Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: the China Health and Retirement Longitudinal Study

Background: Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors. Methods: A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors. Results: A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73–39.45) in 2011, 33.66% (32.32–35.00) in 2013, 39.13% (37.59–40.67) in 2015, and 39.95% (38.59–41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0–5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05). Conclusions: We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19

Effect of Living Arrangements on Cognitive Function in Chinese Elders: A Longitudinal Observational Study

Objective To examine how living arrangement as a social contextual factor can affect Chinese elders’ cognitive function. Setting and participants Our sample consists of 2486 Chinese elders from two waves (2014 and 2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that was administered in 22 of China’s 31 provinces using a multi-stage, disproportionate, purposive random sampling method. The CLHLS aims to better understand the determinants of healthy longevity in China and collects extensive data on a large population of fragile elders aged 80–112 in China. Outcome measures Cognitive function was measured by the Mini-Mental State Examination (MMSE). Living arrangement was divided into living in an institution, living alone and living with household members. Generalised linear regressions were carried out to examine the associations between baseline characteristics and cognitive function, while controlling age, gender and residential area. Results A total of 2486 participants were included in the study at baseline in 2014. Of these, 1162 (46.7%) were men and 1324 (53.3%) were women. The mean age at baseline was 75.07 (±8.31) years. The mean years of schooling were 2.86 (±3.68). The number (proportion) of the three living arrangements (lived in institutions, lived alone and lived with household members) were 93 (3.8%), 463 (18.6%) and 1930 (77.6%), respectively. Among all participants, cognitive function declined over time. Those who lived alone presented with the highest MMSE scores at baseline and showed the lowest decline after 4 years. Living arrangements had significant effects on decreasing cognitive function. Conclusion Chinese elders living in institutions were most vulnerable to cognitive decline. Living alone was not a risk condition in itself for the elderly in terms of cognitive decline. In addition, the benefits of living with household members to support cognitive function were not found in our study

Does public spending structure affect the efficiency of spending? Evidence from a panel tobit model for Chinese provinces

The general financial stress confronting Chinese local governments requires public spending to become more efficient. While previous work has attempted to study what determines the efficiency, the focus was put on various factors that were not under direct control by policymakers. This paper revisits the issue, controlling the factors commonly found to be significant in the literature, by evaluating the role of the spending structure which can be easily adjusted by policymakers. The paper focuses on the investment ratio, as public investment is known to be a key driver of the Chinese economy. Using data of 31 provinces between 2000 and 2017, we estimated a Tobit model, with the efficiency of public spending calculated by data envelopment analysis (DEA). The efficiency of public spending is partially determined by the structure of the spending; the former is an increasing function of the latter up to an optimal rate, which is estimated to be between 19-23 percent. As most local governments are over-investing according to this standard, future improvement of budget management would require policymakers to concentrate much more on non-investment projects, such as spending on benefits, education and healthcare – hence, the provision of public goods and services

Dietary inflammatory potential mediated gut microbiota and metabolite alterations in Crohn's disease:A fire-new perspective

Background & aims: Pro-inflammatory diet interacting with gut microbiome might trigger for Crohn's disease (CD). We aimed to investigate the relationship between dietary inflammatory potential and microflora/metabolites change and their link with CD. Methods: The dietary inflammatory potential was assessed using a dietary inflammatory index (DII) based on the Food Frequency Questionnaire from 150 new-onset CD patients and 285 healthy controls (HCs). We selected 41 CD patients and 89 HCs who had not received medication for metagenomic and targeted metabolomic sequencing to profile their gut microbial composition as well as fecal and serum metabolites. DII scores were classified into quartiles to investigate associations among different variables. Results: DII scores of CD patients were significantly higher than HCs (0.56 ± 1.20 vs 0.23 ± 1.02, p = 0.017). With adjustment for confounders, a higher DII score was significantly associated with higher risk of CD (OR: 1.420; 95% CI: 1.049, 1.923, p = 0.023). DII score also was positively correlated with disease activity (p = 0.001). Morganella morganii and Veillonella parvula were increased while Coprococcus eutactus was decreased in the pro-inflammatory diets group, as well as in CD. DII-related bacteria were associated with disease activity and inflammatory markers in CD patients. Among the metabolic change, pro-inflammatory diet induced metabolites change were largely involved in amino acid metabolic pathways that were also observed in CD. Conclusions: Pro-inflammatory diet might be associated with increased risk and disease activity of CD. Diet with high DII potentially involves in CD by mediating alterations in gut microbiota and metabolites

Can fecal calprotectin accurately identify histological activity of ulcerative colitis? A meta-analysis

Background and Aims: Elevated fecal calprotectin (FC) levels have been reported to correlate with histological activity in patients with ulcerative colitis (UC). However, the accuracy of FC for evaluating histological activity of UC remains to be determined. The aim of this study was to determine the accuracy of FC for evaluating histological activity of UC, based on updated definitions. Methods: Related studies were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. Adult participants diagnosed with UC were included when sufficient data could be extracted to calculate the accuracy of FC for evaluating histological activity. The primary outcome was histological response, and the secondary outcome was histological remission, defined according to a recently updated position paper of European Crohn’s and Colitis Organization. Statistics were pooled using bivariate mixed-effects models. The area under the curve was estimated by summary receiver-operating characteristic curves. Results: Nine studies were included, from which 1039 patients were included for the analysis of histological response and 591 patients for histological remission. For the evaluation of histological response, the pooled sensitivity, specificity, and the area under the curve were 0.69 [95% confidence interval (CI): 0.52–0.82], 0.77 (95% CI: 0.63–0.87), and 0.80 (95% CI: 0.76–0.83), respectively. For the evaluation of histological remission, the corresponding estimates were 0.76 (95% CI: 0.71–0.81), 0.71 (95% CI: 0.62–0.78), and 0.79 (95% CI: 0.75–0.82), respectively. FC had a higher accuracy in studies using Nancy Index. For histological response, the cut-off values of FC ranged from 50 to 172 µg/g, and the sensitivity was higher in studies with FC cut-off values &gt;100 µg/g (0.77 versus 0.65). Conclusion: FC is a valuable biomarker for assessing histological activity in patients with UC. A cut-off value of 100–200 µg/g is more appropriate to spare patients from an unnecessary endoscopy and biopsy

IκBα polymorphism at promoter region (rs2233408) influences the susceptibility of gastric cancer in Chinese

<p>Abstract</p> <p>Background</p> <p>Nuclear factor of kappa B inhibitor alpha (IκBα) protein is implicated in regulating a variety of cellular process from inflammation to tumorigenesis. The objective of this study was to investigate the susceptibility of rs2233408 T/C genotype in the promoter region of <it>IκBα </it>to gastric cancer and the association of this polymorphism with clinicopathologic variables in gastric cancer patients.</p> <p>Methods</p> <p>A population-based case-control study was conducted between 1999 and 2006 in Guangdong Province, China. A total of 564 gastric cancer patients and 566 healthy controls were enrolled in this study. rs2233408 genotypes in <it>IκBα </it>were analyzed by TaqMan SNP genotyping assay.</p> <p>Results</p> <p>Both rs2233408 T homozygote (TT) and T heterozygotes (TC and TT) had significantly reduced gastric cancer risk (TT: OR = 0.250, 95% CI = 0.069-0.909, <it>P </it>= 0.035; TC and TT: OR = 0.721, 95% CI = 0.530-0.981, <it>P </it>= 0.037), compared with rs2233408 C homozygote (CC). rs2233408 T heterozygotes were significantly associated with reduced risk of intestinal-type gastric cancer with ORs of 0.648 (95% CI = 0.459-0.916, <it>P </it>= 0.014), but not with the diffuse or mix type of gastric cancer. The association between rs2233408 T heterozygotes and gastric cancer appeared more apparent in the older patients (age>40) (OR = 0.674, 95% CI = 0.484-0.939, <it>P </it>= 0.02). rs2233408 T heterozygotes was associated with non-cardiac gastric cancer (OR = 0.594, 95% CI = 0.411-0.859, <it>P </it>= 0.006), but not with cardiac gastric cancer. However, rs2233408 polymorphism was not associated with the prognosis of gastric cancer patients.</p> <p>Conclusions</p> <p><it>IκBα </it>rs2233408 T heterozygotes were associated with reduced risk of gastric cancer, especially for the development of certain subtypes of gastric cancer in Chinese population.</p

Min-Max-MSE Transceiver Design for MU-MIMO VLC System

This paper considers a multiuser (MU) multiple-input multiple-output (MIMO) visible light communication (VLC) system with broadcast channels. Due to the simultaneous transmission of the different source data to the receivers covered with the light rays, the interuser interference (IUI) may degrade the system performance. We strive to suppress the IUI by minimizing the maximum mean square errors (MSE) under the assumption of the perfect knowledge of channel state information (CSI). However, since the CSI may not be perfectly known in practice, a robust design is required against the channel uncertainties. Additionally, the nonnegativity and the limited linear range of the optical signals have been taken into account in the VLC transceiver designs. Simulation results validate that the proposed min-max-MSE approach can provide fair transmission, compared with the minimization of sum-MSE approach. Furthermore, it is demonstrated that the robust scheme is capable of providing robustness and gaining a considerable bit error rate (BER) performance