Explore the vast range of titles available.

Although consumption of sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) has increasingly been linked with obesity, type 2 diabetes mellitus, hypertension, and all-cause mortality, evidence remains conflicted and dose–response meta-analyses of the associations are lacking. We conducted an updated meta-analysis to synthesize the knowledge about their associations and to explore their dose–response relations. We comprehensively searched PubMed, EMBASE, Web of Science, and Open Grey up to September 2019 for prospective cohort studies investigating the associations in adults. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for the dose–response association. Restricted cubic splines were used to evaluate linear/non-linear relations. We included 39 articles in the meta-analysis. For each 250-mL/d increase in SSB and ASB intake, the risk increased by 12% (RR = 1.12, 95% CI 1.05–1.19, I 2  = 67.7%) and 21% (RR = 1.21, 95% CI 1.09–1.35, I 2  = 47.2%) for obesity, 19% (RR = 1.19, 95% CI 1.13–1.25, I 2  = 82.4%) and 15% (RR = 1.15, 95% CI 1.05–1.26, I 2  = 92.6%) for T2DM, 10% (RR = 1.10, 95% CI 1.06–1.14, I 2  = 58.4%) and 8% (RR = 1.08, 95% CI 1.06–1.10, I 2  = 24.3%) for hypertension, and 4% (RR = 1.04, 95% CI 1.01–1.07, I 2  = 58.0%) and 6% (RR = 1.06, 95% CI 1.02–1.10, I 2  = 80.8%) for all-cause mortality. For SSBs, restricted cubic splines showed linear associations with risk of obesity ( P non-linearity  = 0.359), T2DM ( P non-linearity  = 0.706), hypertension ( P non-linearity  = 0.510) and all-cause mortality ( P non-linearity  = 0.259). For ASBs, we found linear associations with risk of obesity ( P non-linearity  = 0.299) and T2DM ( P non-linearity  = 0.847) and non-linear associations with hypertension ( P non-linearity  = 0.019) and all-cause mortality ( P non-linearity  = 0.048). Increased consumption of SSBs and ASBs is associated with risk of obesity, T2DM, hypertension, and all-cause mortality. However, the results should be interpreted cautiously because the present analyses were based on only cohort but not intervention studies.

Globally, vaccine hesitancy is a growing public health problem. It is detrimental to the consolidation of immunization program achievements and elimination of vaccine-targeted diseases. The objective of this study was to estimate the prevalence of COVID-19 vaccine hesitancy in China and explore its contributing factors. A national cross-sectional online survey among Chinese adults (≥18 years old) was conducted between August 6, 2021 and August 9 via a market research company. We collected sociodemographic information; lifestyle behavior; quality of life; the knowledge, awareness, and behavior of COVID-19; the knowledge, awareness, and behavior of COVID-19 vaccine; willingness of COVID-19 vaccination; accessibility of COVID-19 vaccination services; skepticism about COVID-19 and COVID-19 vaccine; doctor and vaccine developer scale; and so on. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations by using logistic regression models. A total of 29,925 residents (48.64% men) were enrolled in our study with mean age of 30.99 years. We found an overall prevalence of COVID-19 vaccine hesitancy at 8.40% (95% CI, 8.09–8.72) in primary vaccination and 8.39% (95% CI, 8.07–8.70) in booster vaccination. In addition, after adjusting for potential confounders, we found that women, higher educational level, married residents, higher score of health condition, never smoked, increased washing hands, increased wearing mask, increased social distance, lower level of vaccine conspiracy beliefs, disease risks outweigh vaccine risk, higher level of convenient vaccination, and higher level of trust in doctor and developer were more willing to vaccinate than all others (all p < 0.05). Age, sex, educational level, marital status, chronic disease condition, smoking, healthy behaviors, the curability of COVID-19, the channel of accessing information of COVID-19 vaccine, endorsement of vaccine conspiracy beliefs, weigh risks of vaccination against risks of the disease, making a positive influence on the health of others around you, and lower trust in healthcare system may affect the variation of willingness to take a COVID-19 vaccine (all  p  < 0.05). The prevalence of COVID-19 vaccine hesitancy was modest in China, even with the slight resulting cascade of changing vaccination rates between the primary and booster vaccination. Urgent action to address vaccine hesitancy is needed in building trust in medical personnel and vaccine producers, promoting the convenience of vaccination services, and spreading reliable information of COVID-19 vaccination via the Internet and other media.

Background The level of outpatient satisfaction plays a significant role in improving the quality and utilization of healthcare services. Patient satisfaction gives providers insights into various aspects of services including the effectiveness of care and level of empathy. This study aimed to evaluate the level of patient satisfaction in the outpatient department and to explore its influencing factors in large hospitals (accommodating over 1000 beds) of Henan province, China. Methods We analyzed data from Henan Large Hospitals Patient Satisfaction Survey conducted in the year 2018 and included 630 outpatients. Structural Equation Model (SEM) was used to explore the relationship among evaluation indicators of outpatient satisfaction levels. We used Dynamic Matter-Element Analysis (DMA) to evaluate the status of outpatient satisfaction. Binary Logistic Regression (BLR) was adopted to estimate the impact of personal characteristics towards outpatient satisfaction. Results The overall score for outpatient satisfaction in large hospitals was 66.28±14.73. The mean outpatient satisfaction scores for normal-large, medium-large, and extra-large hospitals were 63.33±12.12, 70.11±16.10, 65.41±14.67, respectively, and were significantly different ( F = 11.953, P < 0.001). Waiting time, doctor-patient communication, professional services, and accessibility for treatment information were shown to have directly positive correlations with outpatient satisfaction ( r = 0.42, 0.47, 0.55, 0.46, all P < 0.05). Results from BLR analysis revealed that patients’ age and frequency of hospital visits were the main characteristics influencing outpatient satisfaction ( P < 0.05). Conclusions The outpatient satisfaction of large hospitals is moderately low. Hospital managers could shorten the waiting time for outpatients and improve the access to treatment information to improve the satisfaction of outpatients. It is also necessary to enhance service provision for outpatients under the age of 18 as well as the first-time patients.

The triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio is considered a simple surrogate of insulin resistance. The aim of this study was to explore the association of the TG/HDL-C ratio with the risk of incident hypertension and whether the TG/HDL-C ratio mediates the obesity–incident hypertension association. The study analyzed 9679 participants from a rural Chinese population. Demographic and anthropometric and laboratory data were collected at baseline (2007–2008) and follow-up (2013–2014) examinations. A multivariate logistic regression model was used to analyze the association of the TG/HDL-C ratio with incident hypertension, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was performed to examine the contribution of the TG/HDL-C ratio to obesity-related incident hypertension. During a median follow-up of 6.00 years, hypertension developed in 1880/9679 participants (19.42%). The risk of incident hypertension was higher in the highest TG/HDL-C ratio quartile than in the lowest quartile (OR = 1.21, 95% CI = 1.02–1.42). Subgroup analyses showed that the risk of incident hypertension was increased by 30%, 36%, and 33% among women, participants < 60 years old and those with prehypertension at baseline, respectively. The TG/HDL-C ratio partially mediated the obesity–incident hypertension association (indirect effect: OR = 1.04, 95% CI: 1.01–1.07; direct effect: OR = 1.36, 95% CI: 1.16–1.62). The TG/HDL-C ratio may be a risk factor for incident hypertension, especially in women, participants < 60 years old and those with prehypertension. The TG/HDL-C ratio may also play a mediating role in obesity-related incident hypertension.

Background Healthy lifestyle behaviors (LBs) have been widely recommended for the prevention and management of cardiovascular disease (CVD). Despite a large number of studies exploring the association between combined LBs and CVD, a notable gap exists in integration of relevant literatures. We conducted a systematic review and meta-analysis of prospective cohort studies to analyze the correlation between combined LBs and the occurrence of CVD, as well as to estimate the risk of various health complications in individuals already diagnosed with CVD. Methods Articles published up to February 10, 2023 were sourced through PubMed, EMBASE and Web of Science. Eligible prospective cohort studies that reported the relations of combined LBs with pre-determined outcomes were included. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using either a fixed or random-effects model. Subgroup analysis, meta-regression, publication bias, and sensitivity analysis were as well performed. Results In the general population, individuals with the healthiest combination of LBs exhibited a significant risk reduction of 58% for CVD and 55% for CVD mortality. For individuals diagnosed with CVD, adherence to the healthiest combination of LBs corresponded to a significant risk reduction of 62% for CVD recurrence and 67% for all-cause mortality, when compared to those with the least-healthy combination of LBs. In the analysis of dose-response relationship, for each increment of 1 healthy LB, there was a corresponding decrease in risk of 17% for CVD and 19% for CVD mortality within the general population. Similarly, among individuals diagnosed with CVD, each additional healthy LB was associated with a risk reduction of 27% for CVD recurrence and 27% for all-cause mortality. Conclusions Adopting healthy LBs is associated with substantial risk reduction in CVD, CVD mortality, and adverse outcomes among individuals diagnosed with CVD. Rather than focusing solely on individual healthy LB, it is advisable to advocate for the adoption of multiple LBs for the prevention and management of CVD. Trial registration PROSPERO: CRD42023431731. Significance The meta-analysis examined the quantitative correlation between lifestyle behaviors (LBs) and the incidence of cardiovascular disease (CVD) and CVD mortality in the general population, as well as adverse outcomes in CVD patients. The results suggest that healthy LBs are associated with substantial risk reduction in these 3 outcomes. Multiple LBs, instead of tackling one certain LB, should be recommended for the prevention and management of CVD.

ObjectiveTo evaluate the level of worry and its influencing factors during the COVID-19 epidemic among teachers in Henan Province in China.Study designA cross-sectional study was conducted.MethodsWe designed a cross-sectional survey that included 88 611 teachers from three cities in Henan Province, China between 4 February 2020 and 12 February 2020. Level of worry was measured using a five-item Likert scale, with 1 being ‘not worried’ and 5 being ‘very worried’. The OR and 95% CI of potential influencing factors for level of worry among study participants were estimated using ordinal logistic regression models.ResultsAbout 59% of teachers reported being ‘very worried’ about the COVID-19 epidemic. The proportion of female teachers was higher than of male teachers (60.33% vs 52.89%). In all age groups considered in this study, a ‘very worried’ condition accounted for the highest proportion. The age group 40–49 years had the lowest proportion of participants who were very worried, 52.34% of whom were men and 58.62% were women. After controlling for potential confounding factors, age, education level, type of teacher, school location, attention level, fear level, anxiety level and behaviour status were all related to level of worry (all p<0.05).ConclusionDuring the COVID-19 epidemic, there was a high proportion of teachers who were ‘very worried’ about the situation in Henan Province, China. Our study may remind policymakers to consider factors including age, educational status, type of teacher, school location, source of information on COVID-19, attention level, anxiety level, fear level and behaviour status to alleviate worry.

Background The increasing prevalence of Chronic Obstructive Pulmonary Disease (COPD) has imposed a considerable economic burden. However, there remains a paucity of relevant evidence regarding the hospitalization costs of COPD cases. Therefore, in this study, we aimed to assess the hospitalization costs among COPD cases and investigate the factors that contribute to their costs in Henan Province, China. Methods We enrolled a total of 1697 cases who were discharged with a diagnosis of COPD from January 1, 2020 to December 31, 2020, into the study. Demographic and clinical characteristics of the cases were obtained from the hospital information system (HIS) of two large tertiary hospitals in Henan Province, China. The factors associated with hospitalization costs were examined using a multiple linear regression model. Results Total hospitalization costs of 1697 COPD cases were $5,419,011, and the median was $1952 (IQR:2031). Out-of-pocket fees accounted for 43.95% of the total hospitalization costs, and the median was $938 (IQR:956). Multiple linear regression analysis revealed that hospitalization costs were higher among older cases, cases with more comorbidities, and cases with longer length of stay. Furthermore, hospitalization costs were higher in cases who paid through private expenses compared to those covered by Urban Employee Basic Medical Insurance. Additionally, we found that cases admitted through an outpatient clinic had higher hospitalization costs than those admitted through the emergency department. Conclusion Hospitalization costs of COPD cases are substantial. Strategies to reduce hospitalization costs, such as shortening LOS, optimizing payment plans, and preventing or managing complications, should be implemented to alleviate the economic burden associated with COPD hospitalizations.

Although the association between serum level of C-reactive protein (CRP) and risk of cardiovascular events (CVEs) has been reported, the comprehensive assessment of the quantitative association of CRP level with risk of CVEs has not been reported. Our meta-analysis aims to quantitatively evaluate the association of CRP level and risk of CVEs. We searched PubMed and Embase databases for articles published up to December 6, 2019. Studies with data on men and women, different types of CVEs and multiple cohorts within a study were treated as independent studies. Generalized least-squares regression models were used to assess the quantitative association between CRP level and risk of CVEs. Restricted cubic splines were used to model the possible linear association between CRP and CVEs. We included 36 articles (60 studies; 227,715 participants) in the analysis. The pooled relative risks (RRs) of high versus low CRP level for cardiovascular disease (CVD), stroke and coronary heart disease (CHD) were 1.64 (95% confidence interval [CI], 1.49–1.82), 1.46 (95% CI, 1.35–1.58), and 1.55 (95% CI, 1.47–1.63), respectively. A linear association was found between CRP level and CVD (P = 0.429), stroke (P = 0.940), and CHD (P = 0.931); with each 1-mg/L increase in CRP level, the pooled RRs for CVD, stroke, and CHD were 1.18 (95% CI, 1.12–1.24), 1.07 (95% CI, 1.04–1.09), and 1.12 (95% CI, 1.08–1.16), respectively. This meta-analysis suggests that risk of CVEs increases with increasing serum CRP level.

Background Life’s Crucial 9 (LC9), an extension for Life’s Essential 8 with the addition of psychological health, provides a new tool for assessing cardiovascular health. However, the association between LC9 and cardiovascular diseases (CVD) in elderly hypertensive patients remains unclear. Methods A cross-sectional survey was carried out among elderly hypertensive patients from the National Basic Public Health Service Programs in Jia County, Henan Province, from July 1 to August 31, 2023. The primary outcome was defined as a composite CVD (coronary heart disease and stroke). The LC9 consisted of 9 metrics (diet, physical activity, nicotine exposure, sleep, psychological health, body mass index, blood pressure, fasting blood glucose, and non-high-density lipoprotein cholesterol). The logistic regression model was established to estimate the odds ratio (OR) and 95% CI of CVD across different LC9 groups. Results A total of 13,032 elderly hypertensive patients (mean age: 73.45) were analyzed. 5,664 (43.46%) patients were diagnosed with CVD (including 4,455 coronary heart disease and 2,062 stroke). The median (interquartile range) of the LC9 score in all patients, those without CVD, and those with CVD were 65.56 (58.33-72.22), 66.67 (59.44-73.33), and 64.44 (56.67-71.11), respectively. As the number of ideal LC9 metrics increased, the prevalence of CVD decreased ( P trend <0.05). After adjusting for potential confounders, the OR (95%CI) of CVD in the LC9 score was 0.80 (0.76 - 0.83). Compared with the low group, the OR (95%CI) of CVD in the moderate group was 0.66 (0.58-0.76), and 0.49 (0.41-0.59) for the high group, respectively. Notably, there was a negative dose-response relationship between LC9 and its domain scores and CVD ( P -nonlinear > 0.05). Conclusion Higher LC9 scores and more ideal health metrics, including psychological health, are associated with lower CVD risk in elderly hypertensive patients, highlighting the need for policy efforts to strengthen primary healthcare, expand access to preventive services, and promote comprehensive CVH management in this high-risk population.

To explore whether DNA methylation of the ATP-binding cassette G1 (ABCG1) gene and its dynamic change are associated with incident type 2 diabetes mellitus (T2DM). We conducted a nested case-control study with 286 pairs of T2DM cases and matched controls nested in the Rural Chinese Cohort Study. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for incident T2DM risk according to ABCG1 methylation level at baseline and its dynamic change at follow-up examination. Spearman's rank correlation coefficients were used to analyze the association between ABCG1 methylation and its possible risk factors in the control group. We found that T2DM risk increased by 16% (OR = 1.16, 95% CI = 1.02-1.31) with each 1% increase in DNA methylation levels of the ABCG1 loci CpG13 and CpG14. DNA methylation change of the ABCG1 locus CpG15 during the 6-year follow-up was associated with increased T2DM risk: T2DM risk increased by 78% in the upper tertile group (methylation gain ≥5%) versus lower tertile group (methylation gain <1%) (OR = 1.78, 95% CI = 1.01-3.15). Furthermore, body mass index was positively correlated with the DNA methylation level of the ABCG1 loci CpG13, CpG14 and CpG15. In conclusion, DNA methylation levels of the ABCG1 loci CpG13 and CpG14 and the methylation gain of locus CpG15 were positively associated with incident T2DM risk, which may suggest a possible etiologic pattern for T2DM and potentially improve T2DM prediction in rural Chinese people.