BACKGROUND:Amid rapid urbanisation, the health effects of the built-environment have been widely studied, while research on elderly-supportive infrastructure and its interaction with PM2.5 (PM, Particulate Matter) exposure remains limited. OBJECTIVES:To examine the effect of PM2.5 on cardiovascular hospitalisation risk among the elderly and the moderating role of elderly-supportive infrastructure in Wuhan, a city undergoing rapid urbanisation. METHODS:A time-stratified case-crossover design was adopted in which the K-means cluster analysis was applied to categorize elderly-supportive infrastructure. The correlation of PM2.5 with cardiovascular hospitalisations and the moderating role of elderly-supportive infrastructure were elucidated through the conditional logistic regression and z-test. Nonlinear relationships among variables were determined using restricted cubic splines. RESULTS:173,486 case days and 589,188 control days were included. The cumulative lag effect of PM2.5 increased over time, peaking at 5 days. For every 10 µg/m3 increase in PM2.5, the risk of hospitalisation rose by 1.5% (OR = 1.0150, 95% CI: 1.0113-1.0190). The aforementioned effect of PM2.5 exposure on health did not differ among varying levels of elderly-supportive infrastructure within a 300 m buffer zone. When the buffer zone was extended to 500 and 1000 m, a higher level of elderly-supportive infrastructure mitigated the adverse effects of short-term PM2.5 exposure on cardiovascular hospitalisations (p = 0.013), particularly for stroke (p = 0.017) and ischaemic heart disease (p = 0.026). CONCLUSIONS:Our findings suggest that high-level elderly-supportive infrastructure may protect against the adverse effects of PM2.5 on cardiovascular hospitalisation, highlighting the need to optimize elderly-supportive infrastructure for its health benefits in the elderly.

BackgroundBody Mass Index (BMI) and grip strength are potentially important risk factors for falls among the older adults. Currently, there is no consensus on the combined effects of grip strength and BMI on falls in the older adults, particularly among the Chinese older adults.ObjectiveTo investigate the incidence of falls among older adults in China and explore the association between BMI and grip strength and the risk of falls in older adults.MethodsData of participants over 60 in China Health and Retirement Longitudinal Study in 2011 and 2013 were collected. Sociodemographic variables, lifestyle, chronic disease status, history of falls and depression and cognitive status were obtained through the 2011 baseline questionnaire. Height, weight and grip strength were collected from a unified physical examination in 2011. Falls during the follow-up period were obtained through the follow-up questionnaire in 2013. Logistic regression was used to explore the association between BMI and grip strength and the risk of falls.ResultsThree thousand six hundred and eighty-five participants over 60 (67.14 ± 6.08) were included, with a fall incidence rate of 17.37%. The fall incidence rate in females (21.15%) was higher than that in male (13.46%). After adjusting covariates, high grip strength was associated with lower falls risks in general population (OR = 0.76; 95 CI: 0.630–0.923) and males (OR = 0.68; 95 CI: 0.503–0.919). Underweight was associated with lower falls risks in general population (OR = 0.77; 95 CI: 0.595–0.981) and females (OR = 0.69; 95 CI: 0.486–0.962) compared to the normal BMI group. Compared with the low grip strength group, females with high grip strength (OR = 0.54; 95 CI: 0.29–0.98) had a lower risk of falls in the underweight BMI group and males with high grip strength (OR = 0.63; 95 CI: 0.43–0.92) had lower risk of falls in the normal BMI group.ConclusionsHigh grip strength and underweight BMI are independently correlated with a lower fall risk, which varies between males and females.

We aimed to investigate and summarize dietary patterns and explore the association between dietary patterns and metabolic syndrome (MS) and its components among adult residents in a rapidly urbanized city. We employed a multi-stage random sampling method to select 1000 adult residents who underwent a comprehensive survey, including questionnaires, physical examinations, and laboratory tests. The diagnosis of metabolic syndrome was made when the participant met 3 or more of the 5 criteria outlined in the “2017 Chinese Guidelines for the Prevention and Treatment of Type 2 diabetes.” Factor analysis and a nonconditioned logistic regression model were used. Nine hundred seventy-five participants with a mean (SD) age of 41.08 (11.06) were included. The prevalence of metabolic syndrome was 19.4% (n = 189). Significant differences were observed between the MS and non-MS groups in terms of patient characteristics in terms of sex (P < .001), age (P < .001), education (P < .001), marital status (P = .025), smoking (P < .001), and alcohol consumption (P = .044). Three dietary patterns were summarized: traditional, coastal, and meat. The coastal pattern was associated with a significantly lower prevalence of MS (P < .001), elevated blood pressure (P < .001), and high triglyceride levels (P = .03). However, in the multivariate analysis, we found no significant associations between dietary patterns and MS or its components after adjusting the demographic characteristics and behaviors, even when the P-value was close to .05. In this study, we did not find an association between dietary patterns and MS and its components after adjusting covariates as much as possible in Pingshan, Shenzhen, a rapidly urbanized city, but underscore the potential health benefits of the coastal dietary pattern, which highlights the importance of conducting further research for a comprehensive understanding.

BackgroundDiurnal temperature range (DTR) is closely associated with cardiovascular health in the elderly, but there is a lack of research on the relationship between DTR and ischemic heart disease (IHD) in the elderly. ObjectiveTo investigate the effect of DTR on daily hospital admissions for IHD in people 65 years and older in Wuhan. MethodsThe study obtained data on elderly inpatients with IHD from all secondary and tertiary hospitals in Wuhan between January 1, 2017 and December 31, 2018, along with synchronous meteorological and air pollution data. Daily DTR was calculated as the difference between the maximum and minimum temperatures in a day. We employed distributed lag nonlinear models based on quasi-Poisson distribution to analyze the association between DTR and hospitalization risk in individuals aged 60 years and above. We assessed the extreme effects of DTR by selected DTR percentiles (the 1st percentile, P1: 1.8 ℃; the 5th percentile, P5: 2.9 ℃; the 95th percentile, P95: 14.3 ℃; and the 99th percentile, P99: 16.2 ℃) on hospitalization for IHD in the elderly population. Additionally, we conducted stratified analyses by gender, age (60-74 years and ≥75 years) and different subtypes (acute IHD and chronic IHD) to investigate the effects of DTR on hospitalizations for IHD across different genders, ages, and subtypes. ResultsThis study included a total of 64212 first-time IHD hospitalizations among individuals aged 65 years and above in Wuhan from 2017 to 2018. The results showed a "J"-shaped exposure-response relationship between DTR and the cumulative risk of IHD hospitalization with a lag of 7 d; the optimal DTR was 5.0 ℃, and as DTR increased or the lag time lengthened, the risk of hospitalization for IHD in the elderly population increased. Extremely high DTR (P99: 16.2 ℃) had a significant impact on the day of exposure (lag 0), with a cumulative RR of 1.58 (95%CI: 1.25, 1.99) at a lag of 7 d. The overall effects of DTR on IHD for different genders, ages, and subtypes of IHD exhibited similar patterns to the effects for overall population. High DTR had a significantly higher impact on hospitalization for chronic IHD (RR=1.46, 95%CI: 1.20, 1.79), compared to acute IHD (RR=1.29, 95%CI: 1.04, 1.61). At a cumulative lag of 7 d, elderly individuals aged 60-74 (RR=1.78, 95% CI: 1.30, 2.42) were more affected by high DTR in terms of IHD hospitalizations compared to those aged ≥75 (RR=1.35, 95% CI: 1.08, 1.70). ConclusionHigh DTR significantly increases the risk of hospitalization for IHD among elderly individuals. The effect of high DTR is particularly pronounced in patients with chronic IHD and elderly individuals aged 60–74 years.

BACKGROUND:Induced abortion, as a legal medical practice in China, has an enormous negative impact on women's sexual and reproductive health. After the implementation of the three-child policy, guiding women to choose appropriate contraceptive measures to protect their fertility is the focus of China's family planning. But little is known about the impact of the family planning policy on women's contraceptive behaviour. METHODS:We collected 7022 cases who underwent abortion between July 2020 and June 2022 in Wuhan. Based on the time of implementation of the policy, the study population was divided into two groups, namely, the pre-policy group (before July 2021, Group 1) and the post-policy group (after July 2021, Group 2). Logistic regression was used to analyse the effect of the policy on women's choice of different contraceptive methods for abortion. RESULTS:There were a total of 3487 cases in Group 1, accounting for 49.65%, and 3535 cases in Group 2, accounting for 50.34%. The proportion of women choosing efficient contraceptive methods after the Three-Child Policy decreased compared with before. A correlation was observed between the implementation of the Three-Child Policy and whether to choose efficient contraceptive methods after abortion (p < 0.001). CONCLUSION:The study has found that after the Three-Child Policy, women opting for induced abortion tend to prefer less effective contraceptive methods, particularly condoms. There is a marked shift towards more effective contraception methods both before and after the implementation of the Three-Child Policy.

对某汽车制造企业2021年在岗的796名工人进行职业健康检查,收集体检数据,并对体检结果进行分析评价,为汽车制造企业工人的健康管理和健康企业的建设提供参考.结果显示,研究对象中,必检项目出现异常的工人有392人,异常率49.25％.全体工人和彩超必检工人彩超异常检出率均随年龄增加呈上升趋势,均为31～35岁工人异常率最高,差异有统计学意义(全体工人:x2=21.08,P＜0.01;必检工人:x2=9.64,P＜0.05);总装车间心电图异常检出率最高,为27.66％(x2=9.21,P＜0.05);喷漆工血常规异常检出率最高,为18.75％(x2=16.94,P＜0.05);接苯作业工人单核细胞值低于非接苯作业工人(t=2.13,P＜0.05),油漆车间工人的单核细胞值为四车间最低(F=4.99,P＜0.05);血清ALT异常检出率随年龄和工龄的增加呈上升趋势,年龄＞35岁及工龄为6.1～9年的工人异常率最高,差异有统计学意义(年龄:x2=11.76,P＜0.05;工龄:x2=9.63,P＜0.05);接触电焊弧光的工人视力异常检出率较不接触的工人低,差异有统计学意义(x2=4.61,P＜0.05).提示,汽车制造企业及工人应注重职业健康管理及防护,应注意高龄工人肝功能及彩超异常情况、喷漆工及接苯作业工人血液系统可能受到的不良影响、总装车间工人心血管系统健康情况及电焊作业工人视力健康情况.

Objective To analyze the association between nap duration and the occurrence of depressive symptoms in middle-aged and older adults. Methods Information on middle-aged and older adults aged 45 years and older from the 2011 China Health and Retirement Longitudinal Study（CHARLS） survey was used as baseline, and this cohort was followed until 2018 to analyze the association between different nap duration and the occurrence of depressive symptoms in middle-aged and older adults using the COX proportional risk model. Results The prevalence of depressive symptoms during follow-up in this cohort was 6.94%. The COX proportional risk model results indicated that napping duration ≥90 min/d was associated with a high risk of depressive symptoms（HR=1.14; 95%CI: 1.02-1.29）, subgroup analysis showed that napping duration ≥90 min/d（HR=1.30; 95%CI: 1.11-1.53） in men, napping duration of 60-89 min/d（HR=1.14; 95%CI: 1.01-1.29） and ≥90 min/d（HR=1.17; 95%CI: 1.02-1.34） in the 45-64 years old group were associated with a high risk of depressive symptoms. Conclusion Nap duration is associated with the occurrence of depressive symptoms in middle-aged and older adults, especially in men and in middle-aged groups.

Objective To analyze the research hotspot and development trend of tiered health care system of type 2 diabetes in China. Methods The relevant research in the field of the tiered health care system of type 2 diabetes in China was sorted out and summarized by using CNKI,WanFang, VIP and Web of Science databases as search objects, and the relevant literature collected between January 1,2009,and September 28,2022,was searched.CiteSpace was used to describe the number of articles published, high-frequency keywords, emerging words, and trends. Results A total of 147 valid papers were included.The overall volume of related articles published showed an upward trend.After visual analysis, nine clusters were obtained, including family doctors, tiered health care system, health service system, and primary care.In the past two years, the research trends were mainly focused on primary care, general practitioners, specialist nurses, and quality of survival. Conclusion Research hotspots are focused on the areas of hierarchical diagnosis and treatment, primary care, family doctors, and community health services, with the words "medical association" and "specialist nurse" emerging in the past two years.In the future, research should be devoted to improving the tiered health care system of type 2 diabetes and opening up a multi-level cooperative research model, so as to effectively bring into play the advantages and effects of the tiered health care system.

Introduction: Theories of epidemiological transition remind the emerging challenge of major non communicable diseases, among which ischemic heart disease (IHD) has been one of the primary global public health issues. However, the influences of built environment (BE) factors on IHD risk have not been fully investigated. Therefore, there is a need to validate the association between community BEs and IHD risk. Method: Multi-source data aggregated in 1025 communities in Wuhan, China, were adopted to explore the related BE-health nexus. A rich variety of BE factors on the community level, including community attributes, urban form and configuration, facilities, landscape, and location, were systematically employed for modeling with the advanced Bayesian conditional autoregressive model. Result: The influences of a series of community BEs on IHD risk were identified. Among them, proportion of seniors, FAR, and distance to public transportation, presented positive association with IHD risk, whereas communities with open space ratio, greenness, healthy food accessibility, and sport facilities, presented lower IHD risk. Conclusion: By combining advanced methods and multi-source data, this study deepened the understanding of the multiplicity of health-related BEs on IHD risk. Based on the findings, the idea of planning as a tool for proactive health intervention was emphasized along with specific planning strategies for optimizing resource allocation and promoting healthy development. This study contributed to the existing literature by not only validating important factors but also enriching classic theories and global experience.

目的 了解"厦门山海健康步道"的使用情况、使用者身体活动现状及影响因素,为指导健康步道建设提供参考依据.方法 2021-01/02采用偶遇抽样的方法,对健康步道沿线出入口共591名步道使用者采用拦截式调查的方式填写问卷,并综合运用SPSS 22.0软件对问卷数据进行描述性统计、x2检验和Logistic回归分析.结果 调查共获得有效问卷586份,结果显示:46.9％(275/586)的被调查者每周有3～5 d使用步道,28.30％(166/586)的人每周有1～2 d使用步道,身体活动活跃人数189人(32.25％).全年龄段使用者以快走为主的人数比例均高于采用散步和慢跑的方式.不同性别(x2=21.780,P＜0.001)、年龄(x2=60.522,P＜0.001)、文化程度(x2=12.518,P=0.002)、职业(x2=35.515,P＜0.001)以及婚姻状态(x2=6.299,P=0.012)的身体活动水平差异均有统计学意义.Logistic回归分析结果显示:环境美化情况更好(OR=18.708,95％CI:6.925～50.543)、交通情况越好(OR=1.398,95％CI:1.084～1.802)、治安情况更好(OR=0.093,95％CI:0.047～0.184)、感知益处更多(OR=4.842,95％CI:2.962～7.915)、家人支持更多(OR=3.738,95％CI:2.071～6.747),步道使用者身体活动更加活跃.结论 步道环境、感知益处以及家人支持都对步道使用者身体活动有重要影响,可以从宣传教育、规划设计、硬件配套等方面进一步提升和改进,提高步道吸引力,满足公众健康生活需要.

This study aimed to use a structural equation model (SEM) to determine the association between parental support and moderate to vigorous physical activity (MVPA) among Chinese adolescents and whether the availability of physical activity (PA) resources in the home environment and autonomous motivation of adolescents mediated the association. Data were collected using questionnaires extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study. A final analytical sample of 3738 adolescents was enrolled. A SEM was performed to evaluate the hypothesized associations. It was found that parental support was not only positively directly but also indirectly associated with MVPA in Chinese boys through the home environment (i.e., availability of PA resources) and the autonomous motivation of adolescents. It is worth noting that the above relationships also exist in Chinese girls, except for the regulatory role of autonomous motivation. These findings suggest that future interventions for increasing adolescents' MVPA should focus on health education for parents to provide more PA resources in the home environment and adequately mobilize children's autonomous motivation.

Objectives: The aims of this study were to assess trends in maternal age in central China and to examine the relationship between maternal age and adverse pregnancy outcomes. Study design: This was a retrospective and observational study. Methods: Data were analysed from the Wuhan Maternal and Child Health Management Information System, which included all pregnant women who were at 24-42 weeks' gestation, with singleton pregnancies and who lived in Wuhan between 2010 and 2017. Joinpoint regression was used to analyse the trends in mean maternal age and the proportion of women with advanced maternal age. Adverse pregnancy outcomes, including pregnancy-induced hypertension (PIH) disorder, gestational diabetes mellitus (GDM), caesarean delivery, postpartum haemorrhage, preterm birth, small for gestational age, large for gestational age (LGA) and 5-min Apgar score <7 among women aged <20, 20-24, 30-35 and >40 years were compared with women aged 25-29 years using multivariate binary logistic regression analysis and stratified analysis. Results: Among the 583,571 women included in this study, 1.2% were aged <20 years, 20.8% were aged 20-24 years, 47.9% were aged 25-29 years, 22.0% were aged 30-34 years, 6.9% were aged 35-39 years and 1.2% were aged >40 years. Between 2010 and 2017, the mean maternal age increased from 27.1 years to 29.7 years, and the proportion of women aged >35 years increased from 4.3% to 13.9%. Relative to women aged 25-29 years, women aged >30 years carried higher risks of PIH, GDM, caesarean delivery, preterm birth, LGA and 5-min Apgar score <7. Relative to older multiparous women, older nulliparous women were more likely to experience caesarean delivery, preterm birth and 5-min Apgar score <7. Conclusions: The average maternal age and the proportion of advanced maternal age showed increasing trends between 2010 and 2017, which may be related to the relaxation of the one-child policy in China. Older maternal age (>30 years) is independently associated with various adverse pregnancy outcomes. The risks of adverse pregnancy outcomes may occur earlier than the commonly used definition of advanced maternal age (>35 years) and may also differ by parity. Ensuring age-and parity-specific clinical counselling, antenatal surveillance and health interventions may significantly improve preg-nancy outcomes in older mothers. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Evidence of the acute effects of air pollutants on ischemic heart disease (IHD) hospitalizations based on the entire population of a megacity in central China is lacking. All IHD hospitalization records from 2017 to 2018 were obtained from the Wuhan Information Center of Health and Family Planning. Daily air pollutant concentrations and meteorological data were synchronously collected from the Wuhan Environmental Protection Bureau. A time-series study using generalized additive models was conducted to systematically examine the associations between air pollutants and IHD hospitalizations. Stratified analyses by gender, age, season, hypertension, diabetes, and hyperlipidemia were performed. In total, 139,616 IHD hospitalizations were included. Short-term exposure to air pollutants was positively associated with IHD hospitalizations. The age group ≥76 was at higher exposure risk, and the associations appeared to be more evident in cold seasons. PM2.5 and PM10 appeared to have greater effects on males and those without hypertension or diabetes, whereas NO2 and SO2 had greater effects on females and those with hypertension or diabetes. The risk of IHD hospitalization due to air pollutants was greater in people without hyperlipidemia. Our study provides new evidence of the effects of air pollution on the increased incidence of IHD in central China.

Background. Few studies have explored the relationship between the level of physical activity and the occurrence or prevalence of obesity and hypertension among people residing in urbanised areas. Method. A cross-sectional study involving a sample of 1,001 adults was conducted. Descriptive statistics were used to describe sociodemographic variables, physical activity levels, body mass index (BMI), and prevalence of hypertension. Logistic regression models were adopted to investigate the relationship between these factors. Results. A total of 939 respondents who provided valid responses were included. Among them, 56.5% of the participants reported engaging in high levels of physical activity. However, 40.4% of the respondents were classified as overweight or obese, and 31.9% had diagnosed hypertension. After adjusting for sociodemographic factors, logistic regression analysis revealed that physical activity levels were negatively correlated with the prevalence of BMI (OR = 0.564, 95% CI: 0.352–0.905; OR = 0.583, 95% CI: 0.375–0.907) and hypertension (OR = 0.556, 95% CI: 0.348–0.888). Conclusions. Our study confirms recent evidence regarding the amount of physical activity that is associated with lower prevalence of obesity and hypertension in Pingshan District. Furthermore, different physical activities of various intensity levels had different effects on hypertension. Residents should be encouraged to engage in physical activities and maintain a healthy weight to improve their quality of life.

武汉是国内遭受新型冠状病毒肺炎疫情冲击最为严重的城市,本文基于武汉中心城区的确诊病例数据,对确诊小区地理位置信息进行空间化处理,利用核密度分析对COVID-19感染人群的空间分布进行估计,分析武汉中心城区的疫情分布及扩散程度.在此基础上,对研究区域进行网格化处理,运用多尺度地理加权回归模型分析了疫情与社会人口、城市形态、城市设施、城市功能等空间风险因素的关联性,揭示了这些因素的效应、影响范围和空间异质性.通过对这些空间风险因素的分析和验证,有利于在未来采取有效的城市规划和建筑设计应对手段,制定更加科学合理的防治措施.

Background The relation between neighbourhood built environment and obesity has been described as both nuanced and complex. Aim The objective of this study was to examine the relationship between the built environment, physical activity, and obesity in a rapidly urbanised area of China. Subjects and methods This is a cross-sectional study. Descriptive statistics were used to describe the socio-demographic variables, physical activity levels and BMI status. Multivariable logistic regression models were used to examine the association between neighbourhood environment, the likelihood of engaging in different types of physical activity, and BMI. Results A total of 842 respondents completed the questionnaires and were included (84.1% response rate). Among them, 56.4% reported meeting high physical activity levels, while 40.7% were overweight or obese. Multivariable regression analysis showed that better road conditions (beta = 0.122, t = 2.999, p = 0.003) and access to physical activity facilities (beta = 0.121, t = 3.193, p = 0.001) were significantly associated with higher levels of physical activity. Physical activity levels were inversely associated with the likelihood of being overweight (OR = 0.565, 95%CI: 0.3 4 9-0.917) or obese (OR = 0.614, 95%CI: 0.3 9 0-0.966). Conclusion The built environment has an important impact on physical activity. However, the direct impact of leisure physical activity on BMI is not significant. This research provides a summary of recent evidence in Pingshan District on built environments that are most favourable for physical activity and obesity.

随着人群期望寿命的增长和传统指标在反映健康水平上有所缺陷,因此健康期望寿命应运而生,该指标综合了生命的长度和质量,更全面地反应了人群的健康水平.此文梳理了健康期望寿命的提出和发展、指标群分类、常用测算方法、国内外应用实例以及国内研究现状,提出建立全国统一的测算方法,并充分利用健康大数据资源,全面评估人群健康期望寿命.

This study conducted scientific evidence linking neighbourhood built environment to adults' leisure-time physical activity (LTPA) among adults in China. Data were obtained from a questionnaire survey conducted from April to July 2017 among 1002 adults aged 18-69 years old in Pingshan District, Shenzhen, China. Chinese Walkable Environment Scale for urban community residents and International Physical Activity Questionnaire were used to measure participants' neighbourhood built environment and leisure-time physical activity, which was categorised into leisure-time walking (LTW) and leisure-time moderate-to-vigorous physical activity (LTMVPA). A total of 986 participants (mean age = 40.7 years, 53.3% females) were included in this research. Descriptive statistics were used to describe the socio-demographic variables, LTW and LTMVPA by sex. Multivariable logistic regression models were used to examine the association between neighbourhood environment characteristics and the likelihood of engaging in active LTW and LTMVPA. Only 20.7% of participants engaged in active LTW and 17.8% active LTMVPA. Better road condition was associated with higher likelihood of active (at least 150 min/week) LTW and LTMVPA. High perceived esthetic was positively associated with LTW and LTMVPA. Active LTW was related to better perception of traffic condition as well. The improvement of the neighbourhood environment characteristics can promote active LTPA among adults living in Shenzhen, China. Our findings support the importance of considering population health effects in urban planning and development.

目的 充分了解《深圳经济特区控制吸烟条例》颁布于实施后公共场所人员劝阻吸烟的意愿并探讨其知信行影响因素.方法 了解龙岗区450个公共场所进行明察暗访并对525名公共场所人员劝阻吸烟的影响因素并对2017年1月—2019年6月间的控烟效果进行评价.结果 知晓控烟条例颁布与实施者占总人数的63.05％(331/525),赞成全市范围内执行公共场所禁烟及本单位室内禁烟者分别占92.76％(487/525)及90.67％(476/525).受教育水平越高,其劝阻吸烟意愿越强烈.公共场所内禁烟标志、控烟宣传资料、控烟管理制度及控烟举报投诉电话张贴率均呈逐年上升趋势.结论 控烟条例的颁布与实施对其劝阻吸烟的知信行行为发挥着积极重要的影响,公共场所禁烟政策的支持率较高.