Browsing by Author "Wu, Chenkai"

Background: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep disorder that affects millions of adults worldwide, with higher prevalence reported in Asia compared to Western countries. If left untreated, OSAHS can lead to serious health complications such as high blood pressure, heart disease, stroke, and diabetes. While polysomnography (PSG) is considered the gold standard of sleep testing, it may not be suitable for all OSAHS patients due to its cost and invasiveness. In recent years, the development of mobile applications has provided a convenient and accessible tool for screening and diagnosis of OSAHS. This study aimed to evaluate the efficacy of the Dr. Being app, a snoring analysis software for smartphones, in screening Chinese adults for OSAHS. The findings of this study will provide insights into the potential of mobile health technologies in improving the detection and management of OSAHS in China.Methods: In this prospective study conducted between December 2021 to December 2022, 50 patients were recruited from the sleep center of Shanghai Sixth People's Hospital. The study participants had a mean age of 49.7±17.4 years, with a male predominance of 70%, and a mean body mass index of 28.2±5.0 kg/m². Each participant underwent monitoring throughout the night using both the Dr. Being app and polysomnography (PSG). The Dr. Being app's automatic analysis generated relevant indicators, which were then compared with the results obtained from PSG interpreted by sleep professionals according to recommended guidelines. The study aimed to evaluate the concordance between the apnea-hypopnea index (AHI) obtained by the Dr. Being app and PSG results. Furthermore, the researchers assessed the sensitivity and specificity of the Dr. Being app in diagnosing OSAHS, which could provide valuable insights into the effectiveness of smartphone apps in sleep testing. Results: This study's findings suggest that there were significant differences between the total sleep time (TST) and apnea-hypopnea index (AHI) measured by the Dr. Being app and PSG. Specifically, the TST measured by the Dr. Being app was found to be significantly higher than PSG, while PSG had a slightly higher AHI measurement than the Dr. Being app. Despite these differences, the Bland-Altman consistency test showed that the AHI measurements obtained from both methods were statistically consistent, indicating that the Dr. Being app can provide accurate measurements of AHI, which is a crucial indicator of OSAHS severity. Furthermore, the study assessed the sensitivity and specificity of the Dr. Being app in diagnosing OSAHS at different AHI thresholds. The results indicated that the app had high sensitivity and specificity for OSAHS diagnosis at an AHI threshold of 5/h and moderate sensitivity and specificity at an AHI threshold of 15/h. However, the sensitivity decreased while the specificity increased as the AHI threshold increased to 30/h. Overall, these findings suggest that the Dr. Being app could be a valuable tool for OSAHS screening and diagnosis, particularly in resource-limited areas. Conclusion: These findings highlight the usefulness of the Dr. Being app in the screening and diagnosis of OSAHS, particularly in resource-limited areas where access to PSG may be limited. The app's high sensitivity in detecting early OSAHS index indicates its potential as a valuable tool for both clinicians and patients. With its ability to provide accurate measurements of mild AHI, the Dr. Being app could aid in the early detection of this condition. Overall, the Dr. Being app could serve as a valuable supplement to traditional sleep testing methods, potentially improving the accessibility and affordability of OSAHS diagnosis and management.

Background: Population aging and rural urbanization were two major trends in China. Past researches had shown that relocation and displacement could have a negative impact on the mental health of senior adults. Land expropriation and increasing rural migration due to China's urbanization process had created a growing but understudied group of "landless farmers." This study explored the impact of relocation from rural villages urban resettlement on the mental health of older adults in China in terms of depression.Method: The mixed-method study collected survey data from 219 adults aged ≥60 years in one relocated village (Zhangjia) and one non-relocated village (Xicheng) in Jinhua City, Zhejiang Province, China. Mental health measures included the Geriatric Depression Scale. Semi-structured interviews with 10 relocated older residents provided qualitative data. Quantitative analyses examined differences in social networks, amenities, and levels of depression between groups. Logistic regression analyzed predictors of depressive symptoms. Qualitative data were analyzed using thematic analysis. Result: No significant difference in depression was found between the two communities, but the social network scores of older adults in the resettlement community were significantly lower than those in the original village. Poor living facilities were associated with a higher rate of depression in both communities. In addition, a good social network was an important protective factor against depression in the relocated population. Qualitative findings revealed feelings of boredom, reduced social interaction, and changes in family relationships following the move. In summary, quantitative and qualitative data suggested that the disruption of living habits and isolation caused by relocation may have a negative impact on the mental health of older adults in rural China. Discussion: Quantitative and qualitative data suggested that the disruption of living habits and isolation caused by relocation may have a negative impact on the mental health of older adults in rural China. Conclusion: The study emphasized the need for targeted interventions to support mental well-being in this vulnerable population undergoing relocation.

AbstractBackground: Common mental disorders (CMDs) can be defined as depression and anxiety, which have a great influence on the quality of life among older adults. CMDs are becoming a serious public health problem among the older adult population, especially depression. Effective management can improve the overall well-being of older adults. The policy significance of combining the hierarchical healthcare system (HHS) and CMDs is to promote the screening of high-risk elderly groups represented by depression, promote the prevention system of early detection, diagnosis, and treatment of elderly diseases, improve the early prevention and management mechanism of mental disorders, improve the psychological serviceability of older adults, and achieve healthy aging. This study aims to investigate the attitudes of older adults in Kunshan towards mental health services in the community and to assess the conditions and challenges of HHS for older adults’ CMDs in Kunshan. Methods: The quantitative analytical sample is restricted to older adults aged over 60 years who lived in Tinglin or Jinxi communities in Kunshan and who responded to the attitude survey (n=100). Attitudes were measured by asking older adults about their willingness or concern for community mental health services. The two-sample t-test and the chi-square test were used to compare the characteristics of the Tinglin and Jinxi communities. Logistic regression was used to determine the adjusted associations between sex, education, and attitudes related to managing common mental disorders in two communities. The qualitative data is obtained from semi-structured qualitative interviews with 7 relevant experts from 7 medical or social departments in Kunshan, including Jinxi People's Hospital, Jinxi Community Health Center (CHC), Mental Disorders Prevention and Treatment Department (MDPTD) of CHC in Jinxi, Kunshan Mental Health Center (KMHC), Kunshan First People's Hospital, Tinglin Community, and the Civil Affairs Bureau (CAB). The semi-structured interview was designed around the current situation of medical systems and mental health services in Kunshan, challenges in managing CMDs in older adults, and science communication for mental health. All interviews will be imported into Nvivo 12 for thematic analysis through grounded theory.   Results: 74% of participants from Tinglin have an education level of Grade 9 and above, but only 28% of those from Jinxi at the same educational attainment. Tinglin residents demonstrated higher levels of understanding and acceptance of mental health. 60% of participants from Tinglin understand mental health, while only 18% in Jinxi. Tinglin residents (17%) show a higher willingness to seek professional treatment compared to Jinxi (4%). Tinglin (68%) exhibited a more favorable attitude towards community-recommended treatment compared to Jinxi (36%). Residents in Tinglin (50%) expressed the necessity of professional psychiatrists in the community, while only 14% in Jinxi. However, only 30% of residents in Tinglin showed a low will to cooperate, while 66% in Jinxi. It was also found that there was a significant association between education level and attitudes towards mental health in older adults. The qualitative results first introduced Kunshan’s family physicians and HHS model, management of severe mental disorders (SMD), screening for dementia, daily care center (DCC) and psychiatric rehabilitation station (PRS), and social workers policy. These provide guidance and experience for the implementation of management of CMD in the elderly. However, the implementation of HHS for older adults’ CMDs is hampered by multiple obstacles from older adults, their families, communities, the medical system, society, and the government. The interviewees also stressed the importance of science communication. Conclusions: With the current level of social development and medical resources, implementing HHS for the CMDs in older adults in Kunshan faces many difficulties at this stage.

Background: Metabolic syndrome is a group of risk factors that, if unaddressed, can lead to various non-communicable diseases such as cardiovascular disease and type 2 diabetes. Previous studies have shown that there is an association between diet and metabolic syndrome. As poor diet and obesity are increasingly prevalent in adolescent populations, adolescents become more at risk of developing metabolic syndrome at an earlier age. This study examined the association between diet quality, as measured by healthy eating index (HEI), and metabolic syndrome in US adolescents aged 12 to 18 years.Methods: The analytic sample consisted of 1,178 adolescents aged 12 to 18 years who participated in NNHANES cycles between 2011 and 2016. Healthy eating index was constructed using information from the NHANES 24-hour dietary recalls, as well as the USDA’s Food Patterns Equivalents Database. HEI was scored continuously on a scale from 0-100. I then categorized participants into quintiles by HEI for further analysis. Metabolic syndrome was measured using data from a variety of NHANES databases using standards for diagnosis of metabolic syndrome in adolescents established in previous NHANES studies. I examined the association between HEI and metabolic syndrome using adjusted and unadjusted logistic regression models. The adjusted model included the covariates age, gender, BMI, ethnicity, household size, income-to-poverty ratio, and physical activity. Finally, I performed a sensitivity analysis to investigate whether the definition of metabolic syndrome used for adolescents was appropriate. Results: HEI was not significantly associated with metabolic syndrome in adolescents when treated as a continuous predictor. When treated as a categorical predictor, only those in the highest quintile of HEI had significantly lower odds of metabolic syndrome (odds ratio [OR] = 0.28; 95% confidence interval [CI]: 0.10, 0.81). The frequency of metabolic syndrome in this quintile was 4.68 percent. The sensitivity analysis found that there was no significant difference in results when using the current diagnosis standards for metabolic syndrome versus more relaxed standards (only 2 symptoms present versus 3). Conclusions: This study found preliminary evidence to support the hypothesis that healthy eating index is inversely associated with risk of metabolic syndrome in adolescents aged 12 to 18 years in the United States. This may be because diet is an important risk factor in the development of the 5 indicators of metabolic syndrome. Adolescents with metabolic syndrome are at higher risk for metabolic syndrome, heart disease, and type 2 diabetes as adults. Therefore, prevention and management of this condition in adolescence is important to change the trajectory of adolescents’ health. A healthy diet in alignment with the USDA’s Dietary Guidelines is beneficial for all adolescents to develop healthy lifestyle habits. Future research should investigate the use of nutrition education and counseling as a tool for metabolic syndrome treatment and prevention in this population.

AbstractBackground: The aging population is rapidly increasing, and falls are a significant threat to the health and well-being of older adults. Falls are the leading cause of injury among individuals aged 65 and older, resulting in increased healthcare costs, morbidity, and mortality. Preventing falls among older adults requires a multifaceted approach that includes education, training, research, and policy development. While studies have evaluated the effectiveness of multifactorial interventions, little attention has been paid to home modification as a fall prevention strategy. The purpose of this study is to examine the impact of home modification on the incidence of falls and fall-related injuries among retired older adults in the United States who are living independently in the community. Using data from the Health and Retirement Study (HRS), we investigated whether home modification is associated with a lower incidence of falls. Method: This study utilized data from the Health and Retirement Study (HRS) to investigate the association between home modifications and falls among community-dwelling older adults in the United States. The study included 4,620 participants aged 60 years and older who completed surveys in 2006 and 2008. The primary outcome was the occurrence of falls during the follow-up period in 2008, and the secondary outcome was injury due to a fall. The binary variable for home modification was created based on whether participants reported having any home modifications in the last two years. Covariates included demographic characteristics, lifestyle factors, and health-related variables. Baseline demographic and health characteristics were described using means, standard deviations, counts, and proportions. Two- sample t-tests and chi-squared tests were used to compare continuous and categorical variables between participants with and without home modifications. Logistic regression models were used to assess the unadjusted and adjusted associations between home modifications and falls, adjusting for various covariates. Interaction analyses were conducted to examine the differences in associations by sex and age. Result: This study aimed to investigate the association between home modification and falls among older adults. A total of 4,620 participants were included in the study, divided into two groups: those with and without home modification. The incidence of falls in the past two years was similar in both groups, with 25.94% in the home modification group and 25.08% in the non-home modification group. Participants with home modification had 17% lower odds of falls than those without home modification. Additionally, participants with home modification had 22% lower odds of fall-related injuries. The study found that the age category of 60-69 had the lowest incidence of falls, and female participants had a lower incidence of falls than males after home modification. The presence of safety and getting around features in home modifications was also associated with a reduced incidence of falls. Conclusion: This study suggests that home modification can be an effective strategy to prevent falls and fall-related injuries among older adults living in the community. The findings are consistent with previous research and provide valuable information for healthcare professionals and policymakers to design interventions that include home modification to reduce the burden of falls and their associated injuries in older adults.

IntroductionSarcopenia, an age-associated disorder characterized by the loss of skeletal muscle mass and function, is becoming increasingly prevalent among older adults in China. High levels of family and social support have been reported to be associated with enhanced health outcomes among the elderly. However, the evidence regarding the protective impact of these factors on sarcopenia remains limited and controversial. Furthermore, only a limited number of studies have examined the prevalence of possible sarcopenia in China. The current study aimed to (1) estimate the prevalence of possible sarcopenia, (2) evaluate the perceived family functioning and social support, and (3) examine the associations between family functioning, social support, and sarcopenia.

MethodsCross-sectional data from 624 community-dwelling older participants aged 60 years and older in Suzhou, China were collected via structured interviews. Possible sarcopenias were defined in accordance with the criteria of the 2019 Asian Working Group for Sarcopenia. Family functioning was assessed using six positive items from the McMaster Family Assessment Device – General Functioning Subscale (GF6+). Social support was evaluated based on the Social Support Rating Scale (SSRS). Univariable and multivariable logistic regression was conducted to examine the association between family functioning, social support, and sarcopenia.

ResultsThe prevalence of possible sarcopenia was 10.58%. Females with sarcopenia were more likely to report depression (P<0.05). The mean scores of GF6+ and the total scores were 1.36 ± 0.61 and 32.96 ± 8.47, respectively. Female participants exhibited higher mean scores for GF6+ (P<0.05) and higher total scores for SSRS compared to male participants (P<0.05). No statistically significant associations between family functioning, social support, and sarcopenia were detected.

ConclusionOur study revealed sex differences in the perception of family functioning and social support among Chinese older adults. However, we did not find statistically significant associations between family functioning, social support, and sarcopenia. More research should be conducted in this novel field to facilitate the early screening and prevention of sarcopenia in China.

Background: The interrelatedness between social determinants of health impedes researchers to identify important social factors for health. Older populations have highly diverse social backgrounds, and a new approach is needed to quantify the aggregate effect of social factors and develop person-centered social interventions. We aim to create a polysocial score index to comprehensively assess the social and physical environments as well as their combined effect on health among older adults.Methods: We included a total of 7,383 adults, consisted of 3,651 participants in 2006 and 3,732 participants in 2008, who were at least 65 years and completed an additional psychosocial questionnaire in the Health and Retirement Study (HRS), a longitudinal study of a nationally representative sample of non-institutionalized residents in the United States. We searched the entire HRS data set and selected 24 social determinants of health encompassing five social domains: (1) economic stability, (2) neighborhood and physical environment, (3) education, (4) community and social context, and (5) health care system. The outcome was five-year mortality. We used a forward stepwise logistic regression model with a threshold of P-value equal to 0.1 to screen for important social factors; those having a 2-sided P value < 0.1 were retained in the final model. We assigned the polysocial score to each participant by summing the score for each social variable based on the raw coefficients of the regression model. The score of each variable was calculated as the absolute value of the raw coefficient times 10. Both continuous and categorical polysocial scores (low: 0-29, intermediate: 30-39, and high: 40+) were constructed. Participants with higher scores had a better social environment. Logistic regressions were used to assess the unadjusted and adjusted associations between polysocial score and five-year mortality. Demographic (age, gender, and race/ethnicity), lifestyles (body mass index, smoking status, and alcohol use), and health conditions (disability in activities of daily living, hypertension, diabetes, cancer, lung disease, heart disease, stroke, psychiatric disease, arthritis, and self-reported health) were included in the adjusted models. Interaction analyses were conducted in additive scales and multiplicative scales to evaluate whether the association between polysocial score and death was different by sex and race/ethnicity. Results: Polysocial score was created using 15 social determinants of health selected from 24 social determinants of health: total household income, total wealth, out-of-pocket medical expenditure, education level, employment status, marital status, type of house, regions of residence, used language, long-term care insurance coverage, life insurance coverage, social engagement, discrimination, stress level, and neighborhood social cohesion. The total score ranged from 7 to 59; the mean (SD) was 35.5 (7.5). Of the 7,383 participants, 491 (30.8%), 599 (17.2%), and 166 (7.8%) deaths occurred over five years among participants with a low (0-29), intermediate (30-39), and high (40+) polysocial score, respectively. In the fully adjusted logistic regression model in which polysocial score was modeled as a continuous variable, a one-point higher polysocial score was associated with 3% (Odds Ratio [OR]= 0.97; 95% CI, 0.96-0.98) lower odds of death over five years. In the fully adjusted model where polysocial score was modeled as a three-level categorical variable, the odds of death were 24% (Odds Ratio [OR]=0.76; 95% CI, 0.65-0.89) and 54% (OR=0.46; 95% CI, 0.36-0.59) lower among participants with an intermediate or high polysocial score, respectively, than those in the low category. Females had lower odds of mortality than males in the unadjusted logistic regression model. Results of racial/ethnic interaction analyses showed that Hispanic/Latino participants had lower five-year mortality (low: 17.2%; intermediate: 11.9%; high: 6.0%) than non-Hispanic white (low: 34.9%; intermediate: 17.9%; high: 7.3%) and other (low: 25.8%; intermediate: 14.3%; high: 6.3%) racial/ethnic subgroup in the additive scale, while we did not find a significant interaction between polysocial score and race/ethnicity in the multiplicative scale. Conclusions: We created a novel polysocial score including 15 social determinants of health encompassing multiple dimensions: economic stability, physical and neighborhood environment, education, community and social context, and the healthcare system. Higher polysocial score was significantly associated with lower five-year mortality among older adults in the US after adjusting for socio-demographic, lifestyles, and health conditions. The polysocial approach may offer possible solutions to monitor social environments and provide evidence-based suggestions for older adults to improve their social status for specific health outcomes.

Introduction: This study explores the cytotoxic effects of Per- and polyfluoroalkyl substances (PFAS), specifically focusing on Perfluorooctanoic acid (PFOA) and its industrial substitute, Gen-X, on a set of human cancer cell lines. PFAS are synthetic chemicals with widespread use and environmental persistence, raising concerns over their potential bio accumulative properties and toxicity. Research aims to elucidate the mechanistic impact of PFOA and Gen-X exposure on cell viability, gene expression, and protein signaling pathways including TGF-β/SMAD, p53 signaling across melanoma (A375), renal (SN12C), liver (HepG2), and colon (SW620) cancer cells.

Method: Employing a comprehensive experimental approach, the study assessed cytotoxicity using the CCK-8 assay, protein expression via Western blot analyses, and gene expression changes through RT-PCR. Four human cancer cell lines were exposed to varying concentrations of PFOA and Gen-X to determine their semi-inhibitory concentrations (IC50) and to analyze the subsequent biological effects.

Result: The results highlighted distinct cytotoxic profiles for PFOA and Gen-X across the examined cell lines, revealing variations in cellular susceptibility and resistance. Melanoma cancer cells (A375) displayed high sensitivity to PFOA but greater tolerance to Gen-X, while renal cancer cells (SN12C) showed significant resistance to both compounds. Molecular analyses indicated that exposure to PFOA and Gen-X modulates the TGF-β/SMAD signaling pathway and activates DNA damage response markers. Furthermore, alterations in the expression of genes related to the cell cycle, apoptosis, and metabolic processes were observed, suggesting potential genotoxic and carcinogenic effects.

Conclusion: The study provides insights into the differential cytotoxic effects of PFOA and Gen-X on human cancer cell lines, underscoring the complex interaction between these PFAS and cellular mechanisms. The findings indicate that PFAS exposure can significantly impact cell viability, gene expression, and protein signaling pathways, contributing to our understanding of their toxicological profile. Given the environmental persistence and widespread use of PFAS, these results underscore the need for further research into their biological impacts and the development of targeted intervention strategies to mitigate their health risks.

Background: In China, the government is attempting to establish a health care system primarily focused on primary health care to address the issue of uneven distribution of domestic medical resources. Community health centers widely present in various regions are the main providers of primary healthcare in the community. The public health service capacity of community health centers is one of the important indicators for evaluating their service quality. At present, the evaluation of it in China mainly relies on the selection of evaluation indicators that focus on the macro level, but the content is not detailed enough to reflect its ability in a practical and specific way. Methods: This study selected a government managed community in the urban and suburban areas of Kunshan City, and conducted a questionnaire survey on 432 community residents using the satisfaction of family doctor services, residents' willingness to seek medical treatment, and SERVQUAL scale to evaluate the public health service capacity of community health centers. At the same time, perform t-test analysis on the data results to test whether there are differences in the distribution of the results. Finally, regression analysis was conducted using potential influencing factors as independent variables to further explore the impact of these influencing factors on the evaluation process of public health service capabilities in community health centers. Results: Among all participants, 387 had an education level of junior high school or below, accounting for 89.58%, and 46.99% of the household population consisted of 2 people. The monthly income of participants is mainly concentrated between 1001-3000 yuan and 3001-5000 yuan, with 202 and 191 people respectively, accounting for 46.76% and 44.21%. At the same time, the majority of participants were those who did not drink at all and drank every day, with 182 and 119 people respectively, accounting for 42.13% and 27.55%. In Tinglin Community, the proportion of residents aged 65-74 is 70%, the proportion of residents aged 75-93 is 30%, and the gender ratio is 41:59. In Jinxi Community, the proportion of residents aged 65-74 is 55%, the proportion of residents aged 75-93 is 45%, and the ratio of males to females is 52:48. The median scores of the two communities in terms of satisfaction with family doctor services are 6 and 5, respectively, with mean values of 4.16 and 3.81. In terms of willingness to seek medical treatment in community health centers, the median scores of residents in both communities are 27, while the mean scores of residents in Jinxi and Tinglin communities are 28.88 and 23.91, respectively. For the five dimensions of the SERVQUAL scale, the overall median scores for tangibility, reliability, responsiveness, guarantee, and cost acceptability are 21, 12, 6, 18, and 6, respectively; The overall mean scores are 17.94, 11.17, 5.54, 16.85, and 5.63, respectively. Through linear regression analysis, it can be concluded that seven variables, including the number of family members, frequency of alcohol consumption, prevalence of chronic diseases, monthly income, exercise frequency, reimbursement methods for medical expenses, and self-assessment of health status, have an impact on the process of evaluating community service capabilities. The goodness-of-fit of linear regression models are generally strong. Conclusions: Compared with residents in Jinxi Community, residents in Tinglin Community have a younger age structure, higher overall education level, a higher proportion of women, a larger household size, higher monthly income levels, and less frequent drinking. At the same time, the willingness of residents from both communities to seek medical treatment at community health centers is not strong. In terms of family doctor services, both community health centers have good service quality, but their coverage needs to be expanded. At the same time, the public health service capacity of Jinxi Community Health Center is stronger than that of Tinglin Community. Factors such as a large number of household members, frequent drinking, exercise, and multiple chronic diseases can make community residents more passive in evaluating the public health service capabilities of community health centers. When the self-assessment of health status is poor, residents often make a more positive evaluation of the public health service capacity of their community health center. The monthly income and medical expense reimbursement methods have different impacts in the two communities.

Objective: This dissertation investigates therapists' perceptions and expectations of technology application in non-pharmaceutical therapies (NPT) for individuals with Mild Cognitive Impairment (MCI) and Dementia, emphasizing the role of Information and Communication Technology (ICT).

Methods: Adopting a qualitative research framework, this study utilizes methodology comprising semi-structured interviews, and participatory observations. Semi-structured interviews employed convenience sampling to engage experienced therapists in in-depth discussions, while participatory observations offered a firsthand examination of therapeutic settings and methodologies, including music therapy, and reminiscence therapy.

Results: Integrating insights from therapist interviews, and immersive participatory observations, the study elucidates the ambivalent nature of ICT’s role in NPT for treating dementia patients. Challenges identified include older patients’ resistance to new technologies and the difficulty in quantifying the therapeutic outcomes of ICT applications. Despite these hurdles, therapists exhibit a collective optimism toward the potential of rapidly evolving technology to enhance the overall efficacy of NPT in the recovery processes for dementia patients.

Conclusion: The research underscores a complex landscape where the integration of ICT in NPT presents both opportunities and challenges. Therapists’ hopeful outlook signals a broader consensus on the potential transformative impact of technology in dementia intervention, suggesting a need for further innovation and research in this domain. This study contributes to the dialogue on integrating ICT in therapeutic practices, offering a nuanced understanding of its implications for enhancing dementia intervention.

AbstractBackground: The vibrant state of the biopharmaceutical industry in Jiangsu Province, China, showcasing its strategic focus and significant growth. The province has implemented various policies to accelerate high-quality development, emphasizing innovation, intelligent and digital transformation. The industry, organized around biological drugs, chemical drugs, traditional Chinese medicine, and medical equipment, has become a national leader, with impressive revenue and output values. The study identifies research gaps related to the role of patents in the industry, highlighting the need for a micro-level analysis, better linkage between patents and economic outcomes, exploration of innovation capabilities, consideration of patent quality, and understanding temporal and geographical specificities. The research aims to address these gaps by assessing the impact of patent indicators at national, provincial, and enterprise levels, providing insights for policymakers and industry stakeholders to foster innovation and growth in the biomedical sector in Jiangsu Province. Methods: This research employs a comprehensive three-tiered analysis to explore the intricate interplay between innovative indicators and economic output in the biomedical industry. The study spans the national, provincial, and enterprise levels, encompassing five diverse countries, all 31 provinces in mainland China, and the top ten pharmaceutical companies globally, domestically, and in Jiangsu Province. In collaboration with the Jiangsu Intellectual Property Protection Center, the study compiles an extensive dataset. This dataset, meticulously curated from publicly available and non-sensitive patent data, includes variables such as patent applications, authorizations, PCT applications, and application growth rates. Economic data, including GDP and market values, is sourced from reputable institutions like the World Bank, the National Bureau of Statistics of China, and Torreya, a renowned biomedical industry innovation consulting company. Inclusive approach ensures a comprehensive representation for a cohort of 30 biomedical enterprises. The study extracts pertinent patent information into STATA for detailed analysis. The economic outcomes are measured through GDP at the national and provincial levels and market value at the enterprise level. The study meticulously examines the nuances of GDP computation and derives the 2022 national GDP data from the World Bank and provincial GDP data from the Bureau of Statistics of the People's Republic of China. Market value, or Market Capitalization, is defined and measured based on the total value of shares issued by listed companies, mainly in US dollars, with data sourced from Torreya, China Securities Regulatory Commission, and the Information Registration Center of the State Administration for Market Regulation. The biomedical patent indicators, comprising patent application numbers, PCT application numbers, patent authorized numbers, and patent in-force numbers, are systematically analyzed at national, provincial, and enterprise levels. Statistical methods, including one-way analysis of variance (ANOVA), correlation analysis, and linear regression analysis, are consistently applied across all levels to scrutinize the association between patent data indicators and economic output. The combined approach of correlation and regression analysis aims to derive precise patent innovation indicators and their impact on economic output, enhancing the clarity and intuitiveness of the research findings. Results: On the global stage, the findings reveal a robust growth in biomedical patents from 2000 to 2022. China emerges as a major player, exhibiting substantial patent applications (1804099 pcs), authorizations (35131 pcs), and PCT patents (1115204 pcs). Correlation analyses indicate positive relationships between a country's GDP and patent-related metrics, further validated by linear regression. These results emphasize the importance of economic strength in fostering biomedical innovation. Turning our attention to Chinese provinces, our investigation spans 31 regions, unraveling diverse patterns in patent outputs. Provinces with higher GDP consistently demonstrate elevated patent activity, showcasing a symbiotic relationship between economic prosperity and biomedical innovation. Correlation and regression analyses reaffirm these findings, emphasizing the quantitative impact of economic factors on biomedical research and development. At the micro-level, the study scrutinizes the top 10 pharmaceutical companies globally, in China, and within Jiangsu province. Striking disparities in patent application numbers, patents in force, and PCT applications highlight China's accelerating innovation capabilities. The correlation analysis establishes positive associations between market value and key patent indices (Coef. for number of patent application, patent in force, and PCT application, respectively 0.74, 0.71, 0.73,) emphasizing the pivotal role of patents in driving economic success for pharmaceutical companies. Linear regression analyses provide nuanced insights into the impact of patent indices on market value. The positive coefficients for patents in force (Coeff =9.77; 95% CI, 8.57 ~ 10.97) and PCT applications (Coeff=21.13; 95% CI, 18.68 ~ 23.58) signify their significant contribution to market values. The accompanying scatterplots visually reinforce these relationships, illustrating a positive linear correlation. Conclusions: Particularly, conducting a micro-level analysis, this research reveals individual pharmaceutical companies' contributions often overlooked in macro-level studies. The nuanced exploration of the relationship between patent indicators and economic outcomes emphasizes the positive correlation between regional economic levels and patent indicators, particularly in the pharmaceutical industry. At the enterprise level, the research establishes a connection between patent numbers and market competitiveness, with more patents associated with stronger market positions. Comparisons with other countries and Chinese provinces highlight strategic gaps and position Jiangsu as a leader in innovation capabilities. The study underscores the critical importance of patent quality over quantity, advocating for strategies that prioritize high-quality patents to drive sustained growth and competitiveness in the biomedical industry.

Objective: This study aims to assess the prevalence of depression and sarcopenia among the elderly population in Suzhou, China, in 2022, and to investigate the correlation between these two conditions. Methods: A cross-sectional study was conducted as part of a collaborative project between Duke Kunshan University and West China University of Medical Sciences. The study involved 1,000 elderly patients from Suzhou, utilizing the Asian Working Group on Sarcopenia (AWGS) 2019 diagnostic approach for possible sarcopenia and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms assessment. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression models. Results: Out of 638 participants analyzed, the prevalence of possible sarcopenia was found to be 21.9%, and the prevalence of depressive symptoms was 17.08%. No significant direct correlation was observed between depression and possible sarcopenia after adjusting for potential confounders such as age, sex, and BMI. However, factors like age and BMI exhibited a significant association with possible sarcopenia. Conclusion: The study did not support the hypothesis that depression significantly influences the prevalence of possible sarcopenia among the elderly in Suzhou. Despite this, the findings highlight the importance of addressing both conditions in geriatric healthcare to improve quality of life. Further longitudinal studies are needed to explore the causal relationships and underlying mechanisms linking depression and sarcopenia.

BackgroundSeveral modifiable risk factors for dementia have been identified. Rising interests focus on how frailty captures heterogeneous treatment and prevention effects. This study aimed to examine the association between modifiable risk factors and all-cause dementia among middle-aged and older adults and compare population-level intervention effects across frailty status.

MethodsParticipants from UK Biobank without dementia and with available data on frailty and modifiable risk factors at baseline were included. Dementia was ascertained from inpatient records. Frailty was defined by a modified version of physical frailty phenotype and classified as non-frail, pre-frail and frail. Thirteen socioeconomic, life-style, environmental, and medical risk factors were included. We used Logistic regression to examine their association with 10-year dementia. Population intervention effects were also estimated by parametric G-computation.

ResultsOf 381, 419 eligible participants with a mean age of 56.9 years, 58.4%, 38.2%, and 3.4% were non-frail, pre-frail, and frail, respectively. Over a 10-year follow-up, 1,688 (0.76%), 1,949 (1.34%), and 378 (2.90%) dementia cases were identified among non-frail, pre-frail, and frail adults. The odds ratios for low education, physical inactivity, central obesity, hearing impairment, high NO2 exposure, and traumatic brain injury increased, but those for smoking, depression, hypertension, and diabetes decreased. Population intervention effects for single risk factors (excluding smoking and excessive alcohol use) increased with severer frailty status. For interventions achieving 100% coverage, the population intervention effect was 0.002, 0.007, and 0.022 in the non-frail, pre-frail, and frail populations, respectively. Even with intervention coverage of only 25% and 50%, the population intervention effect remained highest among the frail population.

ConclusionWe found that frailty modifies the associations between established risk factors and dementia among middle-aged and older adults. Dementia intervention effectiveness appears to be greatest among frail adults. Therefore, routine frailty evaluation should be adopted to identify those who will gain the most from personalized dementia prevention strategies.

Background: To identify the oral health status of children and adolescent with disabilities in one welfare school in Chengdu. With several disabilities, physical and intellectual deficiency will affect disabled children’s daily life. They pay little attention to their own health status especially oral health. Therefore, this vulnerable group require some concerns. Examining their oral health status is necessary to change their situations of low access to oral health resources and failure of describing their feelings for various reasons, which could help them reduce the rate of having oral diseases. We aim to explore the severity of caries and periodontal status among child with disabilities.

Methods: We included 173 disabled children, 92 participants in 2018 and 81 participants in 2019, who were at least three years old and less than 24. They obtained the treatment from West China Stomatological Hospital and participated in an examination of their oral health status. There were four outcomes: caries, gingivitis, dental calculus, and oral health. Although there were three indexes [decayed (dt/DT), missed (mt/MT), and filled (ft/FT) teeth] indicating decayed tooth, we combined three indexes into one (“caries”) to check whether one tooth is healthy or unhealthy. For gingivitis and dental calculus, “yes or no” is the statistical method. Oral health is a new index that represents whether one’s oral health status is healthy. If one person obtains caries or gingivitis or both, it means unhealthy. We used the logistic regression to examine how demographic characteristics (age, sex, household registration, and nationality) were jointly associated with each of the four outcomes (caries, gingivitis, dental calculus, and oral health) separately. 

Results: Four indexes (caries, gingivitis, dental calculus, and oral health) were created to determine disabled children’s oral health status. Disabled children's mean of caries was 2.77, and they shared a caries prevalence rate of 63%. 31 (17.9%) had one caries and 78 (45.1%) had two or more caries. More than 75% of had obtained fewer than five caries. For caries prevalence, we found a significantly higher prevalence of dental caries among participants aged less than 12 years (87.7%) than those aged at least 12 years (50.9%). After mutually adjustment of socio-demographic characteristics, participants aged at least 12 years had a 86% (95% CI: 65%, 94%) lower odds of having dental caries than those aged less than 12 years. For gingivitis, we found a significantly higher gingivitis detection rate among Han (87.7%) than Qiang (18.8%) and Zang (7.9%). After mutually adjustment of socio-demographic characteristics, Zang had a 81% (95% CI: 17%, 96%) lower odds of having gingivitis than Han. For dental calculus, we found a significantly higher detection rate of dental calculus among males (14.6%) than females (3.9%). After mutually adjustment of socio-demographic characteristics, females had a 376% (95% CI: 22%, 1754%) higher odds of having dental calculus than males. For oral health rate, we found a significantly higher oral health rate among participants aged at least 12 years (38.8%) than those aged less than 12 years (10.5%). After mutually adjustment of socio-demographic characteristics, participants aged at least 12 years had a 82% (95% CI: 65%, 94%) lower odds of having good oral health than those under 12 years.

Conclusions: We presented disabled children’s oral health status in three oral health criteria: caries status, periodontal health status (gingivitis and dental calculus), and general oral health status. The comprehensive oral health status of disabled children shared a high mean of caries and a high prevalence rate. Their periodontal health status was better than the Fourth National oral Health Epidemiological Survey criteria. The comprehensive oral health rate was poor. Therefore, additional studies are necessary to make improvements to it.

Background and aim: This study aimed at building the prediction model of all-cause mortality among Chinese dwelling elderly with different methods including regression models and machine learning models and to compare the performance of machine learning models with regression models on predicting mortality. Additionally, this study also aimed at ranking the predictors of mortality within different models and comparing the predictive value of different groups of predictors using the model with the best performance.Method: I used data from the Healthy Ageing and Biomarkers Cohort Study, a sub-study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The baseline survey was conducted in 2008 and participants were followed every 2-3 years till 2018. The analysis sample included 2,448 participants. I used totally 117 predictors to build the prediction model, including 65 questionnaires, 39 biomarkers, and 15 genetics predictors. Four models were built (XG-Boost, random survival forest [RSF], Cox regression with all variables, and Cox-backward). I used C-index and integrated Brier score to evaluate the performance of those four models. Results: The XG-Boost model and RSF model shows slightly better predictive performance than Cox models and Cox-backward models based on the C-index and integrated Brier score. Age. The activity of daily living and Mini-Mental State Examination score were identified as the top 3 predictors in the XG-Boost and RSF models. Biomarker and questionnaire predictors have a similar predictive value, while genetic predictors have no addictive predictive value when combined with questionnaire or biomarker predictors. Conclusion: In this work, it is shown that machine learning techniques can be a useful tool for both prediction and its performance sightly outperformed the regression model in predicting survival.

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