each county showed obvious seasonal changes.ConclusionThe scaling exponent had both temporal trend characteristics and significant heterogeneity in the association between each type of syphilis and population size. Primary syphilis and latent syphilis exhibited a linear pattern, secondary syphilis presented a superlinear pattern, and tertiary syphilis exhibited a sublinear pattern. This suggested that further prevention of infection and transmission among high-risk populations and improvement of diagnostic accuracy in underdeveloped areas is needed. The autoregressive components and the endemic components were the main driving factors that affected the occurrence of syphilis. Targeted prevention and control strategies must be developed based on the main driving modes of the epidemic in each county.

Objective To investigate the factors affecting cataract among the elderly, so as to provide insights into cataract control. Methods Based on the major public health monitoring project of Zhejiang Province, residents at ages of60 years and older were selected from 7 districts（counties） using a multi-stage stratified cluster random sampling method, and were followed up every other year from 2014 to 2020. Demographics, lifestyle, dietary habits and cataract incidence were collected, and factors affecting the incidence of cataract were identified using a multivariable Cox proportional hazard regression model. Results Totally 9 642 residents were investigated, with a mean age of（68.89±7.39） years,and including 4 635 males（48.07%）. There were 828 incident cataract cases, with an incidence rate of 20.946/1 000person-years. Multivariable Cox proportional hazard regression analysis showed that women（HR=1.695, 95%CI: 1.377-2.088）, age of 65 years and older（HR=1.707-5.044, 95%CI: 1.400-7.327）, overweight/obesity（HR=1.313, 95%CI: 1.131-1.524）, educational level（primary school, HR=1.642, 95%CI: 1.400, 1.926; junior high school, HR=1.553, 95%CI: 1.148-2.102）, annual family income（10 000 to 50 000 Yuan, HR=1.353, 95%CI: 1.155-1.585; 50 000 to 100 000 Yuan, HR=0.663, 95%CI: 0.500-0.881; 100 000 to 150 000 Yuan, HR=0.340, 95%CI: 0.204-0.565）, smoking（HR=0.649, 95%CI:0.494-0.853）, frequency of vegetable intake of ＞3 days/week（HR=0.693, 95%CI: 0.527-0.912）, frequency of fruit intake of ＞3 days/week（HR=0.833, 95%CI: 0.694-0.899）, frequency of egg intake of ＞3 days/week（HR=0.579, 95%CI:0.450-0.745）, frequency of soy products intake of ＞3 days/week（HR=0.706, 95%CI: 0.588-0.849）, frequency of dairy products intake of ＞3 days/week（HR=1.510, 95%CI: 1.199-1.901） and frequency of nut intake of ＞3 days/week（HR=1.733, 95%CI: 1.162-2.586） were statistically associated with the development of cataract among the elderly. Conclusion Gender, age, body mass index, educational level, income, smoking, and frequency of vegetables, fruits, eggs, soy products, dairy products and nuts intake are associated with the development of cataracts.