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Zhang X, Ma L, Liu X, Cui N, Guo B, Zhang L. Association between health insurance programs and rehabilitation services utilisation among people with disabilities: evidence from China. Public Health 2024; 232:201-207. [PMID: 38815542 DOI: 10.1016/j.puhe.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Rehabilitation is crucial to improve the health status of people with disabilities. Previous studies mainly analysed the impact of health insurance on utilisation of general health services; the relationship between health insurances and rehabilitation services utilisation among Chinese people with disabilities has been long neglected. This study aimed to analyse the association between health insurance programs and rehabilitation services utilisation among disabled people. STUDY DESIGN This was a cross-sectional study. METHODS The data used in this study were derived from 2021 National Household Income Survey of Disabled People and National Basic Database of People with Disabilities conducted by China Disabled Persons' Federation. Logistic regression model was used to analyse the relationship between health insurance and rehabilitation services utilisation, and the propensity score matching method was used to check the robustness of the results. RESULTS (1) Disabled people insured by the Basic Medical Insurance System for Urban Employees (BMISUE) and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR) were positively associated with rehabilitation service utilisation (odds ratio [OR] = 1.852, 95% confidence interval [CI]:1.268, 2.707; OR = 1.375, 95% CI: 0.962, 1.966). (2) The utilisation level of rehabilitation service among disabled people insured by BMISUE was significantly higher than those insured by BMISURR (OR = 1.355, 95% CI: 1.161, 1.581). (3) The supply of rehabilitation services at the community level was positively correlated with the utilisation by people with disabilities. CONCLUSION Health insurance can improve the financial accessibility of using rehabilitation services, and the utilisation level will increase as the benefits level of health insurance increase.
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Affiliation(s)
- X Zhang
- Institute of Population Research, Peking University, Beijing, 100871, China; The Oxford Institute of Population Ageing, University of Oxford, OX2 6PR, UK.
| | - L Ma
- Institute of Population Research, Peking University, Beijing, 100871, China.
| | - X Liu
- Institute of Population Research, Peking University, Beijing, 100871, China.
| | - N Cui
- Institute of Population Research, Peking University, Beijing, 100871, China.
| | - B Guo
- Institute of Population Research, Peking University, Beijing, 100871, China.
| | - L Zhang
- Institute of Population Research, Peking University, Beijing, 100871, China.
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Wu J, Wang Y, Li Y, Liu H, Yang S, Zhai H, Wu H. Are physically disabled people at high risk of coronary heart disease among disabled population - Evidence from 7.5-year retrospective cohort study. Ann Epidemiol 2024; 90:42-48. [PMID: 37926391 DOI: 10.1016/j.annepidem.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Previous cross-sectional studies suggested that people with physical disabilities (one of the subgroups of disabled people) are associated with an increased risk of cardiovascular diseases (CVD) than healthy peers. However, a longitudinal cohort of disabled people exhibited a different trend, in which the study populations were similar in health inequalities. We aimed to examine whether physical disability was associated with an increased risk of coronary heart disease (CHD) among disabled people. STUDY DESIGN AND SETTING This retrospective cohort study from the Shanghai Health Examination Program included a total of 6419 disabled adults (50.77 [9.88] age) with complete electronic health records and were free of CHD at baseline (2012) were followed-up for a 7.5-year period until 2019. The physical disability and non-physical disability subgroups were characterized based on the Disability Classification and Grading Standard (GB/T 26341-2010). Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios (HR) for subsequent CHD, while Kaplan-Meier curves was used to assess the proportional hazards assumption. We conducted subgroup analyses based on gender, levels of disability, and baseline blood pressure. RESULTS Kaplan-Meier analysis revealed a higher incidence of CHD in the physical disability group compared to the non-physical disability group during the 7.5-year follow-up period (P < 0.05). Subjects with physical disabilities exhibited an increased risk for subsequent CHD occurrence (HR: 1.12; 95% CI: 1.03-1.31), compared to the non-physical subgroup after adjustments for confounders. The sensitivity analysis conducted on subgroups according to gender and disability severity indicated that moderate physical disability and female physical disability were associated with a higher prevalence of CHD, which was confirmed by multi-adjusted regression analysis. The spline curves of BP and CHD indicated that the physical disability group displayed lower SBP and DBP thresholds of 120 mmHg and SBP, respectively. CONCLUSION Within the disabled population, individuals with physical disability are at higher risk of developing CHD, and it is plausible that their optimal BP threshold for CHD prevention may need to be set at a lower level. Further research is essential to investigate BP management among individuals with physical disabilities and its influence on cardiovascular-related adverse events.
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Affiliation(s)
- Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yiyan Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shenglan Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hua Zhai
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.
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Wang Y, Ding R, Luo Y, He P, Zheng X. Does college education reduce the risk of schizophrenia? Evidence from a college enrollment expansion policy in China. Schizophr Res 2024; 264:519-525. [PMID: 38295748 DOI: 10.1016/j.schres.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Schizophrenia occurs worldwide, and the health, and economic burden is substantial. As one of the common proxies of socioeconomic status (SES), education was reported to be associated with the risk of developing schizophrenia. However, there is no causal evidence about the relationship. This paper explores the health benefits of college education for schizophrenia. METHOD Based on exogenous variation in college enrollment across regions and cohorts induced by college enrollment expansion policy, we use instrument variable (IV) estimate strategy to estimate impacts of college education on the risk of schizophrenia with the data from Second National Sample Survey on Disability. RESULTS We find that college education reduces the risk of developing schizophrenia by 4.2 percentage points. Some further analyses suggest the causal protective effect is only found among men, rural, and low-income individuals. CONCLUSIONS These findings provide new evidence for the causal relationship between college education and schizophrenia, and add to the literature on the health benefits of education.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
| | - Ruoxi Ding
- Peking University Sixth Hospital, 38 Huayuan North Road, Haidian District, Beijing 100191, China.
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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Fan Y, Guo S, Dai W, Chen C, Zhang C, Zheng X. Individual-level socioeconomic status and cataract-induced visual disability among older adults in China: the overview and urban-rural difference. Front Public Health 2024; 12:1289188. [PMID: 38406497 PMCID: PMC10885563 DOI: 10.3389/fpubh.2024.1289188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To investigate the prevalence of cataract-induced visual disability and its association with individual-level socioeconomic status (SES) among older adults in China. Methods Using the data of 354,743 older adults (60 years and older) from the Second China National Sample Survey on Disability in 2006. Cross-sectional study design was applied. The differences in visual disability prevalence of cataracts among sociodemographic subgroups were analyzed by the chi-square test, and the association between individual-level SES and cataract-induced visual disability was investigated by the multivariate logistic regression model. Results The weighted visual disability prevalence of cataracts was 4.84% in 2006. Older people with a higher household income per capita (OR = 0.83, 95% CI: 0.81-0.85), higher education level (primary school vs. illiteracy: OR = 0.80, 95% CI: 0.76-0.83; ≥undergraduate college vs. illiteracy: OR = 0.31, 95% CI: 0.25-0.39), and occupation (OR = 0.53, 95% CI: 0.50-0.56) were less likely to suffer from cataract-induced visual disability. Household income per capita and education level increase played a greater role in decreasing the risk of visual disability caused by cataracts in urban areas, while having occupation contributed more to reducing the risk of disability in rural areas. Conclusion The gap in individual-level SES is closely related to the visual health inequities among older Chinese people and there are two distinct mechanisms in rural and urban areas. Strategies to promote collaborative healthcare development regionally, strengthen safeguards for disadvantaged groups, and increase public awareness of visual disability prevention are warranted.
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Affiliation(s)
- Yunyi Fan
- HeSAY/Institute of Population Research, Peking University, Beijing, China
| | - Shuai Guo
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wanwei Dai
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chen Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xiaoying Zheng
- HeSAY/Institute of Population Research, Peking University, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Yu Q, Li Z, Yang C, Zhang L, Xing M, Li W. Predicting functional dependency using machine learning among a middle-aged and older Chinese population. Arch Gerontol Geriatr 2023; 115:105124. [PMID: 37454417 DOI: 10.1016/j.archger.2023.105124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To develop prediction models for assessing functional dependency in a middle-aged and older Chinese population. METHOD Adults ≥45 years old from the China Health and Retirement Longitudinal Study (CHARLS) and without functional dependency at baseline were included. Functional dependency was defined as needing any help in any basic activities of daily living (ADL) or instrumental activities of daily living (IADL). The outcomes were overall functional dependency, ADL and IADL dependency. Stacked ensemble models were constructed based on five selected machine learning models. Models were trained and tested in the 2011-2015 cohort, and were externally validated in the 2015-2018 cohort. SHapley Additive exPlanations (SHAP) was utilized to quantify the significance of predictors. RESULT In the training cohort, a total of 6,297 participants were included at baseline, 1,893 developed functional dependency during the follow-up period. The stacked ensemble model achieved the best performance in terms of discrimination ability for predicting overall functional dependency, ADL and IADL dependency, with AUCs of 0.750, 0.690 and 0.748, respectively; in external validation cohort, the corresponding AUCs were 0.725, 0.719 and 0.727, respectively. A compact model was further developed and maintained similar predictive performance. CONCLUSION The stacked ensemble approach can serve as a useful tool for identifying the risk of functional dependency in a large Chinese population. For ADL dependency, arthritis, age, self-report health, and waist circumference were identified as highly significant predictors. Conversely, cognitive function, age, living in rural areas, and performance in chair stand test emerged as highly ranked predictors for IADL dependency.
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Affiliation(s)
- Qi Yu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zihan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenyu Yang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhi Zhang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Muqi Xing
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Zhu HP, Qi H, Liu XH, Liu K, Li BX, Wen FY, Xie YY, Zhang L. The prevalence of disability and associated factors among community adults in the baseline of CHCN-BTH Cohort Study. BMC Public Health 2023; 23:1727. [PMID: 37670230 PMCID: PMC10481555 DOI: 10.1186/s12889-023-15066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Disability was a major public health problem in China. However, the prevalence of disabilities in community-dwelling adults and their relationships to chronic physical conditions were unclear. We aimed to estimate the prevalence of disabilities and associated factors among a large community-based cohort in China. METHODS Participants who were local permanent residents aged 18 years or above and completed the disability assessments were selected from the Cohort study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH) from 2017 to 2019. Disability was assessed using five questions about impairments and activity limitations based on the International Classification of Functioning (ICF), Disability and Health. Univariate, multivariate and multilevel logistic regressions were conducted to estimate the associations between disabilities and associated factors. RESULTS Totally, 12,871 community-dwelling adults completed the survey. Among of them, 12.9% (95% CI: 12.3%-13.5%) reported having any disability. The prevalence of any disability was significantly higher in participants who were older age, widowed, retired and smokers, had higher BMI, average monthly income < 5000 RMB, lower education level, lower physical exercise frequency and heavy physical labor. Multilevel logistic regressions showed that there were significant associations between disabilities with chronic physical conditions, especially in the vision impairment with lower back pain, and hearing impairment as well as difficulty walking without special equipment with injuries. CONCLUSIONS Many Chinese adults suffered from disabilities. Sustained efforts should be made to develop specific population-based health promotion and prevention programs for disabilities in China. TRAIL REGISTRATION ChiCTR1900024725 (25/07/2019).
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Affiliation(s)
- Hui-Ping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Han Qi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Xiao-Hui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Bing-Xiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Fu-Yuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Yun-Yi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
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Luo Y, Ye X, Wang Y, Liu Y, Liang R, He P, Zheng X. Consequences of China's special send-down movement on infectious disease control in rural areas: a natural experiment. SSM Popul Health 2023; 23:101421. [PMID: 37252290 PMCID: PMC10209325 DOI: 10.1016/j.ssmph.2023.101421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/31/2023] Open
Abstract
Background China's send-down movement in the 1960s and 1970s, as a natural experiment, provides a unique opportunity to investigate the relationship between peers' dissemination of health literacy, community health workers, and infectious disease control in areas with weak health systems and inadequate human resources. To address the lack of studies on the health effects of the send-down movement, this study examined the associations between prenatal exposure to the send-down movement and infectious diseases in China. Methods We analyzed 188,253 adults born in 1956-1977 with rural hukou who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China. Difference-in-difference models were used to detect the effect of the send-down movement on infectious diseases. Infectious diseases were ascertained by using the combination of self- or family members' reports and on-site medical diagnosis of disabilities attributed to infectious disease by experienced specialists. The density of the relocated urban sent-down youth or "sent-down youths" (SDYs) in each county defined the intensity variable of the send-down movement. Results Individuals in SDY-receiving areas with increased intensity of prenatal exposure to the send-down movement had a decreased probability of infectious diseases (β = -0.0362, 95% CI: 0.0591, -0.0133) after controlling for a set of regional and cohort characteristics. This association was stronger in counties with more prevalent infectious diseases prior to the send-down movement (β = -0.0466, 95% CI: 0.0884, -0.0048) than in those with less prevalence (β = -0.0265, 95% CI: 0.0429, -0.010). No substantial differences were found across sex-specific groups or by strictness of send-down movement implementation. On average, prenatal exposure to the send-down movement corresponded to a decrease in the probability of infectious diseases in rural areas by 19.70%. Conclusions For areas with weak health systems, strengthening community health workers and promoting health literacy may be two key points to address the burden of infectious diseases. Increasing education and primary health care through peer-to-peer dissemination may contribute to the reduction of infectious disease prevalence.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Xin Ye
- Institute for Global Public Policy, Fudan University, Shanghai, China
- LSE-Fudan Research Centre for Global Public Policy, Fudan University, Shanghai, China
| | - Yiran Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yunduo Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Richard Liang
- School of Medicine, Stanford University, California, USA
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
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Cui J, Yan B, Du H, Shang Y, Tong L. Application of Foot Hallux Contact Force Signal for Assistive Hand Fine Control. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115277. [PMID: 37300003 DOI: 10.3390/s23115277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Accurate recognition of disabled persons' behavioral intentions is the key to reconstructing hand function. Their intentions can be understood to some extent by electromyography (EMG), electroencephalogram (EEG), and arm movements, but they are not reliable enough to be generally accepted. In this paper, characteristics of foot contact force signals are investigated, and a method of expressing grasping intentions based on hallux (big toe) touch sense is proposed. First, force signals acquisition methods and devices are investigated and designed. By analyzing characteristics of signals in different areas of the foot, the hallux is selected. The peak number and other characteristic parameters are used to characterize signals, which can significantly express grasping intentions. Second, considering complex and fine tasks of the assistive hand, a posture control method is proposed. Based on this, many human-in-the-loop experiments are conducted using human-computer interaction methods. The results showed that people with hand disabilities could accurately express their grasping intentions through their toes, and could accurately grasp objects of different sizes, shapes, and hardness using their feet. The accuracy of the action completion for single-handed and double-handed disabled individuals was 99% and 98%, respectively. This proves that the method of using toe tactile sensation for assisting disabled individuals in hand control can help them complete daily fine motor activities. The method is easily acceptable in terms of reliability, unobtrusiveness, and aesthetics.
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Affiliation(s)
- Jianwei Cui
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Bingyan Yan
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Han Du
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Yucheng Shang
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Liyan Tong
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
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Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
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Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Ning H, Zhang H, Xie Z, Jiang W, Xie S. Relationship of hearing impairment, social participation and depressive symptoms to the incidence of frailty in a community cohort. J Am Geriatr Soc 2022; 71:1167-1176. [PMID: 36504135 DOI: 10.1111/jgs.18164] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/04/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The mediating effect of social participation and depressive symptoms on the relationship between hearing impairment and frailty remains unclear. METHODS A total of 3981 participants from three waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. The outcome was incidental frailty. Hearing impairment, social participation, and depressive symptoms were the main variables. Cox regression models and structural equation models were adopted to examine the relationship between hearing impairment, social participation, depressive symptoms, and the incidence of frailty, with adjustments for demographic characteristics and lifestyle variables at baseline. RESULTS Hearing impairment (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.12, 1.74), social participation (HR 0.72, 95% CI 0.55, 0.94), and depressive symptoms (HR 1.78, 95% CI 1.37, 2.30) were associated with the incidence of frailty. Hearing impairment was associated with frailty not only through social participation (β = 0.015, 95% CI 0.003, 0.037) and depressive symptoms (β = 0.070, 95% CI 0.037, 0.116) separately but also through social participation and depressive symptoms sequentially (β = 0.002, 95% CI 0.001, 0.004). Furthermore, the effect of social participation on frailty occurred in participants with hearing impairment, while the effect of depressive symptoms on frailty occurred in participants with normal hearing status. CONCLUSIONS Hearing impairment is associated with frailty, in which social participation and depressive symptoms partly mediate the association. The effect of social participation and depressive symptoms on frailty varies across hearing statuses. Integrated and comprehensive intervention measures, including hearing screenings, promoting social participation, and improving depressive symptoms, are suggested to prevent frailty.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing Central South University Changsha China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery Xiangya Hospital of Central South University Changsha China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases Changsha China
- National Clinical Research Center for Geriatric Disorders Changsha China
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery Xiangya Hospital of Central South University Changsha China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases Changsha China
- National Clinical Research Center for Geriatric Disorders Changsha China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery Xiangya Hospital of Central South University Changsha China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases Changsha China
- National Clinical Research Center for Geriatric Disorders Changsha China
| | - Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery Xiangya Hospital of Central South University Changsha China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases Changsha China
- National Clinical Research Center for Geriatric Disorders Changsha China
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11
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Jia Z, Gao Y, Zhao L, Han S. Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults. Sci Rep 2022; 12:21270. [PMID: 36481918 PMCID: PMC9732289 DOI: 10.1038/s41598-022-25825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.
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Affiliation(s)
- Zhihao Jia
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Yan Gao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Liangyu Zhao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Suyue Han
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
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12
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He P, Luo Y, Ding R, Zheng X. Is it just a cure? Re-evaluating the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Soc Sci Med 2022; 314:115487. [PMID: 36335705 DOI: 10.1016/j.socscimed.2022.115487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Very limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data. METHODS Using difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members' reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level. RESULTS All DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (-0.0024, 0.0026) for all participants and coefficients of 0.0001 (-0.0041, 0.0043) and -0.0002 (-0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases). CONCLUSION No significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be "cured" by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.
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Affiliation(s)
- Ping He
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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13
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Socioeconomic disparities and dementia in China. Psychiatry Res 2022; 313:114611. [PMID: 35561537 DOI: 10.1016/j.psychres.2022.114611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to investigate the associations between individual-level SES, area-level SES, and their interaction with dementia in China. METHODS This study used data from the Second China National Sample Survey on Disability and restricted our finalized analysis to 688,507 participants aged 50 years or older. Dementia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Multilevel logistic regression models were fitted to examine the associations between individual-level SES, area-level SES, and their interaction with dementia. RESULTS Participants with higher individual SES were less likely to develop dementia; the risk of dementia decreased by 18% for each standard deviation increase in individual SES (OR=0.82, 95% CI=0.77, 0.88). Advantaged areas were associated with an increased risk of dementia in Chinese adults by 1.52 (95% CI=1.43, 1.62). Analysis of the combination between individual-level SES and area-level SES revealed that as the level of area SES increased, the risk of dementia in lower SES people was significantly higher than in higher SES people (OR=1.09, 95% CI=1.04,1.14). DISCUSSION This study found that people with lower SES living in high-SES areas had a higher risk of dementia than people with lower SES living in low-SES areas. Significant socioeconomic differences in the risk of dementia exist in China, and more attention should be given to low-SES populations living in high-SES areas.
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14
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PM<sub>2.5</sub> Air Pollution and Cardiovascular Disease-Associated Disability among Middle-Aged and Older Adults. Glob Heart 2022; 17:41. [PMID: 35837365 PMCID: PMC9205374 DOI: 10.5334/gh.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Increasing evidence regards the role of ambient particles on morbidity and mortality caused by cardiovascular diseases (CVDs). However, there was no evidence about the association between ambient particles and CVD-associated disability. This study used large national representative data to investigate the relationship between long-term exposure to an aerodynamic diameter less than or equal to 2.5 µm (PM2.5) and CVD-associated disability among Chinese adults aged 45 years old and above and estimated the burden of CVD-associated disability attributed to PM2.5. Methods: Using data from the Second National Sample Survey on Disability, this study used a combination of self-reports or family members’ reports and on-site medical diagnosis by experienced specialists to ascertain CVD-associated disability in 852,742 adults aged 45 years old and above. Logistic regression models and spline regression models were used to examine the association between PM2.5 long-term exposure and CVD-associated disability, and the population attributable risk was calculated to assess the burden of CVD-associated disability contributed to PM2.5. Results: Every increase of 10 μg/m3 in PM2.5 was associated with an 8% (OR = 1.08, 95% CI: 1.05, 1.10) increase the odds of CVD-associated disability. Stratified analyses by demographic factors suggested that this association was robust. There were 1.05 (0.74,1.35) million -3.53 (3.29,3.75) million CVD-associated disabilities attributed to high PM2.5 concentration exposure (≥35 µg/m3) among middle-aged and older adults in 2006. A reduction in PM2.5 concentrations to 35 µg/m3 corresponded to a decrease of 13.59% (9.55%, 17.46%)–23.98% (17.17%, 30.25%) in CVD-associated disability by age group, respectively, and this magnitude increased in areas with a high prevalence of CVD-related disability. Conclusions: This study suggests that reducing PM2.5 concentrations may contribute to preventing CVD-associated disability and decreasing air pollution-related medical expenditures and rehabilitation fees.
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Luo Y, He P, Wen X, Gong R, Hu X, Zheng X. Otitis Media and Its Association With Hearing Loss in Chinese Adults: A Population Based Study of 4 Provinces in China. Front Public Health 2022; 10:852556. [PMID: 35651868 PMCID: PMC9149286 DOI: 10.3389/fpubh.2022.852556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Otitis media is a recognized cause of significant hearing loss, particularly in developing countries. This study aimed to investigate the relationship between otitis media and hearing loss in Chinese adults aged 18 years and older. Methods The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 36,783 adults at the ages between 18 years and above were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. All participants underwent clinical ENT check-up and otoscopic examination by doctors trained in ENT. Each participant was assigned a single middle ear diagnosis. Diagnoses were assigned as per the WHO classification of ear and hearing disorders. Results Logistic regressions showed that higher prevalence of hearing loss was found in participants with otitis media, with an unadjusted odds ratio of 5.67 (95%CI: 4.66, 6.90). The next two models (Model 2–3) had slight impact on ORs. The interaction of residency and otitis media was statistically significant (OR = 1.70, 95%CI = 1.15, 2.53); otitis media patients in rural areas had higher risk of hearing loss. However, this interaction became not significant in 65 years old and above participants. Conclusions Otitis media was associated with the risk of hearing loss. Compared with urban patients with otitis media, rural patients have the higher risk of hearing loss. Action to reduce the risk of hearing loss in otitis media will require attention to rural-urban disparities.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xu Wen
- College of Biochemical Engineering, Beijing Union University, Beijing, China
| | - Rui Gong
- China Rehabilitation Research Center for Deaf Children, Beijing, China
| | - Xiangyang Hu
- China Rehabilitation Research Center for Deaf Children, Beijing, China
| | - Xiaoying Zheng
- Chinese Academy of Medical Sciences/Peking Union Medical College, School of Population Medicine and Public Health, Beijing, China
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16
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Design to Assist Better Youthhood for Adolescents with Lower-Limb Disability through Virtual Reality Sports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073985. [PMID: 35409674 PMCID: PMC8997947 DOI: 10.3390/ijerph19073985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023]
Abstract
Background: Youths with lower limb dysfunction display low levels of sports participation, which limits their growth and self-development, both physically and mentally. Recently, VR technology has proven its profound value in the psychological evaluation and treatment, rehabilitation, and immersive training of people in need. We have proposed, designed, and developed a VR rock-climbing game for youths with lower-limb dysfunction that allows them to engage in enjoyable and purposeful in-game tasks that simultaneously bring about intensive real-world exercise. Methods: Pilot studies were conducted on college students whose lower limbs were fixed to chairs. Heart rate monitoring, a flow questionnaire, interviews, and observation were conducted for each participant to evaluate the impact of the VR rock-climbing game. The collected data were trimmed on the basis of Cronbach’s alpha and corrected item−total correlation (CITC) to guarantee the data’s reliability. Results: The average value of each flow experience dimension was greater than 4 (0.76 < SD < 0.91). According to the flow-based analysis and the whole-process feeling distribution (WPFD), the evaluated study brought about the participants’ happiness and a sense of mastery and achievement. Conclusions: By bringing about a deep and enjoyable immersion in VR, it remarkably promotes the participants’ intention to participate in exercises.
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17
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Ding R, He P, Zheng X. Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study. Front Psychiatry 2022; 13:914245. [PMID: 36090373 PMCID: PMC9459142 DOI: 10.3389/fpsyt.2022.914245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Few studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors. METHODS Data were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007-2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association. RESULTS Overall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds. CONCLUSIONS This study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health and Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health and Development Studies, Peking University, Beijing, China
| | - Xiaoying Zheng
- Asia Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
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18
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Kep K, Kobashi Y, Abarca Lopez EJ, Tsubokura M, Okawada M. Difference of sociodemographic characteristics among the disabled population in Cambodia: a cross-sectional study of the demographic and health survey data. J Rural Med 2022; 17:79-84. [PMID: 35432637 PMCID: PMC8984620 DOI: 10.2185/jrm.2021-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: There is an urgent need to raise awareness of the significance of
the social security system for vulnerable populations in developing countries and identify
the widening disparities among people with disabilities. This study determined the
sociodemographic characteristics of people with disabilities in Cambodia. Materials and Methods: This was a cross-sectional study. Data from the
Cambodia Demographic and Health Survey were used to determine the association between
disability and sociodemographic characteristics such as age, gender, number of family
members, residence (rural/urban), and economic status. Results: The results showed that the proportion of people with disabilities
greatly increased with age. The rural-urban residence difference affected the disability
proportion in univariate analysis; however, the effect was not significant after adjusting
for covariables in multivariate analysis. The odds of having a disability were 0.85 times
lower for the high economic status group than for the low economic status group. Conclusion: Raising awareness to expand the capacity of social support for
older adults with disabilities, especially those who do not receive care from their
families, may be an urgent issue in Cambodia. Therefore, a well-designed and
disease-specific study is required. This study was the first to determine the
sociodemographic disparities among people with disabilities in Cambodia.
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Affiliation(s)
- Kanika Kep
- Sunrise Japan Hospital Phnom Penh, Cambodia
| | | | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Japan
| | - Manabu Okawada
- Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Cambodia
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Fan H, Luo Y. Regional Patterns of Disability and Their Relationship with Socioeconomic Conditions — China, 2006. China CDC Wkly 2022; 4:962-966. [DOI: 10.46234/ccdcw2022.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
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20
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Feaster D, Franzen A. From stigma to acceptance: Intellectual and developmental disabilities in Central China. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:507-526. [PMID: 32425086 DOI: 10.1177/1744629520923264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Children with intellectual and developmental disabilities have historically been at high risk for social exclusion and other vulnerabilities. The Western world has shifted away from institutionally-based services and toward community-based services that allow for greater social inclusion as well as for meeting individual developmental needs, and China is beginning the process of exploring how to make this shift. In 2014 and 2015, a situation analysis examining the lived experiences of parents of children with disabilities in Zhengzhou, Henan, China, was undertaken. Perceptions of strengths, needs, opportunities, and barriers experienced by parents of children in intact families (i.e. families where children with disabilities remain in their birth families) were explored by means of parent interviews and focus groups. Families identify experiences of stigma and acceptance related to traditional and alternative social constructions of intellectual and developmental disabilities, and how they use social networks and information-sharing to help develop community-based services.
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21
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Luo Y, Zhao Y, Pang L, Guo C, Liang R, Zheng X. Association Between Urbanicity and Dementia in China: A Population-Based Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:1644-1651. [PMID: 32644163 DOI: 10.1093/geronb/gbaa090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study investigated the relationship between urbanicity and dementia and predicted its nonlinear pattern among Chinese adults aged 50 years and older. METHODS This study used data from the Second National Sample Survey on Disability, which was implemented from April 1 to May 31, 2006 across China. Dementia status was determined by a 2-stage process: the combination of self-reports or family members' reports and an onsite medical diagnosis by experienced specialists based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision Symptom Checklist for Mental Disorders. Logistic regression models were used to examine the relationship between urbanicity and dementia, and restricted polynomial spline regression models were plotted to examine the nonlinear exposure-response relationship of urbanicity and dementia. RESULTS Logistic regression results showed that an increase of 10% in the degree of urbanization was associated with a 73% decrease in the odds of dementia after adjusting for covariates, particularly area-level socioeconomic variables. This observed association was stronger in the younger age group, and this age group difference was only present in women. Spline regression findings suggested a nonlinear exposure-response relationship between urbanicity and the odds of dementia. Areas with very high levels of urbanization were associated with increased odds of dementia. CONCLUSIONS These findings highlight the necessity to properly examine the nuanced relationship between urbanicity and mental health, especially for women in the younger age group. Notably, there were increased odds of dementia at very high levels of urbanicity.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, Beijing, China.,Advanced Systems Analysis, International Institute for Applied Systems Analysis, Laxenburg, Austria.,APEC Health Science Academy, Peking University, Beijing, China
| | - Yihao Zhao
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Lihua Pang
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | | | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
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22
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Future life expectancy with disability among elderly Chinese individuals: a forecast based on trends in stroke and dementia. Public Health 2021; 198:62-68. [PMID: 34364000 DOI: 10.1016/j.puhe.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study aims to predict the life expectancy with disability (LED) of the elderly in China from 2010 to 2030 based on trends in stroke and dementia. STUDY DESIGN This was a prospective cohort study. METHODS Data for 28,667 eligible individuals aged 65+ years were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2002 to 2014. A discrete-time probabilistic Markov model was constructed with nine different health states characterized by the presence or absence of stroke, dementia, disability, or death. Binomial logistic regression was used to estimate the probability of state transition every 3 years based on the survey interval in the CLHLS. The number of disabled individuals was predicted in 2030 using Chinese population data from World Population Prospects 2019 and trends in the incidence and mortality for stroke and dementia as recorded in the CLHLS. A multistate life table was used to predict LED in 2030. RESULTS It is predicted that disability in those aged 65+ years in China will increase from 11.4 million in 2010 to 34.8 million in 2030. Cases associated with stroke and dementia are predicted to increase by 297.9% and 167.8%, respectively, for the 65-79 years age group, and by 402.1% and 247.0%, respectively, for the 80+ year age group. Life expectancy (LE) and LED for 65-year-old individuals are predicted to be 16.1 and 2.2 years in 2030, respectively, with increases of 11.8% and 57.1%, respectively. CONCLUSIONS LED in the elderly is predicted to increase more rapidly than LE from 2010 to 2030, both stroke and dementia increasing the risk of disability.
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23
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Guo C, Zheng X. Restoration of Population Disability Trajectory During Hundreds of Years - China, 1896-2006. China CDC Wkly 2021; 3:468-471. [PMID: 34594915 PMCID: PMC8393110 DOI: 10.46234/ccdcw2021.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/14/2022] Open
Abstract
What is already known about this topic? A previous study found that the size of population with disability was 52.7 million and 84.6 million in 1987 and 2006, with the weighted disability rate of 4.9% and 6.5%, respectively. What is added by this report? This study restored the prevalence of disability and its change trajectory in China during 110 years from 1896 to 2006 across 3 centuries. What are the implications for public health practice? This study realized the innovation of cross-sectional data utilization methods and the expansion of the theory of morbidity transformation while making up for the lack of historical data.
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Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
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24
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Hearing impairment and loneliness in older adults in Shandong, China: the modifying effect of living arrangement. Aging Clin Exp Res 2021; 33:1015-1021. [PMID: 32557333 DOI: 10.1007/s40520-020-01594-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hearing impairment is a highly prevalent condition and potential risk factor of loneliness in older adults. There is little evidence on whether living arrangement modifies the effects of hearing impairment on loneliness in older adults. AIMS (1) Explore the relationship between hearing impairment and loneliness in old adults; (2) investigate the modifying effect of living arrangement on the association between hearing impairment and loneliness. METHODS A cross-sectional analysis was conducted of 7070 participants (aged 60-101) in Shandong province of China. Hearing impairment was measured by a single self-reported question. Variables about social demography and physical functioning were assessed using self-administered questionnaires, and loneliness using short-form UCLA Loneliness Scale. Linear regression models were performed to evaluate the association between hearing impairment and loneliness and possible effect modified by living arrangement. RESULTS After controlling variables, older adults with hearing impairment reported significantly higher levels of loneliness than those with normal hearing (β = 0.024; P < 0.001). Living arrangement has a significant modifying effect on association between hearing impairment and loneliness. CONCLUSIONS Our results underscored the potential impact of hearing impairment on loneliness in older adults, and also suggested that having adult children in the same village/community may play a protective role in reducing the loneliness of older adults with hearing impairment.
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25
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Luo Y, Pang L, Guo C, Zhang L, Zheng X. Association of Urbanicity with Schizophrenia and Related Mortality in China: Association de l'urbanicité avec la schizophrénie et la mortalité qui y est reliée en Chine. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:385-394. [PMID: 32878467 PMCID: PMC8172350 DOI: 10.1177/0706743720954059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Although higher prevalence of schizophrenia in Chinese urban areas was observed, studies focused on the association between schizophrenia and urbanicity were less in China. Using a national representative population-based data set, this study aimed to investigate the relationship between urbanicity and schizophrenia and its related mortality among adults aged 18 years old and above in China. METHODS Data were obtained from the Second China National Sample Survey on Disability in 2006 and follow-up studies from 2007 to 2010 each year. We restricted our analysis to 1,909,205 participants aged 18 years or older and the 2,071 schizophrenia patients with information of survival and all-caused mortality of the follow-up surveys from 2007 to 2010.Schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision. The degree of urbanicity and the region of residence were used to be the proxies of urbanicity. Of these, the degree of urbanicity measured by the ratio of nonagricultural population to total population and the region of residence measured by six categorical variables (first-tier cities, first-tier city suburbs, second-tier cities, second-tier city suburbs, other city areas, and rural areas). Logistics regression models and restricted polynomial splines were used to examine the linear/nonlinear relationship between urbanicity and the risk of schizophrenia. Cox proportional hazards regression models were used to test the role of urbanicity on mortality risk of schizophrenia patients. RESULTS 10% increase in the degree of urbanicity was associated with increased risk of schizophrenia (OR = 1.44; 95% CI, 1.32 to 1.57). The nonlinear model further confirmed the association between the degree of urbanicity and the risk of schizophrenia. This association existed sex difference, as the level of urbanicity increased, schizophrenia risk of males grew faster than the risk of females. The hazard ratio (HR) of mortality in schizophrenia patients decreased with the elevated of urbanicity level, with a HR of 0.42 (95% CI, 0.21 to 0.84). CONCLUSIONS This research suggested that incremental changes in the degree of urbanicity linked to higher risk of schizophrenia, and as the degree of urbanicity elevated, the risk of schizophrenia increased more for men than for women. Additionally, we found that schizophrenia patients in higher degree of urbanicity areas had lower risk of mortality. These findings contributed to the literature on schizophrenia in developing nations under a non-Western context and indicates that strategies to improve mental health conditions are needed in the progress of urbanicity.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Lihua Pang
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Chao Guo
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Lei Zhang
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Xiaoying Zheng
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
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Ao D, Guo S, Yun C, Zheng X. Socio-demographic factors impact disabilities caused by perinatal asphyxia among Chinese children. PLoS One 2021; 16:e0248154. [PMID: 33667274 PMCID: PMC7935314 DOI: 10.1371/journal.pone.0248154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Disabilities caused by perinatal asphyxia will burden child health and well-being. To date, our understanding about the situation and risk factors of perinatal asphyxia-induced disabilities among Chinese children is still limited. Objectives To evaluate the prevalence and socio-demographic risk factors of disabilities caused by perinatal asphyxia among Chinese children in 2006 and compare disability trajectories across different socio-demographic status. Methods Cross-sectional data came from the 2006 China National Survey on Disability which includes a total of 616,940 children aged 0–17 years old was employed in the investigation. Perinatal asphyxia-induced disabilities were identified by following the guidance in consensus manuals. Population-weighted numbers and prevalence rates were investigated, and multivariable logistic regression was performed to evaluate associations between disabilities and socio-demographic factors. Adjusted predictions at representative values were computed to compare the disability trajectories relative to significant socio-demographic variables. Results The prevalence rate of disabilities caused by perinatal asphyxia was 7.70 per 10,000 children (95% CI: 7.01–8.39). Male (OR 1.81, 95% CI: 1.47–2.23) and low family income (OR: 1.73, 95% CI: 1.21–2.49) have higher and the increase of per additional year of age (OR: 0.89, 95% CI: 0.88–0.91) has lower probability of being disabilities caused by perinatal asphyxia. Further disability trajectories showed that differences in probability between gender and family income group were more evident before age 7 and weakened with increasing age. Conclusions Our results showed that both demographic and socioeconomic characteristics are risk factors for disabilities caused by perinatal asphyxia. Of these, gender and family income have much higher impact than other factors on the prevalence rate of disabilities caused by perinatal asphyxia at infants and young children. Multiple society sectors should increase their effort to bring about fundamental social change to prevent disabilities caused by perinatal asphyxia, especially concerning younger children and their families.
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Affiliation(s)
- Deng Ao
- Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing, China
- Department of Preschool Education, Teacher’s College of Beijing Union University, Beijing, China
| | - Shuai Guo
- Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing, China
| | - Chunfeng Yun
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing, China
- * E-mail:
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Duan W, Mu W, Xiong H. Cross-Cultural Adaptation and Validation of the Physical Disability Resiliency Scale in a Sample of Chinese With Physical Disability. Front Psychol 2021; 11:602736. [PMID: 33391120 PMCID: PMC7773810 DOI: 10.3389/fpsyg.2020.602736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
This study adapted the Physical Disability Resilience Scale (PDRS) to Chinese conditions and evaluated the psychometric characteristics of the Chinese version in individuals with physical disability. A total of 438 individuals with physical disability were included in this study. The PDRS was translated to Chinese using a backward translation method. Construct validity, internal consistency reliability, and convergent validity were examined. Confirmatory factor analysis failed to replicate the original five-factor structure of the PDRS. After removing the Spirituality factor and an underperformed item (Item 22), exploratory factor analysis yielded four trait factors (i.e., Emotional and Cognitive Strategies, Physical Activity and Diet, Peer Support, and Support from Family and Friends) and a method-effect factor. A correlated trait-correlated method model that included the four trait factors and a method-effect factor reported better model fit than the four-factor model, which did not consider method effects. The four subscales of the revised PDRS showed adequate internal consistency. The convergent validity of the revised PDRS was established by the moderate-to-strong associations between its four subscales and theoretically related constructs. We conclude that the revised PDRS is a reliable and valid measure in assessing resilience among Chinese people with physical disability.
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Affiliation(s)
- Wenjie Duan
- School of Law and Public Administration, Yibin University, Yibin, China.,Social and Public Administration School, East China University of Science and Technology, Shanghai, China
| | - Wenlong Mu
- School of Economics and Management, Wuhan University, Wuhan, China
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28
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Understanding Stakeholder Attitudes, Needs and Trends in Accessible Tourism: A Systematic Review of Qualitative Studies. SUSTAINABILITY 2020. [DOI: 10.3390/su122410507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The inclusion of people with disabilities (PwD) in tourism is a phenomenon that encompasses various influencing factors, such as accessibility, which must be reviewed for this process to work correctly. Accessible tourism has advantages for both people with disabilities and everyone else. It provides an opportunity for everyone to enjoy leisure without barriers. However, there are still factors that limit the proper operation of the sector, which require a review and new strategies for its improvement. The objective of this review is to offer a synthesis of those challenges that must be addressed in order to achieve quality accessible tourism, as well as to present the various emerging trends that can represent an important advance for the future of accessible tourism. To this end, a qualitative study review process has been carried out where the different opinions and perceptions of the various actors involved in the accessible tourism sector are considered. A thematic analysis and synthesis of the information was conducted using the “Thematic Synthesis” procedure. The methodological quality of the studies included in the synthesis was also assessed. The studies reviewed show a need to recognize disabled travelers as autonomous and independent people who seek to escape from their daily routine, and who require certain specific supports to facilitate their tourist experience. Accessible tourism is valued as a good market opportunity, but its proper development requires greater staff awareness to promote co-creation in tourism, as well as the support of technological systems to create individualized tourist profiles detailing the needs of each person.
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Luo Y, He P, Zhang L, Pang L, Guo C, Liang R, Zheng X. Schizophrenia and education in Chinese metropolises: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1563-1569. [PMID: 32691081 DOI: 10.1007/s00127-020-01898-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 06/09/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Schizophrenia is a public concern in metropolises. Increases in city size may strengthen the correlation between prevalence of schizophrenia and indices of socioeconomic status, such as education. This study used population-based data of adults to investigate the association between education and schizophrenia in Chinese metropolises and its differences between inner city areas and outer suburbs. METHODS Data was obtained from the Second China National Sample Survey on Disability in 2006, and analysis was restricted to 189,143 participants aged 18 years or older in all counties (districts) of Beijing, Shanghai, and Tianjin. Schizophrenia diagnoses were ascertained according to the International Statistical Classification of Diseases, 10th Revision. Logistic regression models were fitted to examine the association between education and schizophrenia. RESULTS An inverse U-shaped pattern between education and schizophrenia was found in inner city areas of Chinese metropolises. Compared with the primary school or below group, the odds ratios of junior high school group and senior high school or above group was 2.79 (95% CI 1.96, 3.96) and 1.45(95% CI 0.99, 2.13), respectively. In outer suburbs, junior high school (OR = 0.87, 95% CI 0.63, 1.19) and senior high school or above groups (0.58, 95% CI 0.38, 0.87) were less likely to develop schizophrenia than the primary school or below group. CONCLUSIONS This study showed an association between education and schizophrenia in Chinese metropolises. In inner city areas, the association was an inverse U-shaped pattern between education and schizophrenia, whereas in suburban areas, the association was a negative linear pattern. Our findings can help identify high-risk populations of schizophrenia in Chinese metropolises. Programs for prevention and early intervention of schizophrenia will need to consider the socioeconomic disparities between inner city and outer suburban areas. Public policies can help improve mental health by developing social security for migrants in inner city areas and promoting regional equality.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, 100871, People's Republic of China.,APEC Health Science Academy, Peking University, Beijing, China.,Advanced Systems Analysis, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Lei Zhang
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, 100871, People's Republic of China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Lihua Pang
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, 100871, People's Republic of China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, 100871, People's Republic of China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Richard Liang
- Department of Integrative Biology and Physiology, University of California, Los Angeles, USA
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road Haidian District, Beijing, 100871, People's Republic of China. .,APEC Health Science Academy, Peking University, Beijing, China.
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Guo C, Chen G, He P, Zhang L, Zheng X. Risk of cognitive impairment in children after maternal exposure to the 1998 Yangtze River flood during pregnancy: analysis of data from China's second National Sample Survey on Disability. Lancet Planet Health 2020; 4:e522-e529. [PMID: 33159879 DOI: 10.1016/s2542-5196(20)30198-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND More research is needed to understand the long-term effects of prenatal exposure to adverse events, such as floods and other natural disasters, on cognitive outcomes in childhood. We aimed to explore the risk of cognitive impairment in children following maternal exposure to the 1998 Yangtze River flood in China during pregnancy. METHODS For this study we obtained and analysed individual-level data from the second China National Sample Survey on Disability (CNSSD), which was done in 2006. We defined the flood period as June-August, 1998. The analytical sample comprised children from four birth cohorts, defined according to their month of birth: the post-partum exposed cohort (children born between June, 1997, and May, 1998), the prenatal exposed cohort (children born between June, 1998, and May, 1999), the preconception exposed cohort (children born between June 1999, and May, 2000), and the unexposed cohort (children born between June, 2000, and May, 2001). In the CNSSD, cognitive impairment was assessed and diagnosed by validated screening tools and procedures. Difference-in-difference models were used to examine variations in the effects of maternal flood exposure on cognitive impairment in childhood across the different birth cohorts and regions. FINDINGS 108 175 children born between June, 1997, and May, 2001, and aged 4-8 years at the time of the survey, were included in our analysis. 1131 children had a cognitive impairment; the prevalence of cognitive impairment was 1·05% (95% CI 0·99-1·11). Maternal exposure to flood during pregnancy increased the risk of cognitive impairment among children (adjusted odds ratio [OR] 2·18 [95% CI 1·54-3·08]; p<0·0001). No significant sex-specific differences were observed, and the risk of cognitive impairment was especially high when maternal flood exposure occurred during the first trimester of pregnancy (adjusted OR 5·05 [95% CI 3·88-6·58]; p<0·0001). The risk of cognitive impairment also increased with longer durations of maternal flood exposure and with increasing severity of flooding; the risk was highest in the prenatal exposed cohort with 3 months of flood exposure in the most severely affected area (adjusted OR 5·56 [95% CI 1·58-19·54]; p=0·007). INTERPRETATION Prenatal flood exposure had a long-term negative effect on cognitive development of children. Greater maternal support and public health interventions during pregnancy and early life after a natural disaster are warranted to facilitate healthy cognitive development in later life. FUNDING National Social Science Foundation of China.
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Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Lei Zhang
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China.
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The effect of the National Birth Defects Intervention Project on the prevention of congenital disabilities among children in China: a natural experiment. Br J Nutr 2020; 124:709-714. [PMID: 32381144 DOI: 10.1017/s0007114520001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Most childhood disabilities are caused by congenital factors such as birth defects. The present study aims to evaluate the effect of periconceptional nutrition intervention on the prevention of congenital disability among Chinese children using the National Birth Defects Intervention Project as a natural experiment. We obtained individual-level data from the Second National Sample Survey on Disability, a nationally representative survey, and 110 365 children born between September 1999 and August 2003 were included for analysis. Difference-in-differences estimates of the project effects on congenital disability were captured by exploiting temporal variation in the timing of project exposure across four birth cohorts along with geographical variation in project category at the province level. The findings contribute to an emerging body of evidence showing that prenatal micronutrient intervention before and during early pregnancy could substantially reduce the risk of congenital disability in childhood (OR 0·73; 95 % CI 0·57, 0·94). The National Birth Defects Intervention Project improved the awareness of reproductive health and disability prevention in the population. It highlights the need for a potential policy change focusing on early-life health investment in China.
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Independent and Combined Relationships of Perceived Neighborhood Social Cohesion and Physical Frailty on Functional Disability in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165912. [PMID: 32824033 PMCID: PMC7460244 DOI: 10.3390/ijerph17165912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022]
Abstract
Functional disability and physical frailty (PF) are debilitating geriatric conditions. Previous studies have suggested both perceived neighborhood social cohesion (PNSC) and PF can influence functional disability and may have an interactive effect too. This cross-sectional study aims to examine the independent and combined relationships of PF and PNSC on functional disability in community-dwelling older adults in Shanghai, China. A total of 1616 older adults aged ≥ 75 years were recruited using multistage sampling. Results showed that prefrailty, frailty (using the modified frailty phenotype criteria), and low PNSC (measured by the Neighborhood Cohesion Scale) were independently associated with increased likelihood of functional disability after adjustment of covariates. To evaluate the combined relationships of PF and PNSC, participants were classified into six groups based on their levels of PF and PNSC. The probability of frail older adults with low PNSC having functional disability stood out compared with the robust older adults with high PNSC. Our findings suggest the importance of high PNSC as a protective factor of maintaining functional ability. Future longitudinal studies are needed to identify the role of PNSC in the development of functional disability among frail older adults.
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Guo C, Chang J, Zheng X, Wang L. Utilization Rate of Healthcare Service of the Elderly with Disabilities - China, 1987-2014. China CDC Wkly 2020; 2:516-519. [PMID: 34594692 PMCID: PMC8422210 DOI: 10.46234/ccdcw2020.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
What is already known about this topic? In the context of rapid population ageing and over represented disabilities among the elderly, healthcare services for the elderly persons with disabilities are one of the most urgent and important population and public health issues. Previous studies indicated that the weighted prevalence rate of lifetime healthcare service use was 36.6% (95% CI: 35.6–37.5) among persons with disabilities aged 60 years and above in 2006. What is added by this report? We found that the lifetime utilization rate of auxiliary aids among elderly with disabilities increased significantly from 4.96% in 1987 to 9.07% in 2006 (ptrend<0.001), and the utilization rate of healthcare service in the last 12 months increased significantly from 18.6% in 2007 to 56.9% in 2014 (ptrend<0.001) among total elderly with disabilities.
What are the implications for public health practice? The arduous achievement indicated the success of social, economic, and medical reforms as well as health equity improvement of China. However, more sound policies and action are needed to further reduce the unmet needs in healthcare services.
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Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Jinghua Chang
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Condessa AM, Giordani JMDA, Neves M, Hugo FN, Hilgert JB. Barriers to and facilitators of communication to care for people with sensory disabilities in primary health care: a multilevel study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200074. [PMID: 32638857 DOI: 10.1590/1980-549720200074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Communication barriers are the main obstacle for people with sensory disabilities (visual and hearing) to access health services. This study aims to describe the presence of facilitators of communication of basic health units in Brazil and to verify its associated factors. METHODS Cross-sectional multilevel study, of 38,811 health units in 5,543 municipalities between 2012 and 2013, collected in the National Program for Improving Access and Quality in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica - PMAQ-AB). The outcome was defined by grouping facilitators of communication (braille material; hearing resources; visual communication; accessible list of service; professionals to welcome users with sensory disabilities). The two levels were structured, using the variables: level I (contextual): macro region, population size, and GDP per capita; and level II (service): extended professional team (psychologist/social worker); service shifts; welcoming room; publishing of service hours; presence of physical access facilitators. Multilevel Poisson regression with hierarchical modeling was used in both stages. RESULTS The presence of facilitators of communication is small in Brazilian health units (32.1%). It is more frequent in the municipalities with a higher GDP (RP = 1.02, 95%CI 0.92 - 1.12) and population size (RP = 1.25, 95%CI 1.02 - 1.52). CONCLUSION Welcoming users is the main access facilitator and should be the focus of initiatives to improve health care for disabled persons. Universal access with adequate services, removal of communication barriers and encouragement to properly welcome users must be promoted.
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Affiliation(s)
| | | | - Matheus Neves
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Luo Y, Pang L, Zhao Y, Guo C, Zhang L, Zheng X. Gender difference in the association between education and schizophrenia in Chinese adults. BMC Psychiatry 2020; 20:296. [PMID: 32532241 PMCID: PMC7291519 DOI: 10.1186/s12888-020-02700-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Improving education level was evidenced to decrease the risk of schizophrenia, but whether this strength of education role depends on gender is not. This study aimed to investigate whether there was gender difference in the association between education and schizophrenia in Chinese adults. METHODS Data were obtained from the Second China National Sample Survey on Disability in 2006, including 1,909,205 participants aged 18 years or older. Schizophrenia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Logistics regression models were fitted to examine the combined effect of gender and education on schizophrenia. RESULTS The lifetime prevalence of schizophrenia in female groups was higher than in male groups, with 0.44% (95%CI: 0.42-0.45%) and 0.36% (95%CI: 0.35-0.37%), respectively. Compared with schizophrenia male patients, more females with schizophrenia experienced severe or extreme difficulty in understanding and communicating. However, more males with schizophrenia suffered from severe or extreme difficulty in the function of daily activities. The combined effect of education and schizophrenia was statistically significant, indicating that, as the level of education increased, schizophrenia risk of females decreased faster than the risk of males. CONCLUSIONS This study showed that additional years of education associated with lower risk of schizophrenia, and this association was stronger in females than in males. As education elevated, the risk of schizophrenia decreased more for women than for men. The findings indicate that improving education level may have an effect on reducing the gender disparities in mental health of China. Actions to prevent schizophrenia and address its gender disparities will require attention to the improving educational opportunities.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- Advanced Systems Analysis, International Institute for Applied Systems Analysis, Schlossplatz 1, A-2361, Laxenburg, Austria
| | - Lihua Pang
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Yihao Zhao
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Chao Guo
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Lei Zhang
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China.
- APEC Health Science Academy, Peking University, No.5 Yiheyuan Road Haidian District, Beijing, 100871, China.
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Ding R, Zhang L, He P, Song X, Zheng X. Income, income inequality and schizophrenia in China: a population-based multilevel analysis. J Epidemiol Community Health 2020; 74:719-725. [PMID: 32434862 DOI: 10.1136/jech-2019-213049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have suggested that socio-environmental factors interact with genetic risk in the genesis of schizophrenia. This study aimed to investigate the relationship between income, income inequality and schizophrenia and its heterogeneity among different geographic scales and subgroups. METHODS We used data from the Second China National Sample Survey on Disability (2006). The sample consisted of 1 909 205 participants aged 18 years or older. Individuals who were suspected to be psychiatrically disabled were administered the WHO Disability Assessment Schedule, Version II and the International Statistical Classification of Diseases, Tenth Revision Symptom Checklist for Mental Disorders by trained clinical psychiatrists to diagnose schizophrenia. Gross household income per capita was used to calculate the Gini coefficient to measure income inequality. Multilevel logistic regression with cross-level interaction was applied to examine the association of income, income inequality and schizophrenia. RESULTS A total of 7 628 persons (0.40%) were identified as having schizophrenia. Income was independently associated with schizophrenia. At the province level, greater income inequality was significantly associated with a higher risk of schizophrenia (OR, 1.03; 95% CI 1.00 to 1.06), and no significant association was observed at the county level. The analysis with cross-level interaction showed that the association at the province level was most pronounced in the highest income quartile (OR, 1.02; 95% CI 1.00 to 1.03). CONCLUSION The significant association between income and schizophrenia was consistent with the absolute income hypothesis. The adverse effect of income inequality on the risk of schizophrenia starts to operate at a larger area level, and it is more pronounced for the affluent population in China. This finding further supports the relative income hypothesis and social causation pathway for schizophrenia and calls attention to the vulnerability of high-income groups.
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Affiliation(s)
- Ruoxi Ding
- Institute of Population Research, Peking University, Beijing, China
| | - Lei Zhang
- Institute of Population Research, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xinming Song
- Institute of Population Research, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China
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Huang Z, Chen Y, Zhou W, Li X, Qin Q, Fei Y, Dong X, Yu F. Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study. Nurs Health Sci 2020; 22:639-647. [PMID: 32141149 DOI: 10.1111/nhs.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.
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Affiliation(s)
- Zhaoyong Huang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Yuzhu Chen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Institute of Nutrition and School Health, Nanning, China
| | - Weiwen Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Institute of Nutrition and School Health, Nanning, China
| | - Xiaopeng Li
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Institute of Nutrition and School Health, Nanning, China
| | - Qiulan Qin
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Institute of Nutrition and School Health, Nanning, China
| | - Yunqing Fei
- University of Minnesota Center for Global Health and Social Responsibility, Minneapolis, Minnesota, USA
| | - Xinqi Dong
- Rutgers University Institute for Health, Health Care Policy and Aging Research, Rutgers University, Rutgers, New Jersey, USA
| | - Fang Yu
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
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Luo Y, Pang L, Guo C, Zhang L, Wang Y, Zheng X. Urbanicity and autism of children in China. Psychiatry Res 2020; 286:112867. [PMID: 32120171 DOI: 10.1016/j.psychres.2020.112867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/15/2020] [Accepted: 02/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Increased risk of autism with the increment of urbanization has been documented in developed countries. However, very few studies in developing countries focused on this topic. By using Chinese nationally representative large dataset, we investigated the association between urbanicity and autism among children aged 0-17 years in China. Also, we analyzed whether there existed a sexually dimorphic effect on this association. METHODS Data from the Second National Sample Survey on Disability (SNSSD) was used in this study, and 616,940 children was selected for analysis. Autism was measured by experienced psychiatrists according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision Symptom Checklist for Mental Disorders. Logistic regression models allowing for multiple demographic and socioeconomic covariates were used to evaluate the association between the level of urbanization and autism in children. RESULTS Compared with children in low level of urbanization areas, those in high urbanization level areas was 2.12 (95%CI: 1.28, 3.49) times more likely to develop autism, and 1.85 (95%CI: 1.21, 2.84) times for those in moderate level of urbanization areas. Stratified analyses found that all observed associations were only in male children, not in female children. CONCLUSIONS Our findings suggested that higher level of urbanicity was associated with higher risk of autism in children. This association was only present in male children, not in female children.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China; Advanced Systems Analysis, International Institute for Applied Systems Analysis, Austria
| | - Lihua Pang
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Lei Zhang
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China
| | - Yiran Wang
- Institute of Population Research, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China; APEC Health Science Academy, Peking University, Beijing, China.
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Major depressive disorder in Chinese persons with speech disability: High rates of prevalence and perceived need for mental health care but extremely low rate of use of mental health services. J Affect Disord 2020; 263:25-30. [PMID: 31818785 DOI: 10.1016/j.jad.2019.11.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/21/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In recent years, there has been increasing awareness on the importance of mental health services for persons with disability in China, but data on mental health of persons with speech disability (PwSD) are scarce. This study examined prevalence and correlates of major depressive disorder (MDD) among Chinese PwSD, as well as their perceived need for and utilization of mental health services. METHODS A total of 227 community-residing adult PwSD were successfully recruited by using multi-stage sampling approach, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Depressed PwSD's perceived need for and utilization of mental health services were also measured. RESULTS 29.5% of the PwSD suffered from MDD during the month before the interview and, of the depressed PwSD, 44.8% perceived a need for mental health care but only 1.5% had sought help from mental health specialists. Factors significantly associated with MDD included female gender (OR=2.42), marital status of "non-married" (OR=2.27), having the disability during childhood (OR=4.60) and adulthood (OR=10.99) (vs. at birth), co-occurring other types of disabilities (OR=2.29), major medical conditions (OR=2.62), and impaired ability of activities of daily living (OR=3.23). LIMITATIONS Findings can only be generalized to PwSD who register with the Disabled People's Federation (DPF) in China, because the sampling frame was based on the registration system of DPF. CONCLUSIONS There is a large unmet need for mental health services among Chinese PwSD. It is urgently needed to integrate the management of MDD and other common mental disorders into the services system for PwSD in China.
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Abstract
Between 1% and 3% of persons in general population are estimated to have some degree of intellectual disability. A diagnosis of intellectual disability is based on clinical history, level of intellectual ability and level of adaptive function. Both, the intellectual and adaptive functioning are measured using individually administered standardized tests. More than 75% of persons who have intellectual disability have mild intellectual disability and an underlying specific etiology is less likely to be identified; whereas, in a small percentage of persons with severe intellectual disability, an underlying specific biologic cause is highly likely to be identified. Genetic abnormalities, inborn errors of metabolism and brain malformations are major categories of causes identified in severe to profound intellectual disability. The initial clinical presentation and recognition depends on the severity and underlying cause of intellectual disability. The etiology, severity, cognitive abilities, and adaptive function, vary among persons with intellectual disability and need consideration in developing a treatment plan. The physician plays an essential role in the evaluation, treatment of associated medical conditions and preventive care, and in facilitating and coordinating consultative services and community based care.
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Affiliation(s)
- Dilip R Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Maria Demma Cabral
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Arlene Ho
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Joav Merrick
- Hadassah Hebrew University Medical Center, Jarusalem, Israel.,University of Kentucky, Lexington, USA.,School of Public Health, Georgia State University, Atlanta, USA
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Wang GF, Han AZ, Zhang GB, Xu N, Xie GD, Chen LR, Su PY. The association between childhood physical disability or long-term health problems and depression among adolescents in China: Mediating effect of childhood maltreatment. Asian J Psychiatr 2019; 46:105-110. [PMID: 31654922 DOI: 10.1016/j.ajp.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Increasing evidence has suggested that childhood maltreatment might mediate the association between physical disability or chronic illness and depression among adolescents. We sought to identify whether childhood maltreatment mediated the relationship between physical disability or long-term health problems and depression in Chinese adolescents. METHOD A total of 5726 middle and high school students aged 12-18 years old were chosen to participant in this study. Participants completed the self-reported questionnaire on childhood physical or long-term health problems, childhood maltreatment and depression. RESULTS The results showed that there were significant differences of childhood maltreatment, depression between adolescents with childhood physical disability or long-term health problems and those without. Physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect mediated the association between childhood physical disability or long-term health problems and depression accounting for 8.7%, 20.6%, 14.5%, 16.3% and 14.7% of the total effect of physical disability or long-term health problems on depression in each single mediator model respectively, whereas the indirect effect of emotional abuse and sexual abuse in the association between physical disability or long-term health problems and depression explained 15.6% and 8.0% of the total effect in a multiple mediation model respectively. CONCLUSION Childhood physical disability or long-term health problems was associated with the increased risk for depression, and the associations between childhood physical disability and long-term health problems and depression were partially mediated by childhood maltreatment experiences. Childhood maltreatment exposure should be considered to prevent depression among adolescents with childhood physical disability or long-term health problems.
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Affiliation(s)
- Geng-Fu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - A-Zhu Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Guo-Bao Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Nuo Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Guo-Die Xie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Li-Ru Chen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China; NHC Key Laboratory of study on abnormal gametes and reproductive tract, No 81 Meishan Road, Hefei 230032, Anhui, China.
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Liu C, Wang A, Huang Y, Zhang Y, Ding H, Wu J, Du L, Yang J, Mai F, Zeng Y, Liu L, Zhao X, Zhang C, Yin A. Development of a community-based hearing loss prevention and control service model in Guangdong, China. BMC Public Health 2019; 19:1601. [PMID: 31783833 PMCID: PMC6884879 DOI: 10.1186/s12889-019-7910-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Hearing loss is a prevalent sensorineural disorder and a major public health issue in China. It is suggested that half of all cases of hearing loss can be prevented through public health measures. However, national strategies for hearing healthcare are not implemented well in Guangdong and some other regions in China. Methods To develop a community-based service model for the prevention and control of hearing loss in Guangdong, we integrated the model with multiple maternal and child healthcare models, and set up a series of clinical programs along with an optimum timeline for the preventive measures and intervention treatments to take place. A total of 36,090 families were enrolled in the study, including 358 high-risk families and 35,732 general-risk families. Results The study lasted for 6.5 years, and 30,769 children were born during that period. A total of 42 children were born with congenital deafness; 17 of them were born into families with advanced genetic risks for hearing loss, 9 were born with specific medical conditions, and 16 were born into general-risk families. About one third of them were diagnosed prenatally, others were diagnosed within 3 months of age, and 72% of them received interventions initiated before 6 months of age. 13 children presented with delayed hearing loss; 9 of them were diagnosed with delayed hereditary sensorineural deafness in neonatal period, and 4 were diagnosed within 3 months after onset. Timely interventions were provided to them, with appropriate referrals and follow-ups. Beside these, 80 families were identified with genetic susceptibility to aminoglycoside ototoxicity. Detailed medication guides were provided to prevent aminoglycoside-induced hearing loss. Moreover, through health education and risk reduction strategies, the prevalence of TORCH syndrome decreased from 10.7 to 5.2 per 10,000. Additionaly, the awareness rates of health knowledge about hearing healthcare significantly increased in the cohort. Conclusions Adapting national strategies for local or district projects could be an important step in implementing hearing loss prevention measures, and developing community-based service models could be of importance in carrying them out.
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Affiliation(s)
- Chang Liu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Anshi Wang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Yanlin Huang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Yan Zhang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Hongke Ding
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Jing Wu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Li Du
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Jie Yang
- Department of Neonatolog, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Fei Mai
- Department of ENT, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Yukun Zeng
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Ling Liu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Xin Zhao
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Changbin Zhang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China
| | - Aihua Yin
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China. .,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 510010, Guangdong, China.
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Ding R, He P, Song X, Zheng X. Season of birth and dementia: Findings from Chinese elderly based on a nationwide data. Am J Hum Biol 2019; 32:e23319. [DOI: 10.1002/ajhb.23319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/25/2019] [Accepted: 08/23/2019] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ruoxi Ding
- Institute of Population ResearchPeking University Beijing China
| | - Ping He
- China Center for Health Development StudiesPeking University Beijing China
| | - Xinming Song
- Institute of Population ResearchPeking University Beijing China
| | - Xiaoying Zheng
- Institute of Population ResearchPeking University Beijing China
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Lu N, Jiang N, Sun Q, Lou VWQ. Community Social Capital and Positive Caregiving Experiences Among Adult-Children Caregivers of Older Adults With Disabilities in Urban China. Res Aging 2019; 42:3-12. [PMID: 31542998 DOI: 10.1177/0164027519876095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study aimed to examine the association between community social capital and positive caregiving experiences among adult-children caregivers of disabled older adults in urban China. Data for this study were derived from the 2016 wave of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai. The final analysis featured 440 disabled older adult and adult-children caregiver dyads. Multiple indicators and multiple causes modeling was used to test the proposed model from a structural equation modeling perspective. Provision of support to others was significantly associated with self-affirmation. Citizenship activity was significantly associated with life enrichment. Support of units (i.e., employers) was significantly associated with self-affirmation and life enrichment. The findings support the integration of the stress process model and social capital theory and highlight the important role of community social capital in enhancing the subdimensions of positive caregiving experiences. Policy and intervention implications are discussed.
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Affiliation(s)
- Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Nan Jiang
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Qian Sun
- Department of Social Security, School of Public Administration, Hebei University of Economics and Business, Shijiazhuang, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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45
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Luo Y, Zhang L, He P, Pang L, Guo C, Zheng X. Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults. BMJ Open 2019; 9:e026532. [PMID: 31488464 PMCID: PMC6731895 DOI: 10.1136/bmjopen-2018-026532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective. SETTING Household interviews in 734 counties (districts), 2980 towns (streets) and 5964 communities (villages) from 31 provinces, People's Republic of China, as part of the cross-sectional survey of Second China National Sample Survey on Disability. PARTICIPANTS 1 909 205 men and women aged 18 years old and above. PRIMARY AND SECONDARY OUTCOME MEASURES A screen followed by clinical diagnosis was used to identify schizophrenia, and schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision (code F20). RESULTS 1-SD increase in individual SES was associated with decreased risk of schizophrenia (OR=0.45, 95% CI 0.43 to 0.46). 1-SD increase in area-level SES was associated with increased risk of schizophrenia (OR=1.30, 95% CI 1.24 to 1.37). The interaction of individual SES and area-level SES was statistically significant (OR=1.05, 95% CI 1.02 to 1.08); as the level of area SES increased, schizophrenia risk of lower SES people grew faster than the risk of higher SES people. CONCLUSIONS Area-level SES is particularly important to mental health of low SES individuals, with low SES people in high SES counties having the highest risk of schizophrenia than other groups. Action to reduce SES disparities in schizophrenia will require attention to the area-level context of low SES adults.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, Beijing, China
| | - Lei Zhang
- Institute of Population Research, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Lihua Pang
- Institute of Population Research, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China
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Poverty and youth disability in China: Results from a large, nationwide, population-based survey. PLoS One 2019; 14:e0215851. [PMID: 31022226 PMCID: PMC6483232 DOI: 10.1371/journal.pone.0215851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Youth with disability contribute to a high burden of disease but are often neglected. This study aims to estimate the prevalence of disability and its association with poverty among Chinese youth aged 15-24 years. METHODS Data were obtained from a nationally representative population-based cross-sectional survey in 2006 and its follow-up investigations from 2007 to 2013 in 31 provinces of mainland China. A total of 357 856 non-institutionalized youth at age of 15-24 years were investigated. Population weighted numbers and prevalence rates with 95% CI of various types and causes of disabilities for the overall youth were estimated where appropriate. Univariate and multivariate logistic regressions were used to identify the association between poverty and each type of and cause-specific disability. RESULTS A weighted number of 3 633 838 youth were living with disability in China, with a prevalence rate of 19.7 per thousand Chinese youth. Youth living in poor households were 3.84 times more likely to be with disability than those living in affluent households (95% CI: 3.56-4.14). Associations were similar for most types of and cause-specific disabilities. Among youth with disability, those from poor households had less healthcare service use (OR: 0.71, 95% CI: 0.61-0.82) than those from affluent households. CONCLUSION A significant number of Chinese youth were living with disability, and poverty is significant associated with the disability among youth. Investment in health and disability prevention are essential to the development of youth, as well as their families and communities.
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Prenatal war exposure and schizophrenia in adulthood: evidence from the Sino-Japanese War of 1937-1945. Soc Psychiatry Psychiatr Epidemiol 2019; 54:313-320. [PMID: 30269260 DOI: 10.1007/s00127-018-1584-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to examine the long-term effect of prenatal exposure to the Sino-Japanese War during 1937-1945 on risk of schizophrenia in adulthood among Chinese wartime survivors. METHODS We obtained data from the Second National Sample Survey on Disability conducted in 31 provinces in 2006. We restricted our analysis to 369,469 adults born between 1931 and 1950. Schizophrenia was ascertained by psychiatrists based on the International Statistical Classification of Diseases 10th Revision. War intensity was assessed by the ratio of war-caused civilian casualties to the pre-war population. The effect of prenatal exposure to war on schizophrenia was estimated by difference-in-difference models, established by examining the variation of war across birth cohorts. RESULTS In the male population, war cohorts of 1937-1946 had no significant higher odds of schizophrenia compared with the pre-war cohorts of 1931-1936. In the female population, war cohorts were 1.16 (95% CI 1.01, 1.33) times more likely than pre-war cohorts to have schizophrenia. Sensitive analyses show that our estimates of war effect on schizophrenia were robust and valid. CONCLUSIONS Prenatal exposure to the Sino-Japanese War of 1937-1945 had long-run detrimental effect on risk of schizophrenia in the female adults. Further investigations are warranted to extend the enduring wartime impact on other health outcomes in China.
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Ge T, Zhang Q, Lu J, Chen G, Sun M, Li X. Association between education and health outcomes among adults with disabilities: evidence from Shanghai, China. PeerJ 2019; 7:e6382. [PMID: 30809431 PMCID: PMC6385680 DOI: 10.7717/peerj.6382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 01/15/2023] Open
Abstract
Background Adults with disabilities often have worse health outcomes than do their peers without disabilities. While education is a key determinant of health, there is little research available on the health disparities across education levels among adults with disabilities in developing countries. We therefore examined the association between health outcomes and education among adults with disabilities in Shanghai, China. Methods We used the health examination records of 42,715 adults with disabilities in Shanghai in 2014. Five health outcomes, including two diseases (fatty liver and hemorrhoids) and three risk factors (overweight [body mass index ≥ 24]), high blood glucose, and high blood lipid), were evaluated. Descriptive statistics and Pearson’s chi-square test were used to assess differences in participants’ demographic and disability characteristics. Pearson’s chi-square test and Fisher’s exact test were conducted to compare the prevalence of each health outcome among the different education levels. Finally, logistic regression analyses were conducted to explore the association between education and health outcomes after adjusting for sociodemographic characteristics. Results People with an elementary school or lower degree had the highest prevalence of overweight (52.1%) and high blood glucose (20.8%), but the lowest prevalence of hemorrhoids (18.6%) and fatty liver (38.9%). We observed significant differences in the association between education and health outcomes across disability types. For example, in physically disabled adults, higher education was related to higher odds of hemorrhoids (p < 0.001); however, there were no significant disparities in hemorrhoids across the education levels among adults with intellectual disabilities. Discussion Compared with people without disabilities, adults with disabilities in Shanghai have relatively poor health. The association between education and health outcomes differed according to the health condition and disability type. To reduce the prevalence rate of overweight and high blood glucose among people with disabilities, tailored health promotion initiatives must be developed for people with lower education levels. In contrast, specific attention should be paid to the prevention of hemorrhoids and fatty liver among more-educated people with disabilities. Our study provides important evidence for targeting educational groups with specific disability types for health promotion and intervention.
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Affiliation(s)
- Tong Ge
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, United States of America
| | - Jun Lu
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Gang Chen
- China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China.,Department of Health Law and Health Inspection/ School of Public Health, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Xiaohong Li
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
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49
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Wei L, Yi H, Hai-Lu Z. Elderly People With Disabilities in China. J Am Geriatr Soc 2019; 67:858-859. [PMID: 30720879 DOI: 10.1111/jgs.15793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ling Wei
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China.,Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, China.,Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin, China
| | - Huang Yi
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China.,Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin, China
| | - Zhao Hai-Lu
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China.,Department of Immunology, Guangxi Area of Excellence, Guilin Medical University, Guilin, China
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50
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Shen R, Guan X, Huang Y, Liu Z, Chen H, Zhang T, Ma C. A descriptive epidemiological study of disability prevalence attributed to neurotic disorders in China. Psychiatry Res 2019; 272:398-403. [PMID: 30611025 DOI: 10.1016/j.psychres.2018.12.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
This study estimated the prevalence, correlates, severity and functional impairment of disabilities attributed to neurotic disorders in the Chinese population. Data from a representative national sample of 2,526,145 non-institutionalized residents were obtained from the Second China National Sample Survey on Disabilities (CNSSD) in 2006. The data were analyzed to estimate prevalence, correlates, severity and functional impairment of disability attributable to neurotic disorders by gender, age, region, and other key socio-demographic and economic factors. The disability prevalence attributed to neurotic disorders was 0.032% (805/2,526,145) in China. Women, rural residents, unemployed job status, low education level and those who were divorced or widowed showed higher prevalence rates than their counterparts. Proportions of mild, moderate, severe and extremely severe of neurotic attributed disability only accounted for 78.48%, 9.14%, 6.5% and 5.9%, respectively. Finally, these findings provide evidence that, prevalence rates of disability attributable to neurotic disorders vary greatly among different population groups and regions. Multiple disabilities including disability attributable to neurotic disorders can bring much more impairment to individuals than disability attributable to neurotic disorder only.
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Affiliation(s)
- Rui Shen
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China
| | - Xing Guan
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China
| | - Yueqin Huang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China.
| | - Zhaorui Liu
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China.
| | - Hongguang Chen
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China
| | - Tingting Zhang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China
| | - Chao Ma
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), No. 51 Hua Yuan Bei Road, Beijing 100191, China
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