Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Association and potential mediators between socioeconomic status and childhood obesity in China:findings from a national cohort study

Objective:Socioeconomic status(SES)is associated with childhood obesity,but the underlying factors remain unknown.This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.Methods:Nationally representative longitudinal data from the China Education Panel Survey of 11 o019 children(13.03±0.79)collected from 2013-2014 to 2016-2017 academic years.Overweight/obesity was defined using Chinese national body mass index cut-points.Principal component analysis was used to convert the four SES indicators(maternal and paternal education,and occupation)into one comprehensive variable.Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.Results:The prevalence of overweight/obesity was 12.8%,and was higher in boys than in girls(17.8%vs.7.6%,P<0.001)at baseline.Among boys,relative risk(RR)of obesity was 1.23(95%CI:1.09 to 1.40,P<O.001)for per unit change in SES.There was no significant association between obesity and SES among girls.Mediation analyses showed that among boys,birth weight,being the only child in the family and children's selfperceived weight status mediated 70.0%of the effects of SES on obesity.No mediation effect was detected in girls.Conclusions:Chinese boys are more likely to be overweight or obese than girls.SES may impact childhood obesity through birth weight,being the only child in the family and children's self-perceived body weight status in boys,but not in girls.More attention should be made to address childhood obesity in high SES families among boys.Interventions targeting at these mediators are needed.

The Association of Socioeconomic Status with the Burden of Cataract-related Blindness and the Effect of Ultraviolet Radiation Exposure: An Ecological Study

Objective To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability(YLD) rates and to determine whether ultraviolet radiation(UVR) levels modify the effect of socioeconomic status on this health burden.Methods National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease(GBD) study 2017. The human development index(HDI) from the Human Development Report was used as a measure of socioeconomic status.Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument(OMI)dataset of the National Aeronautics and Space Administration(NASA).Results Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95%confidence interval(CI): 60%–93%, P < 0.001] than countries with a low HDI;for high-HDI countries, the proportion was 76%(95% CI: 53%–88%, P < 0.001), and for medium-HDI countries, the proportion was48%(95% CI: 15%–68%, P = 0.010;P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden(P value for interaction = 0.047).Conclusion Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

The correlation between socioeconomic status and health self-management in the elderly

Purpose:To determine the correlation between socioeconomic status and health selfmanagement in the elderly and to provide a scientific basis for the promotion of healthy ageing.Methods:We recruited 6173 people aged
60 years from three regions in Hebei Province using the multi-stage stratified cluster sampling method.The participants were surveyed using questionnaires.Results:The health self-management behaviours of elderly people differed with the area of residence,education level,and personal monthly income.An ordered probit model showed that behaviours were better in elderly people who lived in urban areas,who were educated to college level or higher,and with higher monthly incomes(p<0.05).Conclusion:Socioeconomic status plays a decisive role in health self-management in the elderly.We suggest appropriate measures for promoting health self-management among the elderly.

Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank

Background Socioeconomic status(SES)inequity was recognized as a driver of some certain infectious diseases.However,few studies evaluated the association between SES and the burden of overall infections,and even fewer identified preventable mediators.This study aimed to assess the association between SES and overall infectious diseases burden,and the potential roles of factors including lifestyle,environmental pollution,chronic disease history.Methods We included 401,009 participants from the UK Biobank(UKB)and defined the infection status for each participant according to their diagnosis records.Latent class analysis(LCA)was used to define SES for each participant.We further defined healthy lifestyle score,environment pollution score(EPS)and four types of chronic comorbidities.We used multivariate logistic regression to test the associations between the four above covariates and infectious diseases.Then,we performed the mediation and interaction analysis to explain the relationships between SES and other variables on infectious diseases.Finally,we employed seven types of sensitivity analyses,including considering the Townsend deprivation index as an area level SES variable,repeating our main analysis for some individual or composite factors and in some subgroups,as well as in an external data from the US National Health and Nutrition Examination Survey,to verify the main results.Results In UKB,60,771(15.2%)participants were diagnosed with infectious diseases during follow-up.Lower SES[odds ratio(OR)=1.5570]were associated with higher risk of overall infections.Lifestyle score mediated 2.9%of effects from SES,which ranged from 2.9 to 4.0%in different infection subtypes,while cardiovascular disease(CVD)mediated a proportion of 6.2%with a range from 2.1 to 6.8%.In addition,SES showed significant negative interaction with lifestyle score(OR=0.8650)and a history of cancer(OR=0.9096),while a significant synergy interaction was observed between SES and EPS(OR=1.0024).In subgroup analysis,we found that males and African(AFR)with lower SES showed much higher infection risk.Results from sensitivity and validation analyses showed relative consistent with the main analysis.Conclusions Low SES is shown to be an important risk factor for infectious disease,part of which may be mediated by poor lifestyle and chronic comorbidities.Efforts to enhance health education and improve the quality of living environment may help reduce burden of infectious disease,especially for people with low SES.

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years:findings from 19 sub-Saharan African countries

Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries.However,more remains to be known about how a patient’s socioeconomic status(SES)would affect the access to diagnosis of malaria.Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey,we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries.Multivariable logistic regression was used to assess the associations between SES and two binary outcomes:the visit to a health facility and a blood test for fever.Stratified analyses were further conducted by the type of health facilities(public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities)for the latter outcome.Results Fifty-eight percent of the febrile children were taken to health facilities,among whom only 55%took blood tests.Compared to children from households in the highest wealth quintile,children in the lowest quintile were less likely to be taken to medical facilities[adjusted odds ratio(aOR)=0.775,95%confidence interval(CI):0.675–0.889].Parents with more than secondary education were more likely to seek care(aOR=1.830,95%CI:1.561–2.145)and to have blood tests(aOR=1.729,95%CI:1.436–2.082)for their febrile children than parents without formal education.The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles,while these probabilities remained the lowest at private primary healthcare facilities,ranging from 0.100(95%CI:0.074–0.127)to 0.139(95%CI:0.083–0.194)across parental education levels and from 0.104(95%CI:0.078–0.130)to 0.125(95%CI:0.090–0.160)across wealth quintiles.Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries.These disparities were particularly evident in the private sector.Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.

Socioeconomic traits and the risk of Barrett’s esophagus and gastroesophageal reflux disease: A Mendelian randomization study

BACKGROUND Previous observational studies have shown that the prevalence of gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)is associated with socioeconomic status.However,due to the methodological limitations of traditional observational studies,it is challenging to definitively establish causality.AIM To explore the causal relationship between the prevalence of these conditions and socioeconomic status using Mendelian randomization(MR).METHODS We initially screened single nucleotide polymorphisms(SNPs)to serve as proxies for eight socioeconomic status phenotypes for univariate MR analysis.The inverse variance weighted(IVW)method was used as the primary analytical method to estimate the causal relationship between the eight socioeconomic status phenotypes and the risk of GERD and BE.We then collected combinations of SNPs as composite proxies for the eight socioeconomic phenotypes to perform multivariate MR(MVMR)analyses based on the IVW MVMR model.Furthermore,a two-step MR mediation analysis was used to examine the potential mediation of the associations by body mass index,major depressive disorder(MDD),smoking,alcohol consumption,and sleep duration.RESULTS The study identified three socioeconomic statuses that had a significant impact on GERD.These included household income[odds ratio(OR):0.46;95% confidence interval(95%CI):0.31-0.70],education attainment(OR:0.23;95%CI:0.18-0.29),and the Townsend Deprivation Index at recruitment(OR:1.57;95%CI:1.04-2.37).These factors were found to independently and predominantly influence the genetic causal effect of GERD.Furthermore,the mediating effect of educational attainment on GERD was found to be mediated by MDD(proportion mediated:10.83%).Similarly,the effect of educational attainment on BE was mediated by MDD(proportion mediated:10.58%)and the number of cigarettes smoked per day(proportion mediated:3.50%).Additionally,the mediating effect of household income on GERD was observed to be mediated by sleep duration(proportion mediated:9.75%)CONCLUSION This MR study shed light on the link between socioeconomic status and GERD or BE,providing insights for the prevention of esophageal cancer and precancerous lesions.

Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province, China: a population-based study

Background:Chronic obstructive pulmonary disease(COPD)is a common public health problem worldwide.Recent studies have reported that socioeconomic status(SES)is related to the incidence of COPD.This study aimed to investigate the association between SES and COPD among adults in Jiangsu province,China,and to determine the possible direct and indirect effects of SES on the morbidity of COPD.Methods:A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province,China.Participants were selected using a multistage sampling approach.COPD,the outcome variable,was diagnosed by physicians based on spirometry,respiratory symptoms,and risk factors.Education,occupation,and monthly family average income(FAI)were used to separately indicate SES as the explanatory variable.Mixed-effects logistic regression models were introduced to calculate odds ratios(ORs)and 95%confidence intervals(CIs)for examining the SES-COPD relationship.A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES.Results:The mean age of the 2421 participants was 56.63±9.62 years.The prevalence of COPD was 11.8%(95%CI:10.5%–13.1%)among the overall sample population.After adjustment for age,gender,residence,outdoor and indoor air pollution,body weight status,cigarette smoking,and potential study area-level clustering effects,educational attainment was negatively associated with COPD prevalence in men;white collars were at lower risk(OR:0.60,95%CI:0.43–0.83)of experiencing COPD than blue collars;compared with those within the lower FAI subgroup,participants in the upper(OR:0.68,95%CI:0.49–0.97)tertiles were less likely to experience COPD.Such negative associations between all these three SES indicators and COPD were significant among men only.Education,FAI,and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity(FEV1/FVC),FEV1,FVC,and FEV1 percentage of predicted.Education,FAI,and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status,indoor air pollution,and outdoor air pollution.We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index.Conclusions:Education,occupation,and FAI had an adverse relationship with COPD prevalence in Jiangsu province,China.SES has both direct and indirect associations with pulmonary function impairment.SES is of great significance for COPD morbidity.It is important that population-based COPD prevention strategies should be tailored for people with different SES.

Influence of socioeconomic status on acute myocardial infarction in the Chinese population： the INTERHEART China study

Background Many researches report that low socioeconomic status （SES） is associated with a higher risk of coronary heart disease （CHD）. This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction （AMI） in the Chinese population, and to compare the difference in this association between northern and southern regions in China. Methods We conducted a case-control study. Cases were first AMI （n=2909）. Controls （n=2947） were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation. Results Low levels of education （8 years） were more common in cases compared to controls （53.4% and 44.1%; P=0,0001）. After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population （P=-0.0005）. The odds ratio （OR） associated with education of 8 years or less, compared with more than 12 years （trade school/college/university） was 1.33 （95% CI 1.12-1.59）, and for education of 9-12 years 1.04 （95% CI 0.88-1.33）. The proportion of higher income population was more in controls than cases （39.4% and 35.3%）. Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 （95% CI 1.67-3.39） in women, and 1.18 （95% CI 0.99-1.42） in men （P=0.0001, for heterogeneity）. The interaction between levels of education and different regions was significant （P=0.0206, for interaction）. Conclusion Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.

Socioeconomic Status and Obesity Gradient over Age： New Evidence from China

This paper presents a systematic analysis of the impact of socioeconomic status （SES） on overweight and obesity in China and investigates how and why the SES-obesity gradient differs with age. Using a longitudinal sample drawn from the China Health and Nutrition Survey （CHNS）, I find that body mass index （BMI） is positively associated with SES during early childhood but becomes inversely related to childhood SES as children age into adulthood. Estimation results show that children from low SES families are less likely to be overweight or obese than their median and high SES peers. The results from subsamples stratified by living area reveal that the SES gaps of obesity are generally larger for urban residents than rural residents. Females are significantly less likely to be overweight than males in China. The SES during childhood has independent effects after controlling for respondents＇ contemporaneous SES. The relationship between the contemporaneous SES of a male adult and his chance of being overweight or obese is significantly positive, while the contemporaneous SES of a female adult is negatively related to her chance of being overweight or obese.

Impact of Socioeconomic Status and Demographic Composition on Disaster Mortality: Community‑Level Analysis for the 2011 Tohoku Tsunami

On 11 March 2011, the Tohoku tsunami hit the northeastern region of Japan, causing massive damage to people and property. The tsunami was bigger than any other in Japan’s recorded history, but the damage varied by community. This research addressed the effects of socioeconomic status and demographic composition on mortality in the 2011 Tohoku tsunami using community-level data.These effects were estimated using regression analysis, taking into account a variety of potential contributing aspects at the community level, including strength of the tsunami,population characteristics, gender, age, education, household composition, evacuation methods, and occupation. It was found that the height of the tsunami and the shares of threegeneration households and employees in the manufacturing industry are all positively correlated with tsunami mortality.The impacts of these factors on mortality are particularly large for the older adults.

Evaluation of the etiologies and rehabilitation status of patients with blindness: A prospective observational study

Objective:Preventive measures and appropriate rehabilitation are important in reducing the social burden of blindness.This study was to evaluate the etiologies,proportions,and level of rehabilitation for patients with blindness.Materials and Methods:A prospective observational study with 1000 visually impaired patients was conducted.The data regarding age,gender,socioeconomic status(SES),etiologies,curable or incurable blindness(IB),treatments,awareness,and state of rehabilitation were collected and reviewed.Results:The ratio of curable to IB was 0.82:1.The proportion of blindness rises after 40,even while the proportion of curable blindness(CB)increases after 60.The male–female ratios were 1.25:1 and 1:1.66 in the cases of CB and IB,respectively.On the other hand,the male–female ratio for childhood blindness was 1.66:1.Cataracts(78.22%)were the most common cause of CB,whereas diabetic retinopathy(24%),corneal opacity(17.5%),and trauma(12.4%)were causes of IB.Patients with illiteracy,low SES,and female gender were more likely to develop IB.There were low enrollment rates at the blind school and poor rehabilitation,mainly because of a lack of knowledge.Conclusion:Diabetic retinopathy,corneal opacity,and trauma are the major causes of IB.IB and poor rehabilitation were more profound in women and were associated with illiteracy,low SES,and a lack of awareness.

Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma(HCC).Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC,the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific region.This is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination,screening,and treatment in low-resource regions.Demographics including male gender,older age,ethnicity,and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related HCC.Methods to mitigate this impact include increasing screening in high-risk groups according to national guidelines,increasing awareness and health literacy in vulnerable populations,and developing more robust vaccination programs in under-served regions.

Social Determinants of Change in Smoking Status over a 26-Year Follow up Period among Middle-Aged and Older Americans

Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking. Marginalization-related Diminished Returns (MDRs), however, are weaker protective effects of SES indicators for racial and ethnic minority groups compared to non-Hispanic White people. The aim is to test whether racial and ethnic differences exist in the effects of educational attainment and income on cigarette smoking of middle-aged and older American adults. This is a 26-year longitudinal study using data from the Health and Retirement Study (HRS), a nationally representative study of middle-aged and older adults in the US. A total number of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The independent variables were educational attainment and income. The dependent variables were always smoking and being quitters over the follow-up time. Age, gender, self-rated health, and chronic medical conditions were the covariates. Race/ethnicity was the moderator. Logistic regressions were used to analyze the data. Most participants were never smokers (n = 7950), followed by quitters (n = 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99, 95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of being a quitter. Ethnicity, however, showed significant interactions with education on both outcomes suggesting that the effects of educational attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI = 1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93) were smaller for Hispanics than non-Hispanics. In the United States, middle-aged and older Hispanic adults remain at high risk of smoking cigarettes despite high educational attainment. That is, high educational attainment may better help non-Hispanic than Hispanic middle-aged and older adults to avoid cigarette smoking. As a result, we may observe a more than expected burden of tobacco use in middle class Hispanic middle-aged and older adults. Policymakers should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic tobacco disparities may persist in high SES levels as well.

SesIndexCreatoR:An R Package for Socioeconomic Indices Computation and Visualization

In order to study social inequalities, indices can be used to summarize the multiple dimensions of the socioeconomic status. As a part of the Equit’Area Project, a public health program focused on social and environmental health inequalities;a statistical procedure to create (neighborhood) socioeconomic indices was developed. This procedure uses successive principal components analyses to select variables and create the index. In order to simplify the application of the procedure for non-specialists, the R package SesIndexCreatoR was created. It allows the creation of the index with all the possible options of the procedure, the classification of the resulting index in categories using several classical methods, the visualization of the results, and the generation of automatic reports.

SARS-CoV-2 Antibody Seroprevalence in Children and Workers from Belgian French-Speaking Primary Schools

Purpose: During the COVID-19 pandemic, closing schools was discussed to limit the virus transmission, despite a lack of evidence on the role of young children in the virus spread. We undertook a study among Belgian primary schools to assess the SARS-CoV-2 antibody seroprevalence and its relationship with local incidence, school size, and socioeconomic status (SES). Methods: Schools were purposively selected using three criteria: an area with either a low or a high COVID-19 incidence, either a small or a large size, and either a low or a high SES. 932 (/2488, 38%) children and 242 (/444, 55%) staff signed informed consent. COVID-19 antibodies were tested using rapid finger prick tests. Results: Children participation was positively correlated with staff (r = +0.33;95% CI [−0.34;0.78]), and strongly with SES (r = +0.81;95% CI [0.40;0.95]). Seroprevalence was 21% in children (191/922) and 25% in staff (61/240). Seroprevalence did not correlate with local cumulative incidence (children: r = +0.06;95% CI [−0.59;0.67];staff: r = +0.26;95% CI [−0.40;0.74]). In staff, seroprevalence was higher in schools with higher SES (r = +0.37;95% CI [−0.29;0.79]), but not in children (r = −0.10;95% CI [−0.66;0.53]). Conclusion:The lower seroprevalence in children suggests they are lower transmitters than adults, but poor socioeconomic levels were less representative.

Psychosocial Group Intervention at a Low-Resource Setting Environment for Women Who Are Diagnosed and Treated for Breast Cancer: A Systematic Review

Africa faces significant challenges in terms of material and personnel resources for oncology interventions. This is particularly evident in South Africa, where resources are divided into high- and low-resource settings. High-resource settings cater to those with financial means to access private oncology facilities. However, many breast cancer patients receive care in South Africa’s low-resource settings, such as public hospital oncology clinics. Unfortunately, these settings have limited service providers and fail to offer comprehensive interventions, resulting in poor outcomes. However, recent research has highlighted the significance of socially supportive relationships in promoting healing and overall individual well-being, and spirituality has been identified as a source of positive outcomes in cancer patients. This systematic review paper explores the feasibility of implementing support group cancer care and interventions that incorporate social support networks available in community settings, and spiritual practices facilitated by traditional healers, and religious/spiritual leaders. These interventions can be provided within low-resource settings to women diagnosed with breast cancer. Inclusive participation of spouses, children, and extended family in the support group cancer care can facilitate healing for the entire system. Focusing on the strengths and resources within communities and incorporating these complementary services, can enhance the well-being and quality of life for Black African women diagnosed with breast cancer, despite low-resource settings. This approach acknowledges the potential of community-based support networks and encourages collaboration between various stakeholders, including community health educators, nurses, lay counselors, and community volunteers, to address the complex needs of these patients.

Empirical Changes in the Prevalence of Overweight and Obesity among Chinese Students from 1985 to 2010 and Corresponding Preventive Strategies

Objective To determine the extent of the obesity epidemic in school‐aged Chinese children in 2010 and track the increasing trend in different socioeconomic regions over the preceding 25 years. Strategies for preventing childhood obesity are suggested. Methods We used a dataset provided by the Chinese National Survey on Students’ Constitution and Health from 1985‐2010. Subjects were 7‐18‐year‐old students randomly selected from urban and rural areas in 30 provinces. Eight subgroups were created according to region and socioeconomic status. Results Increased rates of the epidemic （overweight and obesity combined） were greatest in large coastal cities‐32.6% and 19.1% among males and females, respectively. These rates has neared that of developed countries. Similar increases were found in all other regions, including the once poverty‐stricken rural west. The epidemic in most of the rural areas began after 2000, but has spread swiftly over the last decade. In 2010, it was estimated that 9.9% of Chinese school‐aged children and adolescents were overweight and that an additional 5.1% were obese, representing an estimated 30.43 million individuals. Conclusion The prognosis for China＇s childhood‐obesity epidemic is dire. To prevent childhood obesity, we suggest several strategies, including reasonable dietary intake, increase physical activity, a change in sedentary lifestyles and corresponding behavioral modifications.

Health-related fitness knowledge growth in middle school years:Individual-and school-level correlates

Background:Health-related fitness knowledge(HRFK)has been an essential concept for many health and physical education programs.There has been limited understanding and longitudinal investigation on HRFK growth.This longitudinal study examined HRFK growth and its individual-and school-level correlates in middle school years under 1 curriculum condition:Five for Life.Methods:Participants were 12,044 students from 47 middle schools.Data were collected at both individual/participant and school/institution levels.Individual-level variables included gender,grade,and HRFK test scores.School-level variables included percentage of students receiving free and reduced meals(FARM),student-to-faculty ratio for physical education,and school academic performance(SAP).We used hierarchical linear modeling to examine HRFK 3-year growth in relation to individual-and school-level correlates.Results:The average HRFK score at 6th grade for females was 42.81%±1.32%.The predicted HRFK growth was 17.06%±1.02%per year,holding other factors constant.A 1-standard deviation increase in FARM correlated with a 14.68%-point decrease in predicted test score(p=0.02).A 1-standard deviation increase in SAP was associated with an 11.90%-point increase in HRFK score.Males had a significantly lower growth rate than females during the middle school years(0.78%/year,p=0.02).Conclusion:The result showed that both individual-and school-level variables such as gender,FARM,and SAP influenced HRFK growth.Educators should heed gender differences in growth curves and recognize the correlates of school-level variables.

Factors affecting anxiety, depression, and self-care ability in patients who have undergone liver transplantation

BACKGROUND Depression,anxiety,and altered self-care ability are among the most important factors affecting the quality of life of liver transplant recipients.Depending on the severity of the underlying liver disease,signs and symptoms of anxiety and depression may become more pronounced.AIM To evaluate the factors affecting depression,anxiety and self-care abilities of liver transplant recipients.METHODS Recipients who are≥18 years and who underwent liver transplantation at Inonu University Liver Transplantation Institute were included in this descriptive and cross-sectional study.Sample size analysis showed that the minimum number of recipients should be 301(confidence level=95%,confidence interval=2.5,population=1382).Three hundred and twenty recipients were interviewed and 316 recipients that have answered the questionnaires accurately were analyzed.The dependent variables were the Beck Depression Scale,State-Trait Anxiety Scale(Form I and II),and Self-Care Agency Scale.The independent variables of the study were sociodemographic characteristics,biliary complications,hepatocellular carcinoma,recommending liver transplantation to other patients,and the interval of out-patient clinic visits.RESULTS Self-care ability scores were lower(P=0.002)and anxiety scores were higher(P=0.004)in recipients with biliary complications.On the other hand,in recipients with hepatocellular carcinoma,self-care scores were lower(P=0.006)while depression(P=0.003)and anxiety scores(P=0.009)were higher.Liver transplantation recipients with a monthly income<3000 Turkish liras had higher depression(P<0.001)and anxiety(P=0.003)scores.The recipients who stated that they would not recommend liver transplantation to others had lower self-care scores(P=0.002),higher depression(P<0.001),higher state anxiety(P=0.02),and trait anxiety(P<0.001)scores.CONCLUSION Presence of biliary complications and hepatocellular carcinoma,low income level,and an obligation for monthly visits to the outpatient clinic are factors that are found to affect self-care capability,depression,and anxiety.