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The relationship between physical activity (PA) and the risk of frailty has not reached a conclusive result. This systematic review with meta-analysis aimed to evaluate the effect of PA on the onset of frailty in the community-dwelling middle and older age adults by pooling data from cohort studies. A systematic literature search was performed via PubMed, Embase, and Web of Science up to June 01, 2021. Pooled adjusted effect estimates (ES) with 95% confidence interval (CI) were calculated by using the random-effect model and by comparing the highest with lowest levels of PA. Heterogeneity was tested using the I2 statistic and Q-test. The quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of ten cohort studies with 14 records were selected, and the GRADE approach classified the quality of evidence as low. In comparison with the lowest level of PA, the highest level of PA was associated with 41% decreased odds of frailty (ES: 0.59, 95% CI: 0.51-0.67; I2 = 70.0%, P-heterogeneity < 0.001) after pooling results from included studies. In stratified analysis by frailty assessment approach, the highest level of PA was significantly associated with 37% (ES 0.63, 95% CI: 0.52-0.77, 49% (ES: 0.51, 95% CI: 0.41-0.63), and 30% (ES: 0.70, 95% CI: 0.65-0.75) reduced odds of frailty when pooling studies using criteria of physical frailty, multidimensional model, and accumulation of disability, respectively. Stratified analyses further by PA indicators and PA assessment tools yielded similar protective effects in any subgroups. This study with moderate-certainty evidence shows that a higher level of PA was associated with lower odds of frailty, and the benefits of PA for frailty prevention were independent of frailty assessment tools, PA indicators, and PA assessment methods. Findings from this study may help implement active exercise strategies to prevent frailty.

This prospective study aimed to explore whether the associations between pain phenotypes, pain relief medications, and stroke risk differ by sex. We used data from 473,729 participants in the UK Biobank. Pain phenotypes were categorized as no pain, short-term pain, chronic localized pain (CLP), and chronic widespread pain (CWP). Stroke events, including ischaemic stroke and haemorrhagic stroke, were identified through hospital and death records. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for stroke, with interaction terms included to assess sex differences. We also evaluated the association between pain relief medications and stroke risk among the chronic pain subcohort. CWP was associated with higher stroke risks in both men (HR 1.36, 95% CI 1.11–1.65) and women (HR 1.31, 95% CI 1.08–1.60); however, women with CLP exhibited a significantly higher risk of stroke (HR 1.16, 95% CI 1.08–1.25) and ischaemic stroke (HR 1.18, 95% CI 1.09–1.28), while no significant associations between CLP and stroke and subtypes were observed in men ( p for sex interactions < 0.001). Regarding pain relief, aspirin use was associated with an increased risk of stroke (HR 1.19, 95% CI 1.08–1.30), and opioid use was linked to a greater increase in the risk of subarachnoid haemorrhage (HR 1.92, 95% CI 1.25–2.95). Chronic pain phenotypes, particularly in women and individuals with multiple CLP sites and CWP, were significantly associated with increased risks of stroke. Use of aspirin and opioids was also associated with higher stroke risks.

Background Evidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults. Methods We conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease. Results Of the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram ( β  = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose–response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups. Conclusion Exposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Background This prospective study aimed to examine the individual and combined population attributable fractions (PAFs) of stroke and its subtypes associated with reproductive factors among Chinese postmenopausal women, highlighting variations across socioeconomic status (SES) stratas. Methods Data were from 138,873 Chinese postmenopausal women enrolled in the China Kadoorie Biobank. Reproductive factors evaluated in this study included early age at menarche, early age at menopause, advanced age at first live birth, high parity, history of stillbirth, history of miscarriage or termination, and non-lactation. PAFs were calculated using hazard ratios, estimated using Cox proportional hazard regression, and prevalence of the seven reproductive factors. PAF for each reproductive risk factor and combined PAFs for all factors were estimated in total population and across SES classes. Results Of the 138,873 included participants, 17,042 developed strokes during a median follow-up period of 8.9 years. Across SES classes, the greatest attributable fractions of total stroke cases were observed for high parity among low-SES women (PAF 17.2%, 95% confidence interval [CI] 13.7%, 20.6%), history of miscarriage or termination among medium-SES women (PAF 11.4%, 95% CI 8.2%, 14.5%), and no history of lactation among high-SES women (PAF 3.1%, 95% CI 1.7%, 4.9%). A multiplicatively estimated 20.5% (95% CI 20.4%, 20.5%) and 3.1% (95% CI 1.7%, 4.9%) of stroke cases were attributable to the seven reproductive risk factors in low-SES and high-SES women, respectively. Conclusions A large fraction of stroke cases among Chinese postmenopausal women were associated with reproductive factors. Targeted cardiovascular prevention strategies are warranted among women with different SES to mitigate risks associated with different reproductive profiles.

Background and objectives Coal miners are exposed to a significant risk of anxiety and depression due to challenging work environment. However, there is a lack of studies comprehensively examining the associated factors of anxiety and depressive symptoms among coal miners. Our study aimed to identify these associated factors among Chinese coal miners in Shanxi Province. Methods In August and September 2022, a cross-sectional study was conducted using a cluster sampling method to enroll all workers from the L coal mines in Linfen City, China. Data were collected using a self-designed and administered online questionnaire, which included the Generalized Anxiety Disorder-7 (GAD-7) and the Center for Epidemiologic Studies Depression Scale 10-item (CESD-10) to assess anxiety and depressive symptoms, along with questions on sociodemographics, work-related factors, health status, and lifestyle factors. Logistic regression was used to identify associated factors for anxiety and depressive symptoms. Sensitivity analysis was conducted using linear regression. Results A total of 1,027 participants were included in the analysis. Among them, 278 (27.07%) exhibited anxiety symptoms, and 238 (23.17%) showed depressive symptoms. In the multivariable logistic regression, associated factors identified for both anxiety and depressive symptoms included having direct or indirect safety accident experience (adjusted odds ratio [aOR] for anxiety: 1.76, 95% confidence interval [CI]: 1.29 ~ 2.40; aOR for depression: 1.72, 95% CI: 1.25 ~ 2.38), presence of occupational diseases (aOR for anxiety: 4.00, 95% CI: 1.51 ~ 11.10; aOR for depression: 3.36, 95% CI: 1.25 ~ 9.23), self-reported non-optimal health status (aOR for anxiety: 1.68, 95% CI: 1.19 ~ 2.37; aOR for depression: 2.01, 95% CI: 1.41 ~ 2.85), current alcohol consumption (aOR for anxiety: 1.83, 95% CI: 1.27 ~ 2.66; aOR for depression: 1.64, 95% CI: 1.12 ~ 2.41), and sleep duration of less than 7 hours (aOR for anxiety: 1.84, 1.36 ~ 2.50; aOR for depression: 1.71, 95% CI: 1.25 ~ 2.36). In addition, working in a management position (aOR: 1.99, 95% CI: 1.02 ~ 3.96) was positively associated with anxiety symptoms. Conclusions Our study identified key factors associated with anxiety and depressive symptoms among Chinese coal miners. Management was more likely to experience anxiety symptoms. These findings underscore the need for targeted mental health interventions within the coal mining industry to improve their well-being.

Background Adverse Childhood Experiences (ACEs) have been implicated in the development of body pain, yet research on their impact on body pain and its progression remains scarce. This study aimed to examine the associations between ACEs and the presence and areas of body pain, as well as their developmental trajectories among middle-aged and older Chinese adults. Methods We included participants aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. Retrospective data on ACEs and pain sites were collected with questionnaires. The presence of pain at different body sites was categorized into three areas: head & neck, trunk, and limbs. ACEs consisted of ten types of adverse experiences and were cumulatively scored. For the cross-sectional analysis (2011), logistic regressions were performed to estimate the associations between ACEs and pain presence in specific areas. In the longitudinal analysis (2011–2018), we further applied group-based trajectory modelling (GBTM) to determine the developmental trajectories of body pain. Multinomial logistic regressions were then conducted to estimate the associations between ACEs and pain trajectories. Results In the cross-sectional analysis ( n  = 8157), ACEs were positively associated with the presence of pain in the head & neck (odds ratio [OR] = 3.55, 95% confidence intervals [CI] = 2.37–4.74), trunk (OR = 3.28, 95% CI = 2.47–4.34), and limbs areas (OR = 2.30, 95% CI = 1.77-3.00) compared to no ACEs. These associations varied by sex and residence. In the longitudinal analysis ( n  = 5188), GBTM identified three developmental trajectories of body pain ( n  = 9521): high-increasing (7.44%), low-moderate (33.67%) and maintained-low trajectories (58.89%) trajectories. Compared to participants without ACEs, individuals had three ACEs and 4 or more ACEs were consistently associated with low-moderate (three ACEs: OR = 2.26, 95% CI = 1.81–2.83, four or more ACEs: OR = 3.11, 95% CI = 2.51–3.87) and high-increasing (three ACEs: OR = 3.28, 95% CI = 2.03–5.30, four or more ACEs: OR = 6.78, 95% CI = 4.30-10.68) body pain trajectories across sexes and residence. Conclusion This study highlighted the significant association between ACEs and body pain among middle-aged and older Chinese, emphasizing the importance of preventing or mitigating ACEs as a strategy for the prevention and management of body pain.

Background Bullying is a rising social concern and public health challenge, threatening the mental health of the youth. Existing evidence lacks comprehensive insight into the gender disparities in such association. This cross-sectional study aimed to elucidate the gender differences in the association between bullying victimization and depressive symptoms among children and adolescents. Methods A total of 21,654 fourth-grade and above students were recruited from the annual school-based survey “China Common Disease and Risk Factor Surveillance among Students” in Zhejiang Province, China, conducted in 2021. Six forms of bullying victimization were assessed with a self-administered questionnaire and further categorized into three subtypes, including physical, verbal, and relational bullying victimization. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. A multilevel generalized linear model was employed to analyze the gender-specific association of bullying victimization (in specific forms, subtypes, and cumulative measures) with depressive symptoms. Gender differences were tested by the girls-to-boys ratios of odds ratios (RORs) and the 95% confidential intervals (CIs). Results The median age of recruited children and adolescents was 15.07 years. All specific forms of bullying victimization were significantly associated with increased odds of depressive symptoms. Girls who were mocked or teased (ROR = 1.27, 95% CI = 1.05–1.56), body-shamed (ROR = 1.39, 95% CI = 1.05–1.85) and experienced the subtype of verbal bullying (ROR = 1.22, 95% CI = 1.01–1.46) exhibited greater depressive symptoms than boys. Concerning cumulative effects, girls who experienced two or more forms of bullying victimization (ROR = 1.42, 95% CI = 1.09–1.84), all three subtypes of bullying victimization (ROR = 1.89, 95% CI = 1.10–3.24) had more prominently increased odds of depressive symptoms than boys. Conclusions Bullied girls exhibited a higher susceptibility to depressive symptoms than boys with the same experience, especially when exposed to multiple bullying incidents. These findings underscore the need for developing gender-specific strategies to protect children from bullying, with an emphasis on safeguarding girls.

Aims/Introduction The cardiometabolic index (CMI) has been proposed as a novel indicator of cardiometabolic status. This study aimed to investigate the effects of CMI and its longitudinal transitions on the development of type 2 diabetes mellitus in middle‐aged and older Chinese. Materials and Methods We used data from the China Health and Retirement Longitudinal Study (2011–2018). CMI was calculated as the product of the waist circumference to height ratio and the triglyceride to high‐density lipoprotein cholesterol ratio. At baseline in 2011, the subjects were classified into low‐ and high‐CMI groups, and then divided into four transition patterns during follow‐up, i.e. maintained‐low, low‐to‐high, high‐to‐low, and maintained‐high CMI. The hazard ratios (HRs) of different transition patterns for type 2 diabetes mellitus were calculated using multivariable Cox frailty models. Results During 2011–2018, 7,347 participants were included. Participants with a high‐CMI at baseline had a significantly higher risk of new‐onset type 2 diabetes mellitus than those with a low‐CMI (HR = 1.78, 95% CI:1.55–2.05). For subjects with a low‐CMI at baseline, the risk of developing type 2 diabetes mellitus increased by 75% if their CMI status changed to high during follow‐up (HRlow‐to‐high = 1.75, 95% CI:1.35–2.28). Meanwhile, for subjects with a maintained‐high CMI, no significant risk reduction for type 2 diabetes mellitus was found when their CMI changed to low status (HRhigh‐to‐low = 0.77, 95% CI: 0.58–1.01). Conclusions Baseline CMI levels and longitudinal CMI transition patterns were associated with a higher risk of type 2 diabetes mellitus. Early anti‐lipid measures should be taken to prevent type 2 diabetes mellitus in middle‐aged and older Chinese. Our study demonstrated that high CMI was a detrimental factor of new‐onset type 2 diabetes mellitus. Additionally, there were significant associations between transitions of CMI status and type 2 diabetes mellitus. For better prevention of type 2 diabetes mellitus, health workers should devote more attention to the general healthy population, and take measures to prevent their CMI progressing from low to high levels. The value of CMI as a reliable and efficient indicator of the early prevention of type 2 diabetes mellitus should be further investigated.

General and central obesity are suggested to be associated with elevated blood pressure (BP), whereas few studies have investigated their combined associations with hypertension in children. This study aimed to assess the associations of combinations of general obesity and central obesity with hypertension in Chinese children, including its stages and phenotypes. A total of 5430 children aged 7–17 years in Zhejiang Province were enrolled. General obesity was evaluated by body mass index (BMI), while central obesity was by waist circumference (WC). Then all children were sorted into three mutually exclusive groups: normal weight with or with no central obesity (NW), abnormal weight with no central obesity (AWNCO), and abnormal weight with central obesity (AWCO). Hypertension was defined as either a systolic or diastolic BP ≥ 95th percentile, and further classified into stage 1 hypertension, stage 2 hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH). Logistic regression was used. AWNCO and AWCO were associated with stage 1 hypertension (AWNCO, odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.59‐2.37; AWCO, 2.67, 2.20‐3.25), stage 2 hypertension (AWNCO, 2.35, 1.33‐4.13; AWCO, 4.53, 2.79‐7.37), ISH (AWNCO, 2.50, 1.96‐3.18; AWCO, 3.95, 3.15‐4.95), and SDH (AWNCO, 2.48, 1.75‐3.52; AWCO, 2.78, 1.94‐3.99). Children with AWCO were more likely to have stage 1 and stage 2 hypertension, as well as ISH and SDH. The combined measurement of general and central obesity is suggested as an appropriate screening tool for hypertension among children and adolescents.