Neighborhood predictors of short sleep duration and bedtime irregularity among children in the United States: results from the 2019-2020 National Surveyof Children's Health

Background Environmental factors may contribute to short sleep duration and irregular bedtime in children.Neighborhood factors and children's sleep duration and bedtime regularity remain a less investigated area.The aim of this study was to investigate the national and state-level proportions of children with short sleep duration and irregular bedtime and their neighborhood predictors.Methods A total of 67,598 children whose parents completed the National Survey of Children's Health in 2019-2020 were included in the analysis.Survey-weighted Poisson regression was used to explore the neighborhood predictors of children's short sleep duration and irregular bedtime.Results The prevalence of short sleep duration and irregular bedtime among children in the United States(US)was 34.6%[95%confidence interval(CI)=33.8%-35.4%]and 16.4%(95%CI=15.6%-17.2%)in 2019-2020,respectively.Safe neighborhoods,supportive neighborhoods,and neighborhoods with amenities were found to be protective factors against children's short sleep duration,with risk ratios ranging between 0.92 and 0.94,P<0.05.Neighborhoods with detracting elements were associated with an increased risk of short sleep duration[risk ratio(RR)=1.06,95%CI=1.00-1.12]and irregular bedtime(RR=1.15,95%CI=1.03-1.28).Child race/ethnicity moderated the relationship between neighborhood with amenities and short sleepduration.Conclusions Insufficient sleep duration and irregular bedtime were highly prevalent among US children.A favorable neighborhood environment can decrease children's risk of short sleep duration and irregular bedtime.Improving the neighborhood environment has implications for children's sleep health,especially for children from minority racial/ethnic groups.

China's National Survey on Teaching-Research Officers and Institutions

Highlights A national survey of basic education teaching-research institutions was conducted as the first nationwide comprehensive survey that involved teaching-research officers and institutions in China.The structures and functions of the provincial,prefectural,and county teaching-research institutions,as well as their role differentiation,were analyzed.

Publishers’Development Strategies in Response to Changes in National Reading-Analysis Based on the 16th to 20th National Reading Survey Report

Since 2014,nationwide reading has been included in the government work report for 10 consecutive times,and twice into the country’s five-year development plan.The importance of reading for individuals,society,and the country has become increasingly prominent.National reading has flourished,and throughout the 2018 to 2022 National Reading Survey Report,there have been welcome changes in national reading in China.This study compares and analyzes the relevant reading indicators of adult nationals from 2018 to 2022,and summarizes the five changes and new trends in national reading.That is,national reading awareness has increased,paper-book reading habits have returned,digital reading has become more diversified,the listening group has grown,and the voice of national reading activities has continued to rise.Accordingly,it provides relevant development strategies for publishers.

The Association of Mercury and ALT with Obesity in Korean Adults Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years(KNHANES 2005,2008-2017)

The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.

Understanding the standard of care in the treatment of type 2 diabetes in China： results from a national survey

Background Given the pace with which standards of care have changed, timely assessment of their impact on routine clinical practice and patient outcomes is needed. In coordination with the Chinese Diabetes Society （CDS）, we developed a quantitative survey to explore the implementation of standards of care for type 2 diabetes （T2D） in China. Methods A national online survey of physicians involved in the management of T2D in China was conducted over a 4-week period in 2012. Completed responses were obtained from 1 028 physicians. Participants responded to 52 questions designed to capture information relating to their demographic and clinical practice profiles. The questionnaire was divided into three sections： basic information, diagnosis practices and screening methods on main complications, and treatment and control practices. The questionnaire was developed in conjunction with the CDS. Results Overall, 83% of surveyed physicians were at least ＂aware＂ of the CDS guidelines on standards of care for T2D. Level of awareness was directly related to hospital grade, specialty, geographic location, professional rank and participation in CDS training. The 2-hour oral glucose tolerance test was reported as the most ever-used approach across all three hospital grades and physician specialties, with a usage rate of 97%. Respondents selected their choice of primary treatment for newly diagnosed T2D patients. Just over half （52%） indicated the use of oral anti-diabetic drugs （OAD） monotherapy, in line with CDS recommendations. However, OAD use varied considerably between different regions and city tiers. Despite hemoglobin Alc being defined as the gold standard for glucose control, it was not universally measured, with more physicians indicating routine use of glucose before fasting and glucose non-fasting. Conclusion The standards-of-care analysis has provided important insights into the current management of T2D among physicians in China across different geographical regions, hospital grades, specialties, professional statuses, and levels of CDS guideline awareness and training.

Prevalence and associations of non-retinopathy ocular conditions among older Australians with self-reported diabetes:The National Eye Health Survey

AIM:To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes.METHODS:Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50 y or older(46.4%male)and 1738 indigenous Australians aged 40 y or older(41.1%male)from all levels of geographic remoteness in Australia.Participants underwent a standardised questionnaire to ascertain diabetes history,and a clinical examination to identify eye disease.We determined the prevalence of uncorrected refractive error,visually significant cataract,cataract surgery,age-related macular degeneration,glaucoma,ocular hypertension,retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes.RESULTS:Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes(28.8%vs 16.9%,OR 1.78,95%CI:1.35-2.34 among non-indigenous Australians,and 11.3%vs 5.2%,OR 1.62,95%CI:1.22-2.14 among indigenous Australians).Diabetic retinopathy(DR)increased the odds of cataract surgery among self-reported diabetic indigenous and nonindigenous Australians(OR 1.89,P=0.004 and OR 2.33,P<0.001 respectively).Having diabetes for≥20 y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes(OR 3.73,P=0.001 and 7.58,P<0.001,respectively).CONCLUSION:Most non-retinopathy ocular conditions are not associated with self-reported diabetes.However,to account for Australia’s worsening diabetes epidemic,interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.

Ecological correlates of sport and exercise participation among Thai adolescents:A hierarchical examination of a cross-sectional population survey

Background:Understanding factors influencing adolescents’ sport/exercise participation(S/EP) is vital to developing effective interventions,but currently,evidence from less developed countries is limited.The purpose of this study was to examine correlates of S/EP across individual,interpersonal,and environmental levels in a nationally representative sample of Thai adolescents.Methods:Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand.Data on S/EP(outcome variable),and psychosocial,home,and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey,Student Questionnaire.School environmental data were collected at the school level using a School Built Environment Audit.Hierarchical regressions taking into account school clustering effects were applied for data analysis.Results:At the individual level,age and body mass index were independently and strongly correlated with S/EP.Adolescents with high preference for physical activity(PA)(odd ratio(OR)=1.71,p <0.001) and at least a moderate level of self-efficacy(OR=1.33,p=0.001) were more likely to have high S/EP.At the interpersonal level,adolescents whose parents joined their sports/exercise at least 1-2 times/week(OR=1.36,p=0.003) received>3 types of parental support(OR=1.43,p=0.005) and who received siblings’(OR=1.26,p=0.004) and friends’(OR=1.99,p <0.001) support had a greater chance of high S/EP.At the environmental level,adolescents’ S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment(OR=2.77,p=0.003),grass areas at school(OR=1.56,p <0.001),and at least 1-2 PA facilities in the community(OR=1.30,p=0.009).Conclusion:Multiple factors at different levels within an ecological framework influencing Thai adolescents’ S/EP were generally similar to those found in developed countries,despite some differences.For those interested in promoting and supporting Thai adolescents’ engagement in sports/exercise,further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level;parental and peer support at the interpersonal level;and home sport equipment,school grass areas,and neighborhood PA facilities at the environment level.

Analysis of Land Use Characteristics in Mountainous Areas in Yunnan Province Based on Second National Land Survey

Abstract Based on Second National Land Survey during 2007-2009 and land use type survey in ftatland areas, status quo of land use in mountainous areas in Yun- nan was measured, and analysis was made on land use in mountainous areas in terms of land use structure, degree and development potential, providing references for rational use of land in mountainous areas in Yunnan.

Toward an Ecological Civilization:China’s Progress as Documented by the Second National General Survey of Pollution Sources

The relationship between environmental quality and economic growth has been a hot topic for decades.After years of rapid industrialization and urbanization,China’s environmental challenges are approaching a turning point.Following the principles of ecological civilization construction,China is on its way to maintaining high-quality and green economic development.On 10 June 2020,the Chinese Government reported the key findings of the Second National General Survey of Pollution Sources(fiscal year 2017),which provides strong quantitative evidence of progress toward ecological civilization.In terms of our comparison between the two National General Surveys in 2007 and 2017,it was found that environmental pollution,measured in terms of many wastewater and air emission pollutant discharges,is decreasing despite the steady growth in economic activities—and at a noticeably fast pace.Other national and local governments can adopt some of China’s ecological civilization practices,within their own individual contexts.

Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults： the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND： Sarcopenia and non-alcoholic fatty liver dis- ease （NAFLD） share similar pathophysiological mechanisms, and the relationship between sarcopenia and NAFLD has been recently investigated. The study investigated whether low skel- etal muscle mass is differentially associated with NAFLD by gender in Korean adults. METHODS： We conducted a cross-sectional analysis of the data from the Fifth Korea National Health and Nutrition Examination Survey. The skeletal muscle index （SMI） was obtained by the appendicular skeletal muscle mass divided by the weight. NAFLD was defined as a fatty liver index （FLI） 〉60 in the absence of other chronic liver disease. RESULTS： Among the included subjects, 18.3% （SE： 1.4%） in men and 7.0% （SE： 0.7%） in women were classified as having FLI-defined NAFLD. Most of the risk factors for FLI-defined NAFLD showed a significant negative correlation with the SMI in both genders. Multiple logistic regression analysis showed that low SMI was associated with FLI-defined NAFLD, inde- pendent of other metabolic and lifestyle parameters in both genders [males： odds ratio （OR）=1.35; 95% confidence inter- val （CI）： 1.17-1.54; females： OR=1.36; 95% CI： 1.18-1.55]. The magnitude of the association between FLI-defined NAFLD and low SMI was higher in middle aged to elderly males （OR-1.50; 95% CI： 1.22-1.84） than in males less than 45 years of age （OR=1.25; 95% CI： 1.02-1.52） and in premenopausal females （OR=l.50; 95% CI： 1.12-2.03） than in postmenopausal females （OR-1.36; 95% CI： 1.20-1.54）.CONCLUSIONS： Low SMI is associated with the risk of FLI- defined NAFLD independent of other well-known metabolic risk factors in both genders. This association may differ ac- cording to age group or menopausal status. Further studies are warranted to confirm this relationship.

Major Data of China's 1% National Population Sampling Survey,1995

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Association between Serum Ferritin Levels and Metabolic-associated Fatty Liver Disease in Adults:a Cross-sectional Study Based on the NHANES

Objective Ferritin,initially acting as an iron-storage protein,was found to be associated with metabolic diseases.Our study was designed to investigate the association between serum ferritin and metabolic-associated fatty liver disease(MAFLD)using data from the National Health and Nutrition Examination Survey(NHANES)of the United State of America.Methods A cross-sectional study was conducted,enrolling a total of 2145 participants from the NHANES in the 2017–2018 cycles.Hepatic steatosis and liver fibrosis were assessed by ultrasound images and several non-invasive indexes.Multiple regression analysis was conducted to determine the associations between serum ferritin concentration and MAFLD and liver fibrosis.Results The analysis revealed that participants with higher serum ferritin levels(Q3 and Q4 groups)had a higher prevalence of MAFLD than those with the lowest serum ferritin levels[Q3 vs.Q1:OR=2.17(1.33,3.53),P<0.05 in fatty liver index(FLI);Q4 vs.Q1:OR=3.13(1.91,5.13),P<0.05 in FLI].Additionally,participants with the highest serum ferritin levels(Q4 group)displayed a higher prevalence of liver fibrosis[Q4 vs.Q1:OR=2.59(1.19,5.62),P<0.05 in liver stiffness measurement;OR=5.06(1.12,22.94),P<0.05 in fibrosis-4 index],with significantly increased risk observed in participants with concomitant diabetes[OR=7.45(1.55,35.72),P=0.012].Conclusion Our study revealed that elevated serum ferritin levels are associated with a higher prevalence of MAFLD and advanced liver fibrosis in patients.Elevated serum ferritin levels combined with diabetes are important risk factors for liver fibrosis.

Relationship between dietary fiber intake and chronic diarrhea in adults

BACKGROUND Dietary fiber is essential for human health and can help reduce the symptoms of constipation.However,the relationship between dietary fiber and diarrhea is,poorly understood.AIM To evaluate the relationship between dietary fiber and chronic diarrhea.METHODS This retrospective study was conducted using data from the United States National Health and Nutrition Examination Survey,conducted between 2005 and 2010.Participants over the age of 20 were included.To measure dietary fiber consumption,two 24-hour meal recall interviews were conducted.The independent relationship between the total amount of dietary fiber and chronic diarrhea was evaluated with multiple logistic regression and interaction analysis.RESULTS Data from 12829 participants were analyzed.Participants without chronic diarrhea consumed more dietary fiber than participants with chronic diarrhea(29.7 vs 28.5,P=0.004).Additionally,in participants with chronic diarrhea,a correlation between sex and dietary fiber intake was present:Women who consume more than 25 g of dietary fiber daily can reduce the occurrence of chronic diarrhea.CONCLUSION Dietary fiber can reduce the occurrence of chronic diarrhea.

Associations between remnant cholesterol levels and mortality in patients with diabetes

BACKGROUND Dyslipidemia is frequently present in patients with diabetes.The associations of remnant cholesterol and mortality remains unclear in patients with diabetes.AIM To explore the associations of remnant cholesterol with all-cause and cardiovas-cular mortality in patients with diabetes.METHODS This prospective cohort study included 4740 patients with diabetes who par-ticipated in the National Health and Nutrition Examination Survey from 1999 through 2018.Remnant cholesterol was used as the exposure variable,and all-cause and cardiovascular mortality were considered outcome events.Outcome data were obtained from the National Death Index,and all participants were followed from the interview date until death or December 31,2019.Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes,in which remnant cholesterol was modeled as both a categorical and a continuous variable.Restricted cubic splines(RCSs)were calculated to assess the nonlinearity of associations.Subgroup(stratified by sex,age,body mass index,and duration of diabetes)and a series of sensitivity analyses were performed to evaluate the robustness of the associations.RESULTS During a median follow-up duration of 83 months,1370 all-cause deaths and 389 cardiovascular deaths were documented.Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality[hazard ratio(HR)95%confidence interval(CI):0.66(0.52-0.85)];however,when remnant cholesterol was modeled as a continuous variable,it was associated with increased risks of all-cause[HR(95%CI):1.12(1.02-1.21)per SD]and cardiovascular[HR(95%CI):1.16(1.01-1.32),per SD]mortality.The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality.Subgroup and sensitivity analyses did not reveal significant differences from the above results.CONCLUSION In patients with diabetes,higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality,and diabetes patients with slightly higher remnant cholesterol(0.68-1.04 mmol/L)had a lower risk of all-cause mortality.

Predicting depression in patients with heart failure based on a stacking model

BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure(HF).AIM To create a stacking model for predicting depression in patients with HF.METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018.Through univariate analysis and the use of an artificial neural network algorithm,predictors significantly linked to depression were identified.These predictors were utilized to create a stacking model employing tree-based learners.The performances of both the individual models and the stacking model were assessed by using the test dataset.Furthermore,the SHapley additive exPlanations(SHAP)model was applied to interpret the stacking model.RESULTS The models included five predictors.Among these models,the stacking model demonstrated the highest performance,achieving an area under the curve of 0.77(95%CI:0.71-0.84),a sensitivity of 0.71,and a specificity of 0.68.The calibration curve supported the reliability of the models,and decision curve analysis confirmed their clinical value.The SHAP plot demonstrated that age had the most significant impact on the stacking model's output.CONCLUSION The stacking model demonstrated strong predictive performance.Clinicians can utilize this model to identify highrisk depression patients with HF,thus enabling early provision of psychological interventions.

Association between composite dietary antioxidant index and stroke among individuals with diabetes

BACKGROUND Recent research has underscored the potentially protective role of dietary antioxidants against chronic conditions,such as cardiovascular diseases and stroke.The composite dietary antioxidant index(CDAI),which reflects the overall intake of key dietary antioxidants,has been identified as a crucial metric for exploring this relationship.Although previous research has shown a negative correlation between CDAI levels and stroke risk in prediabetic individuals,there remains a substantial gap in understanding this association among individuals with diabetes,who are at an inherently greater risk for cerebrovascular events.AIM To investigate the association between CDAI and stroke risk in individuals with diabetes.METHODS Using a cross-sectional study design,this investigation analyzed data from the National Health and Nutrition Examination Survey spanning from 2003 to 2018 that included 6735 participants aged over 20 years with diabetes.The CDAI was calculated from 24-h dietary recalls to assess intake of key antioxidants:Vitamins A,C,and E;carotenoids;selenium;and zinc.Multivariate logistic regression and restricted cubic spline analysis were used to rigorously examine the relationship between CDAI and stroke risk.RESULTS The participant cohort,with an average age of 59.5 years and a slight male majority,reflected the broader demographic characteristics of individuals with diabetes.The analysis revealed a strong inverse relationship between CDAI levels and stroke risk.Remarkably,those in the highest quintile of CDAI demonstrated a 43%lower prevalence of stroke compared to those in the lowest quintile,even after adjustments for various confounders.This finding not only highlights the negative association between CDAI and stroke risk but also underscores the significant potential of antioxidant-rich diets in reducing stroke prevalence among patients with diabetes.CONCLUSION Our findings suggested that CDAI was inversely associated with stroke prevalence among patients with diabetes.These results suggest incorporating antioxidant-rich foods into dietary regimens as a potential strategy for stroke prevention.

Association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women

BACKGROUND Previous studies investigating the association between loss of estrogen at menopause and skeletal muscle mass came to contradictory conclusions.AIM To evaluate the association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women using population-based data.METHODS This study included 673 postmenopausal women,aged 40-59 years,from the National Health and Nutrition Examination Survey between 2013 and 2016.Weighted multivariable linear regression models were used to evaluate the association between serum E2 Level and appendicular lean mass index(ALMI).When non-linear associations were found by using weighted generalized additive model and smooth curve fitting,two-piecewise linear regression models were further applied to examine the threshold effects.RESULTS There was a positive association between serum E2 level and ALMI.Compared to individuals in quartile 1 group,those in other quartiles had higher ALMI levels.An inverted U-shaped curve relationship between serum E2 Level and ALMI was found on performing weighted generalized additive model and smooth curve fitting,and the inflection point was identified as a serum E2 level of 85 pg/mL.CONCLUSION Our results demonstrated an inverted U-shaped curve relationship between serum E2 levels and ALMI in middle-aged postmenopausal women,suggesting that low serum E2 levels play an important in the loss of muscle mass in middleaged postmenopausal women.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

Association of total bilirubin with depression risk in adults with diabetes:A cross-sectional study

BACKGROUND Individuals with diabetes mellitus are more likely to experience depression,although most patients remain undiagnosed.The relation between total bilirubin and depression has been increasingly discussed,but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes,which warrants attention.AIM To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes.METHODS The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018.Depression was determined using the Patient Health Questionnaire-9.Multivariable logistic regression,propensity scorematched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes.RESULTS The study included 4758 adults with diabetes,of whom 602(12.7%)were diagnosed with depression.After adjusting for covariates,we found that diabetic adults with lower total bilirubin levels had a higher risk of depression(OR=1.230,95%CI:1.006-1.503,P=0.043).This association was further confirmed after propensity score matching(OR=1.303,95%CI:1.034-1.641,P=0.025).Subgroup analyses showed no significant dependence of age,body mass index,sex,race or hypertension on this association.Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels.The depression risk heightened with the increasing levels of total bilirubin,reaching the highest risk at 6.81μmol/L and decreasing thereafter.CONCLUSION In adults with diabetes,those with lower levels of total bilirubin were more likely to have depressive symptoms.Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.