Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28)

We investigated the relationship between health-related quality of life (HRQOL) and psychological distress in intensive care unit (ICU) survivors 12 months after ICU discharge. The purpose of this study, conducted and completed before the onset of the COVID-19 pandemic, was to find correlations among psychiatric symptoms detected by a screening tool as the General Health Questionnaire-28 (GHQ-28) and the different domains of HRQOL measured with the SF-36 health survey (SF-36), in order to identify ICU survivors with Post-Intensive Care Syndrome (PICS) who need a specific psychiatric intervention to improve their HRQOL. Among 298 ICU survivors who stayed in the ICU for at least 72 hours, 48 patients were enrolled one year after discharge undergoing a clinical interview to assess their functional impairment (Barthel index), mental health (GHQ-28), and health-related quality of life (SF-36). 19% of those subjects had a GHQ-28 ≥ 5 and were identified as “psychiatric cases”, and they were older and experienced a greater impairment in HRQOL. Anxiety, insomnia, and depressive symptoms seemed to be particularly involved in the impairment of HRQOL. A negative correlation between GHQ-28 total scores and subscales and SF-36 subscales was found. Our findings highlighted that psychological distress in ICU survivors may negatively impact physical health recovery and quality of life;conversely, physical impairment and functional disability may trigger the onset of psychiatric symptoms after discharge. The present study is firstly to investigate the correlations between HRQOL and psychological distress in ICU survivors through the GHQ-28, and then affirms the need to carry out follow-up checks for psychiatric symptoms in ICU survivors.

Missed Opportunities for Vaccination and Associated Factors among Children Aged 12 - 23 Months in Cameroon: Further Analyses of 2018 Cameroon Demographic and Health Survey

Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.

Report on Reproductive Health Survey

BackgroundThemajorobjectiveoftheRH/FPproject,jointlyestablishedbytheChineseGovernmentandtheUnitedNationsPopulationFund(UNFPA),istofacilitatetheChineseGovernmenttofulfillthetargetssetforthbyICPDandotherrelatedinternationalconferencessuchastheWorldSubm...

A diagnostic prediction model for hypertension in Han and Yugur population from the China National Health Survey (CNHS)

Background:The prevalence of hypertension is high among Chinese adults,thus,identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies.Methods:The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017,and they were nonrandomly split into the training set and validation set based on location.Multivariable logistic regression analysis was performed to develop the diagnostic prediction model,which was presented as a nomogram and a website with risk classification.Predictive performances of the model were evaluated using discrimination and calibration,and were further compared with a previously published model.Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model.Results:The Lasso regression analysis identified the significant predictors of hypertension in the training set,and a diagnostic model was developed using logistic regression.A nomogram with risk classification was constructed to visualize the model,and a website(https://chris-yu.shinyapps.io/hypertension_risk_prediction/)was developed to calculate the exact probabilities of hypertension.The model showed good discrimination and calibration,with the C-index of 0.789(95%confidence interval[CI]:0.768,0.810)through internal validation and 0.829(95%CI:0.816,0.842)through external validation.Decision curve analysis demonstrated that the model was clinically useful.The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population.Conclusion:This study developed and validated a diagnostic model for hypertension prediction in Gansu Province.A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.

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.

Reliability and validity of Persian version of Medical Outcome Study-HIV health survey in Iranian people living with HIV

OBJECTIVE: To evaluate the psychometric properties of the Persian version of the medical outcome study human immunodeficiency virus(MOS-HIV)health survey among people living with HIV or acquired immune deficiency syndrome(HIV/AIDS) in Iran is our main goal in this study.METHODS: The MOS-HIV questionnaire was translated into Persian using backward translation and the Persian version was filled by 100 HIV infected patients. Reliability of the questionnaire was estimated using Cronbach's alpha coefficient for the total questionnaire and for each dimension. Convergent, discriminant and construct validity were performed. Comparisons were performed between the subscales of the questionnaire in Iran and some other countries with t-test.RESULTS: The overall Cronbach's alpha in this study was 0.90 and the range of this coefficient was from 0.71 to 0.86 across the subscales with two exceptions, general health perception and role functioning, which were at 0.65 and 0.61. Convergent and discriminant validity were excellent in all domains. The two factor confirmatory factor analysis showed a good fit based on standardized estimates of factor loading, incremental and absolute fit indices.CONCLUSION: The Persian version of the MOS-HIV had good reliability and validity in measuring health related quality of life in people living with HIV in Iran. Furthermore, quality of life for HIV infected patients was very low in comparing with the people in some other countries.

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.

Association between drinking behavior and sleep duration in Chinese adults: findings from the China Health and Nutrition Survey

Background:To examine the association between alcohol drinking and short sleep duration among Chinese adults.Methods:Based on inclusion and exclusion criteria,28,167 records of 15,074 adults longitudinal data were obtained from the China Health and Nutrition Survey for the period from 2004 to 2011.A multilevel logistic regression model was employed to explore the association between alcohol drinking and sleep duration.Results:Compared with nondrinking participants,a high drinking frequency was positively correlated with a short sleep duration in both the males(odds ratio(OR)=1.33,95%confidence interval(CI)=1.20–1.48,P<0.001)and females(OR=1.60,95%CI=1.18–2.18,P=0.003)before the covariates were adjusted.After adjusting for age,residence area,education level,marital status,smoking,coffee consumption,tea consumption,and activity level,this association remained significant in the males(OR=1.31,95%CI=1.17–1.46,P<0.001)but not in the females(OR=1.16,95%CI=0.85–1.59,P=0.340).Conclusion:The present results suggest that a high drinking frequency was positively correlated with a short sleep duration in male population.Comprehensive measures therefore need to be implemented to improve sleep duration,especially to increase awareness of the dangers of drinking alcohol.

Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week:An analysis with 707,616 adolescents

Background:Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity(MVPA).However,using only this cut-off could hide important information.For instance,from a population-level point of view,increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels.Also,including a more sensitive cut-point of≥1 days per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice.Thus,the current study aims to estimate the prevalence of≥60 min of MVPA≥1 days per week among adolescents globally,and to describe any relevant gender inequalities.Methods:We used representative datasets from 146 countries/territories collected between 2003 and 2019.MVPA was self-reported.Participants were grouped into younger(≤14 years old)and older(>14 years old)adolescents.Crude Poisson regression models were used to identify the relative differences in≥60 min of MVPA≥1 days per week between boys and girls,and random-effects meta-analysis models were used to identify the pooled estimates.Analyses were stratified by country and region.Results:Approximately 80%of both younger and older adolescents reported≥60 min of MVPA≥1 days per week.This prevalence was≥94%in Europe and Central Asia and North America,while the estimates for the other regions were<77%.The prevalence of≥60 min of MVPA≥1 days per week was higher among boys than girls,with the largest differences occurring among the oldest adolescents(Prevalence ratio_(≤14y)=1.04(95%confidence interval(95%CI)):1.03-1.04)vs.Prevalence ratio_(>14y)=1.09(95%CI:1.08-1.10)).Conclusion:Approximately 8 out of 10 adolescents reported accumulating≥60 min of MVPA≥1 days per week,with notable differences between regions.Gender differences were observed in several countries,especially among the oldest adolescents.Priorities for physical activity promotion among adolescents should include increasing access/opportunities for physical activity among those who do not achieve≥60 min of MVPA≥1 days per week and reducing gender inequalities.

Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a familiar critical disease in the intensive care unit(ICU)patients.Nursing staff are important spiritual pillars during the treatment of patients,and in addition to routine nursing,more attention needs be paid to the patient’s psychological changes.AIM To investigate the effects of psychological intervention in ICU patients with SAP.METHODS One hundred ICU patients with SAP were hospitalized in the authors’hospital between 2020 and 2023 were selected,and divided into observation and control groups per the hospitalization order.The control and observation groups received routine nursing and psychological interventions,respectively.Two groups are being compared,using the Self-rating Anxiety Scale(SAS),Self-Determination Scale(SDS),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ,and 36-item Short Form Health Survey(SF-36)scores;nursing satisfaction of patients;ICU care duration;length of stay;hospitalization expenses;and the incidence of complications.RESULTS After nursing,the SDS,SAS,and APACHEⅡ scores in the experimental group were significantly lower than in the control group(P<0.05).The SF-36 scores in the observation group were significantly higher than those in the control group(P<0.05).The nursing satisfaction of patients in the experimental group was 94.5%,considerably higher than that of 75.6% in the control group(P<0.05).The ICU care duration,length of stay,and hospitalization expenses in the observation group were significantly lower than those in the control group,and the incidence of complications was lower(P<0.05).CONCLUSION For patients with SAP,the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

Health-related quality of life in patients that have undergone liver resection:A systematic review and meta-analysis

BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.

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.

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.

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 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.

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.

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.