This study aimed to examine the associations and interaction effects of perceived ageism (PA) and poor sleep quality (SQ) on frailty among community-dwelling older adults. This cross-sectional study included 4125 community-dwelling adults aged ≥ 60 from Shanghai. PA was self-reported. Participants completed the Pittsburgh Sleep Quality Index (PSQI), with a score > 5 indicating poor SQ. Frailty was assessed using a 30-item Frailty Index (FI), with participants categorized as robust (≤ 0.10), prefrail (> 0.10 and < 0.25), and frail (≥ 0.25). Both multiplicative interaction and additive interaction were evaluated. After adjusting for covariates, there was a significant multiplicative interaction between PA and PSQI score in relation to FI, indicating a stronger association between PSQI score and FI in participants reporting PA than those without (β = 0.489 [95

Background To address labor force shortages associated with population aging, many countries have proposed raising the retirement age. As health is an important determinant of employment outcomes among older workers, it is important in this context to understand the individual- and country-level factors associated with healthy working life expectancy (HWLE), defined as the average number of years individuals can expect to remain healthy and employed from age 50. Methods and findings This is a multinational prospective cohort study, leveraging data from six health and retirement cohorts. The study included 79,833 men and 95,485 women aged ≥50 years from 28 countries. Individual-level factors included demographics, socioeconomic status, lifestyle factors, and chronic diseases. Country-level factors comprised economic (GDP per capita, health expenditure, tax revenue, Gini index, ease of doing business), employment (flexible working Arrangements, labor force participation, equal workforce opportunities, hiring and firing practices) and governance (effectiveness, corruption control, political stability) metrics sourced from the World Bank. HWLE was estimated using discrete-time Markov multi-state models. Among the total participants, at age 50, the total life expectancy (TLE) was 33.59 years (95% CI [33.49, 33.69]), of which 10.98 years (95% CI [10.87, 11.08]) were HWLE. HWLE among women(9.82 years, 95% CI [9.68, 9.97]) was shorter than HWLE among men(12.36 years, 95% CI [12.22, 12.50]). Marriage, higher education, and healthy lifestyles were associated with longer HWLE, while chronic diseases reduced HWLE, with stroke showing the greatest reduction of 5.49 years (95% CI [4.94,6.04]). At the country level, higher health expenditures, GDP per capita, and tax revenue were associated with longer HWLE. Greater governance effectiveness, corruption control, and ease of doing business were associated with longer HWLE, whereas higher Gini index and political instability were associated with shorter HWLE. Higher levels of flexible working arrangements, labor force participation, equal workforce opportunities, and more favorable hiring and firing practices were consistently associated with longer HWLE and nHWLE and shorter nHnWLE. The main limitations were differences in follow-up periods across cohorts, relatively small samples in some countries, and incomplete global coverage, which may limit cross-country comparability and generalizability. Conclusions In this multinational cohort, the findings revealed the associations of individual- and country-level factors with healthy working lives, underscoring the necessity for measures aimed at extending healthy working lives to align with country-specific social, economic and employment contexts. Besides, interventions targeting individual modifiable risk factors should be warranted through life-course.

OBJECTIVE:To investigate the association of reproductive factors and their joint effects with lifestyle behaviours with cognitive decline in Chinese postmenopausal women. DESIGN:Community-based cohort study. SETTING:Shanghai, China. POPULATION OR SAMPLE:We prospectively followed 1379 cognitively normal postmenopausal women aged ≥ 60 years for 1.8 years on average. METHODS:Menopausal age, menarche age, parity, age at first live birth and breastfeeding duration were assessed at baseline. Associations between reproductive factors or their joint effects with lifestyle behaviours and cognitive decline were examined using logistic regression. The additive interaction was evaluated by the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). MAIN OUTCOME MEASURES:Cognitive decline was defined as an annual decline in Mini-Mental State (MMSE) Examination score exceeding mean decline by 1.0 SD. RESULTS:The ORs (95% CIs) for cognitive decline were 2.55 (1.07, 6.06) for menopausal age < 46 years and 2.32 (1.11, 4.83) for menopausal age 46-50 years compared with menopausal age > 55 years. Meanwhile breastfeeding > 35 months (2.15, 1.02-4.51) and breastfeeding 24-35 months (2.31, 1.13-4.71) had higher risks of cognitive decline than breastfeeding < 12 months. Moreover, the combination of early menopause (≤ 50 years) and insufficient vegetable intake (1.84, 1.12-3.01), physical inactivity (2.11, 1.28-3.48), suboptimal sleep duration (2.15, 1.32-3.51), or an unfavourable composite lifestyle index (CLI) (1.76, 1.06-2.94) was associated with an increased risk of cognitive decline compared with the combination of late menopause (> 50 years) and each favourable lifestyle behaviour. Similarly, prolonged breastfeeding duration (> 23 months) combined with physical inactivity (2.10, 1.23-3.59), suboptimal sleep (2.11, 1.26-3.55), or an unfavourable CLI (2.16, 1.19-3.91) showed elevated risks compared with the combination of short breastfeeding duration (≤ 23 months) and each favourable lifestyle behaviour. In addition, we found additive interactions between early menopause and physical inactivity (RERI = 1.08, 95% CI: 0.37-1.80; AP = 0.51, 95% CI: 0.19-0.83), as well as between long breastfeeding duration and physical inactivity (RERI = 0.89, 95% CI: 0.15-1.63; AP = 0.42, 95% CI: 0.07-0.78). CONCLUSIONS:Unhealthy lifestyle behaviours may exacerbate cognitive decline in women with adverse reproductive factors.

Social isolation (SI) and loneliness are prevalent worldwide; however, their associations with life expectancy and whether these associations vary across healthy lifestyle levels remain unclear. This study aimed to investigate the associations of SI and loneliness with all-cause mortality and years of life lost (YLL), and to examine whether these associations varied across healthy lifestyle levels. Data from the UK Biobank were analyzed. SI and loneliness were assessed using established questionnaire-based measures, and healthy lifestyle was evaluated using a composite score based on five modifiable lifestyle behaviors. Flexible parametric Royston-Parmar survival models were used to estimate hazard ratios (HRs) for all-cause mortality and derive YLL estimates associated with SI and loneliness, both overall and within healthy lifestyle score (HLS) strata. Compared with participants aged 40 years with no social isolation and loneliness, those with only loneliness, only social isolation, and social isolation with loneliness had estimated YLLs of 0.81[95

General practitioners’ (GPs’), attitudes to and acceptance of GP-CDSS-2.0, and the influence of GP-CDSS-2.0, a clinical decision support system for the anticoagulation treatment of non-valvular atrial fibrillation (NVAF) in primary care, on GPs were also essential to further promote GP-CDSS-2.0 after the study. The aim of the study was to identify the effect of applying GP-CDSS-2.0 in community health centers on GPs’ anticoagulation treatment knowledge-attitude-practice (KAP) for patients with AF, and to understand GPs’ perceptions and using experience of GP-CDSS-2.0. This study was a part of the whole cluster randomized controlled trial, targeting GPs, adopting a mixed method, using both quantitative and qualitative studies. It lasted from July 2022 to July 2023, conducted in 14 community health centers in Baoshan District and Jing’an District of Shanghai, China (but one community health center withdrew from the study during primary outcome analysis period). The outcome of the quantitative study was GPs’ anticoagulation treatment KAP for patients with AF, assessed by the KAP questionnaire developed by our team in previous work. Before the end of the follow-up, we interviewed GPs in the 7 community health centers of the intervention group based on the principle of saturation and covering all 7 community health centers. We recorded GPs’ attitudes to and using experience of GP-CDSS-2.0, and analyzed interview documents by thematic analysis. In the quantitative study, we enrolled 285 GPs, with 126 in the intervention group and 159 in the control group. There were no statistical differences in the baseline demographic characteristics of the two groups’ subjects. At the end of the study, the proportion of GPs at a “good” level assessed by the KAP questionnaire in the intervention group and the control group were 60.3

Objective To explore the association between self-efficacy and subjective well-being(SWB)among older adults,thus providing a scientific basis for developing measures to improve the SWB of older adults.Methods A questionnaire survey was conducted from December 2018 to December 2023 among 27 352 older adults aged 65 and above,selected via a two-stage sampling method from 146 communities in 10 cities across China.The Chinese version of the General Self-Efficacy Scale(GSES)was adopted to assess self-efficacy,and the Chinese version of the Personal Wellbeing Index for Adults(PWI-A)was used to assess SWB.A generalized linear regression model was employed to analyze the association between self-efficacy and SWB.Results The 27 352 older adults showed the average SWB score of 52.76±11.85 and the average self-efficacy score of 2.65±0.72.The generalized linear regression model showed that without controlling for other factors,older adults with self-efficacy scores in the second(Q2),third(Q3),and fourth quartiles(Q4)had SWB scores 3.8(95%CI:3.4-4.2),6.0(95%CI:5.6-6.3),and 11.0(95%CI:10.6-11.4)higher,respectively,than those with self-efficacy scores in the first quartile(Q1).After controlling for covariates,such as sex,age,and prevalence of chronic diseases,older adults with self-efficacy scores in Q2,Q3,and Q4 had SWB scores 2.5(95%CI:2.1-2.8),4.0(95%CI:3.6-4.3),and 8.2(95%CI:7.8-8.6)higher than those with self-efficacy scores in Q1.Conclusions There is a positive correlation between self-efficacy and SWB scores in older adults.Providing learning environments,psychological interventions,and improving physical health conditions can enhance the self-efficacy and SWB of older adults.

Importance:An age-friendly environment (AFE) is a key goal for healthy aging, but its association with frailty in older adults remains unclear. Objective:To examine associations of AFE perception with both frailty onset and transitions among community-dwelling older adults, using a culturally adapted AFE scale. Design, Setting, and Participants:This cohort study was conducted in Shanghai, China, from June to December 2020 (baseline period) through June to November 2023 (follow-up period). Participants 60 years or older were enrolled at baseline and completed baseline and follow-up assessments. Statistical analyses were performed from August to December 2025. Exposures:AFE perception was assessed with the 32-item Age-Friendly Community Evaluation Scale covering 6 domains: housing, transportation, built environment, social participation, social inclusion, and community and health services. Each item was rated on a 5-point Likert scale, yielding total scores ranging from 32 to 160, with higher scores indicating greater perceived community age friendliness. Demographic characteristics, health behaviors, and medical history were included as covariates. Main Outcomes and Measures:Frailty was assessed using the 30-item Frailty Index, which classified participants' frailty status as robust, prefrail, or frail. Frailty transitions included frailty progression (deterioration in frailty or death) or frailty improvement. Results:A total of 4067 participants (mean [SD] age, 71.2 [6.3] years; 2244 women [55.2%]) were included. Over the 3 years of follow-up, 1061 participants (26.1%) experienced frailty progression, while 656 of 1411 participants (46.5%) with baseline prefrail or frail status achieved frailty improvement. After adjusting for covariates, higher standardized AFE scores were associated with lower odds of frailty progression (odds ratio [OR], 0.87; 95% CI, 0.81-0.94; P < .001). Significant inverse associations were observed for all AFE domains (eg, social inclusion: OR, 0.88; 95% CI, 0.82-0.95; P = .001). However, there was no association between AFE scores and frailty improvement. Among 3658 participants with nonfrail status at baseline, 351 (9.6%) developed frailty. Higher standardized AFE scores were associated with lower odds of frailty onset (OR, 0.83; 95% CI, 0.73-0.94; P = .003). All AFE domains (except transportation and built environment) were inversely associated with frailty onset: housing (OR, 0.80; 95% CI, 0.71-0.91; P = .001), social participation (OR, 0.83; 95% CI, 0.74-0.94; P = .003), social inclusion (OR, 0.84; 95% CI, 0.74-0.95; P = .005), and community and health services (OR, 0.88; 95% CI, 0.78-0.99; P = .02). Significant nonlinear associations between AFE scores and frailty transitions or onset were not observed. Subgroup analyses showed that a monthly income less than ¥2000 Chinese yuan renminbi (approximately <US $290) moderated the association between AFE scores and frailty onset (OR, 0.44; 95% CI, 0.28-0.68). Conclusions and Relevance:In this cohort study of community-dwelling older adults, greater perception of an age friendly community environment was associated with reduced risk of frailty. These results suggest that targeted interventions focusing on comprehensive and specific AFE domains may help reduce frailty in this population.

This study evaluated the mediating effects of smoking and functional disability on the association between loneliness and mortality. This multinational cohort study harmonized longitudinal data from eight databases, including the UK Biobank, comprising 685,134 participants aged 40 years and older across three continents. Results revealed that loneliness was associated with increased all-cause mortality directly, and indirectly through smoking and functional disability. These findings highlight the imperative need for customized interventions focused on reducing smoking and mitigating functional disability to alleviate the detrimental impact of loneliness on mortality.

China’s primary care was required to improve the quality of atrial fibrillation (AF) management by government. The aim of the study was to investigate whether a clinical decision support system for non-valvular AF (GP-CDSS-2.0) affected appropriate anticoagulation of patients with AF in primary care. The study was a cluster randomized controlled study, carried out in 13 community health centers in Shanghai, China, as 1 community health center in the intervention group withdraw the study. Patients with AF who consented to take part in and finish the follow-up were enrolled. We allocated the 14 community health centers into the intervention and control groups using stratified randomization method at a ratio of 1 to 1. General practitioners in the intervention group treated patients using GP-CDSS-2.0, while those in the control group provided usual care. The proportion of appropriate anticoagulation was the primary outcome. The secondary outcomes and safety outcomes mainly included the transition rate of patients’ anticoagulation therapies and the incidences of bleeding and composite adverse outcomes. 405 patients were included in the analyses of primary outcome, with 182 in the intervention group and 223 in the control group. After 1 year’s follow-up, the proportion of appropriate anticoagulation in the intervention group was higher than that in the control group (55.2

INTRODUCTION:Cognitive impairment among older adults is a significant public health concern worldwide. This study aimed to investigate the prevalence of cognitive impairment, its correlates, and the mediating role of depressive symptoms between frailty and cognitive impairment among older adults in northeast region of China. METHODS:This was a cross-sectional study which used the intercept interview method to recruit participants. Social demographic characteristic, health-related behaviours, physical health, and functional status of the participants were collected. Univariate and multivariate analyses were conducted to correlates of cognitive impairment. Additionally, mediating effect analysis was performed using the Bootstrap tool. RESULTS:Among the 2,859 older adults included in the study, 32.4% of participants screened positive for cognitive impairment. Higher educational attainment had negative association with cognitive impairment in older adults (p < 0.05). Living in rural areas, fair/poor self-rated health, pre-frailty, frailty, having depressive symptoms, impaired activities of daily living, poor sleep quality, and inactive physical activity had positive association with cognitive impairment in older adults (p < 0.05). Furthermore, depressive symptoms exhibited a partial mediating role between frailty and cognitive impairment, with a mediating effect of 58.0%. CONCLUSIONS:Preventive measures should be implemented to address the associated factors with cognitive impairment. Promoting higher education levels, advocating for a positive and healthy lifestyle, and ensuring their physical and mental well-being among older adults are essential. Early diagnosis and proactive prevention of frailty and depressive symptoms in older adults may effectively decelerate cognitive decline.

Objective This study aims to explore individual- and country-level factors associated with loneliness’ transitions and estimate total life expectancy (TLE) and lonely life expectancy (LLE) at age 60 across 24 countries. Design This is a longitudinal study. Setting Data were drawn from five harmonized multinational cohorts. Participants This study included 61,511 older adults aged 60 and above Measurements A multistate Markov model was used to estimate the life expectancy of older adults in states of loneliness and non-loneliness, and factors associated with the state transition probabilities. Results Female, low education, multimorbidity, and psychological disorders were associated with higher risk of transitioning from “Not lonely” to “Lonely”, while physical activity was linked to recovery. Beyond individual-level factors, high GDP, civil society participation, and accessible public transport were linked to lower loneliness risk. However, civil society participation and transport access had limited effects on mortality. TLE for older adults aged 60 was 23.14 years, with a LLE of 4.31 years. Older adults in high-GDP countries had a 1.25-year longer TLE and a 2.40-year shorter LLE. Greater civil society participation was linked to a 0.75-year increase in TLE and a 2.78-year reduction in LLE. In contrast, higher urbanization was associated with a slightly longer TLE but a higher LLE. Public transport accessibility correlated with a significantly reduced LLE by 1.97 years. Conclusions This study highlights the longitudinal associations between individual behaviors, socioeconomic factors and loneliness, offering valuable insights for promoting healthy aging globally.

ObjectiveTo assess the level of health literacy and its influencing factors among middle school students aged 12‒18 years in Jing’an District, Shanghai, so as to provide a solid scientific foundation for further developing more targeted intervention measures.MethodsA stratified cluster random sampling method was used to randomly select 4 middle schools in Jing’an District, Shanghai from November to December 2023, and conducted a health literacy questionnaire survey on non-graduating middle and high school students, respectively. The 2023 Survey on the Status of Health Literacy among Middle School Students in Jing’an District, Shanghai was adopted, which consisted of two parts: health literacy and basic information. Health literacy was divided into three dimensions: health knowledge and concept literacy, healthy lifestyle and behavior literacy, and health skill literacy. Three dimensions could be categorized into six types of health literacy issue: scientific health literacy, infectious disease prevention and control literacy, chronic disease prevention and control literacy, safety and first aid literacy, basic health literacy, and health information literacy.ResultsA total of 1 161 middle school students were enrolled into this study, including 571 males and 570 females. The overall health literacy level of middle school students was 33.51%, with 34.81% among middle school students and 31.69% among high school students, respectively. Results of logistic regression analysis showed that health knowledge acquisition and awareness, as well as application frequency of health knowledge, were the influencing factors for the overall health literacy level among middle school students (P<0.05). The degree of family attention to health maintenance, health knowledge acquisition and awareness, and application frequency of health knowledge were the main influencing factors for the three dimensions and literacy of six types of health issues among middle school students (P<0.05).ConclusionThe levels of different types of health literacy among middle school students in Jing’an District are uneven, with the highest being safety and first aid literacy and the lowest being basic health literacy. It is recommended to take targeted measures to comprehensively improve the health literacy level of middle school students.

The bidirectional causality between frailty and depressive symptoms (DS) in older adults were investigated, while the potential psychological mechanism remains unclear. This study aimed to explore the mediation role of attitudes to aging (AA) in their reciprocal relationships. Data was collected from a community-based prospective cohort in Shanghai, which included 4,082 participants aged 60 and above. Frailty, DS, and AA were assessed using the Chinese Frailty Screening Scale-10, the Patient Health Questionnaire-9, and the Attitudes to Aging Questionnaire-12, respectively. A cross-lagged model was employed to investigate the reciprocal relationship between frailty and DS, as well as to estimate the mediating effect of AA. The findings revealed significant correlations between frailty, DS, and AA at both measurement points. In the cross-lagged model, after controlling for covariates, we observed a bidirectional causality between frailty and DS. Specifically, greater frailty was associated with higher levels of DS (β = 0.142, P < 0.001), and higher levels of DS similarly predicted increased frailty (β = 0.058, P = 0.006). When AA were included in the cross-lagged model, results showed that older adults with more positive AA significantly predicted lower future levels of DS (β=-0.051, P < 0.001) and frailty (β=-0.055, P < 0.001). Mediation analyses indicated that AA had a significant mediating effect (β = 0.003, P = 0.029) between DS and frailty, although this effect was not reciprocated (P = 0.242). These findings underscored the importance of promoting positive AA as preventive measures against both frailty and DS. They also provided valuable insights into the mechanisms underlying the relationship between depression and frailty in older adults.

Abstract Introduction With the increasing competition in the market, the problem of burnout is becoming more and more serious among enterprise workers, and there is a lack of evidence to support the use of participatory workplace facilitation programmes to alleviate burnout in China. Methods A randomised controlled trial was conducted to select 80 corporate employees in Minhang District, Shanghai, China as the research subjects. The intervention group was given a participatory workplace stress reduction course as an intervention, while the control group was not given any intervention. Independent samples t-tests, paired t-tests, etc. were used to compare the changes in occupational tension, burnout and the dimensions before and after the intervention in the two groups of workers. Results There were no significant changes in job stress, burnout and their dimensions before and after the intervention in the control group, and in the experimental group, the burnout score was significantly lower despite a significant increase in the job demand score, a significant decrease in the job autonomy score, and a significant increase in the job stress score before and after the intervention. Discussion In this study, job stress increased significantly in the experimental group after the intervention, which is considered to be due to the fact that the members of the experimental group entered the peak production period of the company. However, at the same time, the level of burnout decreased, which further suggests that the intervention was effective. Conclusion Participatory workplace stress reduction programmes are effective in alleviating burnout among corporate workers.

BackgroundWith the increasing aging population in China, there is a significant shortage of labor force. Delaying retirement age has become a potential method to alleviate this labor shortage. ObjectiveTo estimate the healthy working life expectancy (HWLE) of individuals aged 50 years old in China. MethodsThis study was based on data from four waves (2011—2018) of the China Health and Retirement Longitudinal Study (CHARLS). HWLE was estimated for the overall sample of individuals aged 50 years old and above and stratified by sex, educational attainment, marital status, occupation, Hukou type, and region by using continuous-time multistate modelling. ResultsA total of 50991 person-times aged ≥ 50 years and older were included in the study. The average total life expectancy of the Chinese population aged 50 years old was 29.72 years (95%CI: 29.28, 30.12 years), with a HWLE of 14.05 years (95%CI: 13.76, 14.33 years). The remaining years lived in the states of healthy but not working, not healthy but working, and not healthy and not working were 8.82 years (95%CI: 8.53, 9.15 years), 2.54 years (95%CI: 2.41, 2.68 years),and 4.30 years (95%CI: 4.08, 4.54 years), respectively. The HWLE (95%CI) of individuals in the baseline states of healthy and working, healthy but not working, not healthy but working, and not healthy and not working were 14.97 (14.69, 15.23), 10.86 (10.52, 11.22), 11.73 (11.31, 12.09), and 9.51 (9.09, 9.97) years, respectively. Additionally, women had a higher total life expectancy (95%CI) than men [31.84 (31.10, 32.54) years vs 27.98 (27.35, 28.50) years], but a lower HWLE than men [12.47 (12.12, 12.82) years vs 15.62 (15.23, 15.98) years]. There was no difference in total life expectancy between rural residents and urban residents [29.43 (28.88, 29.97) years vs 30.31 (29.47, 31.02) years], but rural residents had a higher HWLE than urban residents [15.74 (15.39, 16.10) years vs 11.38 (10.97, 11.73) years]. Residents in East China [14.66 (14.22, 15.06) years] and Central China [14.15 (13.86, 14.43) years] had a higher HWLE than residents in West China [13.61 (13.27, 13.98) years] and Northeast China [13.06 (12.51, 13.63) years]. ConclusionThe HWLE of Chinese residents supports the policy of raising the retirement age. There are differences in HWLE levels between urban and rural areas, as well as across different regions. Providing more flexible employment opportunities for older adults can help mitigate the labor shortages caused by population aging.

Background: The relationship between age-friendliness of community (AFC), mental health and sleep quality is still unclear. Method: Using a sample of Chinese older adults aged >= 60 years (N = 3099), this cross-sectional study aimed to investigate the serial mediating roles of resilience and depressive symptoms between AFC and sleep quality through structural equation modeling. Additionally, this study examined the association between each AFC dimension and sleep quality stratified by mental health, using the multivariable linear regression models. Mental health was categorized based on levels of resilience and depressive symptoms. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The AFC dimensions included housing, transportation, built environment, social participation, as well as social inclusion and health services. Results: Resilience and depressive symptoms completely mediated the relationship between AFC and sleep quality through three paths: (1) the independent mediating role of resilience or (2) depressive symptoms, and (3) the serial mediating roles of resilience and depressive symptoms. Furthermore, higher AFC and higher age-friendliness in transportation dimension as well as social inclusion and health services dimension were associated with better sleep quality among older adults with high levels of mental health. Conclusions: Resilience and depressive symptoms played serial mediating roles in the relationship between AFC and sleep quality. For older adults with low or medium levels of mental health, a community-based approach may not be recommended. Limitations: This cross-sectional study used self-reported sleep measures and could not make cause inferences.

Abstract Background Positive self-perception of aging (SPA) is a well-known predictor of longevity, while how and to what extent SPA is linked with all-cause mortality among older adults is still unclear. This study aims to elucidate the relationship between positive SPA and all-cause mortality and its potential mediators among Chinese older adults. Methods This is a 20-year dynamic cohort study conducted among 22,957 older adults aged ≥ 65 years old from a nationally representative sample. Positive SPA was measured using a validated 7-item scale. Potential mediators including health behaviors and social participation were collected using a self-reported questionnaire. Cox proportional hazards regression models were conducted to examine the association between positive SPA and all-cause mortality. A mediation analysis was conducted to determine whether health behaviors and social participation mediated the association between SPA and all-cause mortality. Results Throughout follow-up (median [interquartile range], 46 [21–84] months), all-cause mortality was 87.4%. Compared with older adults with the lowest quartile positive SPA, hazard ratio(HR) of all-cause mortality among older adults with the second, third, and fourth quartile of positive SPA was 0.96(95%CI:0.93-1.00), 0.93(95%CI:0.90–0.99), and 0.92(95%CI:0.87–0.96) respectively after controlling for all potential mediators and covariates. The mediation analysis showed that regular daily vegetable intake, physical activity, and high social participation explained 41.1-48.5% of the variance in the association between positive SPA and all-cause mortality. Conclusions In this cohort study, we found that high positive SPA was associated with decreased all-cause mortality directly, and indirectly through healthy lifestyle behaviors and social participation. These findings suggest that interventions targeted at promoting or maintaining positive SPA may contribute to healthy ageing among older adults in China.

BackgroundPast research indicates that occupational stress negatively predicts health-related productivity. Simultaneously, sleep problem among workers may stem from job stress, subsequently leading to a decline in sleep quality and resulting in reduced health productivity. Therefore, this study aims to idenitify whether the sleep quality of employees functions as a mediator in the process through which job stress impacts health productivity.ObjectivesThis study aimed to assess the status and analyze differences in quality of sleep, job stress, and health-related productivity loss (HRPL) among workers in research and development (R&D) enterprises in Minhang District, Shanghai. We also assessed the mediating effect of sleep quality on the relationship between job stress and HRPL.MethodsA total of 3,216 workers in R&D firms aged between 18 and 60 years participated in this study (mean age 35.15 years; standard deviation 8.44; male-to-female ratio≈2:1). The Nakata Insomnia Questionnaire, the Chinese version of the Brief Job Stress Questionnaire revised edition, and the Chinese version of the Work Productivity and Activity Impairment Questionnaire were used in this study. And the Kruskal–Wallis test, Hierarchical Multiple Regression Analysis, and Path Analysis were utilized for data analysis in this study.ResultsThere were significant differences in the positive detection rate of insomnia among participants according to age, educational level, marital status, position, length of service, and level of financial difficulties (all P < 0.05). We also found significant differences in the positive detection rate of HRPL among participants according to age, marital status, length of service, and level of financial difficulties (all P < 0.05); participants with insomnia scored higher for HRPL than those without insomnia (6.00 vs. 4.20, P < 0.001). Additionally, participants with job stress problems had higher HRPL than those without these issues (7.00 vs. 4.20, P < 0.001). Our findings suggest that sleep quality plays a mediating role between job stress and HRPL (all P < 0.05).ConclusionsOccupational health professionals must pay particular attention to job stress, sleep quality, and their influencing factors to positively influence the wellbeing of workers while improving productivity.

BackgroundWith the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear.MethodThis cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p < 0.05 was considered as significant.ResultsThe results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449–0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%).ConclusionDepression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.

Abstract Artificial intelligence (AI) telephone is reliable for the follow‐up and management of hypertensives. It takes less time and is equivalent to manual follow‐up to a high degree. We conducted a reliability study to evaluate the efficiency of AI telephone follow‐up in the management of hypertension. During May 18 and June 30, 2020, 350 hypertensives managed by the Pengpu Community Health Service Center in Shanghai were recruited for follow‐up, once by AI and once by a human. The second follow‐up was conducted within 3–7 days (mean 5.5 days). The mean length time of two calls were compared by paired t‐test, and Cohen's Kappa coefficient was used to evaluate the reliability of the results between the two follow‐up visits. The mean length time of AI calls was shorter (4.15 min) than that of manual calls (5.24 min, P < .001). The answers related to the symptoms showed moderate to substantial consistency (κ:.465–.624, P < .001), and those related to the complications showed fair consistency (κ:.349, P < .001). In terms of lifestyle, the answer related to smoking showed a very high consistency (κ:.915, P < .001), while those addressing salt consumption, alcohol consumption, and exercise showed moderate to substantial consistency (κ:.402–.645, P < .001). There was moderate consistency in regular usage of medication (κ:.484, P < .001).