Chinese Adults Research Articles

Cultures of learning and expectations by Chinese learners of English in universities of the third age

ABSTRACT This study, through the theoretical lens of Cultures of Learning, investigates what drives older adults to learn English in the unique socio-cultural setting of Universities of the Third Age (U3A) in China. They have been scarcely investigated, even though at least 76,000 such U3As exist with more than 20 million U3A students by the year 2023. A qualitative approach was used to interview 34 participants extensively. The high frequency of critical events revealed their learning cultures which include four dimensions: cognitive, psychological/social, affective and past-to-future orientated. Prominently the affective factors inspired their persistent learning, e.g. making up for past regrets emerges as a likely unique motive among them. Successful learning is guided by their believed learning cultures and possible selves (e.g. the ideal L2-self emphasizing independence from learning, the relational L2-self for extended social relationships, and the anti-ought-to L2-self stressing their educational capability in older age. Their rich past learning and life experiences are re-evoked and become essential resources to promote resilience and flourishing in later life learning. This paper contributes to the understanding of cultures of learning in later life and provides pedagogical implications that facilitate the education provision and wellbeing of Chinese older adults.

Bidirectional associations between social isolation, loneliness, and cognitive function among Chinese older adults.

Social isolation (SI), loneliness, and cognitive function (CF) are increasingly acknowledged as significant public health concerns globally. In this study, we aimed to investigate the bidirectional relationships and mediating effects between SI, loneliness, and CF among older adults in China. We analysed data from six waves of the Chinese Longitudinal Healthy Longevity Survey conducted between 2002-18. The sample included individuals aged ≥65 years. We used the general cross-lagged panel model to account for confounding factors and reveal mediating effects. The findings indicated that SI and loneliness can independently lower CF. Moreover, loneliness may lower CF through SI, and SI may also lower CF through loneliness. Finally, we revealed that decreased CF can increase SI and loneliness. SI and loneliness are significantly intertwined with CF among older adults in China. Interventions aiming at reducing SI, loneliness, and CF should consider the interplay of these factors to enhance the health and well-being of older adults.

Prevalence and associated factors of denture use among older adults living in rural and urban areas of China: a national cross-sectional study

BackgroundsTooth loss, often considered as an inevitable result of ageing, is one of the most frequently stated problems with older adults worldwide, which entails a negative impact on physical and mental health, as well as quality of life. However, there is urban-rural gap among older adults in both oral health condition and dental service utilization. The study focused on the urban-rural gap in Chinese older population, aiming to describe their tooth loss and denture use status, and explore the associated factors, hoping to provide insights into improving the oral healthcare system in China and other developing countries.MethodsThis cross-sectional study used data collected from May to September in 2020. A stratified, multi-stage cluster sampling design was used to produce nationally representative samples of 2709 adults aged 60 years and older. The dependent variable was denture use of the participant. Determinants included demographic characteristics, health status, social support, oral health knowledge and health service utilization. Descriptive analysis was conducted to describe the sample characteristics, and Generalized Linear Mixed Model was used to identify independent factors associated with denture use among older adults in rural and urban China respectively.ResultsThere were significant urban-rural differences in tooth loss, denture use and health service utilization among Chinese older adults. Urban participants’ denture use was associated with oral health knowledge (OR = 1.29, 95%CI = 1.07–1.56). Rural participants’ denture use was associated with oral health knowledge (OR = 1.23, 95%CI = 1.02–1.47), dental checkup in the last six months (OR = 1.19, 95%CI = 1.00-1.40), and social support (OR = 1.22, 95%CI = 1.03–1.44).ConclusionsGreater efforts should be made to enhance oral health education and emphasize the importance of regular dental checkups among older population. Targeted focus on different aspects of oral health based on the characteristics of different populations is suggested. Policymakers should be aware of the urban-rural disparity in distribution and utilization of oral health services.

Association Between Multiple Plasma Toxic Metal and Metalloid Exposures and Hypertension in Elderly Chinese Adults.

Although environmental exposure to toxic metals and metalloids is linked with the risk of cardiovascular diseases, the evidence is limited in the elderly. We evaluated the associations between 12 plasma metal levels including aluminum (Al), titanium (Ti), strontium (Sr), lead (Pb), vanadium (V), chromium (Cr), cobalt (Co), nickel (Ni), cuprum (Cu), zinc (Zn), arsenic (As), and selenium (Se) with prevalence of hypertension in the elderly Chinese population. In this study, stratified cluster sampling was conducted among elderly residents in three communities in Gansu province from June to July 2023, with a total of 330 participants included. The concentrations of metals in whole plasma were measured using inductively coupled plasma mass spectrometry (ICP-MS). Logistic regression and restricted cubic spline analyses were used to evaluate the dose-response relationship between plasma metal levels and hypertension, with all metal concentrations log-transformed. We applied quantile g-computation (QG-comp) and Bayesian kernel machine regression (BKMR) models to examine the associations of both individual metals and metal mixtures with hypertension. After multivariable adjustments, the odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension associated with the highest quartile of metal concentrations compared to the lowest quartile were as follows: 4.20 (1.36, 12.98) for Sr, 3.95 (1.30, 12.03) for V, 3.43 (1.09, 10.78) for Cr, 3.28 (1.16, 9.28) for Cu, 3.28 (1.13, 9.52) for Zn, and 2.87 (0.94, 8.74) for As.Using BKMR and restricted cubic spline analysis, we found that exposure to metal mixtures was positively associated with an increased risk of hypertension, with Ni, Cr, As, and V being the primary contributing factors. In addition, Zn, Ni, and Sr were significantly and positively correlated with hypertension, while plasma titanium levels were negatively associated with hypertension development. These results suggest a complex interaction between various metals and the risk of hypertension in the elderly.Exposure to metal mixtures was positively associated with hypertension risk in elderly Chinese adults, with Ni, Cr, As, and V as key contributors. In addition, Zn, Ni, and Sr are significantly associated with an increased risk of hypertension, while Ti was positively associated with its development.

Association of handgrip strength weakness and asymmetry with cognitive impairment and depressive symptoms in older Chinese adults

This study investigated the association between handgrip strength (HGS) asymmetry and weakness with cognitive function and depressive symptoms among 920 community-dwelling adults aged above 60 years in suburban Shanghai. Participants were selected using a multistage cluster-stratified sampling approach. Assessments included HGS measured with a dynamometer, the Montreal Cognitive Assessment (MoCA) for cognition, and the Geriatric Depression Scale (GDS) for depressive symptoms. Restricted cubic splines revealed a positive association between dominant HGS and MoCA scores, indicating better cognitive performance, and a negative association with GDS scores, suggesting fewer depressive symptoms. The association between the HGS ratio and MoCA scores and the HGS ratio and GDS scores varied by sex. Women with HGS weakness alone (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17–3.37), asymmetry alone (OR = 1.93, 95% CI = 1.14–3.29), or weakness and asymmetry together (OR = 2.57, 95% CI = 1.48–4.46) had a significantly increased risk of cognitive impairment. However, no such associations observed in men. These findings suggest that HGS weakness and asymmetrical HGS may be associated with a higher risk of cognitive decline and depressive symptoms, particularly in women. This study emphasizes the need for sex-specific assessments and prevention strategies to address cognitive and mental health issues among older adults.

Erythrocyte DHA/EPA Ratio Surpasses Its Individual Fatty Acid Levels in Predicting Metabolic Syndrome in Chinese Adults: A Prospective Study

Erythrocyte DHA/EPA Ratio Surpasses Its Individual Fatty Acid Levels in Predicting Metabolic Syndrome in Chinese Adults: A Prospective Study

The Relationship Between Depressive Symptoms and Self-Neglect in Chinese Older Adults Living Alone: A Latent Profile Analysis

The Relationship Between Depressive Symptoms and Self-Neglect in Chinese Older Adults Living Alone: A Latent Profile Analysis

Exploring Features of the Physical Environment as Contributors to Racial and Ethnic Disparities in Sleep Duration and Efficiency among Older Adults.

Racial and ethnic sleep disparities have been documented; however, the mechanisms are unclear. In a cross-sectional analysis, we examined the contribution of features of the physical environment to sleep disparities among Black, Chinese, Hispanic, and White adults (N=1945, average age:68.5+9.1). Physical environment measures were self-reported (aesthetic quality, walking environment) and objectively-measured via Geographic Information Systems (walking destination density, proportion of land dedicated to retail space, overall built environment score). Sleep duration (short:<6 hours) and sleep efficiency were measured via 7-day actigraphy. Multi-level linear and Poisson regression models with robust variance were fit to examine associations with adjustment for covariates. Direct and indirect mediation was tested via path models. Insufficient sleep was highest for minoritized individuals (short sleep: 32.5-44.1%, <85% sleep efficiency: 9.3-10.5%). Living in neighborhoods with higher aesthetic quality scores was associated with sleeping 5.8 minutes (0.67, 10.85) longer on average. Higher walking destination density, proportion retail, and built environment scores were associated with shorter sleep duration and higher prevalence of short sleep (adjusted prevalence ratio: 1.0001 [1.0005,1.0016], 1.02 [1.01,1.04], and 1.06 [1.02,1.09], respectively). Proportion retail partially explained the Black-White (2.8%) and Chinese-White (11.3%) difference in sleep duration. The Hispanic-White difference in sleep duration was partially (5.8-26.5%) explained by differences in aesthetic quality, walking destination density, proportion retail, and built environment score. There were no associations between features of the physical environment and sleep efficiency. Features of the physical environment partially contributed to racial disparities in sleep duration and is a likely target for intervention.

Association Between Sleep Duration and Cognitive Frailty in Older Chinese Adults: Prospective Cohort Study.

Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults is lacking. The objective of our study was to examine the associations of sleep duration and its changes with cognitive frailty. We analyzed data from the 2008-2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6-9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were employed to explore potential non-linear associations. Among 11,303 participants, 1,298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio [OR] =1.71, 95% confidence interval [CI] =1.48-1.97, p<0.001). A J-shaped association between sleep duration and cognitive frailty was also observed (p<0.001). Additionally, during a median follow-up of 6.7 years among 5,201 participants who were not cognitively frail at baseline, 521 (10.0%) developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio [HR] =1.32, 95% CI =1.07-1.62, p=0.008). Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice.

The Mediating Role of Emotional Self-Efficacy in the Relationship Between the Number of Medications and Psychological Distress Among Older Adults with Chronic Illness

ABSTRACT Purpose The present study aimed to examine the associations between the number of medications, emotional self-efficacy, and psychological distress in older adults with chronic illness. Design A cross-sectional study was conducted with a convenience sample of 191 older adults in Anhui, China. Methods Those participants completed a structured questionnaire that included sociodemographic data, medications, emotional self-efficacy, and psychological distress status. Pearson correlation analysis was used to examine the correlation between study variables. The bootstrap method was employed to analyze the mediating role of emotional self-efficacy. Findings The results showed that 10.5% and 14.1% of the participants might be experiencing symptoms of anxiety and depression, respectively. Correlation analysis revealed that emotional self-efficacy was negatively correlated with anxiety and depression. The results showed that emotional self-efficacy partially mediated the relationship between the number of medications and depression, accounting for 51.9% of the total effect. Additionally, emotional self-efficacy partially mediated the relationship between the number of medications and anxiety, accounting for 50.8% of the total effect. However, a suppressor effect was established for the relationship between the number of medications and polypharmacy-related psychological distress. Conclusions The findings suggested that emotional self-efficacy might play an important role in the relationship between the number of medications and psychological distress in Chinese older adults with chronic illness.

The different mediation role of habit features between intolerance of uncertainty and psychopathological symptom dimensions: A transdiagnostic perspective.

The different mediation role of habit features between intolerance of uncertainty and psychopathological symptom dimensions: A transdiagnostic perspective.

Association between dietary patterns and anemia in older adults: the 2015 China adults chronic diseases and nutrition surveillance

BackgroundAnemia is a condition that has been affected 1.92 billion people worldwide in 2021, leading physical decline, functional limitation and cognitive impairment. However, there are currently fewer studies focusing on the relationship between anemia and dietary patterns in older adults. This study aimed to analysis the dietary patterns in older adults aged 60 and above in China and their association with anemia.MethodsThe data was obtained from the 2015 Chinese Adults Chronic Diseases and Nutrition Surveillance (2015 CACDNS), dietary information was collected using the food frequency method within the past year, exploratory factor analysis was used to extract dietary patterns, and logistic regression was used to analyze the relationship between dietary patterns and anemia.ResultsA total of 48,955 elderly people were included, and the number of anemia patients was 4,417 (9.02%). Four dietary patterns were categorized by the exploratory factor analysis, two dietary patterns have been found to have a statistically significant relationship with the prevalence of anemia. Compared to the first quintile, the fifth quintile of dietary pattern 2 (DP2), characterized by high intake of rice and flour, fresh vegetables, livestock and poultry meat, aquatic products, was associated with higher prevalence of anemia in older adults (OR = 1.412, 95%CI: 1.273–1.567, P < 0.0001), and the trend test results showed that score of this dietary pattern was associated with higher prevalence of anemia (p for trend < 0.0001). Compared to the first quintile, Dietary Pattern 4 (DP4), rich in fungi and algae, fried dough products, other grains, various beans, and rice and flour, was linked to lower prevalence of anemia of the fifth quintile (OR = 0.768, 95% CI: 0.674–0.874, P < 0.0001). And DP4 score was associated with lower prevalence of anemia (P for trend < 0.0001).ConclusionsThere were differences in dietary patterns among elderly people over 60 in China, and the prevalence of anemia in older adults was related to DP2, and DP4.

Association between the minimal model of hip structure and risk of hip fracture in Chinese adults

BackgroundMultiple studies have indicated that the minimal model of hip structure can enhance hip fracture risk assessment. This study aimed to investigate the independent association between minimal model variables and hip fracture risk in Han Chinese individuals.MethodsThis cross-sectional study included 937 Han Chinese patients (248 with hip fractures). Minimal model variables were calculated from the hip structural analysis, including bone mineral density (BMD), femoral neck width (FNW), and Delta and Sigma values.ResultsThis study included 937 patients (293 men; mean age = 68.3 years). In logistic regression analyses, BMD increase (per 0.1 g/cm2) correlated with a 45% reduction in the hip fracture risk (odds ratio [OR] = 0.55; 95% confidence interval [CI]: 0.45–0.68) after adjusting for all covariates. However, FNW (per 0.1 cm) and Sigma (per 0.01 cm) and Delta values (per 0.01 cm) were associated with increased risks (OR = 1.28; 95% CI: 1.18–1.37; OR = 1.06; 95% CI: 1.03–1.09; OR = 1.06; 95% CI: 1.03–1.09, respectively). When the Delta was &amp;gt;0.17 cm, the risk of hip fracture rose considerably by 13% (OR = 1.13; 95% CI: 1.08–1.18) for every 0.01 cm that the Delta value increased. The area under the curve (AUC) for hip fracture prediction from BMD alone was significantl lower than those of minimal model (0.781 vs 0.838, p &amp;lt;0.05).ConclusionLarge increases in FNW, Sigma and Delta values and notable declines in BMD were individually and significantly linked to a high hip fracture risk in Han Chinese adults. Our findings suggest that the minimal model of hip structure may improve hip fracture risk assessments.

Prospective Associations of Appearance-Related Teasing With Eating Disorder Psychopathology, Eating-Related Psychosocial Impairment, and Psychological Distress in Chinese Adults: Both Teasing Victimization and Perpetration Matter.

This study examined prospective associations of weight and muscularity teasing, including both victimization and perpetration, with thinness- and muscularity-oriented eating disorder (ED) psychopathology, eating-related psychosocial impairment, and psychological distress. An online sample of 799 Chinese adults (400 men and 399 women) participated in this longitudinal study with two waves of data collection at baseline (T1) and 6 months later (T2). Analyses were conducted separately by gender. Univariable and multivariable longitudinal analyses based on linear regressions were used to examine the prospective links between weight and muscularity teasing experiences at T1 and outcome variables at T2, adjusting for covariates and outcome variables at T1. Univariable analyses revealed that, for both men and women, all teasing experiences at T1 (except for muscularity teasing perpetration in men) were prospectively associated with one or more outcome variables at T2. Multivariable analyses revealed that for men, weight and muscularity teasing victimization at T1 were independently linked to greater eating-related psychosocial impairment and/or psychological distress at T2. For women, weight teasing perpetration at T1 was independently linked to higher thinness-oriented ED psychopathology and greater psychological distress at T2. Findings suggest that both victimization and perpetration of weight and muscularity teasing were prospectively associated with one or more outcome variables, including ED psychopathology, eating-related psychosocial impairment, and psychological distress. Future research and interventions should address both victimization and perpetration in appearance-related teasing to enhance our understanding and mitigate its adverse effects on eating behaviors and mental health.

Handgrip weakness and overall life satisfaction decline: derivation of cutoff values and analysis of sex differences in older Chinese adults

Background and aimsHandgrip strength (HGS) is a cost-effective indicator of skeletal muscle function. However, the sex-specific association between HGS and life satisfaction decline among older Chinese adults remains largely unknown.MethodsThis observational, cross-sectional multicenter study included 3,649 older adults (age range: 60–101 years) from a nationally representative survey in China. Overall life satisfaction was determined using a life satisfaction score (LSS). Correlations between variables were examined using a Spearman’s correlation analysis. Receiver operating characteristic (ROC) curves were utilized to determine the HGS cutoffs for predicting a decline in LSS. Restricted cubic spline (RCS) analysis and multivariate logistic regression were employed to investigate the associations between low HGS and LSS.ResultsThis study included 1,762 women and 1,887 men (median age = 68.3 years). LSS decline was observed in 485 (13.3%) participants. HGS was positively correlated with LSS in both men and women (both P &amp;lt; 0.05). Individuals with low HGS were associated with a higher rate of LSS decline (16.2% vs. 10.8%, P &amp;lt; 0.001). RCS analysis demonstrated a linear-like association between HGS and life satisfaction in men (P &amp;lt; 0.001, P nonlinear = 0.099), but not in women (P = 0.110, P nonlinear = 0.329). ROC analysis revealed that the optimal HGS cutoff for indicating the presence of LSS was 27.5 kg for men and 22.3 kg for women. Multivariable analysis showed that participants with low HGS had higher odds of experiencing a decline in LSS [odds ratios (OR) = 1.509, 95% confidence interval (CI) = 1.218–1.867]. This association was observed only in men (OR = 1.871, 95% CI = 1.358–2.562, P &amp;lt; 0.001), while it was attenuated in women (OR = 1.281, 95% CI = 0.964–1.701, P = 0.087).ConclusionThis study establishes sex-specific cutoffs of HGS for identifying a decline in LSS among older Chinese adults. Low HGS is positively associated with LSS decline among men in a linear-like manner, but not among women. These findings might facilitate the development of strategies to promote healthy aging.

The simplified Chinese version of the Nonrestorative Sleep Scale in Chinese young adults and measurement invariance across language and age

BackgroundTo assess the psychometric properties of the simplified Chinese version of the Nonrestorative Sleep Scale (NRSS) in Chinese young adults and examine measurement invariance across language and age.MethodsAfter cognitive debriefing, the simplified Chinese NRSS was administered to university students in mainland China in this cross-sectional survey (Study 1). The Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-4), and sociodemographic characteristics were also self-reported. The sample was randomly split into two halves to examine the scale structure using exploratory factor analysis (EFA) and asses the psychometric properties of the identified structure by confirmatory factor analysis (CFA), respectively. Incorporating data from two additional studies (Study 2: a survey of Hong Kong Chinese adults; Study 3: a survey of mainland Chinese adolescents), multigroup CFA models were conducted to examine the measurement invariance across language and age, followed by a t-test to determine group differences once invariance was established.ResultsIn the 570 participants of Study 1 (28.8% male, age 20.2 ± 1.5 years), the EFA revealed a four-factor structure. The root mean square error of approximation, comparative fit index, and standardized root mean square residual in the CFA model were 0.053, 0.995, and 0.054, respectively. The statistically significant correlations of NRSS with PSQI (r = − 0.61) and PHQ-4 (r = − 0.53) demonstrated the convergent validity of NRSS. The internal consistency of the whole scale was 0.84. Measurement invariance was concluded between traditional and simplified Chinese NRSS and between young adults and adolescents with the change of comparative fit index and root mean square error of approximation smaller than 0.010. The effect size (Cohen’s d) of difference between mainland Chinese adults and Hong Kong Chinese adults ranged from 0.193 to 0.771, while that between mainland Chinese adults and adolescents ranged from 0.027 to 0.345.ConclusionThe simplified Chinese 12-item NRSS is valid and reliable for assessing NRS among Chinese young adults, and it can be used to measure and compare NRS between individuals using simplified Chinese and traditional Chinese, as well as across different age groups within the simplified Chinese user population.

Multicomponent Intervention for Distressed Informal Caregivers of People With Dementia

Multicomponent interventions for informal caregivers of people with dementia are urgently needed, but evidence regarding which components are most effective is lacking. To apply a multiphase optimization strategy to examine the effects of 5 psychosocial components of an intervention designed to support informal caregivers of people with dementia. In this assessor-blinded randomized clinical trial with a fractional factorial design, Chinese community-dwelling adults (aged ≥18 years) who were informal family caregivers of people with dementia were screened between July 2 and December 28, 2022, in Hong Kong. Eligible participants with elevated depression or caregiving burden were included and randomized to 1 of 16 experimental conditions. Assessments were conducted at baseline, 6 months, and 12 months. The last 12-month follow-up assessment was conducted on February 26, 2024. The intervention involved a core component (dementia caregiving education) and 5 tested psychosocial components (self-care skills [SC], behavioral problem management [BPM], behavioral activation [BA], mindfulness-based intervention [MBI], and support group [SG]). Primary outcomes for each tested psychosocial component were physical health (12-item Short-Form Health Survey), caregiver burden (12-item Zarit Burden Interview) and stress (10-item Perceived Stress Scale), psychological well-being (Ryff Psychological Well-Being Scale), anxiety (Hospital Anxiety and Depression Scale-Anxiety Subscale), depressive symptoms (9-item Patient Health Questionnaire), and social support (20-item Medical Outcomes Study Social Support Survey). Multiple linear regression models were used to analyze score changes from baseline to 6 months and from baseline to 12 months for primary and proximal outcomes across the 5 components. This trial included 250 caregivers (mean [SD] age, 48.9 [13.8] years); most (171 [68.4%]) were female. The MBI component significantly improved multiple caregiver outcomes, with reduced depressive symptoms (β = -2.13 [95% CI, -2.85 to -1.38]; P < .001) and increased mindfulness (β = 4.23 [95% CI, 2.27-6.36]; P < .001), perceived social support (β = 4.76 [95% CI, 1.28-8.15]; P = .007), and active dementia care management (β = 3.70 [95% CI, 1.80-5.66]; P < .001) at 12 months. The SG component significantly improved perceived social support (β = 4.63 [95% CI, 1.32-7.85]; P = .006) at 12 months. BPM had mixed effects; that is, it initially increased caregiver anxiety (β = 1.43 [95% CI, 0.43-2.42]; P = .005) and self-care risk (β = -1.12 [95% CI, -1.82 to -0.43]; P = .002) at 6 months but improved dementia care strategies in terms of encouragement (β = 2.49 [95% CI, 0.74-4.22]; P = .005), active management (β = 5.99 [95% CI, 4.12-7.84]; P < .001), and psychological well-being (β = 3.52 [95% CI, 0.92-6.08]; P = .008) at 12 months. Interaction effects were observed, with the MBI component enhancing the benefits of SC (β = -1.70 [95% CI, -3.05 to -0.35]; P = .01) and BPM (β = -1.40 [95% CI, -2.76 to -0.05]; P = .04) on depression; meanwhile, the MBI and SG components synergistically improved perceived social support (β = 7.58 [95% CI, 0.90-14.26]; P = .03). In this clinical trial of informal caregivers of people with dementia, synergistic interaction effects were noted for MBI, which enhanced the benefits of SC and BPM on depression. The combination of the MBI and SG components also synergistically improved social support. Integrating MBI with SC, SG, or BPM components was an effective multicomponent approach to support caregivers in this study, although ongoing support was needed to mitigate potential short-term risks. Further research is required to validate the efficacy of this optimized intervention package. Chinese Clinical Trial Registry Identifier: ChiCTR2300071235.

Associations of Home-Based Individual and Family Exercise with Personal and Family Well-Being Amid the COVID-19 Pandemic: A Population-Based Survey in Hong Kong

Exercise benefits individuals, but research about exercising with family members (EFM) and personal and family well-being is scarce. We investigated the associations of home-based individual exercise (IE) and EFM with personal and family well-being amid the COVID-19 pandemic. A population-based cross-sectional survey on Hong Kong Chinese adults was conducted from February to March 2021, when COVID-19 was under control (N = 5825). Respondents reported the number of days IE and EFM occurred at home in the past 7 days (0, 1–2, 3–4, 5–6, 7), respectively. Family well-being, personal happiness, and personal/family adversity coping capability (ACC/FACC) were each measured with an 11-point scale (range 0–10). Psychological distress was measured using the four-item Patient Health Questionnaire (range 0–12). Associations were assessed using multiple linear regressions. Of 1911 respondents, 9.2% reported having ≥3 days of EFM. After adjusting for each other and sociodemographic characteristics, more frequent IE or EFM (≥3 vs. 0–2 days) was associated with greater family well-being, FACC, personal happiness, and lower psychological distress. Our findings suggest that home-based EFM or IE may promote personal/family well-being and highlight the potential for incorporating home-based exercise into public health strategies to enhance overall well-being.

Association between percent body fat and the risk of prediabetes among Chinese adults: a 5-years longitudinal cohort study

This study aimed to explore the influence of percent body fat (PBF) on the risk of developing prediabetes among Chinese individuals, given the limited evidence on this relationship. We conducted a retrospective cohort study involving 185,586 Chinese adults. We applied Cox proportional hazards regression models, cubic spline functions, and smooth curve fitting to analyze the relationship between initial PBF and the likelihood of prediabetes, focusing on its nonlinear connection. We conducted various sensitivity and subgroup analyses to strengthen our results. After adjusting for covariates, we found a positive correlation between PBF and the risk of prediabetes (HR = 1.13, 95% CI: 1.12–1.15, p < 0.0001). Moreover, a nonlinear correlation was identified between PBF and the likelihood of prediabetes, with a turning point at 29.5. On the left side of the turning point, the hazard ratio was 1.01 (95% CI: 0.99–1.03, p = 0.4128), while on the right side, it was 1.52 (95% CI: 1.45–1.59, p < 0.0001). Furthermore, sensitivity and subgroup analyses reaffirmed the robustness of these findings. Our research identified a nonlinear relationship between PBF and the development of prediabetes in the Chinese population, marked by a turning point at 29.5. Lowering PBF below 29.5 may reduce the risk of developing prediabetes.

Machine learning-based prediction models for renal impairment in Chinese adults with hyperuricaemia: risk factor analysis

In hyperuricaemic populations, multiple factors may contribute to impaired renal function. This study aimed to establish a machine learning-based model to identify characteristic factors related to renal impairment in hyperuricaemic patients, determine dose‒response relationships, and facilitate early intervention strategies. Data were collected through the big data platform of Nanjing Hospital of Traditional Chinese Medicine, encompassing 2,705 patients with hyperuricaemia (1,577 with renal impairment, 828 without) from June 2019 to June 2022. After multiple imputations for missing values, the dataset was randomly split into training (70%) and validation (30%) sets. We employed three machine learning algorithms for feature selection: random forest (with 100 decision trees and an OOB error rate of 23.34%), LASSO regression (optimal lambda of -3.58), and XGBoost (learning rate of 0.3, maximum tree depth of 1, and 50 rounds of boosting). The intersection of features identified by these algorithms through Venn diagram analysis yielded four key predictors. A logistic regression model was subsequently constructed and evaluated for discrimination (AUC), calibration (Brier score), and clinical utility (DCA). Restricted cubic spline (RCS) curves were utilized to analyse the dose‒response relationships. The model, which incorporates age, cystatin C (Cys-C), uric acid (UA), and sex, demonstrated robust performance, with an AUC of 0.818 [95% CI (0.796–0.817)] in the training set and an AUC of 0.82 [95% CI (0.787–0.853)] in the validation set. Calibration tests yielded Brier scores of 0.160 and 0.158, respectively. Clinical decision curves revealed optimal prediction probability intervals of 6-99.02% and 7-93.14%. In the hyperuricaemic population, each 0.5 mg/L increase in Cys-C, 10-year increase in age, and 100 µmol/L increase in UA corresponded to increased risks of 13%, 81%, and 73%, respectively. RCS analysis revealed nonlinear relationships for Age and Cys-C and a linear relationship for UA, with sex-specific distribution patterns. The machine learning-based model incorporating these four indicators demonstrated excellent predictive performance for renal impairment in hyperuricaemic patients. These findings suggest that monitoring Cys-C and UA levels while considering age and sex differences is crucial for risk assessment and prevention strategies.