To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of ment...To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of mental health systems internationally.展开更多
This paper reviews the progress of population geography in China since the 1980 s. The review results suggest that contrary to the common perception of its invisibility and marginalized status in the field, tremendous...This paper reviews the progress of population geography in China since the 1980 s. The review results suggest that contrary to the common perception of its invisibility and marginalized status in the field, tremendous progress has been made in population geography in China since the 1980 s. Population geographers have made significant contribution to the understanding of a wide range of population issues from geographical perspectives, including migration, urbanization, population distribution, the relationships between population, environment and resources, aging, marriage patterns, and migrants＇ crimes, although such contribution often did not appear in the geographical circle. Furthermore, population geographers have played an indispensable role in revitalizing population studies in China and forging its links to human geography, occupying an important position in this multi-disciplinary field. Population geographers＇ contribution to the areas of migration and urbanization research has been particularly significant, reflected in their leading roles in these areas＇ research. The paper demonstrates that as latecomers in the field after more than 20 years of isolation, population geographers in China have gone through a process of catching up and increasing engagement with developments in social sciences and increasing interaction with social scientists since the 1980 s, and have benefited greatly from it; however, there is a tendency for population geography to be increasingly alienated from the main stream human geography, a phenomenon similar to but not exactly the same as Anglo-American geography in the late 1990 s and early 2000 s. The paper argues that population geography is only half way in the course to forge the links between population studies and human geography, and it needs to return to geographical sciences to strike a healthy balance between the field of population studies and that of human geography, and promote its further development in a multi-disciplinary field.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
China is faced with a decreasing labor supply and therefore is losing its cost advantage.However,benefiting from continuous improvement of population quality,China's population quality-based demographic dividend b...China is faced with a decreasing labor supply and therefore is losing its cost advantage.However,benefiting from continuous improvement of population quality,China's population quality-based demographic dividend begins to replace the quantity-based dividend to play a dominant role in economic development.Thus,in supply-side structure,rather than essential factors,it paves the way for the sustainable development of the Chinese economy.With the addition of the successful industrial transformation and upgrading,China still has the advantage to overcome the middle income trap and maintain the momentum of economic growth.展开更多
Atrial fibrillation （AF） is the most common arrhythmia diagnosed in clinical practice. The consequences of AF have been clearly estab- lished in multiple large observational cohort studies and include increased stro...Atrial fibrillation （AF） is the most common arrhythmia diagnosed in clinical practice. The consequences of AF have been clearly estab- lished in multiple large observational cohort studies and include increased stroke and systemic embolism rates if no oral anticoagulation is prescribed, with increased morbidity and mortality. With the worldwide aging of the population characterized by a large influx of ＂baby boomers＂ with or without risk factors for developing AF, an epidemic is forecasted within the next 10 to 20 years. Although not all studies support this evidence, it is clear that AF is on the rise and a significant amount of health resources are invested in detecting and managing AF This review focuses on the worldwide burden of AF and reviews global health strategies focused on improving detection, prevention and risk stratification of AF, recently recommended by the World Heart Federation.展开更多
Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought ...Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.展开更多
Context: Experimental and epidemiological data suggest that vitamin E supplementation may prevent cancer and cardiovascular events. Clinical trials have generally failed to confirm benefits, possibly due to their rela...Context: Experimental and epidemiological data suggest that vitamin E supplementation may prevent cancer and cardiovascular events. Clinical trials have generally failed to confirm benefits, possibly due to their relatively short duration. Objective: To evaluate whether long-term supplementation with vitamin E decreases the risk of cancer, cancer death, and major cardiovascular events. Design, Setting, and Patients: A randomized, double-blind, placebo-controlled international trial(the initial Heart Outcomes Prevention Evaluation[HOPE] trial conducted between December 21, 1993, and April 15,1999) of patients at least 55 years old with vascular disease or diabetes mellitus was extended(HOPE-The Ongoing Outcomes[HOPE-TOO]) between April 16,1999, and May 26, 2003. Of the initial 267 HOPE centers that had enrolled 9541 patients, 174 centers participated in the HOPE-TOO trial. Of 7030 patients enrolled at these centers, 916 were deceased at the beginning of the extension, 1382 refused participation, 3994 continued to take the study intervention, and 738 agreed to passive follow-up. Median duration of follow-up was 7.0 years. Intervention: Daily dose of natural source vitamin E(400 IU) or matching placebo. Main Outcome Measures: Primary outcomes included cancer incidence, cancer deaths, and major cardiovascular events(myocardial infarction, stroke, and cardiovascular death). Secondary outcomes included heart failure, unstable angina, and revascularizations. Results: Among all HOPE patients, there were no significant differences in the primary analysis: for cancer incidence, there were 552 patients(11.6%) in the vitamin E group vs 586(12.3%) in the placebo group(relative risk[RR], 0.94; 95%confidence interval[CI], 0.84-1.06; P=.30); for cancer deaths, 156(3.3%) vs 178(3.7%), respectively(RR, 0.88; 95%CI, 0.71-1.09; P=.24); and for major cardiovascular events, 1022(21.5%) vs 985(20.6%), respectively(RR, 1.04; 95%CI, 0.96-1.14; P=.34). Patients in the vitamin E group had a higher risk of heart failure(RR, 1.13; 95%CI, 1.01-1.26; P=.03) and hospitalization for heart failure(RR, 1.21; 95%CI, 1.00-1,47; P=.045). Similarly, among patients enrolled at the centers participating in the HOPE-TOO trial, there were no differences in cancer incidence, cancer deaths, and major cardiovascular events, but higher rates of heart failure and hospitalizations for heart failure. Conclusion: In patients with vascular disease or diabetes mellitus, longterm vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase the risk for heart failure.展开更多
BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether s...BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODS: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. RESULTS: Mean plasma homocysteine levels decreased by 2.4 μmol per liter(0.3 mg per liter) in the active-treatment group and increased by 0.8 μmol per liter(0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients(18.8 percent) assigned to active therapy and 547(19.8 percent) assigned to placebo(relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes(relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction(relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke(relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina(relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUSIONS: Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease.展开更多
BACKGROUND: The combined use of anticoagulants, antiplatelet agents, and invasive coronary procedures reduces ischemic coronary events but also increases bleeding in patients with acute coronary syndromes. We therefor...BACKGROUND: The combined use of anticoagulants, antiplatelet agents, and invasive coronary procedures reduces ischemic coronary events but also increases bleeding in patients with acute coronary syndromes. We therefore assessed whether fondaparinux would preserve the anti-ischemic benefits of enoxaparin while reducing bleeding. METHODS: We randomly assigned 20,078 patients with acute coronary syndromes to receive either fondaparinux(2.5 mg daily) or enoxaparin(1 mg per kilogram of body weight twice daily) for a mean of six days and evaluated death, myocardial infarction, or refractory ischemia at nine days(the primary outcome); major bleeding; and their combination. Patients were followed for up to six months. RESULTS: The number of patients with primary outcome events was similar in the two groups(579 with fondaparinux[5.8 percent] vs. 573 with enoxaparin[5.7 percent]; hazard ratio in the fondaparinux group, 1.01; 95 percent confidence interval, 0.90 to 1.13), satisfying the noninferiority criteria. The number of events meeting this combined outcome showed a nonsignificant trend toward a lower value in the fondaparinux group at 30 days(805 vs. 864, P=0.13) and at the end of the study(1222 vs. 1308, P=0.06). The rate of major bleeding at nine days was markedly lower with fondaparinux than with enoxaparin(217 events[2.2 percent] vs. 412 events[4.1 percent]; hazard ratio, 0.52; P< 0.001). The composite of the primary outcome and major bleeding at nine days favored fondaparinux(737 events[7.3 percent] vs. 905 events[9.0 percent]; hazard ratio, 0.81; P< 0.001). Fondaparinux was associated with a significantly reduced number of deaths at 30 days(295 vs. 352, P=0.02) and at 180 days(574 vs. 638, P=0.05). CONCLUSIONS: Fondaparinux is similar to enoxaparin in reducing the risk of ischemic events at nine days, but it substantially reduces major bleeding and improves long term mortality and morbidity.展开更多
Based on the Chinese longitudinal healthy longevity survey conducted in 2002, this paper uses hierarchical linear model (HLM) to make an approach to the possible determinants of activities of daily living (ADL) of Chi...Based on the Chinese longitudinal healthy longevity survey conducted in 2002, this paper uses hierarchical linear model (HLM) to make an approach to the possible determinants of activities of daily living (ADL) of Chinese oldest old (aged 80 and above) by combining both individual and provincial level factors. The descriptive analysis shows that there is a great differ- ential in ADL by province among Chinese oldest old. The findings turn out that there does exist a significant differential in ADL between oldest old and young old, and that there is also a great differential in ADL by province among Chinese oldest old. The HLM demonstrates that comorbidity, age, cognitive impairment, visual impairment, and emotion could be the most important indi- vidual factors while natural environment, medical facilities, type of staple food and poverty rate in urban areas are the most sig- nificantly regional determinants of ADL of oldest old. The find- ings imply that future actions should not only be taken at individ- ual level, but also at regional level in order to achieve the goal of a healthy aging society in China.展开更多
This thesis analyzes the change of labor resources distribution in the whole country and the effect of financial crisis on the labor force by use of employment population size,investment scale and the relevant data of...This thesis analyzes the change of labor resources distribution in the whole country and the effect of financial crisis on the labor force by use of employment population size,investment scale and the relevant data of GDP scale from different provinces in China.The optimal investment model of labor force is built according to the Marginal Product Elasticity Theory to estimate the quantity of surplus labor force in provinces and cities in China.It also analyzes the effect of investment on the labor force migration according to Capital-Labor Force Flow Model of Thomas B.The study shows that there is no shortage of labor resources in our country;the labor resources distribution in eastern regions is close to the optimization;the largescale surplus labor force still exist in central and western regions;western regions will become the regions with the largest number of surplus labor resources instead of central regions.展开更多
With the aging of population,the academic researches tend to focus on the size,structure,quality of the labor forces.This article,based on the data of 2012 CLDS,describes demographically the employment status of China...With the aging of population,the academic researches tend to focus on the size,structure,quality of the labor forces.This article,based on the data of 2012 CLDS,describes demographically the employment status of China’s labor force by fourtypes:employee,employer,selfemployed and farming and analyzesthe variations in the indicators of the 4 types employment status,such a shuman capital,working hours,worksites,in come,social security,job evaluation and work values and identity of social class,etc.Understanding these variations is a great significance to the proper labor policy-making.展开更多
The following article has been retracted due to the investigation of complaints received against it. The Editorial Board found that substantial portions of the text came from other published papers. The scientific com...The following article has been retracted due to the investigation of complaints received against it. The Editorial Board found that substantial portions of the text came from other published papers. The scientific community takes a very strong view on this matter, and the Health treats all unethical behavior such as plagiarism seriously. This paper published in Vol.3 No. 3,102-110?pages, 2013, has been removed from this site.展开更多
Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains un...Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to RYGB.In contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.展开更多
Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these...Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.展开更多
Context: Although reperfusion therapy, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors reduce mortality when used early in patients with acute myocardial infarction(MI), mortality and morbidity rema...Context: Although reperfusion therapy, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors reduce mortality when used early in patients with acute myocardial infarction(MI), mortality and morbidity remain high. No antithrombotic or newer antiplatelet drug has been shown to reduce mortality in acute MI. Objective: To evaluate the effects of reviparin, a low-molecular-weight heparin, when initiated early and given for 7 days in addition to usual therapy on the primary composite outcome of death,myocardial reinfarction, or strokes at 7 and 30 days. Design, Setting, and Patients: A randomized, doubleblind, placebo-controlled trial(Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation [CREATE]) of 15570 patients with ST-segment elevation or new left bundle-branch block, presenting within 12 hours of symptom onset at 341 hospitals in India and China from July 2001 through July 2004. Intervention: Reviparin or placebo subcutaneously twice daily for 7 days. Main Outcome Measure: Primary composite outcome of death, myocardial reinfarction, or stroke at 7 and 30 days. Results: The primary composite outcome was significantly reduced from 854(11.0%) of 7790 patients in the placebo group to 745(9.6%) of 7780 in the reviparin group(hazard ratio [HR], 0.87; 95%CI, 0.79-0.96; P=.005). These benefits persisted at 30 days(1056 [13.6%] vs 921 [11.8%] patients; HR, 0.87; 95%CI, 0.79-0.95; P=.001) with significant reductions in 30-day mortality(877 [11.3%] vs 766 [9.8%]; HR, 0.87; 95%CI, 0.79-0.96; P=.005) and reinfarction(199 [2.6%] vs 154 [2.0%]; HR, 0.77; 95%CI, 0.62-0.95; P=.01), and no significant differences in strokes(64 [0.8%] vs 80 [1.0%]; P=.19). Reviparin treatment was significantly better when it was initiated very early after symptom onset at 7 days(< 2 hours: HR, 0.70; 95%CI, 0.52-0.96; P=.03; 30/1000 events prevented; 2 to< 4 hours: HR, 0.81; 95%CI, 0.67-0.98; P=.03; 21/1000 events prevented; 4 to< 8 hours: HR, 0.85; 95%CI, 0.73-0.99; P=.05; 16/1000 events prevented; and ≥8 hours:HR,1.06; 95%CI, 0.86-1.30; P=.58; P=.04 for trend). There was an increase in lifethreatening bleeding at 7 days with reviparin and placebo(17 [0.2%] vs 7 [0.1%], respectively; P=.07), but the absolute excess was small(1 more per 1000) vs reductions in the primary outcome(18 fewer per 1000) or mortality(15 fewer per 1000). Conclusions: In patients with acute ST-segment elevation or new left bundle-branch block MI, reviparin reduces mortality and reinfarction, without a substantive increase in overall stroke rates. There is a small absolute excess of life-threatening bleeding but the benefits outweigh the risks.展开更多
背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月...背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月至2003年3月间纳入研究对象，包括来自5个南亚国家15所医学中心的1732例首发AMI患者和2204例年龄、性别匹配的对照者，以及来自其他国家的10728例患者和12431例对照者。主要观察指标：AMI与危险因素的关系。结果：南亚首发AMI患者的平均年龄低于其他国家（53．0±11．4岁 vs 58．8±12．2岁；P〈0．001）。展开更多
基金funded by National Institute for Health Research(NIHR)(RP-PG-1212-20019)。
文摘To the editor:Peer workers-people with personal experiences of using mental health services,trained to provide support to others currently using similar services--are increasingly integrated into the workforce of mental health systems internationally.
基金National Natural Science Foundation of China,No.41471132,No.41501163
文摘This paper reviews the progress of population geography in China since the 1980 s. The review results suggest that contrary to the common perception of its invisibility and marginalized status in the field, tremendous progress has been made in population geography in China since the 1980 s. Population geographers have made significant contribution to the understanding of a wide range of population issues from geographical perspectives, including migration, urbanization, population distribution, the relationships between population, environment and resources, aging, marriage patterns, and migrants＇ crimes, although such contribution often did not appear in the geographical circle. Furthermore, population geographers have played an indispensable role in revitalizing population studies in China and forging its links to human geography, occupying an important position in this multi-disciplinary field. Population geographers＇ contribution to the areas of migration and urbanization research has been particularly significant, reflected in their leading roles in these areas＇ research. The paper demonstrates that as latecomers in the field after more than 20 years of isolation, population geographers in China have gone through a process of catching up and increasing engagement with developments in social sciences and increasing interaction with social scientists since the 1980 s, and have benefited greatly from it; however, there is a tendency for population geography to be increasingly alienated from the main stream human geography, a phenomenon similar to but not exactly the same as Anglo-American geography in the late 1990 s and early 2000 s. The paper argues that population geography is only half way in the course to forge the links between population studies and human geography, and it needs to return to geographical sciences to strike a healthy balance between the field of population studies and that of human geography, and promote its further development in a multi-disciplinary field.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
文摘China is faced with a decreasing labor supply and therefore is losing its cost advantage.However,benefiting from continuous improvement of population quality,China's population quality-based demographic dividend begins to replace the quantity-based dividend to play a dominant role in economic development.Thus,in supply-side structure,rather than essential factors,it paves the way for the sustainable development of the Chinese economy.With the addition of the successful industrial transformation and upgrading,China still has the advantage to overcome the middle income trap and maintain the momentum of economic growth.
文摘Atrial fibrillation （AF） is the most common arrhythmia diagnosed in clinical practice. The consequences of AF have been clearly estab- lished in multiple large observational cohort studies and include increased stroke and systemic embolism rates if no oral anticoagulation is prescribed, with increased morbidity and mortality. With the worldwide aging of the population characterized by a large influx of ＂baby boomers＂ with or without risk factors for developing AF, an epidemic is forecasted within the next 10 to 20 years. Although not all studies support this evidence, it is clear that AF is on the rise and a significant amount of health resources are invested in detecting and managing AF This review focuses on the worldwide burden of AF and reviews global health strategies focused on improving detection, prevention and risk stratification of AF, recently recommended by the World Heart Federation.
文摘Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.
文摘Context: Experimental and epidemiological data suggest that vitamin E supplementation may prevent cancer and cardiovascular events. Clinical trials have generally failed to confirm benefits, possibly due to their relatively short duration. Objective: To evaluate whether long-term supplementation with vitamin E decreases the risk of cancer, cancer death, and major cardiovascular events. Design, Setting, and Patients: A randomized, double-blind, placebo-controlled international trial(the initial Heart Outcomes Prevention Evaluation[HOPE] trial conducted between December 21, 1993, and April 15,1999) of patients at least 55 years old with vascular disease or diabetes mellitus was extended(HOPE-The Ongoing Outcomes[HOPE-TOO]) between April 16,1999, and May 26, 2003. Of the initial 267 HOPE centers that had enrolled 9541 patients, 174 centers participated in the HOPE-TOO trial. Of 7030 patients enrolled at these centers, 916 were deceased at the beginning of the extension, 1382 refused participation, 3994 continued to take the study intervention, and 738 agreed to passive follow-up. Median duration of follow-up was 7.0 years. Intervention: Daily dose of natural source vitamin E(400 IU) or matching placebo. Main Outcome Measures: Primary outcomes included cancer incidence, cancer deaths, and major cardiovascular events(myocardial infarction, stroke, and cardiovascular death). Secondary outcomes included heart failure, unstable angina, and revascularizations. Results: Among all HOPE patients, there were no significant differences in the primary analysis: for cancer incidence, there were 552 patients(11.6%) in the vitamin E group vs 586(12.3%) in the placebo group(relative risk[RR], 0.94; 95%confidence interval[CI], 0.84-1.06; P=.30); for cancer deaths, 156(3.3%) vs 178(3.7%), respectively(RR, 0.88; 95%CI, 0.71-1.09; P=.24); and for major cardiovascular events, 1022(21.5%) vs 985(20.6%), respectively(RR, 1.04; 95%CI, 0.96-1.14; P=.34). Patients in the vitamin E group had a higher risk of heart failure(RR, 1.13; 95%CI, 1.01-1.26; P=.03) and hospitalization for heart failure(RR, 1.21; 95%CI, 1.00-1,47; P=.045). Similarly, among patients enrolled at the centers participating in the HOPE-TOO trial, there were no differences in cancer incidence, cancer deaths, and major cardiovascular events, but higher rates of heart failure and hospitalizations for heart failure. Conclusion: In patients with vascular disease or diabetes mellitus, longterm vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase the risk for heart failure.
文摘BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODS: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. RESULTS: Mean plasma homocysteine levels decreased by 2.4 μmol per liter(0.3 mg per liter) in the active-treatment group and increased by 0.8 μmol per liter(0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients(18.8 percent) assigned to active therapy and 547(19.8 percent) assigned to placebo(relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes(relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction(relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke(relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina(relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUSIONS: Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease.
文摘BACKGROUND: The combined use of anticoagulants, antiplatelet agents, and invasive coronary procedures reduces ischemic coronary events but also increases bleeding in patients with acute coronary syndromes. We therefore assessed whether fondaparinux would preserve the anti-ischemic benefits of enoxaparin while reducing bleeding. METHODS: We randomly assigned 20,078 patients with acute coronary syndromes to receive either fondaparinux(2.5 mg daily) or enoxaparin(1 mg per kilogram of body weight twice daily) for a mean of six days and evaluated death, myocardial infarction, or refractory ischemia at nine days(the primary outcome); major bleeding; and their combination. Patients were followed for up to six months. RESULTS: The number of patients with primary outcome events was similar in the two groups(579 with fondaparinux[5.8 percent] vs. 573 with enoxaparin[5.7 percent]; hazard ratio in the fondaparinux group, 1.01; 95 percent confidence interval, 0.90 to 1.13), satisfying the noninferiority criteria. The number of events meeting this combined outcome showed a nonsignificant trend toward a lower value in the fondaparinux group at 30 days(805 vs. 864, P=0.13) and at the end of the study(1222 vs. 1308, P=0.06). The rate of major bleeding at nine days was markedly lower with fondaparinux than with enoxaparin(217 events[2.2 percent] vs. 412 events[4.1 percent]; hazard ratio, 0.52; P< 0.001). The composite of the primary outcome and major bleeding at nine days favored fondaparinux(737 events[7.3 percent] vs. 905 events[9.0 percent]; hazard ratio, 0.81; P< 0.001). Fondaparinux was associated with a significantly reduced number of deaths at 30 days(295 vs. 352, P=0.02) and at 180 days(574 vs. 638, P=0.05). CONCLUSIONS: Fondaparinux is similar to enoxaparin in reducing the risk of ischemic events at nine days, but it substantially reduces major bleeding and improves long term mortality and morbidity.
文摘Based on the Chinese longitudinal healthy longevity survey conducted in 2002, this paper uses hierarchical linear model (HLM) to make an approach to the possible determinants of activities of daily living (ADL) of Chinese oldest old (aged 80 and above) by combining both individual and provincial level factors. The descriptive analysis shows that there is a great differ- ential in ADL by province among Chinese oldest old. The findings turn out that there does exist a significant differential in ADL between oldest old and young old, and that there is also a great differential in ADL by province among Chinese oldest old. The HLM demonstrates that comorbidity, age, cognitive impairment, visual impairment, and emotion could be the most important indi- vidual factors while natural environment, medical facilities, type of staple food and poverty rate in urban areas are the most sig- nificantly regional determinants of ADL of oldest old. The find- ings imply that future actions should not only be taken at individ- ual level, but also at regional level in order to achieve the goal of a healthy aging society in China.
文摘This thesis analyzes the change of labor resources distribution in the whole country and the effect of financial crisis on the labor force by use of employment population size,investment scale and the relevant data of GDP scale from different provinces in China.The optimal investment model of labor force is built according to the Marginal Product Elasticity Theory to estimate the quantity of surplus labor force in provinces and cities in China.It also analyzes the effect of investment on the labor force migration according to Capital-Labor Force Flow Model of Thomas B.The study shows that there is no shortage of labor resources in our country;the labor resources distribution in eastern regions is close to the optimization;the largescale surplus labor force still exist in central and western regions;western regions will become the regions with the largest number of surplus labor resources instead of central regions.
文摘With the aging of population,the academic researches tend to focus on the size,structure,quality of the labor forces.This article,based on the data of 2012 CLDS,describes demographically the employment status of China’s labor force by fourtypes:employee,employer,selfemployed and farming and analyzesthe variations in the indicators of the 4 types employment status,such a shuman capital,working hours,worksites,in come,social security,job evaluation and work values and identity of social class,etc.Understanding these variations is a great significance to the proper labor policy-making.
文摘The following article has been retracted due to the investigation of complaints received against it. The Editorial Board found that substantial portions of the text came from other published papers. The scientific community takes a very strong view on this matter, and the Health treats all unethical behavior such as plagiarism seriously. This paper published in Vol.3 No. 3,102-110?pages, 2013, has been removed from this site.
基金The study was pre-registered with the Prospective Register of Systematic Reviews,PROSPERO identification code:CRD42018090367.
文摘Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to RYGB.In contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.
文摘Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.
文摘Context: Although reperfusion therapy, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors reduce mortality when used early in patients with acute myocardial infarction(MI), mortality and morbidity remain high. No antithrombotic or newer antiplatelet drug has been shown to reduce mortality in acute MI. Objective: To evaluate the effects of reviparin, a low-molecular-weight heparin, when initiated early and given for 7 days in addition to usual therapy on the primary composite outcome of death,myocardial reinfarction, or strokes at 7 and 30 days. Design, Setting, and Patients: A randomized, doubleblind, placebo-controlled trial(Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation [CREATE]) of 15570 patients with ST-segment elevation or new left bundle-branch block, presenting within 12 hours of symptom onset at 341 hospitals in India and China from July 2001 through July 2004. Intervention: Reviparin or placebo subcutaneously twice daily for 7 days. Main Outcome Measure: Primary composite outcome of death, myocardial reinfarction, or stroke at 7 and 30 days. Results: The primary composite outcome was significantly reduced from 854(11.0%) of 7790 patients in the placebo group to 745(9.6%) of 7780 in the reviparin group(hazard ratio [HR], 0.87; 95%CI, 0.79-0.96; P=.005). These benefits persisted at 30 days(1056 [13.6%] vs 921 [11.8%] patients; HR, 0.87; 95%CI, 0.79-0.95; P=.001) with significant reductions in 30-day mortality(877 [11.3%] vs 766 [9.8%]; HR, 0.87; 95%CI, 0.79-0.96; P=.005) and reinfarction(199 [2.6%] vs 154 [2.0%]; HR, 0.77; 95%CI, 0.62-0.95; P=.01), and no significant differences in strokes(64 [0.8%] vs 80 [1.0%]; P=.19). Reviparin treatment was significantly better when it was initiated very early after symptom onset at 7 days(< 2 hours: HR, 0.70; 95%CI, 0.52-0.96; P=.03; 30/1000 events prevented; 2 to< 4 hours: HR, 0.81; 95%CI, 0.67-0.98; P=.03; 21/1000 events prevented; 4 to< 8 hours: HR, 0.85; 95%CI, 0.73-0.99; P=.05; 16/1000 events prevented; and ≥8 hours:HR,1.06; 95%CI, 0.86-1.30; P=.58; P=.04 for trend). There was an increase in lifethreatening bleeding at 7 days with reviparin and placebo(17 [0.2%] vs 7 [0.1%], respectively; P=.07), but the absolute excess was small(1 more per 1000) vs reductions in the primary outcome(18 fewer per 1000) or mortality(15 fewer per 1000). Conclusions: In patients with acute ST-segment elevation or new left bundle-branch block MI, reviparin reduces mortality and reinfarction, without a substantive increase in overall stroke rates. There is a small absolute excess of life-threatening bleeding but the benefits outweigh the risks.
文摘背景：南亚人中年轻时急性心肌梗死（AMI）的发生率高于其他国家个体，但原因不明。目的：评价并比较南亚本地人和来自其他国家的个体中危险因素与AMI的关系，尤其关注较年轻AMI。设计、地点和参与者：此标准化病例对照研究于1999年2月至2003年3月间纳入研究对象，包括来自5个南亚国家15所医学中心的1732例首发AMI患者和2204例年龄、性别匹配的对照者，以及来自其他国家的10728例患者和12431例对照者。主要观察指标：AMI与危险因素的关系。结果：南亚首发AMI患者的平均年龄低于其他国家（53．0±11．4岁 vs 58．8±12．2岁；P〈0．001）。
