ABSTRACT To investigate the associations between social jetlag and depressive symptoms and further analyze the interaction of social jetlag and chronic diseases on depressive symptoms among adults. Data were derived from a cross-sectional survey. Information on social jetlag, depressive symptoms, demographic characteristics, lifestyles, and health situations were collected via a structured self-administered questionnaire. The multivariable logistic regression analyses and restricted cubic splines regression were performed to test the association between social jetlag and depressive symptoms. The multiplicative model was applied to analyze the interaction of social jetlag and chronic disease on depressive symptoms. A total of 5818 adults were included and the prevalence of social jetlag was 22.95%. After multivariable adjustment, adults who experienced more than 2 hours of social jetlag had a significantly greater risk of depressive symptoms (OR = 1.43,95%CI:1.00–2.05, P = 0.049). Compared with participants having<1 hour of social jetlag and no chronic disease, participants having chronic disease were more likely to report depressive symptoms(OR = 3.22,95%CI = 2.59–4.00, P < 0.001). Moreover, among those who have chronic disease, the greater the social jetlag they reported, the greater risk of depressive symptoms they have (OR = 3.81,95%CI = 2.77–5.33, P < 0.001; OR = 4.08,95%CI = 2.24–7.43, P < 0.001). Social jetlag was linearly associated the with risk of depressive symptoms, according to restricted cubic splines. This study shows that 22.95% adults experience more than 1 hour of social jetlag. Social jetlag was positively associated with an increased risk of depressive symptoms. Among those who have chronic disease, the greater the social jetlag they reported, the greater risk of depressive symptoms they have.

Cooking with biomass fuels has been reported to have adverse effects on health. This study aims to explore the association between cooking with biomass fuels and vision impairment among Chinese older adults aged 65 years and above. This cohort study drew on data from the 2011/2012 wave and the 2014 follow-up wave of the Chinese Longitudinal Healthy Longevity Survey. Participants’ visual function was examined through a vision screening test. Exposure to indoor biomass fuels was self-reported. Cox proportional hazards models were applied to explore the relationship between biomass fuel use and vision impairment. Additionally, we compared the risk of vision impairment between participants who switched cooking fuel types and those who did not. Subgroup and interaction analyses were conducted to explore the potential effect modifiers. A total of 4711 participants were included in this study. During the follow-up, 1053 (22.35

Objective To analyze spatial difference and dynamic time evolution of public health resources in China, and to provide evidence for optimizing the allocation of public health resources. Methods The data of 2012 to 2020 on public health resources were collected from China Health and Family Planning Statistics Yearbook and the China Health Statistics Yearbook. Entropy method was used to calculate annual index of public health resource supply at provincial level; the Dagum Gini coefficient and the Kernel density estimation method were applied to examine spatial difference and dynamic time evolution of public health resources in China. Results During 2012 – 2020, the Dagum Gini coefficient for public health resource supply increased slowly from 0.236 2 to 0.278 6 first, and then fluctuated and decreased to 0.240 9; the Kernel density estimation curves suggested that the public health resource supply in China increased sharply from 2012 to2014, but the supply was insufficient after 2014. Conclusion The supply of public health resources in China needs to be increased in quantity and equity among different regions.

To explore the relationship between Dietary Approaches to Stop Hypertension (DASH) diet and serum uric acid (SUA) levels among the Chinese adult population, and verify the mediating effect of BMI between DASH diet and SUA levels. A total of 1125 adults were investigated using a self-administered food frequency questionnaire. SUA levels were determined by uricase colorimetry. The total DASH score ranged from 9 to 72. The relationship between the DASH diet and SUA levels was examined by multiple adjusted regression analysis. Method of Bootstrap was used to test the mediation effect of BMI in the correlation of the DASH diet and SUA levels. After multivariable adjustment, there was a significant linear relationship between the DASH diet and SUA (P < 0.001). Compared with the lowest group, SUA of participants in group of highest DASH diet score decreased by 34.907 (95% CI − 52.227, − 17.588; P trend < 0.001) μmol/L. The association between the DASH diet scores and SUA levels was partly mediated by BMI (− 0.26, Bootstrap 95% CI − 0.49, − 0.07), with 10.53% of the total effect being mediated. Adopting the DASH diet might be helpful in reducing SUA level, and the effect might be partly mediated by BMI.

Objective: To investigate whether the effects of leisure activities on cognition differ among socioeconomic groups and the effects of changes in the frequency of habitual leisure activities on cognition. Methods: We included 5869 older adults from the Chinese Longitudinal Healthy Longevity Survey (2008-2014). Five typical leisure activities were used to calculate the Leisure Activity Index (LAI). The Mini-Mental State Examination was used to assess cognition. Latent class analysis was used to construct the overall socioeconomic status (SES). Cox proportional hazard regression was applied to explore the associations and further stratified the analysis by SES. Results: Participants in the highest quartile of LAI had a 50 % lower risk of developing cognitive impairment compared with the lowest quartile of LAI (HR: 0.50, 95 % CI: 0.40-0.62) (Ptrend < 0.01). Compared with participants who participated in leisure activities with increased frequency during the follow-up period, the HR (95 % CIs) of participants with no change in frequency was 3.10 (2.39-4.01), and that of participants with decreased frequency was 2.34 (1.81-3.04). A significant interaction between LAI and SES were found (Pinteraction = 0.02). The association between LAI and cognitive function was more pronounced in participants with high SES (HRQ4 vs Q1: 0.31, 95 % CI: 0.16-0.59) than in participants with low SES (HRQ4 vs Q1: 0.61, 95 % CI: 0.45-0.83). Conclusions: Leisure activities may have significant benefits in preventing cognitive impairment. However, promoting leisure activities alone may not substantially reduce socioeconomic inequalities in cognitive health. Measures addressing the social determinants of cognitive health still need to be further explored.

Background Liver fibrosis plays a key role in the progression of non-alcoholic fatty liver disease to cirrhosis. Considering weight change is known to be closely associated with increased risk of liver fibrosis, we aimed to address a gap in evidence regarding the existence of this association in patients with type 2 diabetes (T2D). Methods We included data on 622 T2D patients and 1618 non-T2D participants from the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). According to the participants' body mass index (BMI) at age 25 (early adulthood), 10 years prior (middle adulthood), and at the 2017-2018 cycle (late adulthood), we categorised weight change patterns into stable non-obese, weight loss, weight gain, and stable obese. We applied logistic regression to association analysis and used population attributable fraction (PAF) to analyses hypothetical prevention regimens. Results The prevalence of liver fibrosis was higher in T2D patients (23.04%) than in non-T2D participants (6.70%), while weight change was associated with a greater risk of fibrosis in the former compared to the latter group. Compared with T2D patients in the stable non-obese group, stable obese individuals from 10 years prior to the 2017-2018 cycle had the highest risk of developing liver fibrosis, corresponding to an adjusted odds ratio (aOR) of 3.13 (95% confidence interval = 1.84-5.48). Absolute weight change patterns showed that the risk of liver fibrosis was highest (aOR = 2.94) when T2D patients gained at least 20 kg of weight from 10 years prior to 2017-2018 cycle. Conclusions Obesity in middle and late adulthood is associated with an increased risk of T2D complicated with liver fibrosis.

This study used data from the Chinese Longitudinal Healthy Longevity Survey (n = 9765, age 65+) to investigate the impact of biomass fuels on the mortality of the Chinese elderly population. The association between biomass fuels and mortality was examined using a Cox proportional hazards model. We evaluated the difference in risk of death between those who switched fuel types from biomass to clean fuels and from clean to biomass fuels versus those who did not during the follow-up period. Participants who used biomass fuels had a higher risk of death than participants who used clean fuels (HR = 1.09, 95% CI: 1.01-1.17). For participants who switched cooking fuel types during the follow-up period, switching from biomass to clean fuels significantly reduced the risk of death (HR = 0.78, 95% CI: 0.67-0.91), while no evidence of an association between switching from clean to biomass fuels and risk of death was found (p > 0.05). Interactions and subgroup analyses indicated that effect estimates were greater for women and non-smokers. Biomass fuels may be associated with a higher risk of death among Chinese elderly. Research measuring personal exposure levels to indoor air pollution caused by biomass fuels combustion is required to confirm our results.

The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies. We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008–2018). The Cox regression model was used to estimate hazard ratio (HR) and 95

Objective To comprehensively evaluate the construction effect of China hierarchical diagnosis and treatment system, and provide scientific basis for improving the hierarchical diagnosis and treatment policy.Methods The data of the National Health and Health Statistical Yearbook was adopted from 2010 to 2022, the differences in the average annual growth rate of general hospitals and primary medical and health institutions in the number of institutions, health personnel, beds, volume of diagnosis and treatment services, and income were analyzed.Results From 2009 to 2021,China medical and health service capacity continued to improve, but there are significant differen-ces in the average annual growth rates of indicators such as the number of hospitals and primary medical institutions in the number of institutions（3.83% vs-0.12%）,the amount of health personnel（1.48% vs-2.02%）,and the number of beds（0.91% vs-2.6%）,the volume of medical services（2.02% vs-1.54%）,and institutional income（0.67% vs-1.15%）.The differences of annual growth rate of these indicators is statistically significant.Conclusion Although China hierarchical diagnosis and treatment system has achieved certain results, it is still facing the problem of unreasonable allocation of medical resources and the problem of improvement of primarily diagnosis and treatment rate.The construction of this system is far-reaching.

BACKGROUND:High turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department.METHODS:A national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians.RESULTS:A total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI)  = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department.CONCLUSION:This study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.

Background and Aim Considering the inconsistent findings of research into the associations between serum levels of liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and gamma-glutamyltransferase [GGT]) and mortality among elderly people, we aimed to investigate the associations of ALT, AST, GGT, and De-Ritis ratio (DRR, defined as AST/ALT) and all-cause or cause-specific mortality among the US elderly people using National Health and Nutrition Examination Surveys data. Methods We included 6415 elderly participants (>= 65 years). Exclusion criteria included positive test for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection at baseline. Multivariable-adjusted Cox regression models calculating hazard ratios (HR) and 95% confidence intervals were developed for each of the liver enzyme measures. Results All-cause cumulative mortality was 33.8%, of which 23.8% were cardiovascular disease (CVD) deaths, 15.6% were cancer deaths, and 60.6% were other cause deaths. Adjusted Cox models found increased all-cause mortality risk for low ALT (HR: 1.70), low AST (HR: 1.13), high GGT (HR: 1.25), and high DRR (HR: 1.68). Low ALT and high DRR predicted CVD mortality. Low ALT (HR: 1.91), low AST (HR: 1.16), high GGT (HR: 1.40), and high DRR (HR: 1.76) predicted other cause mortality. Conclusions Low ALT and high DRR were associated with increased CVD and cancer mortality. All serum liver enzyme measures were associated with all-cause mortality and other cause mortality in the US elderly population. Further studies may validate these findings in other elderly populations.

Previous studies show inconsistent associations between niacin supplementation and diabetes mellitus (DM) in high-risk population, but little is known about the relationship between dietary intake of niacin and DM in the generation population. Our study aimed to explore the associations of dietary niacin intake with the risk of DM in the United States (US) adult population. These data were derived from the National Health and Nutrition Examination Survey (NHANES) 2003–2018 of 35,606 individuals aged 20 years or older. Niacin intake and food sources were measured by two 24-h dietary recall interviews. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Binary logistic regression and restricted cubic spline models were applied to evaluate the association of dietary niacin intake and DM. Among the 35,606 individuals, the prevalence of DM was 11.47%. The full-adjusted odds ratio(aOR) of DM was 1.27(95%CI 1.06–1.52) for quartile (Q) 4 v. Q1 of dietary niacin intake. In the dose–response analysis, the shape of the association of niacin intake with the risk of DM was approximately J-shaped (non-linear, p < 0.05). Energy-adjusted niacin of 26.08 mg/day was the optimal cut-off value for predicting DM. High dietary niacin intake was positively associated with DM among US adults. Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Epidemiological studies have revealed associations between several temperature parameters and allergic rhinitis (AR). However, few studies have reported the association of AR with daily temperature variability, which indicates both short-term intra- and interday temperature changes. This study aimed to analyze associations between temperature variability and initial outpatient visits for AR. The analysis was conducted with an over-dispersed Poisson model using daily time-series data on temperature and the number of initial AR outpatients from 2013 to 2015 in Changchun, China. The composite index of temperature variability was derived by calculating the standard deviation of daily minimum temperature and maximum temperature over exposure days. Stratified analysis by season was also conducted. There were 23,344 AR outpatients during the study period. In the total period, per 1 °C increase in temperature variability at 0–2 days (TV0–2), 0–3 days (TV0–3), and 0–4 days (TV0–4) was associated with a 4.03% (95% CI: 0.91–7.25%), 4.40% (95% CI: 0.95–7.97%), and 4.12% (95% CI: 0.38–8.01%) increase in the number of AR outpatients, respectively. When stratified by season, the strongest effect was shown in spring. Our results suggested that temperature variability was associated with increased initial outpatient visits for AR, which may provide helpful implications for formulating public health policies to reduce adverse health impacts of unstable temperature.

目的:分析我国医疗资源配置效率,为进一步合理配置医疗卫生资源提供科学依据.方法:采用2000—2020年《中国统计年鉴》和《中国卫生健康统计年鉴》数据,运用数据包络分析法对我国医疗资源配置效率进行评价,同时采用Malmquist模型进行动态分析.结果:1999—2019年,我国医疗资源配置效率不断提高,但受多因素综合影响,地区间差异较大,东部地区最优,西部次之,中部最低.结论:我国医疗卫生资源配置效率不断提高,但地区和省际间资源配置效率差距明显,部分省市配置的低效率和投入的规模不足问题并存.因此,政策制定和实施者应重视医疗资源配置问题,一方面要增加资源的有效供给,合理布局医疗资源;另一方面要优化资源投入和投入结构,提高产出效率.

Background South–North Water Diversion Project (SNWDP) migrants were vulnerable to developing mental health problems due to post-migration stresses and lack of social support. However, the evidence on the mental health, psychosocial stress and social support of SNWDP migrants and their interrelationships are limited and inconclusive. We aimed to explore the mechanism of influence of social support on the relationship between mental health and social psychosocial stress of SNWDP migrants. Methods We performed a cross-sectional analysis of the data of 983 SNWDP migrants. The mental health status, psychosocial stress and social support of the participants were evaluated by Symptom Checklist-90-Revised (SCL-90-R), Psychosocial Stress Survey for Groups (PSSG) and Social Support Rating Scale (SSRS). Multiple stepwise regression model was used to analyze the data. Results Among the 983 individuals, the average SCL-90-R score was 1.47, the PSSG score was 30.50, and the SSRS score was 40.30. The SCL-90-R was positively correlated with PSSG (r=0.483, P<0.001) and negatively correlated with SSRS (r=−0.257, P<0.001), PSSG was negatively correlated with SSRS (r=−0.516, P<0.001). Multiple regression analysis showed that PSSG and SSRS had significant effects on SCL-90-R prediction and that SSRS played a partial intermediary role in SCL-90-R and PSSG (46.87%). Conclusion The SNWDP migrants performed a strong correlation between social support, mental health and psychosocial stress. Social support plays a part role in mediating mental health and psychosocial stress.

Purpose: Although a significant proportion of type 2 diabetes mellitus (T2DM) cases arose from normal-weight individuals, studies on indicators that can predict T2DM in normal-weight people are limited. Accordingly, this study aims to investigate the predictive value of obesity indices and triglyceride glucose related parameters (TyG-related parameters) in T2DM among normal-weight Chinese elderly. Methods: A total of 24,215 normal-weight Chinese elderly (age ≥ 60 years) [body mass index--BMI (18.5-23.9 kg/m 2 )] were included. Obesity indices and triglyceride glucose related parameters (TyG-related parameters) included waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), and TyG-related parameters (TyG, TyG-BMI, TyG-WC, and TyG-WHtR). Multivariate logistic regression analysis was performed to examine the associations between obesity-and TyG-related indices and T2DM. The areas under the curve (AUC) of the receiver-operating characteristic (ROC) curve analyses were used to evaluate and compare the predictive value of the different indices. Results: The prevalence of T2DM was 14.2% in normal-weight individuals. Among the indices, TyG was significantly associated with T2DM among men and women, respectively (adjusted odds ratio--aOR 19.005; 95% CI 13.235–27.291) and (aOR 25.262; 95% CI 16.957–37.634). Compared with other indices, TyG had the highest AUC value for T2DM in men (AUC: 0.818, 95% CI 0.810–0.825) and women (AUC: 0.824, 95% CI 0.814–0.833). Conclusions: TyG is an effective marker and outperforms than other indices when predicting T2DM in the normal-weight Chinese elderly population. Level of evidence: Level V