Cardiovascular health is increasingly recognized as a key determinant of cognitive aging. The American Heart Association recently introduced Life's Essential 8 (LE8), integrating both behavioral and clinical components of cardiovascular health. However, the relative contributions of behavioral versus clinical factors to cognitive outcomes remain unclear, particularly in Chinese older adults. This study included 2,527 participants aged ≥ 65 years from the Ma'anshan Healthy Aging Cohort. Weighted linear and logistic regression models were used to examine the associations of LE8 scores with cognitive function and mild cognitive impairment (MCI). Restricted cubic spline (RCS) models were applied to assess dose–response relationships. Subgroup and sensitivity analyses were conducted. Higher LE8 scores were significantly associated with better cognitive function and lower risk of MCI. Each 10-point increase in LE8 score was associated with a 0.532-point higher MMSE score (95

Adverse childhood experiences (ACEs) and bullying victimization are risk factors for adolescent suicidal ideation, yet the interaction between ACEs and bullying victimization in affecting suicidal ideation remains inadequately explored. A retrospective cohort study was conducted among adolescents. ACEs, bullying victimization and Suicidal ideation were assessed through questionnaire survey. Logistic regression analyses were used to examine the relationship between ACEs, bullying victimization, and suicidal ideation. Interaction analyses were performed to explore the interaction of ACEs and bullying victimization on suicidal ideation. One thousand one hundred nine adolescents were included and 7.2

Fine particulate matter (PM2.5) exposure is linked to elevated fasting plasma glucose (FPG), but roles of metal constituents and mechanisms remain unclear. We examined cumulative lagged effects of short-term exposure to PM2.5 and its metal constituents on FPG in older adults, identified metal sources, and assessed whether systemic inflammation, measured by the systemic inflammation response index (SIRI), statistically mediated these associations. This 2024 longitudinal cohort enrolled 109 non-diabetic older adults from four communities in Hefei city, Anhui province, with baseline and three follow-ups measuring FPG and SIRI. PM2.5 and 19 metal constituents were estimated for the 1-7 days prior to each visit. Linear mixed-effects (LME) models were used to assess single-pollutant associations, while weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) were applied to evaluate mixture effects. Positive matrix factorization (PMF) was used to apportion metal sources, and mediation modeling was employed to examine the potential mediating role of SIRI. At lag0-3 days, each 10 μg/m³ increase in PM2.5 was associated with a 4.921% rise in FPG (95% CI: 2.138%, 7.781%). Additionally, 14 metals showed positive associations, with uranium (U), selenium (Se), and manganese (Mn) exhibiting the largest effects. WQS and BKMR indicated that Mn and cesium (Cs) were the primary contributors to the positive mixture effect. PMF attributed Mn to fuel oil combustion and Cs to coal combustion. SIRI statistically mediated the associations between PM2.5, several metals (aluminum (Al), arsenic (As), barium (Ba), gallium (Ga), manganese (Mn)), and FPG. Short-term exposure to PM2.5 and its metal constituents, especially Mn, is associated with higher FPG in the elderly, and these associations are partially explained by systemic inflammation levels.

The effects of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) and its interactions on the development of sleep quality in adolescents were unclear. To investigate the effect of ACEs and PCEs on the developmental trajectories of sleep quality in adolescents and to examine the potential moderating role of PCEs on the effects of ACEs. This study was conducted based on Anhui Child & Adolescent Healthy Growth Cohort. Latent class growth analysis (LCGA) was applied to capture the developmental trajectory of sleep quality. Logistic regression analyses were conducted to determine the effects of ACEs and PCEs exposure on sleep quality trajectories. Interaction analyses were performed to explore the moderating role of PCEs on the impact of ACEs. A total of 877 adolescents were included in this study (mean age: 11.31 ± 1.63, 51.1% were boys). Adolescents with ACEs exposure showed higher risk of poor development of sleep quality and there was a positive dose-response relationship. Adolescents with a pattern of 'high ACE levels' exposure (OR: 3.74, 95% CI: 2.02-6.91) were more likely to experience poor sleep quality development. In contrast, adolescents with a pattern of 'high PCE levels' (OR: 0.50, 95% CI: 0.31-0.80) were less likely to experience poor sleep quality development. Moderate to high levels of PCEs exposure (3-7 PCEs) can significantly moderate the adverse effects of ACEs on sleep quality development. This study suggests that ACEs exposure adversely affects the development of sleep quality among adolescents, while PCEs can moderate this effect. These findings highlight the urgency of early screening and intervention for ACEs and emphasise the importance of implementing various strategies in early life to promote PCEs.

BACKGROUND:Men who have sex with men (MSM) in China experience high HIV prevalence, yet little is known about the HIV testing behaviors of MSM among those who engage in sexualized drug use (SDU). Clarifying these patterns is essential for designing targeted HIV prevention interventions. METHODS:We analyzed baseline survey data from 1,800 MSM recruited in Chengdu, Suzhou, and Wuhan (2021-2022). Participants reported HIV testing history and SDU, including alcohol, rush/poppers, amphetamines, and other drugs (ketamine, marijuana, heroin, Ma Gu). Logistic regression estimated associations between SDU and HIV testing within 6 months, adjusting for demographics. RESULTS:The mean age was 31.1 years; nearly half held a bachelor's degree or higher. Alcohol (68%) and rush/poppers (43%) were the most common substances used before or during sex, while amphetamines (1.8%) and other drugs (1.7%) were rarely used. Any drug use excluding alcohol was positively associated with recent HIV testing (adjusted OR = 1.35; 95% CI: 1.08-1.68). Rush/poppers use specifically was linked to higher odds of testing (adjusted OR = 1.32; 95% CI: 1.05-1.63). CONCLUSIONS:SDU-particularly rush/poppers use-is prevalent among Chinese MSM and associated with greater HIV testing uptake. Tailored interventions that integrate substance use counseling with HIV testing promotion may help sustain high testing uptake and reduce transmission risk.

Adverse childhood experiences (ACEs) may precipitate depressive symptoms among children and adolescents, yet whether resilience and sleep quality jointly mediate this link remains unclear. Therefore, this study aimed to investigate these potential mediating pathways. From April to June 2024, a total of 3258 children and adolescents were included for this cross-sectional study from 11 primary and secondary schools in Chaohu City, Anhui Province, China. We used a series of scales to assess their depressive symptoms, ACEs, resilience, and sleep quality. To explore the potential mediating pathways between depressive symptoms, ACEs, resilience, and sleep quality, the chain mediation analysis was conducted using the PROCESS macro (Model 6). The prevalence of depressive symptoms was 30.1% among children and adolescents. The multivariate logistic regression analyses showed that females, ACEs total score, resilience, and poor sleep quality were independent correlates of depressive symptoms. When the dimensions of ACEs were involved in the regression model, emotional abuse, physical abuse, emotional neglect, physical neglect and mother suffered from domestic violence were also independent risk factors. Notably, resilience and sleep quality had a chain-mediated effect between ACEs and depressive symptoms. A high proportion of children and adolescents reported depressive symptoms. Moreover, resilience and sleep quality may have a chain-mediated effect between ACEs and depressive symptoms. Hence, the impact of ACEs, resilience and sleep quality on depressive symptoms among children and adolescents should be highlighted and targeted interventions should be implemented.

Promoting HIV self-testing (HIVST) among men who have sex with men (MSM) is an effective strategy for preventing and controlling HIV infection. We aimed to explore the prevalence, associated factors, and probabilistic dependencies of HIVST uptake among HIV-negative MSM who engaged in condomless sex during the past 6 months in China using logistic regression and Bayesian networks. We performed analysis of baseline data from a large longitudinal randomized controlled trial. In total, 1800 MSM were included and 37.5

Objective To investigate the latent categories and influencing factors of frailty change over time among elderly residents in Ma'anshan city,Anhui province,and to provide a reference for the development of prevention and control measures against the onset and progression of frailty in this population.Methods A multistage random sampling method was used to recruit 3 476 community-dwelling adults aged≥60 years from three districts of Ma'anshan city.Baseline data were collected through face-to-face interviews(December 2016-March 2017)using standardized instruments:a self-developed questionnaire,the Scale of Elderly Self-neglect(SESN),the Psychological Stress Resilience Quotient Scale,the Social Support Scale(both validated by Chinese researchers),and the Frailty Index to assess frailty status.Follow-up surveys were conducted in December 2018 and December 2021.Among the initial cohort,2 495 participants completed all three surveys and were included in the final analysis.Latent class analysis(LCA)identified distinct trajectories of in frailty over time,while multinomial logistic regression identified key influencing factors.Results Among the participants included in the analysis,three latent categories of change in frailty during the observation period were identified:improvement,progression,and early fluctuation,with percentages of 534(21.4%),188(7.5%),and 1 773(71.1%)participants,respectively.The results of multinomial logistic regression analyses(with the improvement group as the reference)revealed the following significant baseline factors influencing membership in either the progression or early fluctuation groups:increased odds of being in the progression or early fluctuation groups were associated with age≥75 years,annual or occasional physical examinations(occasional examinations significant only for the progression group),occasional or regular physical activity(significant only for the early fluctuation group),history of falls in the past year,self-neglect,and central obesity;whereas decreased odds of being in either group were associated with average monthly income of 2 000-4 999 Chinese yuan,living alone(significant only for the progression group),moderate or higher self-rated work intensity,alcohol consumption,and high psychological resilience scores.Conclusions The main latent category of frailty status among community-dwelling older adults in Ma'anshan city was early fluctuation.Age,average monthly income,living alone,self-reported work intensity,alcohol consumption,physical examination status,physical activity,falls in the past year,self-neglect,central obesity,and psychological resilience score were the main influencing factors of latent categories of frailty among the elderly.

Hearing loss is highly prevalent among the older population, and elder self-neglect will become a prominent issue worldwide as the population ages. The purpose of this study was to examine if hearing loss is associated with self-neglect in old adults. Data are from the wave 3 (2494 participants) of the Ma’anshan Healthy Aging Cohort (MHAC) in China. Multiple linear regression models and structural equation models were adopted to examine the relationship between hearing loss, social support, depressive symptoms, and the self-neglect. The results showed that hearing loss, social support, depression, and self-neglect were significantly correlated (P < 0.001). Hearing loss could not only have a direct positive impact on self-neglect older adults (β = 0.046; 95

Depression is the second most prevalent mental disease among adolescents, yet only a small percentage seek or receive treatment for the disease. Physical activity (PA) interventions hold promise as an alternative or adjunct to clinical treatment for depression. However, previous studies have been inconsistent regarding the relationship between PA and depressive symptoms in children and adolescents. The purpose of this study was to assess the effect of PA intervention on depressive symptoms in children and adolescents through a meta-analysis. Literature from 10 electronic databases and 4 registries was systematically searched. Combined estimates (standardized mean difference, SMD) and 95

Digital health interventions have demonstrated great potential to advance HIV prevention and care. However, their effectiveness in improving the pre-exposure prophylaxis (PrEP) care continuum has not yet been validated. This systematic review aimed to evaluate the effectiveness of digital health interventions in enhancing the PrEP care continuum among men who have sex with men (MSM) populations. Following PRISMA guidelines, a comprehensive search was conducted across four databases—PubMed, Web of Science, Embase, and Cochrane Library—to identify randomized controlled trials (RCTs) published before July 2, 2024. Out of the 3,539 records initially identified, 12 RCTs met the inclusion criteria. The majority of the studies were conducted in the United States (10/12, 83.3

This study aimed to explore the development of child anxiety and examine multiple mediating roles of child maltreatment and resilience in the association between caregiver anxiety and child anxiety. The longitudinal study included 1595 preschool children and their caregivers in Anhui Province, China. Paired t-tests were employed to compare differences in child anxiety between the baseline and follow-up. Linear regression analyses were performed to explore predictive effects of individual and family factors on child anxiety, while path analyses were applied to analyze mediating effects. The results indicated that child anxiety decreased during the one year follow-up. Child sex, resilience, mother's education, caregiver anxiety and child maltreatment could longitudinally predict child anxiety. Child maltreatment and resilience not only independently mediated the association between caregiver anxiety and child anxiety but also played a chain-mediating effect. These results elucidated a complex mechanistic model involving both risk and protective factors, indicating that caregiver anxiety transmits its effects through increased maltreatment risk and diminished child resilience. Consequently, comprehensive intervention strategies should concurrently target the reduction of caregiver anxiety, prevention of maltreatment, and strengthen child resilience to effectively mitigate the development of anxiety in preschool children.

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

BACKGROUND:Elder self-neglect (ESN) is usually ignored as a private problem and impairs the health outcomes of older adults. It is essential to construct a robust and efficient tool for risk prediction which can better detect and prevent self-neglect among older adults. METHODS:This study included 2494 study participants from the Ma'anshan Healthy Ageing Cohort (MHAC). First, the group-based trajectory model (GBTM) was used to estimate ESN development trajectory groups. Then, feature selection methods were used to select variables; after that, we compared six machine learning models (Decision Tree Classifier (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM) and XGBoost (XGB)). In addition, Synthetic Minority Oversampling Technique (SMOTE) is used to address the data imbalance problem. RESULTS:The results show that the ESN can be defined as two trajectory groups (rising and stable). After feature selection, the final model contains eight predictors. The area under the curve (AUC) of the raw dataset was 0.637-0.769. In the dataset with SMOTE, the AUC was 0.635-0.765 and RF was the optimal model. The top five most important characteristics were quality of life, psychological resilience, social support, education, and income. CONCLUSIONS:The RF developed in this study may be considered a simple and scientific aid in the risk prediction of self-neglect among community-dwelling old adults.

This study was conducted to quantify the association of adverse childhood experiences (ACEs) and the academic performance of children and adolescents. The literature was systematically searched in six electronic databases, and a meta-analysis was conducted. Twenty studies with a total of 1,196,631 children and adolescents from five countries were included. Meta-analysis showed that ACE score was positively associated with poor academic achievement, grade repetition, and special education support. Compared with children and adolescents without any ACE, those with one or more ACE had a significantly higher risk of poor academic achievement (pooled odds ratio [OR]: 1.45, 95% confidence interval [CI] [1.13, 1.85], I2 = 82.6%) and grade repetition (pooled OR: 1.36, 95% CI [1.29, 1.43], I2 = 71.0%). Moreover, all types of ACEs were positively associated with poor academic achievement and grade repetition. In addition, there was a significant dose-response relationship between the ACE score and the risk of poor academic achievement. This study supported that ACE had a significant impact on the academic performance of children and adolescents. Based on these findings, we recommend that early screening of ACEs for children and adolescent is critical and appropriate support and prevention in education should be developed for those with ACEs. Further studies are needed to further explore the long-term effect of ACEs on education and its gender differences.

Background:: Men who have sex with men (MSM) in China have a high risk for HIV infection but experience suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled “WeTest-Plus” (WeTest+) as a user-centered “one-stop service” approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care. Objective:: The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM. Methods:: Participants completed a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. “Click-through” rates were assessed to examine engagement with online content. Results:: 28 participants were included, and the average age was 27.6 years (standard deviation = 6.8). Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features. Conclusion:: This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services for MSM in China. Findings underscore the utility of a user-centered approach to mHealth program design.

ObjectivesThe associations of posteriori dietary patterns with the risk of hyperuricemia (HUA) are contradictory. Several fair-quality observational studies with inconsistent results have been published following a prior review. Herein, we carried out an updated systematic review and meta-analysis to quantitatively analyze the aforementioned relationships.MethodsOur analysis protocol has been registered with PROSPEPO (Number: CRD42022376745). English publications were searched in Embase, PubMed, and Web of Science from inception to January 1, 2024. Summary odds ratio (OR) and 95% confidence intervals (CIs) were calculated by a random-effects model. We also conducted subgroup, sensitivity, and meta-regression analyses and publication bias assessments.ResultsThirteen studies with a total of 163,192 participants were included in the current meta-analysis. Our finding revealed that the plant-based pattern was linked with a 17% decreased risk of HUA (OR = 0.83, 95%CI = 0.72–0.94, I2 = 72.9%, n = 10). There was no evidence of publication bias in the present analysis. The results of subgroup analyses were generally consistent with the main findings. In meta-regression analyses, no evidence of heterogeneity was detected in the subgroups. Furthermore, our analyses indicated that the animal-based food pattern (OR = 1.36, 95%CI = 1.25–1.47, I2 = 26.7%, n = 11) and sweet food pattern (OR = 1.24, 95%CI = 1.06–1.46, I2 = 0, n = 2) was related to an increased risk of HUA.ConclusionThe plant-based pattern is inversely correlated with HUA risk, whereas animal-based food patterns and sweet food patterns are positively correlated with HUA risk.

This study aimed to examine the association between nighttime sleep duration and emotional and behavioral problems (EBPs) among rural preschool children. This longitudinal study including 1595 preschool children aged 3–6 years from 26 kindergartens in four counties was conducted in Anhui Province rural areas. Cross-lagged panel models and multivariable logistic regressions were performed to examine the bidirectional association between nighttime sleep duration and EBPs and further explore the predictive effect of nighttime sleep duration on EBPs. Compared to baseline, preschool children at follow-up had significantly more nighttime sleep duration (10.01 ± 0.68 vs. 10.15 ± 0.69) and lower EBPs (total difficulties: 15.8% vs. 11.2%; prosocial behavior problems: 12.4% vs. 7.0%). Results of cross-lagged panel models indicated that nighttime sleep duration was a predictor for EBPs, but not vice versa. Results of logistic regression analysis showed that each 1-h increase in nighttime sleep duration at T1 was associated with a 0.77-fold reduction in the risk of total difficulties at T2 (the most adjusted OR = 0.774, 95% CI 0.607–0.988, P = 0.040), but not with the prosocial behavior. Interestingly, the predictive effect of nighttime sleep duration at T1 on EBPs at T2 was only found in girls, children aged 3 years and children with lower maternal education. The decreased nighttime sleep duration may predict future EBPs, especially in girls, younger preschool children and children with lower maternal education. Extending sleep duration may improve EBPs in preschool children.

Many studies have established a correlation between air pollution and green space with age-related diseases, yet the relationship between air pollution, green space, and frailty among older adults is not fully understood. The primary objective of this investigation is to examine the longitudinal association among air pollution, green space, and frailty in older adults, as well as the potential interaction and mediating effect. Analyzed data were obtained from the multi-wave CLHLS investigation (2008-2018). The participants' environmental exposure was evaluated using six air pollutants (PM1, PM2.5, PM10, PM10-2.5, O3, and NO2), and normalized difference vegetation index (NDVI). Annual ambient air pollutants were estimated using satellite-based spatiotemporal models. Time-varying Cox proportional risk models were employed to investigate the longitudinal relationships between air pollutants, greenness, and the onset of frailty in the elderly population. We conducted a variety of subgroup analyses, sensitivity analyses, and assessed potential interaction and causal mediating effects. A total of 6953 eligible elderly individuals were enrolled in our study. In the fully adjusted model, per IQR uptick in levels of PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 corresponded to a 17% (95% CI 1.10-1.24), 25% (95% CI 1.17-1.34), 29% (95% CI 1.20-1.39), 35% (95% CI 1.24-1.47), 12% (95% CI 1.04-1.20), and 11% (95% CI 1.05-1.18) increase in frailty risk, respectively. For NDVI, increased IQR was significantly negatively associated with the risk of frailty (aHR 0.82, 95% CI 0.77-0.87). Our results revealed a significant interaction effect among O3, NO2, and residential greenness. PM1, PM2.5, PM10, and PM10-2.5 play a mediating role in the estimated relationship between residential greenness and frailty. In summary, our study reveals that PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 correspond to elevated risks of frailty in the elderly. Residential greenness is associated with a lower risk of frailty in the elderly. Residential greenness can exert a positive impact on frailty by reducing particulate matter concentrations.

Aim This study aimed to explore the trajectory and predictors of subjective well-being (SWB). Methods Elderly in Ma'anshan were followed up for 5 years. SWB was measured using the Memorial University of Newfoundland Scale of Happiness (MUNSH). GBTM was used to group the trajectories of SWB, and multivariate logistic regression was used to explore the influencing factors of the different trajectories. Results 2495 adults aged ≥60 years completed the survey. Four SWB trajectories were identified: low score ascending group [130(5.2 %)], high score decline group [316(14.7 %)], high score stable group [1827(73.2 %)], moderate score fluctuation group [172(6.9 %)]. With the high score stable group as the reference, social support, depressive symptoms and self-reported health were predictors of SWB for all the groups. Conclusions The SWB of the elderly has different developmental trajectories. Nursing staff may be carry out intervention on SWB of the elderly from social support, reducing depression and improving physical health.