Several studies have shown that athletic retirement can lead athletes to experience identity disruption, or in narrative terms, to 'narrative wreckage'. However, less is known about processes that support adaptive changes in athletes' narrative identities. This study uses Career Construction Theory, a narrative approach to career development, to examine how individuals' construct a continuous sense of self during the transition out of elite athletic careers. Sixteen Swiss elite athletes (eight women, eight men), representing both winter and summer sports, participated in narrative interviews within three months of announcing their athletic retirement. The data were analysed through a three-phase thematic narrative analysis. We identified five higher-order life themes (strive, autonomy, contribution to the collective, contentment and self-discovery) that unified and added meaning to athletes' stories about their careers. Importantly, in the final phases of analysis, we observed that all participants' stories involved a life theme change which informed the decision to retire and proactively began the process of narrative adaption. These changes were shaped via the three types of character arcs that we identified across the dataset that described how athletes' goals and motives evolved throughout their careers and ultimately explained why retirement provided continuity in their narratives despite objective change. The three character arc types (Maverick, Ember and Merrit) are conveyed through composite vignettes to enrich the findings. We discuss the implications of our findings for narrative career counselling for retiring athletes and processes that support identity continuity in athletic retirement.
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Cognitive impairment among older adults poses a substantial and growing public health burden. Despite established links between SES and cognition, the psychosocial pathways and their variation across national contexts remain unclear. This study examines the relationship between SES and cognitive function in middle-aged and older adults, and explores the mediating roles of social activity and loneliness in this association. Using data from the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS) in the United States and the English Longitudinal Study of Ageing (ELSA), we analyzed participants aged ≥ 50. SES was derived from latent class analysis of family income, educational level, and employment status. Cognitive function was assessed through standardized tests. Linear mixed models evaluated SES-cognition associations, and mediation analyses explored potential associative pathways. Higher SES was significantly associated with better cognitive function in all cohort studies, with the strength of the association varying cross-nationally: strongest in CHARLS (β = 0.21, 95% CI: 0.16-0.26), intermediate in HRS (β = 0.14, 0.11-0.17), and weakest in ELSA (β = 0.031, 0.003-0.058). Social activities mediated 7.28% to 12.08%, and loneliness mediated 1.89% to 18.33% of these associations. The relationships remained consistent across the subgroups. Socioeconomic status demonstrated a robust, graded association with cognitive function in older adults, with this relationship partially mediated by social activity involvement and loneliness. The cross-national gradient in effect sizes suggests that macro-level structural and policy contexts may substantially moderate this relationship. These findings highlight the need for integrated interventions addressing both psychosocial mediators and structural determinants to reduce cognitive health disparities.
Stroke remains a leading cause of death and disability worldwide, with abdominal obesity (AO) and insulin resistance (IR) recognized as modifiable risk factors. However, their joint effects and potential mediating relationships with stroke risk remain unclear. This study enrolled 5,537 eligible middle-aged and older Chinese adults from the China Health and Retirement Longitudinal Study (CHARLS). AO was defined on the basis of waist circumference, and cumulative average nontraditional IR parameters were calculated from blood samples collected in 2011 and 2015. Cox proportional hazards models were used to assess adjusted associations, whereas Kaplan-Meier analysis was used to estimate cumulative hazards. Restricted cubic splines evaluated nonlinear relationships between nontraditional IR parameters and stroke risk among AO participants. Subgroup analyses stratified by age, gender, BMI, smoking, drinking, and hypertension were used to assess the interaction effects. Sensitivity analyses were used to examine the robustness of the results. Exploratory mediation analyses were performed, with emphasis on indices not directly incorporating waist circumference to reduce potential mathematical overlap with AO. During a median follow-up of 57.2 months, 490 (8.85%) participants experienced stroke. Participants with both AO and elevated IR indices presented the highest stroke risk (P-trend <0.05). Among AO individuals, CVAI showed the highest AUC for stroke among the nontraditional IR indices (0.591, 95% CI, 0.560-0.622), indicating modest discriminative ability. Nonlinear associations between LAP, TyG-WC, and stroke risk were observed in non-AO individuals, with significant risk increases above thresholds (LAP 0.64; TyG-WC 594.09). Exploratory mediation analyses suggested potential bidirectional pathways, particularly for indices not directly incorporating waist circumference. AO and nontraditional IR parameters jointly contribute to stroke risk. The incorporation of these indices into clinical assessments may increase the accuracy of early stroke prevention strategies and improve risk stratification in middle-aged and older populations.
Stressful life events (SLEs) across the life course have been associated with cognitive decline, but evidence on their cumulative impact and potential modifiers remains limited. We aimed to examine the associations between SLE exposure in childhood, adulthood, or both life stages and cognitive trajectories, and to investigate whether these associations vary by sex and education. We used data from the China Health and Retirement Longitudinal Study, a nationally representative cohort of adults aged ≥45 years. Participants with complete data on SLEs, cognition, and covariates were included (n = 5922). SLEs were retrospectively assessed for childhood and adulthood. Cognitive function was measured using a composite score (range 0-21) across three waves (2011-2015). Linear mixed-effects models examined longitudinal associations, adjusting for sociodemographic factors, health behaviors, and chronic conditions, with interaction analyses for sex and education. Compared with participants reporting no SLEs, cumulative exposure showed the strongest association with cognitive decline (β = -0.52, 95% CI -0.69 to -0.35), followed by childhood-only (β = -0.34, -0.48 to -0.20) and adulthood-only exposure (β = -0.22, -0.37 to -0.07). Sex significantly moderated the associations for childhood and cumulative exposure, with women exhibiting greater cognitive vulnerability. Higher educational attainment attenuated the associations between single-period stress and cognitive decline, with only partial protection observed against cumulative adversity. Cumulative life-course stress is associated with accelerated cognitive decline in Chinese middle-aged and older adults. Women appear more vulnerable to stress-related cognitive effects, whereas higher education confers partial resilience, highlighting the need for sex-sensitive and education-informed prevention strategies.
Cardio-kidney-metabolic (CKM) syndrome progression from early stages (0-3) to stage 4 is a critical clinical threshold with irreversible organ damage, but population-specific associated factors for Chinese adults remain understudied. Traditional adiposity measures lack specificity for visceral adiposity, a key driver of CKM. The Chinese Visceral Adiposity Index (CVAI) is a validated population-specific surrogate for visceral adiposity, and its association with CKM progression is unexplored. A secondary analysis of the prospective China Health and Retirement Longitudinal Study (CHARLS) cohort was conducted, including 3,857 participants with baseline CKM stages 0-3 (2011) and 4-year prospective follow-up (2015). Participants were stratified by CVAI tertiles. Cox proportional hazards regression models were used to assess the risk of CKM stage 4 progression, with stratified analyses for effect modifiers and restricted cubic spline curve fitting for dose-response relationships. Variance Inflation Factor was used to avoid multicollinearity in covariate selection.Comprehensive pre-specified sensitivity analyses were performed to validate the robustness of the core findings. High CVAI (highest tertile, 119.9-261.5) was independently associated with 33% higher CKM progression risk (adjusted HR = 1.33, 95% CI 1.02-1.75, P = 0.038). No statistically significant overall linear or non-linear dose-response relationship was observed between continuous CVAI and CKM progression (P overall = 0.159, P non-linearity = 0.19). Diabetic patients with high CVAI had a nearly threefold higher progression risk (HR = 3.08, 95% CI 1.28-7.43), with a marginally significant synergistic effect. Sensitivity analyses consistently confirmed the robustness of the association between high CVAI and elevated CKM progression risk. CVAI is a population-specific associated factor of CKM progression in Chinese middle-aged and elderly adults, with high value for identifying high-risk subgroups (especially diabetic patients). It can be integrated into clinical practice to guide targeted visceral fat reduction interventions and improve CKM outcomes.
General practice across the European region faces a systemic workforce crisis that threatens patient access to health services as well as the coordination, continuity, and equity of care within European health systems. In this Health Policy paper, we use an analysis of the WHO/Europe-Eurostat-Organisation for Economic Co-operation and Development (OECD) Joint Questionnaire on Non-Monetary Health Care Statistics dataset for 43 countries, evidence from a dedicated research collection, and a rapid review of policy interventions to assess the scale, drivers, and solutions to general practitioner (GP) shortages. Although headcounts have increased since 2010, GP density has stagnated, and effective full-time equivalent capacity has declined due to ageing, early retirement, part-time work, migration, administrative burden, and private-sector competition. We argue that incremental responses are insufficient and propose a coordinated, lifecycle-based strategy spanning training, recruitment, retention, and late-career roles. Key actions include expanded training pathways, improved employment conditions, rural and return-migration incentives, expanded multidisciplinary teams, reduced administrative workload, and full-time equivalent-sensitive workforce monitoring linked to modernised funding and contracting. Tailored national implementation within a shared European framework will be essential to rebuild sustainable GP capacity.
This study aimed to investigate the association between dynamic changes in frailty status, cumulative frailty index (FI), and the risk of incident stroke, providing novel evidence to inform stroke prevention strategies. This prospective study used data from the China health and retirement longitudinal study. Frailty transitions across 2 waves were classified into 7 patterns: stable robust, robust to pre-frail/frail, stable pre-frail, pre-frail to robust, pre-frail to frail, stable frail, and frail to pre-frail/robust. Multivariable Cox models estimated stroke risk for each transition, with "stable robust" as the reference. The cumulative FI was assessed categorically (quartiles) and continuously (per standard deviation increase). Restricted cubic splines evaluated dose-response associations. Subgroup and sensitivity analyses tested robustness. Among 6947 participants (median follow-up 7 years), stroke risk varied markedly by frailty transition. Compared with stable robust, the stable frail group showed the highest risk (hazard ratio [HR] = 4.48; 95% confidence interval [CI]: 3.25-6.18). Robust to pre-frail/frail transitions increased risk by 81% (HR = 1.81; 95% CI: 1.31-2.50). Relative to stable pre-frail, improving to robust was protective, whereas transition to frail increased risk by 58% (HR = 1.58; 95% CI: 1.24-2.01). Compared with stable frail, improvement to pre-frail/robust reduced risk (HR = 0.60; 95% CI: 0.43-0.84). The cumulative FI showed a strong linear association with stroke: each 1 - standard deviation increase was associated with a 55% higher risk (HR = 1.55; 95% CI: 1.45-1.65), and participants in the highest versus lowest quartile had over 3-fold higher risk (HR = 3.29; 95% CI: 2.59-4.17). Worsening frailty status substantially elevates stroke risk, whereas frailty improvement confers measurable protection. Cumulative FI is linearly associated with incident stroke, underscoring the importance of early identification and long-term management of frailty in stroke prevention.
Disability among older adults in China is becoming an increasing public health challenge due to rapid population aging. We aim to investigate how cognitive deficits, depression, and physical function limitation jointly contribute to the onset and progression of disability. We included 4226 individuals aged ≥60 years from the China Health and Retirement Longitudinal Study, who were followed for a mean of 7.8 years (2010-2020). Physical function, cognition, and depressive symptoms were assessed. Outcomes included incident activities of daily living (ADL) disability and the number of ADL and instrumental ADL disabilities. Cox regression, linear mixed-effects models, and structural equation modeling were applied. Having ≥2 conditions of cognitive deficits, depression, and physical function limitation concurrently at baseline was associated with a higher risk of incident ADL disability (hazard ratio [HR]2 versus 0, 1.70 [95% CI, 1.44-2.00]; HR3 versus 0, 2.10 [95% CI, 1.65-2.68]) and a faster annual increase in ADL/instrumental ADL limitations compared with those without (β2×time=0.010 [95% CI, 0.007-0.013]; β3×time=0.014 [95% CI, 0.010-0.019]). The association between physical function limitations and longitudinal ADL/instrumental ADL accumulation appeared to be mediated by the biannual rate of cognitive decline and increases in depression scores. The co-occurrence of cognitive deficits, depression, and physical function limitations may synergistically drive long-term disability. Our findings highlight the importance of early screening and holistic management of cognitive, mental, and physical health to reduce the burden of disability in aging populations.
Handgrip strength (HGS) is a key indicator of health. However, it remains understudied in low-income rural populations in Ecuadori. To analyze the associations between sociodemographic and health conditions and HGS in adults aged 55 years and older living in rural areas of Ecuador. This cross-sectional study included 258 participants aged 55 years or older. Univariate and multivariate linear regression models were used to examine the associations between HGS and sociodemographic variables, as well as health and physical function indicators. Ecuadorians mean HGS of the sample (n = 258) was 24.0 ± 7.7 kg. Men had significantly higher HGS than women (28.6 ± 8.1 kg vs 20.5 ± 5.0 kg; β = 8.56, p < 0.001). In the fully adjusted model (adjusted R2 = 0.55; F = 16.21, p < 0.001), higher HGS was independently associated with male sex (β = 8.56, p < 0.001), higher educational level (β = 3.44, p = 0.029), being retired (β = 2.11, p = 0.043), and normal walking speed (β = 2.04, p = 0.028), while age showed a negative association (β = - 0.35, p < 0.001). Income, physical activity, and multimorbidity were not significantly associated with HGS. HGS is associated with key sociodemographic and functional factors in adults from rural areas of Ecuador. These findings support its usefulness as a simple and relevant indicator of functional health in resource-limited settings.
Adverse childhood experiences (ACEs) may accelerate early menopause and influence neurodegenerative processes, contributing to sex-specific dementia risk. This study examined associations with cognitive decline and incident dementia in ACEs and early menopause. We studied 6093 women and 5784 men aged ≥50 years from the Health and Retirement Study, a US cohort spanning between 2010 and 2022. Incident dementia was based on self-report of physician-diagnosed dementia. Cognition was measured using a composite score of immediate and delayed recall, serial sevens subtraction, and counting backwards (range, 0-27). ACEs were assessed using seven items and classified into none, 1, 2, and ≥3 ACEs. Age at menopause was classified into <47, 47 to 52, and ≥53 years. We included men and defined the four categories of sex and age at menopause, assessing varying levels of female hormones with age at menopause serving as the proxy indicator of those differences. Covariates included lifestyle risk factors for dementia. We used a longitudinal panel design with each observation containing baseline covariates and 2-year follow-up outcomes. We applied a random-effects model to survival analysis for incident dementia and to linear regression analysis for cognition. Here we show that experiencing 2 (hazard ratio: 1.32 [95% CI: 1.07-1.62]) or ≥3 ACEs (1.32 [1.03-1.68]) is associated with higher dementia risk compared with no ACEs. Dementia risk does not differ by sex and age at menopause in women. Women with early menopause (β = -0.22 [95%CI: -0.41 to -0.03]) and men (-0.92 [-1.06 to -0.78]) have worse cognition than women with late menopause. ACE level is not associated with cognition. No mediation by early menopause is observed between multiple ACEs, dementia, or cognition in women. Mechanisms linking ACEs and early menopause to dementia risk may differ. Risk reduction strategies should consider preventing and addressing ACEs and early menopause, respectively.
Splenic diseases in dogs and cats present significant diagnostic challenges, particularly in differentiating benign from malignant lesions using conventional clinical and imaging modalities. While histopathology remains the gold standard, artificial intelligence, especially large language models (LLMs), offers emerging diagnostic support capabilities. This two-center, retrospective diagnostic-accuracy study compared the performance of two state-of-the-art LLMs (ChatGPT-5 and Gemini 1.5 Pro) with experienced and novice veterinary clinicians in diagnosing splenic diseases in 38 dogs and cats that underwent splenectomy between 2021 and 2025. Each assessor received standardized multimodal case packets, including clinical, laboratory, ultrasonographic, and intraoperative macroscopic data. Histopathology served as the reference standard. Diagnostic performance was evaluated using generalized linear mixed-effects models, malignancy ROC analysis, and information-modality sensitivity assessments. Experts achieved the highest exact specific-entity accuracy (92.1% and 89.5%), followed by ChatGPT-5 (76.3%) and Gemini 1.5 Pro (71.1%), whereas novices performed lowest (57.9% and 52.6%). Upper-category classification was generally higher than exact diagnosis across groups, and adding imaging and macroscopic data improved accuracy for all assessors. Receiver-operating performance followed a consistent gradient (Expert > LLM > Novice), with AUCs of 0.97 for Expert-1, 0.86 for ChatGPT-5, and 0.71 for Novice-2. These findings indicate that modern LLMs, even in zero-shot settings, can provide meaningful diagnostic triage support that exceeds novice performance and, when multimodal inputs are available, approaches but does not demonstrate equivalence to expert-level classification. Prospective multicenter studies and the evaluation of natively multimodal models capable of directly interpreting clinical images may further enhance their clinical applicability in veterinary diagnostic workflows.
Endoscopic spine surgery (ESS) is increasingly recognized for its clinical efficacy and patient-centered advantages, including reduced morbidity and faster recovery. However, despite growing global interest, its adoption remains highly variable, shaped more by systemic, economic, and institutional forces than by technical limitations. To evaluate global adoption barriers to ESS using psychometrically validated tools and identify region-specific structural disparities through Rasch analysis and differential item functioning (DIF). A cross-sectional global survey was conducted among 1834 spine surgeons. Of the 1040 individuals who began the survey, 438 (42.6%) from 46 countries completed the survey. A 27-item instrument assessed access, reimbursement, training infrastructure, and institutional support for ESS. Rasch rating scale modeling was used to test internal validity, unidimensionality, and item fit. DIF analysis and 1-way analysis of variance were performed to detect region-specific biases in item responses. Respondents were stratified by country and region, including China, India, Brazil, the United States, Latin America, and Europe. Collectively, the responding surgeons reported an extrapolated cumulative experience of 1,286,496 endoscopic spine procedures, suggesting that responses were anchored in substantial clinical experience. Rasch analysis confirmed acceptable model fit. DIF analysis revealed strong regional disparities. Surgeons in China and India reported high institutional support, better training access, and fewer reimbursement obstacles, suggesting high system adaptability. Conversely, respondents from the United States and Latin America cited limited training integration, poor reimbursement, and institutional inertia. Europe exhibited a structural stalemate driven by low surgeon compensation and excessive bureaucratic gatekeeping. Despite these differences, surgeon and patient interest in ESS remained uniformly high across regions, identifying shared global momentum for minimally invasive innovation. The global diffusion of ESS is hindered less by clinical limitations than by systemic inertia and fragmented policy frameworks. Countries with flexible, market-responsive systems (eg, China and India) are emerging as innovation leaders, while historically dominant regions (eg, United States and Europe) risk stagnation without structural reform. ESS serves as a diagnostic lens for broader health system adaptability, highlighting the urgent need for investment in training, reimbursement reform, and institutional endorsement. This study provides level II evidence that endoscopic lumbar decompression is a surgical work comparable to open techniques and should be valued accordingly. Grounded in more than 1.2 million cases and expert consensus, this study supports policy recommendations to retire Current Procedural Terminology 62380 and to adopt reimbursement frameworks based on surgical work rather than visualization method. While this study cannot be reclassified in the strict Oxford Centre for Evidence-Based Medicine hierarchy, the authors employ the following analogy: Rasch/DIF methods filter bias in the same way randomization filters bias in clinical trials. While it relies on self-reported surgeon data rather than direct clinical outcomes, the application of Rasch modeling and DIF analysis strengthens internal validity and minimizes measurement bias. Importantly, surgeon responses were anchored in an extrapolated cumulative experience of more than 1.28 million endoscopic spine procedures, reflecting deeply internalized clinical judgment rather than anecdotal opinion. These methodological features distinguish the study from unvalidated descriptive surveys and support its classification as higher-level clinical evidence-offering a filtered and reliable lens into global surgical practice patterns and systemic barriers to ESS adoption. Based on its cross-sectional observational design enhanced by validated psychometric methodology, the authors consider this survey study a psychometrically validated, high-quality observational survey study. This study identifies structural and systemic barriers that limit global adoption of ESS and highlights key targets-such as training, reimbursement, and institutional support-for improving access and accelerating safe implementation.
Digital inclusion has become increasingly important for healthy aging, yet evidence on its association with depression among older adults remains limited, particularly with respect to potential cognitive heterogeneity. This study examined the association between digital inclusion and depressive symptoms among Chinese older adults and explored whether cognitive function moderates this association, as well as potential mediating pathways. Data were drawn from the 2020 wave of the China Health and Retirement Longitudinal Study, including 9,111 individuals aged 60 years and older. A multidimensional digital inclusion index was constructed based on access, use, and skills related to digital technologies, standardized to a 0-10 scale. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10; each item scored 0-3, total range 0-30, treated as a continuous score). Multi-variable regression models were used to examine associations, with interaction terms and Johnson-Neyman analysis applied to assess moderation by cognitive function, with effect size estimated using Cohen's f2. Structural equation modeling was conducted to explore potential mediating mechanisms. Cognitive function significantly moderated the association between digital inclusion and depressive symptoms (β = -0.002, P < 0.05). Among participants in the highest quartile of cognitive function, each unit increase in digital inclusion was associated with a 0.517-point decrease in depression scores, whereas no statistically significant association was observed among those in the lowest quartile (β = -0.137, P = 0.327). Pathway analyses suggested that the association operated through multiple pathways, with the direct pathway accounting for 66.7% of the total association-likely reflecting immediate psychological mechanisms including enhanced self-efficacy, expanded access to health information, and a sense of digital mastery-while cognitive-related and social participation pathways explained 8.3% and 8.0%, respectively; a sequential cognitive-social pathway accounted for a further 2.8%, and the remaining 14.2% was attributable to other model-estimated pathways, with all pathways together accounting for 100% of the total association. Executive function and immediate memory emerged as the cognitive domains most strongly associated with moderation patterns. These findings suggest that greater digital inclusion is associated with lower depressive symptoms among older adults and that cognitive function shapes heterogeneity in this association. Enhancing digital inclusion while accounting for cognitive differences may help inform digital health strategies aimed at promoting mental well-being in aging populations.
The Lancet Diabetes & Endocrinology Commission proposed a new definition for clinical obesity. However, its prognostic value remains unclear. Clinical obesity was defined using the Commission's criteria in the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Aging (ELSA), and the National Health and Nutrition Examination Survey (NHANES). Prevalence estimation was conducted across four categories based on obesity and organ dysfunction status. Cox proportional hazards models were used to assess associations with clinical outcomes. The prevalence of clinical obesity was 2.50% (CHARLS), 6.18% (ELSA), and 9.08% (NHANES), respectively. Overall, older adults and men had lower prevalence, while older men in NHANES showed higher prevalence. Compared with non-obesity without dysfunctions, clinical obesity and non-obesity with dysfunctions showed higher risks of cardiovascular outcomes. Compared with preclinical obesity, clinical obesity elevated cardiovascular risk in CHARLS (HR = 2.49, 95% CI: 1.32-4.70) and ELSA (HR = 1.80, 95% CI: 1.02-3.17) and increased all-cause (HR = 1.88, 95% CI: 1.23-2.87) and cardiovascular (HR = 3.11, 95% CI: 1.49-6.50) mortality risk in NHANES. The prevalence of clinical obesity varied by age, sex, and country. Overall, the prevalence was lower among older adults and men. Clinical obesity was associated with increased cardiovascular event risk across cohorts and increased all-cause mortality risk in NHANES, highlighting its value for risk stratification.
This study presents a high-throughput automated open-column chromatography system designed for high-precision isotope analysis based on a hydraulic remote-drive mechanism. The system operates by using pressurized fluid to indirectly control eluent delivery, resulting in a completely metal-free separation unit that fully isolates metal components (pump, sensor, and valve) from corrosive acid solutions and vapors. This design effectively eliminates the corrosion and contamination risks inherent to conventional systems. Coupled with pressure sensing and mass flow feedback control, the hydraulic drive enables multichannel parallel elution (currently 8 channels) with high accuracy (error <3%) and excellent interchannel consistency (variation <0.5%). Constructed primarily from low-cost polymers, the system offers an economical and scalable platform for automated sample preparation. Validation using Cd and Cu isotope separation protocols demonstrated high recoveries (Cd: 97.5 ± 1.6%; Cu: 98.3 ± 1.4%) and low procedural blanks (Cd: 0.17 ng; Cu: 0.72 ng). Analysis of geological reference materials (e.g., BHVO-2, BCR-2, NOD-P-1) yielded isotopic ratios consistent with published values, confirming method reliability. Overall, the system provides a scalable, cost-effective, and metal-free platform for high-throughput separations required for high-precision isotope analysis.
ObjectiveTo investigate the association between the high-sensitivity C-reactive protein-to-hemoglobin ratio and stroke risk among middle-aged and older adults.MethodsA prospective follow-up study was conducted using cohort data from the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study of Ageing (ELSA). Participants without a history of stroke at baseline were included, comprising 5368 individuals from CHARLS and 1422 from ELSA. Cox proportional hazards regression models were used to analyze the association between C-reactive protein-to-hemoglobin ratio levels and stroke risk, along with dose-response analyses and subgroup interaction testing.ResultsAfter adjusting for sex, age, lifestyle factors, and multiple clinical biochemical indicators, the participants in Q2, Q3, and Q4 demonstrated a significantly higher risk of stroke than those in Q1 (reference group). The hazard ratios were 2.23 (1.35-3.69), 2.24 (1.36-3.71), and 3.14 (1.93-5.12), respectively (all P < 0.01). Dose-response analysis revealed an approximately linear positive association between C-reactive protein-to-hemoglobin ratio and stroke risk.ConclusionsC-reactive protein-to-hemoglobin ratio levels are significantly and positively associated with stroke risk in middle-aged and older adults.
The Cochrane Review of 'Water fluoridation for the prevention of dental caries' published in 2024 has been quoted around the world and has particularly impacted decisions in the USA. The objectives, methods and conclusions have changed little from the Cochrane Review of the same subject published in 2015. The 2015 review was heavily criticised, since evaluations of public health programmes are seldom amenable to methods such as randomised controlled trials. Using such criteria results in the exclusion of much relevant information. There have been recent advances in methods to evaluate longitudinal and cross-sectional observational studies using 'causal inference'. The aim of this paper is to consider the merits of the 2024 Cochrane Review in light of advances in evaluating public health programmes and the wider evidence base.
Systemic diseases increasingly complicate oral treatment, particularly in hypertensive patients requiring comprehensive care. Using nationally representative cross-sectional data, this study investigated the association between hypertension and oral health in Chinese adults aged ≥ 45 years. Data were drawn from the 2013 and 2015 CHARLS, including 4770 participants aged ≥ 45 years. Linear and logistic regression examined blood pressure-oral disease associations, with systolic/diastolic pressure first as continuous, then categorical variables. Curve fitting and restricted cubic splines further validated the cross‑sectional associations. A total of 4770 participants were included in this study, including 1568 patients with hypertension. The characteristics of the hypertensive population are married elderly men who enjoy smoking and drinking, suffer from other chronic diseases, and low to moderate level of self-reported health. Logistic regression revealed positive associations of systolic and diastolic blood pressure with dental visits, and a stable positive correlation between hypertension and dental visits persisted across multiple adjustment models, further validated by curve fitting and restricted cubic spline analyses. Hypertension is significantly and positively associated with oral health issues in a nationally representative sample of middle-aged and older Chinese adults. Healthcare providers should prioritize integrated blood pressure and oral health management in this population to mitigate the mutual exacerbation of chronic diseases.