Rural Communities In China Research Articles

Socioeconomic Status and Health Disparities: A Comprehensive Study of Rural Communities in China

Aim: This study aims to determine the role of socioeconomic status in influencing health disparities among rural communities in China. Method: For this purpose, the data was gathered from Chinese General Social Survey (CGSS) of years 2009, 2014 and 2019 to investigate health inequality and determinants within China. Within this regard, the ordinal complementary log–log model was used. Result: The results obtained show that health status varies with different social and individual factors. Different health determinants such as gender, region, residential area, ethnicity, and income level, were found to have a significant impact. However, it has been observed that the individuals with lower socioeconomic status had poor health status as compared to the individuals with higher socioeconomic status. Implication: The current study would prove effective in providing useful insights and implications to reduce health disparities within China.

Multi-objective optimization for generative morphological design using energy and comfort models with a practical design of new rural community in China

In recent years, the development of new rural communities has emerged as a pivotal new trend in china, aimed at enhancing energy efficiency and residential comfort in rural regions. This study introduces a multi-objective optimization design framework for the morphological design of residential area, with a focus on performance objectives such as building energy use intensity, summer thermal comfort, and winter thermal comfort. A case study of a new rural community design project in Hongnan Village, Yancheng City, was conducted. Utilizing the Rhino-Grasshopper parametric platform, this study undertook parametric modeling, performance simulation, and multi-objective optimization to receive the Pareto-optimal solutions. ParetoResults indicate that in the Pareto-optimal morphology scheme for the Hongnan Village community, open spaces are predominantly located on the upwind side with respect to the prevailing summer winds of the site. The number of duplex houses is often 28, and the building orientations are predominantly aligned at 23°, mirroring the direction of the surrounding structures. There is a significant correlation between residential unit configuration, building spacing, and energy use intensity, with correlation coefficients of 0.53 and −0.43, respectively. This study would like to offer valuable insights into the energy-efficient design of new rural communities, thereby contributing to the creation of a more sustainable and habitable rural living environment.

Cost-effectiveness of latent tuberculosis infection testing and treatment with 6-week regimen among key population in rural communities in China: a decision analysis study.

Several model studies suggested the implementation of latent tuberculosis infection (LTBI) testing and treatment could greatly reduce the incidence of tuberculosis (TB) and achieve the 2035 target of the "End TB" Strategy in China. The present study aimed to evaluate the cost-effectiveness of LTBI testing and TB preventive treatment among key population (≥ 50 years old) susceptible to TB at community level in China. A Markov model was developed to investigate the cost-effectiveness of LTBI testing using interferon gamma release assay (IGRA) and subsequent treatment with 6-month daily isoniazid regimen (6H) (as a standard regimen for comparison) or 6-week twice-weekly rifapentine and isoniazid regimen (6-week H2P2) in a cohort of 10,000 adults with an average initial age of 50 years. In the base-case analysis, LTBI testing and treatment with 6H was dominated (i.e., more expensive with a lower quality-adjusted life year (QALY)) by LTBI testing and treatment with 6-week H2P2. LTBI testing and treatment with 6-week H2P2 was more effective than no intervention at a cost of $20,943.81 per QALY gained, which was below the willingness-to-pay (WTP) threshold of $24,211.84 per QALY gained in China. The one-way sensitivity analysis showed the change of LTBI prevalence was the parameter that most influenced the results of the incremental cost-effectiveness ratios (ICERs). As estimated by a Markov model, LTBI testing and treatment with 6-week H2P2 was cost-saving compared with LTBI testing and treatment with 6H, and it was considered to be a cost-effective option for TB control in rural China.

Sustainable development of the mining sector for achieving common prosperity in Chinese rural areas

This study investigates the correlation between sustainable mining practices and the well-being of rural communities in China. Utilizing data spanning from 1990 to 2021 and employing the ARDL (Autoregressive Distributed Lag) methodology for analysis, our findings indicate that a 1% improvement in mining efficiency corresponds to a short-term rise of 0.23% and a long-term rise of 0.30% in common prosperity. On the other hand, rapid growth in the rural population has a detrimental effect on common prosperity, resulting in a short-term reduction of 0.37% and a long-term reduction of 0.49%. Moreover, investments play a pivotal role in boosting rural prosperity, demonstrating a short-term increase of 0.15% and a long-term increase of 0.24% for every 1% investment growth. To advance rural prosperity through environmentally sustainable mining, policy initiatives should prioritize digitalization, the creation of green jobs, and the promotion of rural green entrepreneurship.

Linking Natural Resource Dependence to Sustainable Household Wellbeing: A Case Study in Western China

To reduce the threat of natural disasters, protect natural resources, and promote human wellbeing, Shaanxi Province, China has implemented the largest disaster resettlement project since 2011. It has moved 2.4 million people in three prefectures over 10 years. Using survey data from southern Shaanxi, China, this article measures sustainable household wellbeing (SHWB) and natural resource dependence in the context of disaster resettlement. It explores the differences in SHWB and natural resource dependence across different groups and relocation characteristics. To specifically analyze the effects of natural resource dependence on SHWB, ordinary least square (OLS) regression models were used to investigate their relationship. The results show that natural resource dependence shows significant positive correlation with SHWB. Meanwhile, the food dependence, energy dependence, and income dependence of relocated households show significant positive correlation with SHWB. Additionally, the SHWB of relocated households, voluntary relocation households, and centralized relocation households is significantly lower than local households, involuntary relocation households, and scattered relocation households. These findings have broader implications for rural communities in China and other developing countries, and are crucial for rural households to change the heavy dependence on natural resources and improve their wellbeing.

Model innovation construction of social work participation in grassroots community governance based on fuzzy comprehensive evaluation model

Abstract Grass-roots community governance is a large volume in China, the “last mile” for implementing national policies, and has a special status in promoting the construction of China under the rule of law. Guided by the theory of the rule of law government, governance and good governance theory, competence-based theory and system theory, this paper constructs a model of grassroots community multi-governance. And by using the theoretical knowledge of the fuzzy comprehensive evaluation model and the Delphi method, we analyzed the factors influencing the rule of law competence of grassroots cadres and focused on constructing an index system of the grassroots cadres’ rule of law competence and establishing a multi-level evaluation model. The results show that: through the empirical analysis of the grassroots community multi-level shared governance model, the KMO values are 0.728 and 0.851, respectively, which are greater than 0.7 and pass the KMO test. The approximate chi-square values are 415.127 and 1254.23, respectively, and the significance level sig is 0.000, which passes Bart’s spherical test and has good sexual validity. The grassroots community pluralistic shared governance model proposed in this paper improves the comprehensive service capacity of urban and rural communities in China, complements the governance shortcomings at different levels, and takes multiple measures to improve the governance level of urban and rural communities China.

Association of Triglyceride-Glucose Index With Cognitive Function and Brain Atrophy: A Population-Based Study

ObjectiveTo investigate the associations of triglyceride-glucose (TyG) index, a reliable surrogate marker for insulin resistance, with the function of various cognitive domains and brain structures among older adults. DesignA population-based cross-sectional study. SettingOlder adults living in the rural communities in China. ParticipantsAbout 4,541 rural-dwelling dementia-free participants (age ≥65 years; 56.37% women) undertook examinations in March–September 2018 for MIND-China. MeasurementsTyG index was calculated as ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. A neuropsychological test battery was used to assess memory, attention, verbal fluency, and executive function. Volumetric brain measures were assessed on magnetic resonance imaging (MRI) in a subsample (n = 1,019). Data were analyzed with restricted cubic spline and multivariable general linear models. ResultsAn inverted J-shaped association was observed between TyG index and z-scores of multiple cognitive domains, such that among individuals with TyG index ≥8.57 (median), a higher TyG index was significantly associated with lower z-scores of memory, attention, verbal fluency, executive function, and global cognition (all p < 0.05); among people with TyG index <8.57, a higher TyG index was significantly associated with a higher executive function z-score (p < 0.05), but not with any of the other examined cognitive domains. In the MRI subsample, a higher TyG index was significantly associated with lower volumes of total brain tissue, gray matter, and white matter as well as greater cerebrospinal fluid volume (p < 0.05), but not with white matter hyperintensity volume. ConclusionsInsulin resistance, as indicated by a high TyG index, was associated with poor function in multiple cognitive domains and global brain atrophy.

Peer Support Self-Management Intervention for Individuals With Type 2 Diabetes in Rural Primary Care Settings: Protocol for a Mixed Methods Study.

The increasing prevalence of diabetes is placing important demands on the Chinese health care system. Providing self-management programs to the fast-growing number of people with diabetes presents an urgent need in rural primary care settings in China. Peer support has demonstrated effectiveness in improving self-management for individuals with diabetes in urban communities in China. A priority then becomes developing and evaluating a peer support program in primary care settings in rural communities of China and determining whether it is feasible and acceptable. The aims of this study are (1) to evaluate the feasibility and acceptability of a peer support approach to type 2 diabetes self-management in rural primary care settings; (2) to identify enabler and facilitator factors likely to influence the peer support implementation; (3) to provide primary data and evidence for developing a version of the program suitable for a randomized controlled trial in rural primary care settings. Three townships will be sampled from 3 different counties of Anhui province as the study setting. Participants will be recruited based on these counties' local primary care health record system. The peer supporters will be recruited from among the participants. The peer support program will be led by peer supporters who have completed 12 hours of training. It will be guided by primary care providers. The program will include biweekly meetings over 3 months with varied peer support contacts between meetings to encourage the implementation of diabetes self-management. Mixed methods will be used for evaluation. Qualitative methods will be used to collect information from health care system professionals, individuals with diabetes, and peer supporters. Quantitative methods will be used to collect baseline data and data at the end of the 3-month intervention regarding psychosocial factors and self-management practices. The results will include (1) quantitative baseline data that will characterize type 2 diabetes self-management practices of individuals with diabetes; (2) qualitative data that will identify enablers of and barriers to self-management practices for individuals with type 2 diabetes in rural communities; (3) both qualitative and quantitative evaluation data, after the 3-month intervention, to demonstrate the feasibility and acceptability of the peer support approach for individuals with type 2 diabetes. Our findings will inform the design of a tailored intervention program to improve self-management among individuals with type 2 diabetes in rural primary care settings. If we find that the peer support approach is feasible and acceptable, we will develop a larger randomized controlled trial to evaluate effectiveness in multiple rural settings in the province. PRR1-10.2196/47822.

Characterising personal, household, and community PM2.5 exposure in one urban and two rural communities in China

BackgroundCooking and heating in households contribute importantly to air pollution exposure worldwide. However, there is insufficient investigation of measured fine particulate matter (PM2.5) exposure levels, variability, seasonality, and inter-spatial dynamics associated with these behaviours. MethodsWe undertook parallel measurements of personal, household (kitchen and living room), and community PM2.5 in summer (May–September 2017) and winter (November 2017-Janauary 2018) in 477 participants from one urban and two rural communities in China. After stringent data cleaning, there were 67,326–80,980 person-hours (ntotal = 441; nsummer = 384; nwinter = 364; 307 had repeated PM2.5 data in both seasons) of processed data per microenvironment. Age- and sex-adjusted geometric means of PM2.5 were calculated by key participant characteristics, overall and by season. Spearman correlation coefficients between PM2.5 levels across different microenvironments were computed. FindingsOverall, 26.4 % reported use of solid fuel for both cooking and heating. Solid fuel users had 92 % higher personal and kitchen 24-h average PM2.5 exposure than clean fuel users. Similarly, they also had a greater increase (83 % vs 26 %) in personal and household PM2.5 from summer to winter, whereas community levels of PM2.5 were 2–4 times higher in winter across different fuel categories. Compared with clean fuel users, solid fuel users had markedly higher weighted annual average PM2.5 exposure at personal (78.2 [95 % CI 71.6–85.3] μg/m3 vs 41.6 [37.3–46.5] μg/m3), kitchen (102.4 [90.4–116.0] μg/m3 vs 52.3 [44.8–61.2] μg/m3) and living room (62.1 [57.3–67.3] μg/m3 vs 41.0 [37.1–45.3] μg/m3) microenvironments. There was a remarkable diurnal variability in PM2.5 exposure among the participants, with 5-min moving average from 10 μg/m3 to 700–1200 μg/m3 across different microenvironments. Personal PM2.5 was moderately correlated with living room (Spearman r: 0.64–0.66) and kitchen (0.52–0.59) levels, but only weakly correlated with community levels, especially in summer (0.15–0.34) and among solid fuel users (0.11–0.31). ConclusionSolid fuel use for cooking and heating was associated with substantially higher personal and household PM2.5 exposure than clean fuel users. Household PM2.5 appeared a better proxy of personal exposure than community PM2.5.

Promoting Elderly Care Sustainability by Smart Village Facilities Integration—Construction of a Public Service Field with Introduction of Fall Posture Monitoring

In recent years, rural communities in China have been actively exploring a novel approach to elderly care that integrates treatment with health preservation. This study aims to contribute to the sustainable development of rural elderly care by introducing smart technology, specifically fall posture monitoring, into public services and facilities within rural communities. The focus of this study is on addressing a critical issue in elderly medical care: the timely feedback and treatment of falls. To begin, we conduct a comprehensive review of the current status and challenges associated with the application of fall posture monitoring technology. Additionally, we examine the environmental factors that contribute to the risk of falls in public spaces for the elderly. These assessments serve as the technical and environmental foundation for developing the proposed service framework. Our research is conducted from two primary perspectives: the supply of service resources that combine treatment with health preservation and the identification of risk factors associated with outdoor public spaces in the community where falls are likely to occur. Data for this study are collected through behavior mapping and field interviews. In conclusion, we present a constructive logic for the development of a public service field that effectively combines treatment with health preservation. This logic encompasses the integration of technology applications, resource coordination, and improvements to the physical environment. The findings from this study provide a scientific basis for the construction of public service fields in “smart villages” and serve as practical references for similar villages striving to adopt this innovative model. By leveraging the insights gained from this research, it is expected that rural communities will be better equipped to address the challenges of elderly care and facilitate the widespread adoption of this integrated care model.

Ventricular Electrocardiographic Signatures Associated with Dementia and Plasma Alzheimer's Disease Biomarkers in Older Adults: A Population-Based Study.

Evidence has emerged that altered ventricular electrocardiogram profiles are associated with dementia, but the neuropathological mechanisms underlying their associations are poorly understood. To investigate the interrelationships of ventricular electrocardiogram profiles with dementia and plasma Alzheimer's disease (AD) biomarkers among older adults. This population-based cross-sectional study included 5,153 participants (age ≥65 years; 57.3% women) living in rural communities in China; of these, 1,281 had data on plasma amyloid-β (Aβ)40, Aβ42, total-tau, and neurofilament light chain (NfL) protein. The QT, QTc, JT, JTc, QRS intervals, and QRS axis were derived from the 10-second electrocardiogram recording. The DSM-IV criteria were followed for clinical diagnosis of dementia, the NIA-AA criteria for AD, and the NINDS-AIREN criteria for vascular dementia (VaD). Data were analyzed using general linear models, multinomial logistic models, and restricted cubic splines. Of the 5,153 participants, 299 (5.8%) were diagnosed with dementia, including 194 with AD and 94 with VaD. Prolonged QT, QTc, JT, and JTc intervals were significantly associated with all-cause dementia, AD, and VaD (p < 0.05). Left QRS axis deviation was significantly associated with all-cause dementia and VaD (p < 0.01). In the subsample of plasma biomarkers (n = 1,281), prolonged QT, JT, and JTc intervals were significantly associated with a lower Aβ42/Aβ40 ratio and higher plasma NfL concentrations (p < 0.05). Alterations in ventricular repolarization and depolarization are independently associated with all-cause dementia, AD, VaD, and AD plasma biomarkers in older adults (age ≥65 years). Ventricular electrocardiogram parameters may be valuable clinical markers for dementia and the underlying AD pathologies and neurodegeneration.

Relationship between rural land titling and land transfer in China: a systematic literature review and meta-analysis

The traditional land system of rural communities in China has been an obstacle to the sustainable development of land transfer. To facilitate a more efficient allocation of resources, the Chinese government has implemented the largest rural land titling action in the world. However, there has been much debate in scholarly circles regarding the correlation between rural land titling and rural land transactions. By employing meta-analysis technology, this paper evaluates the relationship between rural land titling and rural land transactions. According to the meta-analysis results, rural land titling is only a minor contributor to rural land transfer; it only contributes to rural land transfer-out, with no effect on rural land transfer-in. Furthermore, education, age, labor force, agricultural fixed assets owned, area of contracted rural land, and publication time were identified as situational variables that affect the relationship between rural land titling and rural land transfer-out. This research provides insight into how to promote the sustainable development of agricultural land economy by promoting land transfer, as well as further topics for future study.

The complex impact of family caregiver kinship type on the rehabilitation of patients with mental disorders in rural communities of China.

In 2009, the Chinese government incorporated severe mental disorders into the central subsidized local health funding project for the effective management, treatment, and reintegration of patients with severe mental disorders from hospitals into the community (Project 686). The conditions that were classified as 'severe' by this project included: schizophrenia, schizoaffective disorders, paranoid disorders, bipolar disorders, mental disorders caused by epilepsy, and mental retardation accompanying mental disorders. Patients in rural communities received better care after project implementation, of which 62.91% were farmers. This paper attempts to investigate the complex impact of Project 686 on the levels of rehabilitation of patients by their families. The last follow-up visit of the community psychiatrists in city H in 2020 was used as the time point. Finally, 174 samples were used in the analysis model. The type of kinship between family caregivers and patients with mental disorders was operationalized according to the information provided under the 'primary caregiver' item within the basic information section of the follow-up form. The software Stata15 was used to perform descriptive statistics, baseline regression model analysis, and a robustness test on the types of kinship identified and patients' recovery. The types of kinship, current symptoms, and medication use all affected patients' recovery, were found to have regression coefficients of -0.148, -1.756, and 0.902, respectively. Parents of patients with mental disorders remain in the caregiver category with the largest proportion. Community acceptance of patients is high; current symptoms, medication use, and types of caregiver-patient relationships influence patients' recovery levels. Project 686 has solved some of the rehabilitation and living difficulties of patients with mental disorders in rural communities. The types of kinship between family caregivers and patients with mental disorders in rural communities affect patients' rehabilitation levels. Patients' current symptoms and medication use can effectively moderate the impact of kinship type on patients' recovery in terms of complete self-knowledge, productive work, and life and good social relationships. It is necessary for mental illness prevention-treatment organizations to establish supplemental, replacement, and substitution mechanisms for the life and rehabilitation of patients with mental disorders in rural communities. Furthermore, the sense of reward and concern for family caregivers should be actively enhanced, and greater scientific use of the rehabilitation function of the 'family care + village doctor management' model should be made.

Association between low fluoride exposure and children's intelligence: a meta-analysis relevant to community water fluoridation

ObjectivesPrevious meta-analyses have mainly focused on studies conducted in endemic fluorosis areas with relatively high fluoride concentrations. These are impoverished rural communities in China, India, and Iran, and the findings cannot be generalised to developed countries. Therefore, we investigated the association between fluoride concentrations relevant to community water fluoridation and children's cognition measured with IQ scores by synthesising effect sizes reported in observational studies. MethodsA previous meta-analysis and the National Toxicology Program database that included a search of multiple databases and the authors' search of PubMed, Google Scholar, and Mendeley provided the data. Cross-sectional and cohort studies examining the association between fluoride and children's cognition and intelligence scores were selected. Two reviewers abstracted data using standard procedures. We performed three meta-analyses to synthesise the effects using the random effects models. ResultsEight studies of standardized mean difference in IQ scores from non-endemic fluorosis areas found no statistically significant difference between recommended and lower levels of fluoride (standardized mean difference = 0.07; 95% confidence interval: −0.02, 0.17; I2 = 0%), and no significant fluctuation in IQ scores across the differences in fluoride concentrations by non-linear modeling with restricted cubic spline (P = 0.21). Meta-analyses of children's and maternal spot urinary fluoride associated pooled regression coefficients (Betachildren = 0.16; 95% confidence interval: −0.40, 0.73; P = 0.57; I2 = 0%, Betamaternal = −0.92; 95% CI: −3.29, 1.46; P = 0.45; I2 = 72%) were not statistically significant. Further regression analysis by standardizing absolute mean IQ scores from lower fluoride areas did not show a relationship between F concentration and IQ scores (Model Likelihood-ratio test: P-value = 0.34.) ConclusionsThese meta-analyses show that fluoride exposure relevant to community water fluoridation is not associated with lower IQ scores in children. However, the reported association observed at higher fluoride levels in endemic areas requires further investigation.

The Impact of Empowerment Practice on the Rural Collective Economy: Empirical Evidence from Rural Communities in China

As a vivid practice of urban-rural interaction, empowerment is playing an increasingly salient role in rural revitalization around the world. Yet, existing studies on empowerment practices are still insufficient. This paper examines how empowerment practices affect the economic development of rural communities in China. This study constructs an integrated variable to measure the practice of rural empowerment in China. Data for this study were obtained from the community data of the China Rural Household Panel Survey (CRHPS) in 2017 to empirically verify the impact of empowerment practices on the rural collective economy. The results indicate that empowerment practice has a significant role in promoting the economic development of rural communities. Regarding the heterogeneity of the number of leaders, the fewer rural community leaders there are, the less empowered a village will be. For the heterogeneity of the income of the rural collective economy, the higher the income is, the more significant the promoting effect of empowerment on rural communities will be.

The home language environment in rural China: variations across family characteristics

BackgroundA rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households—even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China.MethodsUsing Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score).ResultsIn this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics.ConclusionIn this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment.

Independent and combined effect of income and education attainment on the incidence of stroke events: a large-scale cohort study from rural communities in China

ABSTRACT Objectives Few studies have longitudinally evaluated income and education, and their combined effect on incident of stroke in China. Methods The present study was based on a cohort with a baseline survey in China. A total of 15,913 participants were finally included. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated to evaluate the association of income, education, and their combination with stroke risk by Cox proportional hazard model. Results Lower income and less years of education was significantly associated with an increased risk of total stroke [income: adjusted HR: 1.54 (95% CI: 1.22–1.95); education: adjusted HR: 1.59 (95% CI: 1.11–2.28)]. Notably, the highest risk for total stroke was seen among those with lower income and higher education (adjusted HR: 2.46, 95% CI: 1.36–4.47). Sensitivity analysis by excluding the first year of follow-up showed similar findings with the primary analysis. Discussion Lower income and education attainment were associated with an increased risk of stroke in Chinese countrysides. A joint effect of income and education existed on the risk of developing stroke. Special attention should be paid for rural community residents, especially for people with low income levels.

Research on the application of air source heat pump and biomass boiler combined heating systems in northern new rural communities.

In today’s society, the country is vigorously promoting clean energy heating to replace coal heating with high carbon emissions. In recent years, with the rapid development of new rural communities and abundant biomass resources in rural areas, biomass boiler heating can save energy and reduce energy consumption. However, the heating efficiency of a single biomass boiler is low. The air source heat pump and biomass boiler are combined to form a combined heating system, which has higher heating efficiency and better energy-saving effect compared with separate air source heat pump heating equipment and separate biomass boiler system. In addition, air source heat pumps and biomass boilers are both clean heating methods, which can better promote the clean heating of new rural communities in China.

Algorithms for Screening for Active Tuberculosis among Individuals with Latent Tuberculosis Infection in a Rural Community in China.

Screening for active tuberculosis (TB) among individuals with latent tuberculosis infection (LTBI) is important for the initiation and evaluation of TB preventive treatment. The performances of different tools and their combinations had rarely been studied in community-level screening among individuals with LTBI in China. This study aimed to explore appropriate algorithms for screening for active TB among individuals with LTBI in rural China. Three sputum samples were collected from each participant for smear microscopy, culture, and an Xpert MTB/RIF assay. Chest digital radiography and TB symptoms were investigated as well. The performances of different testing algorithms were compared with that of sputum culture as the gold standard. Overall, 1,564 study participants with LTBI were investigated, with a final diagnosis of 20 TB cases by sputum culture. Compared with other tests, the Xpert MTB/RIF assay detected 80.00% (95% confidence interval [CI], 58.40% to 91.93%) of culture-positive cases, with the highest sensitivity. When tests were combined using "or," "and," or "step" algorithms, the highest sensitivity reached 90.00% (95% CI, 69.90% to 97.21%) for the combination of the Xpert MTB/RIF assay and chest radiography, but the positive predictive value (PPV) decreased to 22.22% (95% CI, 14.54% to 32.41%). The Xpert MTB/RIF assay alone showed the best agreement with sputum culture, with a kappa value of 0.840. Pathogen molecular detection alone showed good performance compared to the other algorithms, for ruling out active TB in general LTBI, but the high cost might be a challenge for scaling it up. Identifying those with a high risk for progression to TB more precisely and establishing a cost-effective screening algorithm deserve further exploration. IMPORTANCE Enhancing community-wide active case screening in target LTBI populations is important for achieving the early treatment of active TB, and ruling active TB out is a prerequisite for initiating preventive treatment. The current study evaluated the performances of multiple tests and their combinations in screening for active TB among individuals with LTBI at the community level. Compared with the classical "TB symptoms and chest radiography" algorithm, the application of Xpert MTB/RIF improved the sensitivity from 45% to 80%. When the Xpert MTB/RIF assay was combined with chest radiography, the sensitivity was further improved to 90.00%, which achieved the World Health Organization (WHO) target product profiles. However, the algorithm requires caution as the PPV decreased from 88.89% for Xpert MTB/RIF alone to 22.22% for the combination. Xpert MTB/RIF alone offered remarkable sensitivity without compromising the PPV but would have major resource implications. Thus, identifying target populations for LTBI treatment more precisely and developing cost-effective and high-throughput screening tools and algorithms deserve further efforts.

Prevalence and Factors Influencing Sarcopenia Among Community-Dwelling Older Adults Using the Asian Working Group for Sarcopenia Definition.

This study aimed to explore the prevalence and impact of related factors for sarcopenia among community-dwelling older people in Chongming district, China, according to the diagnostic criteria of the Asia Working Group for Sarcopenia-2019. We conducted a cross-sectional study from April 2021 to December 2021. Diagnosis of sarcopenia (non-sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia) was based on appendicular skeletal muscle mass index, handgrip strength, gait speed, and the 5-time chair stand test. Staff collected all subjects' clinical and sociodemographic characteristics, cardiovascular disease (CVD) risk factors, inflammatory markers, physical activity (PA), and daily lifestyle activities to identify sarcopenia-related factors. A total of 1407 older people aged ≥ 65years were enrolled into the study (58.7% female). The prevalence of confirmed sarcopenia was 19.6% (17.1% in females and 23.1% in males). The prevalence of possible sarcopenia, sarcopenia, and severe sarcopenia were 19.7% (22.2% in females, 16.2% in males), 11.9% (10.1% in females, 14.5% in males), and 7.7% (7% in females, 8.6% in males), respectively. Increasing age, gender, depression status, and high-fat mass were associated with an increased likelihood of sarcopenia in all subjects. In females, living alone, high-fat mass, lower body mass index (BMI), lower body weight, and have no time spent doing housework increased the likelihood of sarcopenia. In males, depression status, high-fat mass, higher neutrophils-to-lymphocytes ratio (NLR), lower BMI, lower body weight increased the likelihood of sarcopenia. Our study showed a high prevalence of sarcopenia among community-dwelling older people in the Chongming district. Detection, prevention, and treatment efforts are needed to reduce the impact of sarcopenia in older, rural communities in China.