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Objective We compare the reliability and validity of the Short Form 36 (version 1, SF-36) and the Short Form 12 (version 1, SF-12) in adolescence, the period of life when a child develops into an adult, i.e., the period from puberty to maturity terminating legally at the age of majority (10–19 years), thus supplying evidence for the selection of instruments measuring the quality of life (QOL) and decision-making processes of adolescents in China. Methods Stratified cluster random sampling was adopted according to geographical location, and the SF-36 was administered to assess QOL. The Pearson correlation coefficient was used to show correlation. Cronbach’s alpha and construct reliability (CR) were used to evaluate the reliability of SF-36 and SF-12, while criterion validity and average variance extracted (AVE, convergence validity) were used to evaluate validity. Confirmatory factor analysis was used to calculate the load factors for the items of the SF-36 and SF-12, then to obtain the CR and AVE. The Semejima grade response model (logistic two-parameter module) in item response theory was used to estimate item discrimination, item difficulty, and item average information for the items of the SF-36 and SF-12. Results 19,428 samples were included in the study. The mean age of respondents was 14.78 years (SD = 1.77). Reliability of each domain of the SF-36 was better than for the corresponding domain of the SF-12. The domains of PF, RP, BP, and GH in SF-36 had good construct reliability (CR > 0.6). The criterion validities of some domains of the SF-36 were a little higher in some corresponding dimensions of the SF-12, except for PCS. The convergence validities of the SF-12 were higher than the SF-36 in PF, RP, BP, and PCS. The items of BP, SF, RP, and VT in the SF-12 had acceptable discrimination of items that were higher than in the SF-36. The items’ average amounts of information on BP, VT, SF, RE, and MH in the SF-36 and SF-12 were poor. Conclusion Two component (PCS and MCS) measurements of the SF-12 appeared to perform at least as well as the SF-36 in cross-sectional settings in adolescence, but the reliability and validity of the 8 domains of the SF-36 were better than those of the SF-12. Some domains, for instance SF and BP, were not suitable for adolescents or need to be studied further.

Background Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors. Methods A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors. Results A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73–39.45) in 2011, 33.66% (32.32–35.00) in 2013, 39.13% (37.59–40.67) in 2015, and 39.95% (38.59–41.31) in 2018 ( p  < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 ( p  < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0–5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors ( p  < 0.05). Conclusions We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

Background Idiopathic inflammatory myopathies (IIM) are associated with a significantly higher risk of opportunistic infections including Pneumocystis jirovecii pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated PJP infection in subtypes of IIM. Objectives To investigate the prevalence and mortality rate of PJP infection in subgroups of IIM patients stratified according to myopathy-specific antibodies. Methods In the first part of the study, 463 consecutive patients with IIM were prospectively followed for a period of at least 1 year to analyze the incidence of PJP. In the second part of the study, we enrolled 30 consecutive PJP patients with any rheumatic disease in order to identify the mortality rate and risk factors by Cox regression analysis. The Kaplan-Meier method with log-rank testing was used to assess differences in survival. Results The prevalence of PJP in IIM patients was found to be 3.0/100 person-years, while in MDA5 + DM patients it was 7.5/100 person-years and in MDA5 − IIM patients 0.7/100 person-years ( P < 0.05). PJP typically occurred in the first 2 months in the case of MDA5 + DM patients who had a significant decrease in their CD4 + T cell counts and lymphocyte counts ( P < 0.05). In PJP patients, 3-month mortality was higher for MDA5 + DM patients than in those with other rheumatic diseases (83.3% vs 38.9%, P < 0.05). Alarmingly, MDA5 + DM patients seemed not to benefit from prompt anti-PJP treatment, unlike patients with other rheumatic diseases whose survival improved when anti-PJP treatment was started within 6 days ( P < 0.05). Conclusion PJP has an alarming high incidence and mortality in MDA5 + DM patients. Timely treatment for PJP seems not to improve the prognosis of patients with this particular subtype. Hence, there remains a crucial unmet need to develop PJP prophylaxis for MDA5 + DM patients.

Objective The study examined the impact of social support (SS) on quality of life (QoL) among older adults and whether these impacts varied across different levels of QoL during the COVID-19 pandemic. Methods A cluster-random-sampling survey was adopted within two towns in Dongguan, China for two months during the epidemic lockdown. Demographic characteristics, SS and QoL were measured. The number of types of services provided by the community, and the frequency and benefits of participation in community activities were used to assess formal social support (FSS), and the Social Support Appraisals (SS-A) scale for informal social support (ISS). The 36-Item Short-Form Health Survey (SF-36) was used to measure QoL. Multiple quantile regression adjusting for demographic characteristics variables was employed to explore the impact of SS on QoL among older adults. Results One thousand one hundred thirty older adults (≥ 60 years) were included. The mean age was 78.97 years (± 8.99), over half of (53.45%) received one or two types of community-provided services. 49.29% participated in community activities occasionally. 60.80% perceived these activities as beneficial to their health. In terms of ISS, the mean (SD) scores for social support from family, friends, and others were 23.68 (3.27), 20.14 (2.81), and 15.27 (1.72). The mean PCS-T and MCS-T scores were 50.00 (SD: 6.87) and 50.00 (SD: 9.04), respectively. When controlling for confounders, the results showed that “often” participating in community activities demonstrated a significant positive association with PCS-T, with the associated attenuation at higher quartiles. SS from others exhibited a significant negative correlation only at the lowest quartile of the PCS-T(β= -0.61, p  = 0.005). “Always” participating in community activities demonstrated a significant negative association with MCS-T at the highest quantile. SS from family exhibited a significant positive association with MCS-T at both the 5th (β = 0.77, p  < 0.001) and 95th (β = 0.8, p  < 0.001) quantiles, with SS from others showing a positive association specifically at the highest quantile (β = 0.51, p  = 0.022). Conclusions Formal community-based social support called for greater attention to the needs of older adults with a poorer quality of life, expanding its coverage, and enhancing the effectiveness of their participation in community activities. Fostering a harmonious and caring social and community environment proved to be a pathway to improving the quality of life for older adults during the pandemic.

Background The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults. Methods A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval. Results 621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants’ average monthly economic income was 800 (500–1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors ( B  = 0.024, 95% CI : 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness ( B  = 0.114, 95% CI : 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income. Conclusion The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.

Background Utilization of primary health care is an important aspect of elderly internal migrants’ access to screening and preventive services in China. It has been evident that social contacts, such as community engagement, social mobilization, and the ability to communicate were related to health service delivery, but little has been done to explore the relationship between social contacts and utilization of primary health care for this group. This study aimed to explore the factors influencing utilization of primary health care from the perspective of social contacts among elderly internal migrants in China. Methods This was a cross-sectional study including 1544 elderly internal migrants in eight cities. Whether these indivdiuals had chosen to participate in the free health checkup organized in the previous year was adopted as an indicator of the utilization of primary health care. The number of local friends and amount of exercise time per day were measured as a proxy for social contacts. Multivariate binary logistic regression was used to investigate the association of social contacts with the likelihood of using primary health care. Results 55.6% of the respondents were men, and the mean age was 66.34 years (SD, 5.94). 88.6% had received an education of high school or below. 12.9% had no local friends. 5.2% did not exercise. Just 33.1% had participated in a free medical check-up. Social contacts, age, and medical insurance were associated with more use of primary health care among elderly internal migrants in China. Conclusion The role of the community in promoting the use of primary health care should be expanded, such as creating community-based campaigns specifically targeting elderly internal migrants or designing social or sports activities tailored to increase the opportunity for contact between local elders and their internal migrant peers.

Background To examine the interaction between social income inequality, social integration, and health status among internal migrants (IMs) who migrate between regions in China. Methods We used the data from the 2014 Internal Migrant Dynamic Monitoring Survey in China, which sampled 15,999 IMs in eight cities in China. The Gini coefficient at the city level was calculated to measure social income inequality and was categorized into low (0.2 < Gini <= 0.3), medium (0.3 < Gini <= 0.4), high (0.4 < x < = 0.5), and very high (Gini >0.5). Health status was measured based upon self-reported health, subjective well-being, and perceptions of stress and mental health. Social integration was measured from four perspectives (acculturation and integration willingness, social insurance, economy, social communication). Linear mixed models were used to examine the interaction effects between health statuses, social integration, and the Gini coefficient. Results Factors of social integration, such as economic integration and acculturation and integration willingness, were significantly related to health. Social income inequality had a negative relationship with the health status of IMs. For example, IMs in one city, Qingdao, with a medium income inequality level (Gini = 0.329), had the best health statuses and better social integration. On the other hand, IMs in another city, Shenzhen, who had a large income inequality (Gini = 0.447) were worst in health statues and had worse social integration. Conclusion Policies or programs targeting IMs should support integration willingness, promote a sense of belonging, and improve economic equality. In the meantime, social activities to facilitate employment and create social trust should also be promoted. At the societal level, structural and policy changes are necessary to promote income equity to promote IMs’ general health status.

Background The BRICS (Brazil, Russian, India, China and South Africa) was still in rapid development with great potential to promote the global governance of the type 2 diabetes mellitus (T2DM). The study aimed to offer practical experience and strategies for global T2DM management, particularly for developing countries by evaluating the trends, cross-country inequalities of T2DM burden in the BRICS in the past and further predict their changes to 2035. Methods Age-standardized rate of incidence, prevalence, and disability-adjusted life years (DALYs) of T2DM were calculated. Estimated annual percentage change, Joinpoint regression and age-period-cohort model were used to analyze trend, decomposition analysis were used to attribute changes in total DALYs to population aging, population growth, and DALYs change, and Bayesian age-period-cohort model was used to predict. Results The cases number and ASR of T2DM incidence, prevalence and DALYs in the BRICS increased from 1990 to 2021, with obvious growth in Russia and South Africa. The highest incident relative risk (RR) in Brazil and China peaked at 55–59 years old with a notable RR in Chinese youths aged 20–24 years old, whereas it peaked at 60–64 years old in Russia, India and South Africa. The higher prevalent RR was after 65 years in the BRICS. The incident and prevalent RRs in the BRICS increased over time except for China where the incident RR decreased since 1995. Individuals born earlier had higher incident and prevalent RRs in Brazil, Russia, India and South Africa while individuals born later had higher incident RRs in China. Males bore a heavier burden of T2DM in India and China while females bore heavier in Brazil, Russia and South Africa. The impacts of population aging, population growth and epidemiological changes in China, Brazil, and Russia were the greatest respectively. The DALYs difference per 100,000 between countries with the lowest and highest SDI was 429.89 (95%CI: 187.62 to 672.17) in 1990, rising to 711.63 (95%CI: 416.73 to 1006.53) in 2021. The health inequality concentration index was − 9.60 (95%CI: -10.00 to -9.20) in 1990 and − 12.91 (95%CI: -13.71 to -12.10) in 2021. Until 2035, the incidence, prevalence and DALYs were projected to increase overall in the BRICS. Conclusion Developing comprehensive T2DM guidelines should be a key BRICS cooperation priority, leveraging proven aging population and chronic disease management experiences. Russia, India, and South Africa should prioritize older adults, whereas China and Brazil need to focus on middle-aged and older adults, with China additionally addressing younger-onset T2DM trends. Insulin shortages and severe infectious diseases pose major challenges, particularly in less developed countries, necessitating the expansion of early intervention programs, educational initiatives, and integrated hospital care to enhance T2DM control.

ObjectiveTo examine how living arrangement as a social contextual factor can affect Chinese elders’ cognitive function.Setting and participantsOur sample consists of 2486 Chinese elders from two waves (2014 and 2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that was administered in 22 of China’s 31 provinces using a multi-stage, disproportionate, purposive random sampling method. The CLHLS aims to better understand the determinants of healthy longevity in China and collects extensive data on a large population of fragile elders aged 80–112 in China.Outcome measuresCognitive function was measured by the Mini-Mental State Examination (MMSE). Living arrangement was divided into living in an institution, living alone and living with household members. Generalised linear regressions were carried out to examine the associations between baseline characteristics and cognitive function, while controlling age, gender and residential area.ResultsA total of 2486 participants were included in the study at baseline in 2014. Of these, 1162 (46.7%) were men and 1324 (53.3%) were women. The mean age at baseline was 75.07 (±8.31) years. The mean years of schooling were 2.86 (±3.68). The number (proportion) of the three living arrangements (lived in institutions, lived alone and lived with household members) were 93 (3.8%), 463 (18.6%) and 1930 (77.6%), respectively. Among all participants, cognitive function declined over time. Those who lived alone presented with the highest MMSE scores at baseline and showed the lowest decline after 4 years. Living arrangements had significant effects on decreasing cognitive function.ConclusionChinese elders living in institutions were most vulnerable to cognitive decline. Living alone was not a risk condition in itself for the elderly in terms of cognitive decline. In addition, the benefits of living with household members to support cognitive function were not found in our study.

Neurolisteriosis is a foodborne infection of the central nervous system that is easily misdiagnosed, especially in healthy adults with atypical symptoms. A 50-year-old man presented with a 3-day history of distortion of the oral commissure. Facial neuritis was diagnosed and treated with intravenous dexamethasone. His condition deteriorated rapidly, and he presented with a slow pharyngeal reflex, stiff neck, and signs of peripheral facial paralysis. Brain magnetic resonance imaging revealed multiple ring-enhanced foci in the brainstem. Routine and biochemical cerebrospinal fluid (CSF) analyses showed increased white blood cells and microproteins. Blood culture and high-throughput genome sequencing revealed Listeria monocytogenes DNA in the CSF. Ampicillin, amikacin, and meropenem were administered, and the patient was transferred from the intensive care unit to a standard medical ward after 2 months. The patient could walk and eat normally; however, he required intermittent mechanical ventilation at 11 months after discharge. Although L. monocytogenes meningitis is rare in healthy immunocompetent adults, it must be considered as a differential diagnosis, especially in adults whose conditions do not improve with cephalosporin antibiotic administration. L. monocytogenes rhombencephalitis mimics facial neuritis and develops quickly. Prompt diagnosis is essential for rapid initiation of antibiotic therapy to achieve the best outcome.