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Purpose: The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults. Methods: This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60 years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL. Results: A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = − 0.097, 95% CI − 0.110, − 0.084; β = − 0.030, 95% CI − 0.038, − 0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant. Conclusion: Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults. [ABSTRACT FROM AUTHOR]

College freshmen are special populations facing great challenges in adapting to the brand new environment, and their lifestyle and emotional states are worthy of attention. Especially during the COVID-19 pandemic, their screen time and prevalence of negative emotions were significantly increased, but few studies have focused on such situation of college freshmen and illustrated relevant mechanisms. Thus, based on a sample of Chinese college freshmen during the COVID-19 pandemic, the current study aimed to investigate the association between their screen time and negative emotions (depression, anxiety and stress), and further explore the mediating effects of sleep quality. Data from 2,014 college freshmen was analyzed. The screen time was self-reported by participants using predesigned questionnaires. The Pittsburgh Sleep Quality Index (PSQI) and Chinese Version of Depression Anxiety and Stress Scale-21 (DASS-21) were used to assess sleep quality and emotional states, respectively. The mediation analysis was conducted to examine the meditation effect. Results indicated that participants with negative emotions tended to have longer daily screen time and worse sleep quality, sleep quality partially mediated the association between screen time and negative emotions.The critical role of sleep quality and related intervention measures should be recognized and implemented. [ABSTRACT FROM AUTHOR]

Purpose: Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China. Methods: Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women. Results: A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women. Conclusion: Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women. [ABSTRACT FROM AUTHOR]

Research indicates that sleep problem is a behavioral risk factor of obesity. However, few research have applied a multi-dimensional approach to investigate the relationship between sleep health and adiposity. Therefore, the current study aimed to examine the associations of sleep characteristics (duration, quality) and chronotype with overweight/obesity as measured by body mass index. Data were obtained from 2014 college students from the Dali University in the Yunnan province of China in the year 2021. Sleep characteristics and chronotype were measured using self-reported questionnaires. The presence of overweight/obesity was assessed by anthropometric measurements. Multiple logistic regression models and restricted cubic spline hazard models were established to examine associations between sleep characteristics, chronotype and adiposity. After adjusting for demographic characteristics and other obesity-related behavioral risk factors, evening type was positively associated with overweight/obesity, and an L-shaped dose-effect relationship was observed between chronotype scores and the presence of overweight/obesity. However, sleep duration and quality were not associated with the presence of overweight/obesity in the logistic regression models and restrictive cubic splines models. This study indicated that Chinese college students who had the evening chronotype were more likely to be affected by overweight/obesity. Chronotype as an important dimension of sleep health should be incorporated in obesity intervention programs. [ABSTRACT FROM AUTHOR]

Background: Problematic mobile phone use (PMPU) is becoming increasingly popular and has serious harmful effects on physical and mental health among adolescents. Inadequate health literacy (HL) is related to some risky behaviors and mental health problems in adolescents. Nevertheless, few studies have explored the relationship between HL and PMPU and the gender difference in the relationship among Chinese adolescents. The aim of this study was to examine the associations between HL and PMPU and explore gender difference in the associations. Methods: A total of 22,628 junior and senior high school students (10,990 males and 11,638 females) in 6 regions of China participated in this study. HL and PMPU were measured by self-report validated questionnaires. Chi-square tests and logistic regression analysis were conducted in the study. Results: Logistic regression analysis showed that students with inadequate HL are likely to have PMPU (OR = 2.013, 95% CI: 1.840–2.202), and different degrees of association can be seen in six dimensions. Besides, in both males and females, students with inadequate HL had a higher risk of PMPU (ORmale = 1.607, 95% CI: 1.428–1.807; ORfemale = 2.602, 95% CI: 2.261–2.994). Regarding the gender difference, the results showed that males had more PMPU than females, and the difference was more significant for students with adequate HL than those with inadequate HL (ORinadequate = 1.085, 95% CI: 1.016–1.159; ORadequate = 1.770, 95% CI: 1.490–2.101). Similarly, there were associations in the six dimensions. Conclusions: HL decreases PMPU, and males have a higher risk of PMPU than females. These findings suggest a reasonable strategy to reduce PMPU by improving the HL level of adolescents. [ABSTRACT FROM AUTHOR]

Background: The effect of tea consumption on metabolic syndrome (MetS) remains controversial. The objective of this study is to examine the prospective association of tea consumption with 5-year incident MetS among aged population in China. Methods: This analysis included 3005 Chinese adults aged 60 years or older who were free of MetS at baseline examination. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III. Information regarding tea consumption was collected via an interviewer-administrated questionnaire. The prospective associations between tea consumption at baseline and 5-year incident MetS, as well as its individual components, were assessed by multiple logistic regression models. Results: Of the 3005 participants free of MetS at baseline, 406 participants (cumulative incidence: 13.5%) developed MetS at the 5-year follow-up examination. In multiple logistic regressions, 5-year cumulative incidence of MetS was found to be higher in those who drank tea more than 5 times per week as compared with non-habitual drinkers (OR = 1.38, 95% CI: 1.05-1.82; P = 0.02). This relationship still existed in men (OR = 1.43, 95%CI: 1.00-2.01; P = 0.05) when stratified by gender. Among the five major components of MetS, low high-density lipoprotein cholesterol was observed in men, while high body mass index, elevated blood pressure and the presence of diabetes mellitus were significant in women. Conclusions: High-frequent tea consumption increased the risk of MetS among older Chinese adults. These findings may add novel knowledge to the current studies regarding the controversial effect of tea consumption on cardiovascular and metabolic health among the aged population. [ABSTRACT FROM AUTHOR]

Background and Aims: The association between serum uric acid (SUA) and tea consumption has been studied in previous work, and there were arguments among various population group employed as well as different statistical approaches. The aim of this work is to investigate the tea effect on SUA levels among older adults by comparing three large-scale populations with both cross-sectional and longitudinal analyses.Method: We examined the relationship between intake and SUA levels among older adults using linear regression. All the studies include the parameters SUA levels, tea intake, age, sex, education level, smoking status, alcohol drinking status, body mass index (BMI), and health history (diabetes, hypertension, and fasting plasma glucose). The cross-sectional analyses were conducted with 4579 older adults in the Weitang Geriatric Diseases Study (WGDS, ≥60 years), 2440 in the China Health and Nutrition Survey (CHNS, ≥60 years) and 1236 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS, ≥62 years); and the longitudinal analyses were performed with 3870 (84.5%) in the WGDS and 420 (34.0%) in the CLHLS. Multivariable linear regression analyses were performed in both cross-sectional and longitudinal studies.Results: Cross-sectional studies showed that tea consumers tended to have higher SUA levels than non-tea consumers in all the three datasets (P < 0.05). However, longitudinal associations of SUA levels with tea consumption had no statistical significance (P>0.05). The results of sex-stratified analyses were consistent with those of the whole datasets.Conclusions: This work implied that any possible association between tea consumption and SUA levels could be very weak. [ABSTRACT FROM AUTHOR]

Background: To determine the associations of reduced presenting visual acuity (VA), refractive errors and health-related quality of life (HRQoL) in healthy adolescents in rural China.Methods: A total of 2,235 grade 7 students without systemic medical problems from 10 middle schools aged 13-14 years in Mojiang, a small county located in southwestern China, were included in the analysis. Reduced VA was defined as presenting VA of worse than 6/12 in the presence of an ophthalmic aetiology which could be identified. The refractive status of each participant was measured after cycloplegia using an autorefractor. The Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales was used for measuring HRQoL of the participants.Results: Among all the participants included in the data analysis, 279 (12.5 per cent) individuals were affected by reduced VA based on the better-seeing eye data. After adjusting for the effect of gender, body mass index, the education level of the father, and the use of a corrective device, the total (adjusted mean difference: -3.27; 95 per cent confidence interval [CI] -4.95 to -1.59; p = 0.01), social functioning (adjusted mean difference: -3.44; 95 per cent CI -5.87 to -1.01; p = 0.02) and school functioning scores (adjusted mean difference: -3.12; 95 per cent CI -5.89 to -0.35; p = 0.04) of the adolescents with reduced presenting VA were significantly lower compared with those with normal vision. The associations between corrected refractive errors and HRQoL were not significant.Conclusions: Healthy adolescents with reduced VA reported lower HRQoL scores including total, social functioning and school functioning scores, compared with those with normal vision. [ABSTRACT FROM AUTHOR]

Objectives: In China, multiple approaches to calculating EQ-5D utilities are available, including the two EQ-5D-3L (3L2014 and 3L2018) scoring functions, the EQ-5D-5L (5L) scoring function, and the crosswalk function linking the 3L utilities and 5L health states. The study compared utilities derived from them in terms of agreement and discriminative power; and assessed whether the use of different approaches may affect QALY estimation in Chinese type 2 diabetes (T2D) patients. Methods: Cross-sectional data of 289 T2D patients who self-completed both the 5L and 3L questions were used. Agreement were examined using intraclass correlation coefficient (ICC) and Bland–Altman plots. The ability of the EQ-5D utilities in differentiating the patients with and without clinical conditions was evaluated using F-statistics. Their influence on QALY estimation was assessed adopting mean absolute difference (MAD) in utility values between the patients. Results: The ICC values were 0.881 (3L2014-3L2018), 0.958 (5L-c5L2014), and 0.806 (5L-c5L2018). The two 3L utilities and the three 5L utilities had poor agreement at the lower end of utility scale according to Bland–Altman plots. The 3L2018 utilities had lower F-statistics compared to the 3L2014 utilities; the two c5L utilities had larger or similar F-statistics compared to the 5L utilities. The mean MADs were 0.138 (5L), 0.116 (3L2014), 0.115 (c5L2014), 0.055 (c5L2018), and 0.055 (3L2018). Conclusion: The 3L2014 utilities is more discriminative than the 3L2018 utilities; and the two c5L utilities have no worse discriminative power compared with the 5L utilities. The choice of the approach to calculating the EQ-5D utilities is likely to affect QALY estimates. [ABSTRACT FROM AUTHOR]

Background: To measure health-related quality of life (HRQOL) of elementary and secondary school students in rural China using the simplified Chinese version of the EQ-5D-Y.Method: Both the samples of students were from a school-based cohort study in a county located in southwestern China. The students self-completed the EQ-5D-Y. Feasibility was evaluated according to the percentages of missing values. Known group validity was assessed by comparing the frequency of reporting EQ-5D-Y problems between groups known to differ in health status.Results: A total of 1728 elementary students and 2116 secondary students were included in the analysis. Their respective mean age was 8.7 (range: 7-15) years and 14.8 (range: 11-18) years, with girls being 45.1 and 50.1%, respectively. The missing values in both samples were quite low. Elementary students were less likely to have problems on'having pain or discomfort' and 'feeling worried, sad or unhappy' dimensions, but more likely to report problems on the dimensions related to physical functioning. Gender difference in HRQOL was only detected for secondary students in terms of 'doing usual activities', 'having pain or discomfort,' and 'feeling worried, sad or unhappy' (P < 0.05 for all). The significant differences in HRQOL were not observed for the other characteristics.Conclusions: It appears that the EQ-5D-Y is feasible and valid instrument in school-aged children and adolescents in rural China; but it suffers from similar disadvantages to those found in other general populations. The HRQOL distributions measured by the EQ-5D-Y were also provided. [ABSTRACT FROM AUTHOR]

Background: Although older diabetes patients with unique characteristics should be cared carefully to improve their health-related quality of life (HRQOL), the association between diabetes and HRQOL remain unclear, especially in Asians. We aimed to compare the HRQOL between older Chinese patients with type 2 diabetes (T2D) and their age-gender-matched controls. Methods: Older patients with T2D were recruited from a community hospital in Suzhou located in the east part of China while controls were selected from a community-based health survey of older adults aged 60 years or older. HRQOL of cases and controls was assessed by the EQ-5D-3L. The impact of T2D on HRQOL was investigated using a liner regression model and the relationship between T2D and EQ-5D health problems was evaluated using logistic regression models. Results: A total of 220 cases and 440 controls were included. The mean age of the participants was 68.8 years and women accounted for 69.1% of the study sample. The EQ-5D-3L index score was lower for older people with T2D (0.886) than their controls (0.955). After multivariable adjustment, the difference in ED-5D-3L index score between older people with and without T2D was 0.072. In logistic regression analyses, T2D was positively associated with reporting of problems in mobility (odds ratio [OR] = 5.00); pain/discomfort (OR = 1.66), and anxiety/depression (OR = 3.2). Conclusions: T2D has a detrimental effect on HRQOL of older Chinese people. [ABSTRACT FROM AUTHOR]

Purpose: Parental rural-to-urban migration has a wide range of health effects on children's but its impact on children's refractive status remains unclear. We aim to examine whether parental rural-to-urban migration could influence the refractive status of their children in rural areas of China. Methods: Among the 2346 grade 7 students in the Mojiang Myopia Progression Study, information regarding parental migration was collected by questionnaires and was successfully obtained in 2105 participants. Refractive error was measured in diopters (D) with cycloplegia using an autorefractor and axial length (AL) was measured using an IOL Master. One-to-one nearest-neighbor matching techniques with a 0.01 caliper level were used to estimate the propensity score matching (PSM) models. Results: Among all the participants, 472 pairs (1 student with vs. 1 student without migrant parents) were successfully matched based on propensity scores. Students with migrant parents had a lower proportion of myopia (29.2% vs. 40.7%; P <.001) and more hyperopic refractions (−0.25D vs. −0.31D; P =.04) compared with those without. They also had shorter ALs (23.4 mm vs. 23.6 mm) but the difference was not significance (P =.18). In addition, students with migrant parents spent less time reading after school per day (0.87 vs. 1.01 hours; P =.01). Conclusions: Myopia is less prevalent among children with migrant parents compared with those without. This study indicated that living without parents might be a protect factor for myopia in Chinese school student via giving them less pressure on study. [ABSTRACT FROM AUTHOR]

Purpose: To examine the distribution and determinants of central corneal thickness (CCT) including birth weight and gestational age in a school-based samples of Grade 7 students in rural China. Methods: 2346 (93.5%) grade 7 students with a mean age of 13.8 years participated in the study. CCT was measured for both eyes using the LenStar LS900. Information regarding birth weight and gestational age was retrieved from the participants' delivery records. A linear regression model was established to examine the relationship of birth weight, gestational age and other factors with CCT. Results: The mean CCT in this population was 534.7 µm and boys had a greater CCT compared with girls (P =.06). CCT was positively related to axial length (r = 0.056) while negatively related to anterior chamber depth (r = −0.076) and corneal power (r = −0.105). In multivariate analyses, the cornea was 19.35µm thinner in individuals with low birth weight compared with those with normal. In addition, the cornea was 25.25µm thinner in prematurely born adolescents compared with full-term ones. The combined effect of birth weight and gestational age on CCT was not statistically significant (P for interaction = 0.12) Conclusions: Low birth weight and small gestational age are associated with thinner corneas in adolescence. This disparity across groups with different levels of birth parameters should be taken into account by future studies investigating CCT as risk factors or diagnostic tests for glaucoma. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between tea consumption and cognitive impairment (CoI). Methods: 4579 adults (≥60 years) from the Weitang Geratric Diseases Study were assessed for characteristics of tea consumption and cognitive function by administering questionnaires and the Abbreviated Mental Test (AMT), respectively. We divided the subjects into normal cognitive function group (AMT score ≥8) and CoI group (AMT score ≤7).   The association between tea consumption and risk of CoI was determined by logistic regression models. Results: The least-squared means of the AMT scores for the subjects who seldom consumed tea were less favorable than those who habitually consumed tea. An inverse association was found between tea consumption (of any type) and prevalence of CoI (odds ratio = 0.74, 95% confidence interval = 0.57-0.98, P = 0.032). Interestingly, the protective correlation of tea was more obvious in never smokers (odds ratio = 0.63), but vanished in current/former smokers (odds ratio = 1.10). In never smokers, frequency of tea consumption was significantly associated with CoI (P for trend = 0.010). Conclusion: Habitual tea consumption is suggested to be associated with a decreased risk of CoI among elders in Suzhou, and a higher frequency of tea consumption was associated with a lower prevalence of CoI among never smokers. [ABSTRACT FROM AUTHOR]

Purpose: We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).Methods: A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group's five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.Results: The mean EQ-5D-5L index scores were 0.971 ± 0.082 among individuals with unilateral DR and 0.970 ± 0.145 among those with bilateral DR, which were lower compared with those without DR (0.986 ± 0.045, P = 0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR] = 0.16, P = 0.02, comparing participants with unilateral vs. no DR; OR = 0.11; P = 0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P > 0.05).Conclusion: Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the loss of health-related quality of life (HRQOL) associated with common chronic conditions in older Chinese population.Weitang Geriatric Diseases Study is a community-based health survey on 5557 Chinese aged 60 years or older. The study population was measured with EQ-5D-3L for HRQOL assessment. We also assessed the coexisting chronic conditions of depression, cognitive dysfunction, stroke, heart disease, diabetes, hypertension, obesity, hyperlipidemia and visual impairment based on self-completed questionnaires, biomarkers and medical records. Ordinary Least Square regression was performed to model the relationship between the conditions and the EQ-5D-3L index scores. The robust standard error (RSE) estimator was adopted to calculate 95% confidence interval (CI) for coefficients. The mean EQ-5D-3L representing overall HRQOL was 0.954 (standard deviation: 0.081) with 70% of participants reporting full health. After controlling for socio-demographic characteristics and comorbidities, depression, stroke, heart disease and cognitive dysfunction had significantly adverse impact on the EQ-5D index score. The respective coefficients (95% CI) of each condition were −0.191 (−0.233, −0.150), −0.052 (−0.086, −0.019), −0.019 (−0.029, −0.010), and −0.016 (−0.024, −0.008). Chronic conditions were found to contribute to HRQOL loss in older Chinese population. The utility and utility decrement estimated can be used for quality-adjusted life-year calculation. [ABSTRACT FROM AUTHOR]

Objectives: Tea has long been hypothesized to possess hypotensive effects. However, there is uncertainty regarding the association of tea consumption with arterial blood pressure (BP). We aimed to examine the association between tea consumption and BP components including systolic BP (SBP) and diastolic BP (DBP). Design: Community-based, cross-sectional study of Suzhou City, Jiangsu Province, China. Setting: Tea consumption has protective influence on BP and presence of hypertension. Participants: 4579 older adults aged 60 years or older from the Weitang Geriatric Diseases study. Measurements: Detailed information regarding tea consumption was collected using a pre-designed questionnaire. BP components were measured at least 3 times with a minimum 5-minute interval, by well-trained research nurses. Methods: Data of 4579 older adults (response rate: 82%) aged 60 years or older from the Weitang Geriatric Diseases study were included in the analysis and we estimated the relationship of tea consumption and BP using linear regression models and the association between tea consumption and risk of hypertension using logistic regression models. Results: In linear regression models, higher tea consumption frequency was found to be associated with lower systolic BP values, after adjusting for the effect of age, sex, education level, lifestyle-related factors, and cardiometabolic confounding factors in overall (coefficient =-1.49, P=0.0003), normotensive (coefficient =-0.91, P=0.017) and participants without anti-hypertensive treatment (coefficient =-1.26, P=0.027). Significant inverse association between diastolic BP and frequency of tea consumption was also observed in the overall subjects (coefficient =-0.74, P=0.003). In multivariate logistic analyses, habitual tea drinking was inversely associated with presence of hypertension [odds ratio (OR)=0.79, P=0.011], and there was a progressive reduction in risk associated with higher frequency of tea consumption (P for trend=0.011). Conclusion: Habitual tea consumption was found to be associated with lower values of components of BP and a reduced likelihood of having hypertension in older adults. Given the widespread consumption of tea throughout China and the world, together with the major cardiovascular disease risk, our findings have important implications for human health. [ABSTRACT FROM AUTHOR]

Purpose: Few population-based data support the hypothesis that refractive errors are associated with depressive symptoms. We aim to assess the impact of myopia on the risk of having depressive symptoms in a community-based cohort of elderly Chinese. Methods: A community-based cross-sectional study of 4611 Chinese adults aged 60 years or older was conducted. Depressive symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9) depression scale in 4597 adults. Refraction was determined by auto-refraction followed by subjective refraction. Myopia was defined as spherical equivalent (SE) < -0.50 diopters (D) and high myopia as SE < -6.00 D. Results: After adjusting for age, gender, education, lifestyle-related exposures, presenting visual acuity and age-related cataract, myopic adults were more likely to have any depressive symptoms compared with non-myopic ones (odds ratio = 1.39; 95% confidence interval 1.04, 1.92). There were no significant differences in the risk of having any depressive symptoms between those with and without high myopia. Myopia or high myopia was not associated with having moderate depressive symptoms. The impact of myopia on depressive symptoms was stronger in adults with no formal education compared with those with formal education. Conclusions: Myopia was related with the presence of depressive symptoms among older adults. [ABSTRACT FROM AUTHOR]

Purpose: To determine the difference between cycloplegic and non-cycloplegic refractive error and its associated factors in Chinese children and adolescents with a high prevalence of myopia. Methods: A school-based study including 1565 students aged 6 to 21 years was conducted in 2013 in Ejina, Inner Mongolia, China. Comprehensive eye examinations were performed. Pre-and postcycloplegic refractive error were measured using an auto-refractor. For cycloplegic refraction, one drop of topical 1.0% cyclopentolate was administered to each eye twice with a 5-minute interval and a third drop was administered 15 minutes after the second drop if the pupil size was less than 6 mm or if the pupillary light reflex was still present. Results: Two drops of cyclopentolate were found to be sufficient in 59% of the study participants while the other 41% need an additional drop. The prevalence of myopia was 89.5% in participants aged over 12 years and 68.6% in those aged 12 years or younger (P<0.001). When myopia was defined as spherical equivalent (SE) of less than -0.5 diopter (D), the prevalence estimates were 76.7% (95% confidence interval [CI] 74.6–78.8) and 54.1% (95%CI 51.6–56.6) before and after cycloplegic refraction, respectively. When hyperopia was defined as SE of more than 0.5D, the prevalence was only 2.8% (95%CI 1.9–3.6) before cycloplegic refraction while it was 15.5% (95%CI 13.7–17.3) after cycloplegic refraction. Increased difference between cycloplegic and non-cycloplegic refractive error was associated with decreased intraocular pressures (P = 0.01). Conclusions: Lack of cycloplegia in refractive error measurement was associated with significant misclassifications in both myopia and hyperopia among Chinese children and adolescents. Decreased intraocular pressure was related to a greater difference between cycloplegic and non-cycloplegic refractive error. [ABSTRACT FROM AUTHOR]

Purpose To determine the prevalence, types and awareness of glaucoma in a rural community in China and to examine possible ethnic variations. Methods The Yunnan Minority Eye Study was a multi-ethnic community-based eye survey using random cluster sampling strategies. 2133 Bai, 2205 Han and 2208 Yi Chinese aged 50 years or older participated in this study. Glaucoma including primary open-angle glaucoma ( POAG), primary angle-closure glaucoma ( PACG) and secondary glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. Results The overall age-standardized prevalence of all glaucoma was 2.6% (95% confidence interval [ CI]: 2.2-3.1%) in this population. It was 1.8% (95% CI: 1.1-1.9%) for POAG and 0.5% (95% CI: 0.9-1.6%) for PACG, respectively. Among 29 people with secondary glaucoma, 27 (93%) were blind in at least one eye. The presence of primary open-angle glaucoma was associated with male gender (odds ratio [ OR] = 2.94; comparing men with women), Yi ethnicity ( OR = 2.27; comparing Yi with Han people), higher IOP ( OR = 1.09 per mmHg increase), and the presence of myopia ( OR = 1.84). Of the 212 participants with glaucoma, only 38 (18%) were aware of the disease and had been diagnosed previously as having glaucoma or suspected glaucoma. Patients who were better educated tended to be aware of the disease. Conclusions Significant ethnic difference in the prevalence of POAG was observed in this study. The low awareness of glaucoma highlights the pressing need to increase public awareness of this potentially blinding condition in rural China. [ABSTRACT FROM AUTHOR]

Purpose. To determine the prevalence, causes, and associations of visual impairment (VI) among participants aged 60 years or older in a rural community in China. Methods. A community-based survey was undertaken in a rural town located in Eastern China and 4579 people aged 60 years or older participated in the study. Presenting visual acuity was assessed using a Snellen chart with tumbling-E optotypes and anterior segment was examined using a slit-lamp. VI was defined as presenting VA <6/18 and it included moderate VI (<6/18 to 6/60) and blindness (<6/60). Results. The prevalence of VI was 5.4% (95% confidence interval [CI] 4.7–6.0). In multivariate analysis, the presence of VI was positively associated with increasing age (odds ratio [OR] = 1.12, 95% CI 1.10–1.16, per year increase), female gender (OR = 2.33, 95% CI 1.53–3.55), the presence of hypertension (OR = 1.31, 95% CI 1.001–1.85), living alone (OR = 1.52, 95% CI 1.08–2.62), and increased sleeping hours (OR = 1.10, 95% CI 1.001–1.22). Drinking 3 or more glasses of green tea per day was inversely associated with VI (OR = 0.79, 95% CI 0.63–0.98). Conclusion. VI was less prevalent in this community compared with previous report in other areas in China. [ABSTRACT FROM AUTHOR]

Purpose To determine the prevalence and possible causes for reduced visual acuity ( VA) in preschool children in a metropolis in China. Methods A school-based paediatric eye survey including 5862 preschool children aged three to 6 years was conducted from 2011 to 2012 in Yuhuatai District, Nanjing, China, using an age-stratified random sampling procedure. Clinical examinations including ocular alignment, ocular motility, visual acuity, prism cover test, cycloplegic refraction, stereopsis screening, slit lamp examination and fundus examination were performed by trained study ophthalmologists and optometrists. Reduced VA was defined as presenting VA of worse than 0.30 log MAR (Snellen 6/12 or 20/40), for both better and worse eyes. Results 5667 (94.8%) children with complete VA data were included in the data analyses. Among them, 208 and 93 had reduced VA in the worse and better eye, respectively. Reduced VA was detected in 3.7% (95% confidence interval [ CI] 3.2%-4.2%) in the worse eye and 1.6% (95% CI 1.3%-2.0%) in the better eye. No significant age and gender differences in reduced VA were observed ( p > 0.05). Refractive errors and amblyopia were the principal causes for reduced VA in the worse eye which accounted for 66.8% and 32.7% of the total cases with reduced VA, respectively. Astigmatism and hyperopia were the major types of refractive errors causing reduced VA. Conclusions The burden of reduced VA in preschool children in China was similar to that of Asian children of similar ages in the United States. Uncorrected refractive error and amblyopia were the principal causes for reduced VA among preschoolers (aged three to 6 years) in China. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association of season of birth and refractive error in very young Chinese children in China. Methods: We conducted a population-based study of Chinese children aged 0 to 3 years residing in eastern China. Refraction was determined by non-cyclopegic autorefraction using a hand-held autorefractor. Date of birth was retrieved from birth certificate of the individual subjects. A generalized linear regression model was fitted to estimate the regression coefficient and 95% confidence interval (CI) of refractive error for season of birth, adjusting for confounders. Results: Of the 1385 children eligible to participate, 1222 (88.2%) were examined. Refractive error data were available for 1219 children. The mean spherical equivalent were 1.21 diopters (D) in children born Spring, 1.24 D in those born in Summer, 1.23 D in those born in Autumn, 1.15 D in Winter. After adjusting for age, sex, father's educational level, birth weight and the number of summers between birth and examination date the children have been exposed to, children born in winter had a 0.12 D more myopic refraction compared with those born in summer (regression coefficient: −0.12; 95% CI, −0.27,−0.06; P = 0.006). The association between season of birth and cylinder power was not statistically significant. Conclusions: In China, children born in winter had a more myopic refraction compared with those born in other seasons. The observed association between season of birth and refractive error was independent of parental educational level and birth weight, suggesting that light level may have a small impact on refractive development in early life. [ABSTRACT FROM AUTHOR]

Citation information: Pan C-W, Ramamurthy D & Saw S-M. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt 2012, 32, 3-16. doi: 10.1111/j.1475-1313.2011.00884.x Abstract Background: Myopia, the most common type of refractive error, is a complex trait including both genetic and environmental factors. Numerous studies have tried to elucidate the aetiology of myopia. However, the exact aetiology of myopia is still unclear. Purpose: To summarize the worldwide patterns and trends for the prevalence of myopia and to evaluate the risk factors for myopia in population-based studies. Recent findings: The prevalences of myopia vary across populations of different regions and ethnicities. In population-based studies on children, the prevalence of myopia has been reported to be higher in urban areas and Chinese ethnicity. The regional and racial difference is not so obvious in adult populations aged over 40 years. More time spent on near work, less time outdoors, higher educational level and parental history of myopia have been reported to increase the risk of myopia. Conclusions: Environmental factors play a crucial role in myopia development. The effect of gene-environment interaction on the aetiology of myopia is still controversial with inconsistent findings in different studies. A relatively hyperopic periphery can stimulate compensating eye growth in the centre. Longitudinal cohort studies or randomized clinical trials of community-based health behaviour interventions should be conducted to further clarify the aetiology of myopia. [ABSTRACT FROM AUTHOR]

Background: We aim to determine the association of iris surface features including crypts, color and contraction furrows with anterior chamber depth (ACD) in a school-based sample of Chinese teenagers.Methods: Totally, 2346 students aged 13 to 14 years in Mojiang located in the Southwestern part of China contributed to this analysis. Iris surface features were graded based on standardized slit-lamp photographs. Ocular biometric parameters including ACD were measured using an IOL Master. Generalized estimating equation was incorporated in the linear regression models to assess the relationship between iris surface features and ACD.Results: A significant trend of increasing ACDs with more contraction furrows were observed. On average, the mean ACD was 3.03 mm in participants with contraction furrows of grade 1 while it was 3.10 mm in those with grade 3 (mean difference, 0.07 mm, P = 0.01). Adjusting for other potential confounders such as gender, height and weight did not significantly changed the associations. Compared with individuals with contraction furrows of grade 1, those with grade 3 had a greater ACD of 0.06 mm (95% confidence interval: 0.01, 0.11) in multivariate-adjusted model. There were no significant relationships between ACD and iris crypts or color. (P > 0.10).Conclusions: More iris contraction furrows are associated with greater ACDs while the association with iris color and crypts were not significant. [ABSTRACT FROM AUTHOR]

Background: To determine the one-year incidence and progression rates of myopia and its association with baseline ocular biometric parameters in school-based samples of children and adolescents in China.Methods: Two thousand four hundred thirty two grade 1 and 2346 grade 7 students living in the southwest part of China participated in the baseline survey. After 1 year, 2310 (95.0%) grade 1 and 2191 (93.4%) grade 7 students attended the follow-up examination. Refractive error was measured after cycloplegia using the same autorefractor and by the same optometrists in the baseline and follow-up examination. Myopia was defined as spherical equivalent of less than - 0.50 diopter.Results: The overall one-year incidence of myopia was 33.6% (95% confidence interval [CI]: 31.7-35.5) among grade 1 students and 54.0% (95% CI: 51.5-56.5) for grade 7 students. The one-year myopia progression rate was - 0.97 D (95% CI: -1.22 to - 0.71) in grade 1 students and - 1.02 D (95% CI: -1.07 to - 0.96) in grade 7 students. Per mm increase in baseline axial lengths increased the risk of myopia onset by 28% among grade 1 students and 22% among grade 7 students after 1 year. The incidence rates of myopia were found to be higher in grade 7 students with thinner premyopic lenses.Conclusions: The incidence and progression rates of myopia were very high in Chinese children and adolescents in recent years. Premyopic eyes were characterized with longer axial lengths and thinner lenses. These data had considerable implications for formulating myopia prevention strategies in China. [ABSTRACT FROM AUTHOR]

Background: We aim to assess the prevalence of myopia in Chinese school children with low educational pressure and explore which factors could explain the differences in prevalence between generations.Methods: A school-based epidemiologic study including 2432 grade 1 and 2346 grade 7 students was conducted from 2016 in rural areas of China. Each participant's refractive status was measured before and after cycloplegia using an autorefractor and axial length (AL) was measured using an IOL Master. The questionnaires were completed by the parents or legal guardians of the children to collect detailed information regarding risk factors. Myopia was defined as spherical equivalent less than - 0.50D.Results: Grade 7 students had a higher prevalence of myopia (29.4% vs. 2.4%; P < 0.001) and high myopia (0.4% vs. 0.1%; P < 0.001) compared with grade 1 students. Grade 7 students also had longer ALs (23.50 mm vs. 23.37 mm; p = 0.004) after adjusting for the effect of gender, height and other myopia-related risk factors. Adjustment for time spent on reading and writing after school per day led to a reduction in the excess prevalence of myopia in grade 7 students by 15.1%. In addition, adjustment for time outdoors reduced the excess prevalence of myopia in grade 7 students by 33.4%.Conclusions: We reported a relatively lower prevalence of myopia in school students in rural China, suggesting that Chinese may not have a genetic predisposition to myopia and environmental factors may play a major role in the development of school myopia in Chinese children. [ABSTRACT FROM AUTHOR]

Previous studies have reported that the prevalence of depression and depressive symptoms was significantly higher than that before the COVID-19 pandemic. This study aimed to explore the prevalence of depressive symptoms and evaluate the importance of influencing factors through Back Propagation Neural Network (BPNN). Data were sourced from the psychology and behavior investigation of Chinese residents (PBICR). A total of 21,916 individuals in China were included in the current study. Multiple logistic regression was applied to preliminarily identify potential risk factors for depressive symptoms. BPNN was used to explore the order of contributing factors of depressive symptoms. The prevalence of depressive symptoms among the general population during the COVID-19 pandemic was 57.57 %. The top five important variables were determined based on the BPNN rank of importance: subjective sleep quality (100.00 %), loneliness (77.30 %), subjective well-being (67.90 %), stress (65.00 %), problematic internet use (51.20 %). The prevalence of depressive symptoms in the general population was high during the COVID-19 pandemic. The BPNN model established has significant preventive and clinical meaning to identify depressive symptoms lay theoretical foundation for individualized and targeted psychological intervention in the future. • This study established multi-layer perception neural network model to predict depressive symptoms among Chinese population. • Subjective sleep quality, loneliness, subjective well-being, stress and problematic internet use were stronger contributors. • This study aims to provide a solid theoretical basis for later individualized and targeted psychological intervention. [ABSTRACT FROM AUTHOR]

Background: College freshmen tend to have more psychological and behavioral problems compared with other populations, especially depressive symptoms. Perceived parental control has been proved to play a significant role in mental health among children and adolescents. Based on the theoretical and empirical research of chronotype and sleep quality, this study constructed a chain mediating model to examine whether they mediated the relationship between parental control and depressive symptoms among Chinese college freshmen.Methods: A total of 2014 college freshmen from Dali University were recruited to participate in this study and completed self-report Parental Bonding Instrument (PBI), Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Depression Scale (SDS). PROCESS 3.5 for SPSS was applied to determine the chain mediating effect of chronotype and sleep quality between parental control and depressive symptoms.Results: College freshmen with depressive symptoms have higher levels of parental control and worse subjective sleep quality than normal population (all p < 0.001). All study variables are correlated with each other, while chronotype has no significant association with depressive symptoms (r = -0.03, p > 0.05). Both maternal and paternal control have a direct link with depressive symptoms (β = 0.86, p < 0.001; β = 0.88, p < 0.001). Parental control could affect depressive symptoms via the independent mediating effect of sleep quality and the chain mediating effect of chronotype and sleep quality. The total indirect effects of maternal and paternal control on depressive symptoms are 0.93 and 0.94, respectively.Conclusions: Chronotype and sleep quality could mediate the association between parental control and depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to investigate the association between sleep and the development of metabolic syndrome (MetS) in Chinese older adults and to accumulate evidence for the prevention of MetS through sleep management.Methods: This prospective study followed 3005 participants aged over 60 derived from the Weitang Geriatric Diseases Study who were without MetS at baseline. MetS was defined according to the Adult Treatment Panel III (ATP III) criteria. Logistic regression models were fit to assess the association between sleep and MetS incident and a linear regression model was used to examine the impact of sleep duration on every component of MetS. Data on sleep-related parameters were obtained based on a self-reported questionnaire.Results: After five-year follow-up, 13.51% participants developed MetS, of which 46.86% were women. The incidence of MetS was highest among adults who slept 6 h or less and lowest among those who slept 7 h after adjusted for multiple variables. Subgroup analyses showed no gender specificity. The variation of fasting plasma glucose (FBG) for ≥9 h per night was significantly lower than that for 7.01-7.99 h per night (β = -0.18, P < 0.05). Sleeping for 8-8.99 h also decreased the variation of diastolic blood pressure (DBP) compared to 7.01-7.99 h (β = -0.84, P < 0.05).Conclusion: We conclude that both short and long sleep duration are risk factors for MetS incident in older adults. [ABSTRACT FROM AUTHOR]

• White blood cell count mediates the relationship between depression and all-cause mortality among the elderly. • This study was the first to examine whether white blood cell count meditated the depression-death association. • Mediation analysis is used to test the potential mechanism between two variables and whether mediator affects the relationship. One possible pathway by which depressive symptoms influence all-cause mortality is through their relationship with markers of inflammatory response. We aimed to examine whether white blood cell (WBC) count mediated the relationship between the presence of depressive symptoms and all-cause mortality among older Chinese people. This community-based cohort study targeted 4053 individuals aged 60 years or over. A bootstrapping approach was applied to examine whether WBC count mediated the relationship between the presence of depressive symptoms and all-cause mortality. WBC count was evaluated as a mediator. The presence of depressive symptoms was assessed by the nine-item Patient Health Questionnaire (PHQ-9). The mediating effect was considered significant if the 95% confidence interval (CI) did not include 0. Mediation analysis indicated that WBC count played an important mediating role in the relationship between PHQ-9 score and all-cause mortality based on the significance of indirect effect (β = -0.0039, 95% CI = -0.01, -0.0009). The direct effect from PHQ-9 score to all-cause mortality was not statistically significant (P = 0.11) after adjusting for WBC count. WBC count was associated with depressive symptoms and all-cause mortality. The association of depressive symptoms with all-cause mortality was fully mediated by WBC count. [ABSTRACT FROM AUTHOR]

• A latent mixture model for systolic blood pressure is used in this study. • Five trajectories of systolic blood pressure are identified in older Chinese adults. • Habitual tea consumption is associated with favorable systolic blood pressure. Tea consumption may contribute to the management of blood pressure; however, evidence from longitudinal studies is lacking. This study aimed to examine the relationship between habitual tea consumption and trajectories of systolic blood pressure in a community-based sample of Chinese adults aged 60 years or older. A prospective cohort of 3870 participants was investigated from 2014 to 2018. Trajectories of systolic blood pressure were identified using latent mixture modeling with the Proc Traj procedure. Multiple logistic regression models were fitted to explore associations between tea consumption habits and trajectories of systolic blood pressure. In the overall sample, participants were less likely to be habitual tea drinkers if they were in the "moderate-stable" (144.4–149.9 mm Hg), "moderate-increasing" (157.2–180.0 mm Hg), and "elevated-increasing" (184.7–209.8 mm Hg) groups as compared to those in the "low-stable" group (125.3–130.0 mm Hg). The "elevated-decreasing" group (170.7 – 167.2 mmHg) consistently showed no significant difference in the likelihood of habitual tea drinking as compared to the "low-stable" group. This community-based prospective study indicated that habitual tea consumption was associated with relatively favorable long-term systolic blood pressure statuses. [ABSTRACT FROM AUTHOR]

• Elevated neutrophil to lymphocyte ratio was associated with an increased risk of cognitive impairment. • Adding neutrophil to lymphocyte ratio to a conventional risk factor model did not increase the predictive value of cognitive impairment. • Whether neutrophil to lymphocyte ratio may act as a clinically relevant predictor for cognitive impairment is unclear. Previous studies have assessed the association of neutrophil to lymphocyte ratio (NLR) with cognitive impairment (COI) in clinical settings. Whether NLR is associated with COI among free-living seniors at population level remains unknown. We aimed to assess the relationship between NLR and COI among community-dwelling older adults and the predictive value of NLR for COI screening in the community. Data of 4579 older adults aged 60 or older in Weitang Geriatric Diseases study, a community-based cross-sectional study conducted in Suzhou located in the east part of China, were analyzed. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. Cognitive function of the participants was assessed using the Abbreviated Mental Test. Compared to those in the first quartile of NLR, older adults in the 4th quartile of NLR had a greater risk of COI (odds ratio = 1.34, 95 % confidence interval = 1.06–1.69). Elevated NLR quartile was associated with increasing risk of COI (p value for trend = 0.02). Addition of NLR to the conventional risk factors model could improve the correct reclassification of COI about 9.0 % (p = 0.02) and integrated discrimination improvement value was 0.0012 (p = 0.09). We found that elevated NLR was associated with an increased risk of COI and whether NLR may act as a clinically relevant predictor for COI among community-dwelling older adults could not be determined. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between ambient air pollution and dry eye symptoms (DES) during the COVID-19 pandemic and explore whether air pollution had increased the risk of DES to a greater extent than other risk factors., Methods: A nationwide cross-sectional survey was conducted from June 20, 2022 to August 31, 2022. The Ocular Surface Disease Index-6 (OSDI-6) questionnaire was used to assess the presence of DES. Logistic regression models were employed to analyze the associations between DES and air pollution variables, including air quality index (AQI), fine particulate matter (PM 2.5 ), PM 10 , sulfur dioxide (SO 2 ), carbon monoxide (CO), nitrogen dioxide (NO 2 ), ozone (O 3 ) and residing near industrial zones. We explored the interactions of air pollutants and other risk factors in the additive models by calculating the synergy index (SI). Standardized regression coefficients were calculated to compare the relative importance of risk factors for DES., Results: A total of 21,909 participants were included in the analysis. Residing near industrial zones was significantly correlated with a higher risk of DES (Odds ratio (OR): 1.57, 95 % confidence interval (CI): 1.38-1.79). No significant associations were found between DES and air pollutants except SO 2 (OR: 1.05, 95 % CI: 1.02-1.09, per standard deviation increment in SO 2 concentration). The restricted cubic spline analyses revealed a linear concentration-response relationship between SO 2 and DES. The interaction analyses suggested synergetic interactions of SO 2 with depression and problematic internet use. Among the risk factors, depression, anxiety and problematic Internet use contributed more to the increased risk of DES., Conclusion: The association between ambient air pollutants and DES may have been mitigated during the pandemic due to increased time spent indoors. Despite this, our findings support the deleterious health impact of air pollutants. Future urban planning should plan industrial zones further away from residential areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aims: To investigate myopic maculopathy in Chinese children with high myopia and its association with choroidal and retinal changes., Methods: This cross-sectional study included Chinese children aged 4-18 years with high myopia. Myopic maculopathy was classified by fundus photography and retinal thickness (RT) and choroidal thickness (ChT) in the posterior pole were measured by swept-source optical coherence tomography. A receiver operation curve was used to determine the efficacy of fundus factors in classifying myopic maculopathy., Results: In total, 579 children aged 12.8±3.2 years with a mean spherical equivalent of -8.44±2.20 D were included. The proportions of tessellated fundus and diffuse chorioretinal atrophy were 43.52% (N=252) and 8.64% (N=50), respectively. Tessellated fundus was associated with a thinner macular ChT (OR=0.968, 95% CI: 0.961 to 0.975, p<0.001) and RT (OR=0.977, 95% CI: 0.959 to 0.996, p=0.016), longer axial length (OR=1.545, 95% CI: 1.198 to 1.991, p=0.001) and older age (OR=1.134, 95% CI: 1.047 to 1.228, p=0.002) and less associated with male children (OR=0.564, 95% CI: 0.348 to 0.914, p=0.020). Only a thinner macular ChT (OR=0.942, 95% CI: 0.926 to 0.959, p<0.001) was independently associated with diffuse chorioretinal atrophy. When using nasal macular ChT for classifying myopic maculopathy, the optimal cut-off value was 129.00 µm (area under the curve (AUC)=0.801) and 83.85 µm (AUC=0.910) for tessellated fundus and diffuse chorioretinal atrophy, respectively., Conclusion: A large proportion of highly myopic Chinese children suffer from myopic maculopathy. Nasal macular ChT may serve as a useful index for classifying and assessing paediatric myopic maculopathy., Trial Registration Number: NCT03666052., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified., Methods: For this cohort analysis, we included 9024-14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms., Results: Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05-1.26) to 1.64 (1.38-1.96) and 5% (0-10%) to 17% (6-28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11-1.42), 1.34 (1.07-1.69), 1.45 (1.29-1.63), and 2.01 (1.36-2.96), and respective PAFs (95% CIs) of 5% (0-10%), 8% (-4-21%), 12% (7-17%), and 20% (5-35%)., Conclusion: Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese., Competing Interests: Declaration of competing interest The authors have no conflicts to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This study examined the moderating role of outdoor time on the relationship between overweight and myopia., Methods: The data for this study was obtained from a prospective study in Shanghai, where non-myopic children wore wristwear and were followed up for 1 year. Eye examinations were performed at each visit. The modification effect was assessed on the additive scale using multivariable logistic regression, and relative excess risk due to interaction was used to calculate the modification effect., Results: A total of 4683 non-myopic children were included with 32.20% being overweight at baseline. Following a 1-year period, 17.42% of children had myopia. When compared to those who spent <90 minutes outdoors, children who spent >120 had a relative risk of myopia onset that was reduced to 0.61. As time spent outdoors decreased, more risks of myopia onset were identified among overweight children than among normal children, the modification effect on the additive scale was -0.007, with ~70% of this effect attributed to the modifying influence of outdoor time., Conclusions: Increasing outdoor time can reduce myopia more among overweight children than normal. Future interventions should focus on outdoor activities among overweight children to reduce myopia risks., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Several studies have previously reported the normal values of corneal volume (CV) in various populations, whereas little is known about the CV distribution in healthy young Chinese adults. Our study aimed to investigate the distribution of CV and its relationships with other ocular biometric parameters among healthy young Chinese adults., Methods: A total of 1645 eyes from 1645 students at Dali University in Yunnan Province, China, were analyzed. Pentacam was used to measure CV. Central corneal thickness (CCT) and biomechanically corrected intraocular pressure (bIOP) were evaluated by Corvis-ST. Other biometrical parameters, including axial length (AL), keratometry, and white-to-white (WTW) distance, were measured using IOL Master., Results: The mean age of the study population was 19.01 ± 0.92 years, and 68.81% of them were women. The CV was normally distributed in the whole sample, with a mean value of 61.23 ± 3.22 mm 3 . CV and CCT were significantly smaller in the Yi ethnic group than in the Han ethnic group (p < 0.01). CCT (coefficient: 0.085; p < 0.001) and keratometry (coefficient: 0.422; p < 0.001) were positively correlated with CV, while AL (coefficient: -0.204; p < 0.001), WTW distance (coefficient: -0.236; p < 0.001) and bIOP (coefficient: -0.06; p < 0.001) were inversely associated with CV., Conclusions: Our study provides an age-specific distribution of CV among healthy young Chinese adults. CCT, keratometry, AL, WTW distance and bIOP were important factors associated with CV., (© 2024. The Author(s).)

Background: Many studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live., Methods: The study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms., Results: NCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = -0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults., Conclusions: NCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest in relation to the subject of this study., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Myopia is prevalent in children and adolescents. Understanding the effect of multiple behaviors and their latent patterns on ocular biometric parameters may help clinicians and public health practitioners understand the behavioral risk pattern of myopia from a person-centered perspective. The purpose of this study was to identify the patterns of four major behavioral risk factors associated with myopia, including time spent outdoors, digital screen time, sleep duration, and performance of Chinese eye exercises. The study also examined the relationships between these behavioral patterns and myopia as well as ocular biometric parameters in a sample of Chinese college students., Methods: This study included 2014 students from the Dali University Students Eye Health Study. The average age of the subjects was 19.0 ± 0.9 years old, ranging from 15.7 to 25.1 years old. Each participant's refractive status was measured using an autorefractor without cycloplegia and ocular biometric parameters were measured using an IOL Master. Behavioral risk factors were collected using a pre-designed self-administered questionnaire. Latent class analysis (LCA) was performed to identify cluster patterns of various behaviors., Results: The prevalence of myopia was 91.8% in this population. The 2-class model was selected for the LCA based on goodness-of-fit evaluation metrics. Among the overall study sample, 41.1% and 58.9% were assigned into the high-risk and low-risk class, respectively. The risk of myopia [odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.52-3.14], high myopia (OR = 1.43, 95% CI = 1.14-1.78) and axial length/corneal radius (AL/CR) ratio of more than 3.0 (OR = 1.82, 95% CI = 1.22-2.72) were significantly higher in the high-risk compared with low-risk class., Conclusions: Chinese university students showed differential risks of myopia and could be subdivided into high- and low-risk clusters based on four behavioral variables., (© 2023. The Author(s).)

Purpose: To assess the impacts of area-level socioeconomic and environmental measures on reduced visual acuity (VA)., Methods: This ecological study used the nationally representative cross-sectional data from the Chinese National Survey on Students' Constitution and Health in 2014 (CNSSCH 2014), which included 261,833 participants aged 7 to 22 years randomly selected from 30 mainland provinces in China. Area-level socioeconomic measures assessed included gross domestic product (GDP), population density, density of hospital beds, and nighttime light data measured as the mean digital number (DN) of each region; environmental factors assessed included latitude, annual sunlight duration, and park green space density. The main outcome measure was the prevalence of reduced VA in each province of Mainland China., Results: GDP (coefficient: 0.221; P < 0.001), mean DN (coefficient: 0.461; P < 0.001), latitude (coefficient: 0.093; P < 0.001), and annual sunlight duration (coefficient: 0.112; P < 0.001) were positively associated with the prevalence of reduced VA, while population density (coefficient: -0.256; P < 0.001), park green space per 10,000 people (coefficient: -0.145; P < 0.001), and number of hospital beds per 10,000 people (coefficient: -0.146; P < 0.001) were negatively associated with reduced VA prevalence. Factor analysis indicated a marginally nonsignificant positive correlation between socioeconomic factors and the prevalence of reduced VA (coefficient: 0.034; P = 0.07)., Conclusions: Increased GDP and mean DN, which reflect economic development, were associated with a higher prevalence of reduced VA, while larger park green space and number of hospital beds per 10,000 people seemed to play a protective role, which could be targeted to design preventive strategies for myopia.

Purpose: To describe the prevalence and risk factors of primary angle-closure glaucoma (PACG) and to explore nationality difference in Chinese., Methods: The Yunnan Minority Eye Study was conducted in a rural multiethnic area in Yunnan province and included 6546 participants aged over 50 years. PACG was diagnosed based on International Society of Geographical and Epidemiologic Ophthalmology criteria by experienced ophthalmologists. Multivariate regression modelling was conducted to examine risk factors for PACG. Principal component analyis (PCA) was performed to evaluate the effects of ethnicity on PACG., Results: The overall prevalence of PACG was 0.7% (95% CIs: 0.5% to 0.9%). PCA indicated that ethnicity is significantly related to the presence of PACG (p<0.001) after controlling for other risk factors. In addition, higher PACG prevalence was also correlated with older age (60-69 years group (OR: 3.47; 95% CI: 1.11 to 10.84; p<0.05) and 70-79 years group (OR: 4.71; 95% CI: 1.40 to 15.86; p<0.05) as compared with 50-59 years group), higher intraocular pressures (OR: 1.26; 95% CI: 1.17 to 1.36; p<0.001), shorter axial lengths (OR: 0.42; 95% CI: 0.32 to 0.56; p<0.001) and thinner central corneal thicknesses (OR: 0.89; 95% CI: 0.81 to 0.99; p<0.05)., Conclusions: This multiethnic study on Chinese adults living in the same geographical location indicated that ethnicity is a significant risk factor for PACG. However, there were still some of the effects of ethnic differences on the prevalence of PACG that could not be explained and further studies should take culture and lifestyle factors into account., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To describe the study design, methodology, and cohort profile of the Eastern China Student Health and Wellbeing Cohort Study. The cohort baseline includes (1) targeted disease (myopia, obesity, elevated blood pressure, and mental health) and (2) exposures (individual behaviors, environment, metabolomics, and gene and epigenetics)., Participants: Annual physical examination, questionnaire-based survey, and bio-sampling have been carried out in the study population. In the first stage (2019-2021), a total of 6,506 students in primary schools are enrolled in the cohort study., Findings to Date: Of all the cohort participants, the ratio of male to female is 1.16 among a total of 6,506 student participants, of which 2,728 (41.9%) students are from developed regions and 3,778 (58.1%) students are from developing regions. The initial age of observation is 6-10 years, and they will be observed until they graduate from high school (>18 years of age). (1) Targeted diseases: The growth rates of myopia, obesity, and high blood pressure vary by regions, and for developed regions, the prevalence of myopia, obesity, and elevated blood pressure is 29.2%, 17.4%, and 12.6% in the first year, respectively. For developing regions, the prevalence of myopia, obesity, and elevated blood pressure is 22.3%, 20.7%, and 17.1% in the first year, respectively. The average score of CES-D is 12.9 ± 9.8 in developing regions/11.6 ± 9.0 in developed regions. (2) Exposures: ① The first aspect of individual behaviors : the questionnaire topics include diet, physical exercise, bullying, and family. ② The second aspect of environment and metabolomics: the average desk illumination is 430.78 (355.84-611.56) L X , and the average blackboard illumination is 365.33 (286.83-516.84) L X . Metabolomics like bisphenol A in the urine is 0.734 ng/ml. ③ The third aspect of gene and epigenetics: SNPs (rs524952, rs524952, rs2969180, rs2908972, rs10880855, rs1939008, rs9928731, rs72621438, rs9939609, rs8050136 and so on) are detected., Future Plans: Eastern China Student Health and Wellbeing Cohort Study is aiming to focus on the development of student-targeted diseases. For children with student common diseases, this study will focus on targeted disease-related indicators. For children without targeted disease, this study aims to explore the longitudinal relationship between exposure factors and outcomes, excluding baseline confounding factors. Exposure factors include three aspects: (1) individual behaviors, (2) environment and metabolomics, and (3) gene and epigenetics. The cohort study will continue until 2035., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Zhao, Ma, Tao, Pan, Zhang, Wang, Yang, Xiang, Wang, Tian, Yang, Du, Zhou and ES-SCI Work Group.)

Background: This study aimed to determine sleep patterns and the prevalence and association factors of sleep disorders in a regionally representative sample in Mo Jiang, China., Methods: A total of 2,346 (participation rate 93.5%) Grade 7 students (aged 13-14 years) from 10 middle schools, including 1,213 (51.7%) boys and 1,133 (48.3%) girls, participated in the study. All the participants were invited to complete questionnaires that acquired information on sleep patterns, academic performance, academic stress, and sociodemographic factors. Sleep disorders were assessed using the Chinese version of the Children's Sleep Habits Questionnaire. Logistic regression models were used to investigate factors associated with sleep disorders., Results: The prevalence of sleep disorders among rural adolescents was 76.4%, which is higher than that among urban adolescents. Compared with previous findings in urban areas, our results indicate that sleep loss is much more severe in rural adolescents. Sleep disorders were positively associated with factors, such as watching TV [odds ratio (OR) = 1.22, p  = 0.001], academic performance (OR = 1.80, p  < 0.001), and academic stress (OR = 1.38, p  = 0.04). In addition, girls were more likely to suffer from sleep disorders than boys (OR = 1.36, p  = 0.01)., Conclusion: Insufficient sleep and sleep disorders have become common health problems in rural Chinese adolescents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Li, Nie, Li, Tao, Zhao, Zhong and Pan.)

Backgrounds: Many literature reviews summarized relationships between screen time and child health, but they only included a few studies conducted in Chinese children and adolescents. The potential influence of screen time may vary by social context. The current systematic review and meta-analysis aimed to evaluate relationships between screen time and health issues among Chinese school-aged children and adolescents., Methods: Peer-reviewed articles written in Chinese and English were retrieved from CNKI, Wanfang, PubMed, Embase, and Web of Science from inception to June 2020. The Downs & Black checklist was applied to assess study quality. Meta analyses used random effect models and mixed effects model to calculate pooled adjusted odds ratios and 95% confidence intervals. Heterogeneity, sensitivity, and publication bias were assessed using Q and I 2 statistics, "one-study removed" analysis, the funnel plot, trim and fill analysis, and classical fail-safe N, respectively., Results: In total, we identified 252 articles reporting 268 studies with unique samples. These studies investigated relationships between screen time and health issues of adiposity, myopia, psycho-behavioral problems, poor academic performance, cardiometabolic disease risks, sleep disorder, poor physical fitness, musculoskeletal injury, sub-health, and miscellaneous issues of height and pubertal growth, injury, sick leave, and respiratory symptoms. Proportions of studies reporting positive relationships with screen time were lowest in adiposity (50.6%) and higher in myopia (59.2%) and psycho-behavioral problems (81.8%). Other health issues were examined in 10 or less studies, all of which had more than half showing positive relationships. The pooled odds ratio from 19 studies comparing health risks with the screen time cutoff of 2 hours per day was 1.40 (95% CI: 1.31 to 1.50, I 2  = 85.9%). The pooled effect size was 1.29 (95% CI: 1.20 to 1.39) after trimming 7 studies for publication bias adjustments., Conclusions: Findings exclusively generated from Chinese school-aged children and adolescents resonate those mainly from western countries. Evidence suggests that higher levels of screen time are related with greater risks of various health issues, although the relationships appear to be weak and intertwined with other confounding factors. Future studies need to investigate health-specific dose effects and mechanisms of screen time., (© 2022. The Author(s).)

Purpose: To assess the ability of the 3-level EQ-5D (i.e., EQ-5D-3L) in predicting all-cause mortality in older Chinese adults., Methods: The data were from a 5-year longitudinal study, Weitang Geriatric Diseases Study, including 4579 community-dwelling older people in eastern China, with the mean age of 72.5 years at baseline and female being 52.0%. Three multivariable logistic regression models were adopted to assess the associations of the baseline EQ-5D data [i.e., the EQ-5D problems, EQ-5D-3L index score, and EQ-5D visual analog scale (VAS) score] with the 5-year all-cause mortality, adjusting for socio-demographic characteristics, and subsequently, health conditions and lifestyle habits., Results: A total of 183 participants died over the 5-year study period. A larger proportion of the dead reported problems in physical dimensions (i.e., including three dimensions: mobility, self-care, and usual activities, p < 0.05 for all). The mean EQ-5D index score (0.928) and EQ-VAS score (79.7) of the living were higher than those of the dead (0.915 and 73.2, p < 0.05 for both). In multivariable logistic analyses, the EQ-5D health problems in the physical-related dimensions [odds ratio (OR) 2.16, p < 0.05] and the EQ-VAS score (OR: 0.97, p < 0.001) were associated with the 5-year all-cause mortality when adjusting for socio-demographic characteristics, health conditions, and lifestyle habits., Conclusions: It appears that the EQ-5D-3L could predict mortality in general older Chinese, which could be used to detect high-risk older individuals in China., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Little is known regarding the association between depressive symptoms and metabolic syndrome (MetS) among older Chinese adults. This study aimed to examine the association of depressive symptoms with MetS and its components among Chinese elderly. Based on whether they showed depressive symptoms at baseline, 262 age-gender-matched participants from a community-based cohort study were included. The presence of depressive symptoms was measured using the nine-item Patient Health Questionnaire (PHQ-9). MetS was defined according to the Adult Treatment Panel III of the National Cholesterol Education Program. Linear regression and logistic regression analyses were performed to assess associations of depressive symptoms with MetS and its components. The incidence of MetS among the participants with depressive symptoms at baseline was 15.27% (20/131). The association of the presence of depressive symptoms with MetS was significant (odds ratio [OR] = 2.53, 95% confidence intervals [CI] = 1.07, 5.95). There was a negative association between depressive symptoms and hypertension (OR = 0.04, 95% CI = 0.002, 0.98). The change in mean arterial pressure varies approximately 1.03 mmHg with a 1-point change in PHQ-9 score. In this study, baseline depressive symptoms were associated with subsequent MetS. The presence of depressive symptoms was negatively associated with elevated mean arterial pressure., (© 2021. The Author(s).)

Purpose: High myopia is associated with blinding ocular morbidities. Identifying novel biomarkers may provide clues on pathogenic pathways that are currently unknown. We aimed to identify serum metabolic biomarkers and investigate the metabolic alterations in relation to high myopia., Methods: Forty adults with high myopia and 40 with low myopia aged 60 years or older from the Weitang Geriatric Diseases study were included in the case-control study. Refractive error was determined by autorefraction followed by subjective refraction. We performed the metabolomic analysis of serum samples from patients with high myopia and age- and sex- matched controls with low myopia, using a nontargeted gas chromatography coupled to time-of-flight mass spectrometer. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacities of each metabolite marker. Databases including KEGG and MetaboAnalyst were utilized to search for the potential pathways of metabolites., Results: Serum metabolomic profiles could well distinguish high myopia from low myopia. Twenty metabolic biomarkers were identified as potential serum biomarkers for high myopia, yielding AUC values of 0.59-0.71. Metabolic pathways in relation to high myopia, mainly characterized by increased energy metabolism, increased oxidative stress, abnormal amino acid metabolism, and altered biotin metabolism, provide a foundation to support myopia progression., Conclusions: This study identified valuable metabolic biomarkers and pathways that may facilitate an improved understanding of the disease pathogenesis. The finding holds translational value in the development of new therapeutic measures for high myopia-related complications.

It remains unclear whether leukocyte-related parameters could be used as biomarkers to differentiate metabolically unhealthy overweight/obesity (MUO) from metabolically healthy overweight/obesity (MHO). We aimed to examine the differences in the distribution of leukocyte-related parameters between older adults with MHO and MUO and the correlations of leukocyte-related parameters with individual components of metabolic abnormality. In the Weitang Geriatric Diseases Study on older Chinese adults aged 60 years or above, 404 individuals with MHO and 480 with MUO contributed to the analysis. Overweight/obesity was defined as body mass index (BMI) of 25 kg/m 2 or more. MHO and MUO were discriminated based on the Adult Treatment Panel III (ATP III) criteria. Leukocyte-related parameters were assessed using an automated hematology analyzer. All leukocyte-related parameters except monocytes were elevated in MUO group compared with MHO group (all P < 0.05). The prevalence of MUO increased by 24% with each 10 9 /L increase of leukocytes after adjusting for confounders in the multiple-adjusted model (P < 0.01) and each unit elevation of other parameters except lymphocytes and monocytes were significantly associated with the presence of MUO (all P < 0.01). Trend tests revealed a linear trend for the association between MUO and all the leukocyte-related parameters (all P for trend < 0.05). Significant interactions between leukocyte-related parameters and sex on the presence of MUO were observed (all P value for interaction < 0.05). Higher leukocyte-related parameters were found in patients with MUO than those with MHO and were associated with higher prevalence of MUO which seems to be sex-dependent. Further studies are needed to see whether these parameters could be used as biomarkers for the screening or diagnosis for MUO in clinical or public health practice.

Background: Whether and to what extent outdoor activity and screen time are relevant to adiposity among rural adolescents remain largely unknown as most of relevant evidence was generated from high-income countries and urban areas. This study aimed to investigate associations of outdoor activity and screen time with adiposity among early adolescents living in rural southwest China., Methods: In this cross-sectional study, seventh graders (n = 2264) were recruited from 10 middle schools of a rural county. Overweight and obesity was assessed using adolescents' body mass index and waist circumference. Adolescents' outdoor activity and screen time were measured using self-reported daily time spending on outdoor activity, watching TV, playing video games, and computers on weekdays and weekends, respectively., Results: The prevalence of overweight/obesity and high waist circumferences were 8.0 and 4.9% and were higher among those from one-child families and with parents having high school or higher education and whose fathers were not farmers. Adolescents who did not have ≥1 h outdoor activity on weekdays were more likely to be overweight/obese (OR: 1.86, 95% CI: 1.30, 2.66) and have high waist circumferences (OR: 2.22, 95%CI: 1.39, 3.57). Adolescents who had > 2 h screen time on weekends were more likely to have high waist circumferences (OR: 2.08, 95% CI: 1.14, 3.80). Lack of outdoor activity and excessive screen time also showed synergistic effects on overweight/obesity (OR: 1.93. 95% CI: 1.15, 3.24) and high waist circumferences (OR: 3.02, 95% CI: 1.54, 5.94)., Conclusions: Lack of outdoor activity and excessive screen time were relevant to adiposity among rural Chinese adolescents even when the obesity prevalence was low. Efforts to promote active lifestyles may help prevent rural adolescents from losing their advantage in the era of the global obesity epidemic.