The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians:A longitudinal study

Background:A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease(CVD)prevention.However,despite their interlinked effects on metabolic health,the 2 behaviors are rarely considered jointly,particularly within the context of CVD prevention.We examined the independent,interactive,and joint associations of diet and physical activity with CVD hospitalization,CVD mortality,and all-cause mortality.Methods:CVD-free Australian participants aged 4574 years(n=85,545)reported physical activity,diet,sociodemographic,and lifestyle characteristics at baseline(20062009)and follow-up(20122015),and data were linked to hospitalization and death registries(03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality).Diet quality was categorized as low,medium,and high based on meeting dietary recommendations.Physical activity was operationalized as(a)total moderate-to-vigorous physical activity(MVPA)as per guidelines,and(b)the composition of MVPA as the ratio of vigorous-intensity physical activity(VPA)to total MVPA.We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.Results:During a median of 10.7 years of follow-up,6576 participants were admitted to the hospital for CVD and 6581 died from all causes(876 from CVD during 9.3 years).A high-quality diet was associated with a 17%lower risk of all-cause mortality than a low-quality diet,and the highest MVPA category(compared with the lowest)was associated with a 44%and 48%lower risk of CVD and all-cause mortality,respectively.Multiplicative interactions between diet and physical activity were non-significant.For all outcomes,the lowest risk combinations involved a high-quality diet and the highest MVPA categories.Accounting for total MVPA,some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.Conclusion:For CVD prevention and longevity,one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

From London buses to activity trackers:A reflection of 70 years of physical activity research

In 1953,Morris et al.^(1)published their ground-breaking findings among London bus drivers and conductors,linking physical activity to a major chronic disease for the first time.This seminal paper marked the birth of a new field—physical activity epidemiology.^(1)Since then,the field has flourished,evidenced by mounting scientific publications.^(2)Our knowledge about the role of physical activity in disease prevention has expanded from coronary heart disease in Morris et al.’s^(1)initial study to dozens of additional diseases and conditions,such as diabetes,cancers,and dementia.^(3)More than 7 decades and thousands of publications later,we critically reflect on several aspects of the progress in physical activity epidemiology.

Occupational physical activity, all-cause, cardiovascular disease, and cancer mortality in 349,248 adults: Prospective and longitudinal analyses of the MJ Cohort

Background:Evidence on the health benefits of occupational physical activity(OPA)is inconclusive.We examined the associations of baseline OPA and OPA changes with all-cause,cardiovascular disease(CVD),and cancer mortality and survival times.Methods:This study included prospective and longitudinal data from the MJ Cohort,comprising adults over 18 years recruited in 1998-2016,349,248 adults(177,314 women)with baseline OPA,of whom 105,715(52,503 women)had 2 OPA measures at 6.3±4.2 years(mean±SD)apart.Exposures were baseline OPA,OPA changes,and baseline leisure-time physical activity.Results:Over a mean mortality follow-up of 16.2±5.5 years for men and 16.4±5.4 years for women,11,696 deaths(2033 of CVD and 4631 of cancer causes)in men and 8980 deaths(1475 of CVD and 3689 of cancer causes)in women occurred.Combined moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men(multivariable-adjusted hazard ratio(HR)=0.93,95%confidence interval(95%CI):0.89-0.98 compared to light OPA)and women(HR=0.86,95%CI:0.79-0.93).Over a mean mortality follow-up of 12.5±4.6 years for men and 12.6±4.6 years for women,OPA decreases in men were detrimentally associated(HR=1.16,95%CI:1.01-1.33)with all-cause mortality,while OPA increases in women were beneficially(HR=0.83,95%CI:0.70-0.97)associated with the same outcome.Baseline or changes in OPA showed no associations with CVD or cancer mortality.Conclusion:Higher baseline OPA was beneficially associated with all-cause mortality risk in both men and women.Our longitudinal OPA analyses partly confirmed the prospective findings,with some discordance between sex groups.

Dose-dependent associations of joint aerobic and muscle-strengthening exercise with obesity:A cross-sectional study of 280,605 adults

Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengthening exercise(MSE:push-ups/sit-ups,using weight machines)has more favorable associations with optimal weight status.However,few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.Methods:Based on cross-sectional analyses of the European Health Interview Survey Wave 2(2013-2014),we examined prevalence ratios(PRs)of joint and stratified associations between MVPA(4 categories:(ⅰ)0 min/week,(ⅱ)1-149 min/week,(ⅲ)150-299 min/week,and(ⅳ)≥300 min/week)and MSE(3 categories:(ⅰ)0 day/week,(ⅱ)1 day/week,and(ⅲ)>2 days/week)with body mass index-defined obesity(body mass index of>30.0 kg/m2)using Poisson regression with robust error variance.PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics(e.g.,sex,age,education,income,and smoking status).Results:Data were available for 280,456 adults(≥18 years),of which 46,166(15.5%)were obese.The interaction MVPA x MSE guideline adherence was statistically significant for obesity(p≤0.05).The joint MVPA-MSE analysis showed that compared to the reference group(i.e.,no MVPA and no MSE),the PRs followed a dose-dependent pattern,with the lowest observed among those reporting≥150 MVPA min/week and≥1 MSE days/week(PR:0.43;95%confidence interval:0.41-0.46).When stratified across each MVPA strata,the PRs were mostly lower among those engaging in MSE 1 day/week,as compared to those doing MSE≥2 days/week.Conclusion:"There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity.Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

Stair climbing,genetic predisposition,and the risk of incident type 2 diabetes:A large population-based prospective cohort study

Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.

Physical activity volume,frequency,and intensity:Associations with hypertension and obesity over 21 years in Australian women

Background:Optimal patterns of accrual of recommended levels of physical activity(PA)for prevention of hypertension and obesity are not known.The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years.Specifically,we investigated whether,for the same weekly volume of PA,the number of sessions(frequency)and vigorousness of PA(intensity)were associated with a reduction in the occurrence of hypertension and obesity in women.Methods:Data from the 1973-1978 and 1946-1951 cohorts of the Australian Longitudinal Study on Women's Health were analyzed(n=20,588;12%-16%with a Bachelor's or higher degree).Self-reported PA,hypertension,height,and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021.Generalized Estimating Equation models with a 3-year lag model were used to investigate the association of PA volume(metabolic equivalent min/week)(none;33-499;500-999;≥1000,weekly frequency(none;1-2 times;3-4times;5-7 times;≥8 times),and the proportion of vigorous PA to total volume of PA(none;0%;1%-33%;34%-66%;67%-100%)with odds of hypertension and obesity from 2000 to 2021.Results:The cumulative incidence of hypertension was 6%in the 1973-1978 and 23%in the 1946-1951 cohort;27%of women in the 1973-1978;and 15%in the 1946-1951 cohort developed obesity over the period.Overall,a higher volume of PA was associated with reduced odds of hypertension and obesity.When the volume of PA was considered,the odds of hypertension did not vary according to the frequency or intensity of PA.However,increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obe sity.Conclusion:PA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity.Incorporating more sessions,particularly of vigorous-intensity PA,may provide extra benefits for the prevention of obesity.

Evaluating efficacy of screening for upper gastrointestinal cancer in China:a study protocol for a randomized controlled trial

Objective： To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China. Setting： Seven cities/counties, representing three economical-geographical regions （Eastern, Central and Western） in China, were selected as screening centers： three in high-risk areas and four in non-high-risk areas. Participants： Villages/communities in these seven centers regarded as clusters were randomly assigned to either intervention group （screening by endoscopic examination） or control group （with normal community care） in a 1：1 ratio stratified by each center. Eligible participants are local residents aged 40-69 years in the selected villages/communities with no history of cancer or endoscopic examination in the latest 3 years who are mentally and physically competent. Those who are not willing to take endoscopic examination or are unwilling to sign the consent form are excluded from the study. Totally 140,000 participants will be enrolled. Interventions： In high-risk areas of upper gastrointestinal cancer, all subjects in screening group will be screened by endoscopy. In non-high-risk areas, 30% of the subjects in screening group, identified through a survey, will be screened by endoscopy. Primary and secondary outcome measures： The primary outcome is the mortality caused by upper gastrointestinal cancer. The secondary outcomes include detection rate, incidence rate, survival rate, and clinical stage distribution. Additional data on quality of life and cost-effectiveness will also be collected to answer important questions regarding screening effects. Conclusions： Screening strategy evaluated in those areas with positive findings may be promoted nationally and applied to the majority of Chinese people. On the other hand, negative findings will provide scientific evidence for abandoning a test and shifting resources elsewhere. Trial registration： The study has been registered with the Protocol Registration System in Chinese Clinical Trial Registry （identifier： ChiCTR-EOR-16008577）.

Step it up: Advancing physical activity research to promote healthy aging in China

1.Introduction China has been transforming.Since the late 1970s,China’s economy has increased many fold,the proportion of Chinese living in urban areas has more than doubled,life expectancy has increased by 10 years^1 and the country has transitioned from the'bicycle kingdom'to the world’s largest'auto market'.~2 As a result,China is now challenged by the'side effects'of eco-

Overdiagnosis of breast cancer in population screening:does it make breast screening worthless?

The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.

膝关节疼痛与身体活动水平关系量性研究的范围综述

目的身体活动对于膝关节疼痛有缓解作用并且能够预防其他健康问题.然而,进行身体活动对于有膝关节疼痛的人极具有挑战性.理解膝关节疼痛是如何影响身体活动能够帮助降低这一类患病人群因为膝关节疼痛不敢参与身体活动而造成的负面影响.本文旨在对膝关节疼痛与身体活动水平之间的定量关系及其影响因素进行范围综述.方法依据PRISMA-ScR流程和Peter的方法学框架,在Medline、PsycINFO、CINAHL及Scopus数据库通过关键词进行检索.结果共纳入9篇文献.其中,1篇文献发现膝关节疼痛水平的增高会导致身体活动水平的增高;4篇文献研究发现膝关节疼痛与身体活动水平之间存在负相关;1篇文献发现膝关节疼痛水平的增高会带来中等强度的身体活动水平下降,但并不影响低强度的身体活动水平;3篇文献发现膝关节疼痛水平对身体活动水平并没有影响.同时,负面情绪的放大、疼痛相关的活动干扰和某些特定的日常活动会降低膝关节疼痛人群的身体活动水平.结论目前针对膝关节疼痛和身体活动的定量关系研究有限且结论不一致,需要后续进一步的探索.两者之间的关系同时会被心理因素及不同的身体活动强度和类型所影响.因此,在设计提高膝关节疼痛人群身体活动水平的干预措施时,应当综合考虑多种因素的共同作用,从而达到有效提高该人群的身体活动水平的目的.

New fecal test for non-invasive Helicobacter pylori detection:A diagnostic accuracy study

AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13 C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test). The detection of bacterial 23 S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive(PPV) and negative(NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio(LR), together with 95% confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninetyfive(32.3%) participants had a positive ^(13)C-urea breath test. Twenty-three(7.8%) participants underwent upper endoscopy with histology, with a full concordance between ^(13)C-urea breath test and histology in detecting H. pylori infection. Four(1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2%(CI: 84.2%-96.3%), specificity 98.5%(CI:96.8%-100%), PPV 96.5%(CI: 92.6%-100%), NPV 95.6%(CI: 92.8%-98.4%), accuracy 95.9%(CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10(CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34(41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27(32.5%) had bacterial strains resistant to clarithromycin, 3(3.6%) to levofloxacin, and 4(4.8%) to both antibiotics. CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.

Modelling home advantage for individual teams in UEFA Champions League football

Background:Home advantage(HA) is well documented in a wide range of team sports including association football(soccer).Although much attention has been paid to differences in the overall magnitude of HA between football competitions and across time,few studies have investigated HA at the team level.Methods:A novel method of estimating HA for individual teams,based solely on home performance,was used to compare HA between the highest performing teams and countries in the Union of European Football Associations(UEFA) Champions League over a 10-year period(2003/2004 to 2012/2013).Away disadvantage(AD) was also estimated based on each team's performance away from home.Poisson regression analysis was used to estimate covariate adjusted HA and AD in terms of the percentage of goals scored at home(HA) and conceded away from home(AD).Results:When controlling for differences in team ability,HA did not vary significantly between the 13 selected teams.There was evidence(p < 0.1),however,of between-team variation in AD,ranging from 45%(away advantage) to 68%(away disadvantage).When teams were grouped into the 11 selected countries,both HA and AD varied significantly(p < 0.02) between countries:HA ranged from 52% for Turkish teams to 70%for English teams,while AD ranged from 52%(France) to 67%(Turkey).Conclusion:Differences in style of play and tactical approaches to home and away matches may explain some of the variation in HA and AD between teams from different countries.

Widening socioeconomic disparity in lung cancer incidence among men in New South Wales, Australia, 1987–2011

Objective：We assessed the trends in lung cancer incidence over a 25-year period by socioeconomic groups for men in New South Wales（NSW）,Australia.Methods：Men diagnosed with lung cancer between 1987 and 2011 were divided into five quintiles according to an Index of Education and Occupation（IEO）.We assessed relative socioeconomic differences over time by calculating age-standardized incidence ratios（SIRs）by 5-year period of diagnosis,and estimated absolute differences by comparing the observed and expected numbers of cases using the highest IEO quintile as the reference.Results：Lung cancer incidence for men decreased from 1987 to 2011 for all IEO quintiles,with a greater rate of decline for men living in the highest IEO areas.Thus,the relative disparity increased significantly over the 25-year period（P=0.0006）.For example,the SIR for the lowest IEO quintile increased from 1.28 during 1987–1991 to 1.74during 2007–2011.Absolute differences also increased with the proportion of＂potentially preventable＂cases doubling from 14.5% in 1987–1991 to 30.2% in 2007–2011.Conclusions：Despite the overall decline in lung cancer incidence among men in NSW over the past 25 years,there was a significant increase in disparity across socioeconomic areas in both relative and absolute terms.

Toward a nomenclature consensus for diverse intelligent systems:Call for collaboration

Disagreements about language use are common both between and within fields.Where interests require multidisciplinary collaboration or the field of research has the potential to impact society at large,it becomes critical to minimize these disagreements where possible.The development of diverse intelligent systems,regardless of the substrate(e.g.,silicon vs.biology),is a case where both conditions are met.Significant advancements have occurred in the development of technology progressing toward these diverse intelligence systems.Whether progress is silicon based,such as the use of large language models,or through synthetic biology methods,such as the development of organoids,a clear need for a community-based approach to seeking consensus on nomenclature is now vital.Here,we welcome collaboration from the wider scientific community,proposing a pathway forward to achieving this intention,highlighting key terms and fields of relevance,and suggesting potential consensus-making methods to be applied.

过度诊断的挑战始于其定义

过度诊断对不同的人而言意义不一样。S M Carter及其同事们认为,我们应该使用一个宽泛的术语,如倡导使用过度医疗,并根据研究和临床目的,逐步制定精确的过度诊断定义。支撑卫生保健的隐性社会契约能减少疾病和可预防性的死亡,并改善生活质量。但有时这些承诺并未实现。

治疗 普瑞巴林和加巴喷丁治疗疼痛

患者老年女性,65岁,持续性背部钝痛和腿痛四年余。三个月前行腰椎减压术,但术后仍有疼痛。查体无神经系统受损征象。患者正在接受高血压和慢性肾病的治疗,无法服用非甾体类抗炎药。曾口服扑热息痛、可待因、曲马多和阿米替林镇痛,无明显效果。予普瑞巴林试用,如果出现头晕或不能耐受药物副作用,需继续随访。

老年人用药过多？通过共享决策减停用药

用药过多问题逐渐被人们所承认，老年人不合理多重用药就是其中一个表现。多重用药通常定义为服用超过5种常规处方药。多重用药在利大于弊的情况下是可行的，但是其增加了老年人发生药物不良反应、身体和认知功能受损及住院的风险。老年人应用多重用药的依据有限，尤其是对有共患病、认知功能障碍及身体虚弱的老年人。

对低风险癌症重新命名

Brooke Nickel及其同事认为,对于不治疗也不会对患者造成伤害的低风险癌症,应该摘掉它们的癌症标签,这会减少过度诊断和过度治疗情况。越来越多的证据表明,疾病标签会影响人们的心理反应和他们对治疗手段的选择使用更多医学化的标签会增加患者对疾病的担忧,使得他们更偏向于侵入性的治疗方法。鉴于目前对于低风险癌症普遍存在过度治疗的状况2-5,我们考虑摘掉癌症标签的潜在影响,以及如何实现这一点。

在临床试验中保持"平衡" 必须记录和报告可能影响结果的联合干预

联合干预是指临床试验参与者接受了在方案中没有明确规定的额外治疗、医嘱或其他干预措施,而这些联合干预可能会影响试验预先确定的结果。但是,对联合干预情况报告不全的现象在所有健康领域都比较常见。例如,在最近的一项系统评价中,超过三分之二的大型心血管临床试验均未充分报告联合干预。