Tingting Sha

Background: Osteoarthritis is common and often coexists with other chronic conditions, which may contribute to increased all-cause mortality. Maintaining a healthy lifestyle contributes to increased longevity; however, considering physical functions and physiological conditions of patients with osteoarthritis differ from the general population, the impact of maintaining a healthy lifestyle in these patients remains uncertain, which poses a challenge to implementing-related interventions in this population. This study aims to examine the association between healthy lifestyle factors and mortality in individuals with osteoarthritis. Methods: This cohort study enrolled 52 973 participants from the UK Biobank who met the criteria for osteoarthritis as defined via hospitalisation or primary care records. Seven lifestyle factors, consisting of smoking, alcohol intake, physical activity, diet, television watching time, sleep duration and social connection, were included. HRs (with 95% CIs) for total and cause-specific mortality were estimated by Cox proportional hazards regression models. Results: A total of 4637 deaths were recorded during the follow-up period. Seven healthy lifestyle factors were all independently associated with a low mortality risk. When compared with participants meeting only 0–2 healthy lifestyle criteria, the adjusted HRs (95% CI) for those adhering to 3–7 factors were 0.70 (0.62 to 0.78), 0.60 (0.54 to 0.67), 0.49 (0.44 to 0.54), 0.46 (0.41 to 0.52) and 0.42 (0.36 to 0.49), respectively ( p for trend p for trend <0.001), whereas no significant trend emerged for mortality due to neurodegenerative diseases. Conclusions: Adherence to a greater number of healthy lifestyle factors was associated with a significantly lower risk of mortality among individuals with osteoarthritis. Our findings hold important public health implications and provide empirical evidence that adhering to a healthy lifestyle could mitigate the burdens caused by osteoarthritis.

Background: Over half the people over 60 years of age experience cognitive impairment, with limited treatment options, making it crucial to identify risk factors. Studies have examined the association between sarcopenia and cognitive impairment; however, the evidence is inconclusive and cannot be used to make causal inferences. Objective: This study aims to appraise the causal association of sarcopenia with cognitive impairment by triangulating the data from a cohort study and Mendelian randomization (MR) analysis. Methods: Using UK Biobank data, we first examined the associations of sarcopenia and its indices (appendicular lean mass [ALM], handgrip strength, and gait speed) with cognitive function (fluid intelligence and prospective memory) by using mixed-effects regression models. Then, we explored the causal associations of genetically predicted sarcopenic indices with cognitive function through a 2-sample MR, and examined potential mediation by omega-3 fatty acids, vitamin D levels, physical inactivity, falls, frailty, sleep disorders, anxiety, depression, stroke, metabolic syndrome, and type 2 diabetes. Results: A total of 34,457 participants, with a mean age of 56.4 (SD 7.6) years, 51.1% (n=17,620) of which were female, completed baseline cognitive tests between 2006 and 2010 and attended at least 1 follow-up visit in 2012, 2014, or 2019, and were included in the observational analysis. The cohort study revealed that sarcopenia was significantly associated with cognitive impairment, which was evidenced by reduced fluid intelligence scores (β=−0.91, 95% CI −1.68 to −0.15; P=.02). Each of the sarcopenic indices also exhibited significant associations with either fluid intelligence or prospective memory (all P<.05). MR analyses yielded compelling evidence of positive associations between the genetically predicted increases in ALM (β=0.09, 95% CI 0.07-0.12; P<.001), handgrip strength (β=0.18, 95% CI 0.08-0.29; P<.001) and gait speed (β=0.78, 95% CI 0.53-0.29; P<.001) and improved cognitive function. The effects of ALM and handgrip strength on cognitive function were partially mediated by genetically predicted physical activity, with indirect effects of 0.01 (95% CI 0.00-0.02) for ALM and 0.02 (95% CI 0.00-0.05) for handgrip strength. Conclusions: Our study suggests that sarcopenia is a potential causal risk factor for cognitive impairment, with physical activity acting as a modifiable mediator in this relationship.

Objective Observational studies have found that cigarette smoking increased the prevalence and incidence of sarcopenia, whereas alcohol consumption appeared to decrease the risk. These findings, however, may be susceptible to either confounding bias or reverse causation. We conducted a Mendelian randomisation (MR) study to appraise the causal relation of cigarette smoking and alcohol consumption to the risk of sarcopenia. Methods Genetic instruments associated with cigarette smoking (cigarettes per day) and alcohol consumption (drinks per week) were retrieved from the publicly available genome-wide association data. Individual-level, electronic medical record-linked data on sarcopenia, grip strength and appendicular lean mass were obtained from the UK Biobank. We performed two-sample univariable and multivariable MR analyses to examine the relation of genetically determined cigarette smoking and alcohol consumption to the risk of sarcopenia and its indices. Results One SD increase of genetically determined cigarette smoking was associated with an increased risk of sarcopenia (OR=2.51, 95% CI: 1.26 to 5.01, p=0.001), decreased grip strength (β=−0.63 kg, 95% CI: −1.13 to −0.13, p=0.01) and less appendicular lean mass (β=−0.22 kg, 95% CI: −0.44 to −0.01, p=0.04). Although one SD increase of genetically determined alcohol consumption was associated with decreased grip strength (β=−1.15 kg, 95% CI: −2.09 to −0.10, p=0.02), no statistically significant causal association was observed between genetically determined alcohol consumption and either sarcopenia (OR=0.96, 95% CI: 0.35 to 2.62, p=0.94) or appendicular lean mass (β=−0.23 kg, 95% CI: −0.91 to 0.45, p=0.51). Conclusions Our findings showed that genetically determined cigarette smoking, but not alcohol consumption, was causally associated with the risk of sarcopenia.

Metabolites’ connection to sarcopenia through inflammation and mitochondrial dysfunction is presumed, but their impact remains unclear due to limitations in conventional observational studies caused by confounding bias and reverse causation. We conducted a Mendelian randomization (MR) analysis to elucidate the association of serum metabolites with sarcopenia and its related traits, i.e., appendicular lean mass and grip strength. Genetic instruments to proxy the serum metabolites were extracted from the most comprehensive genome-wide association study on the topic published so far. The corresponding summary statistics for the associations of genetic instruments with outcomes were calculated from the UK Biobank (n = 324,976 participants). The primary analyses were assessed by an inverse-variance weighted (IVW) method. The weighted median and MR-PRESSO methods were used as sensitive analyses. Fourteen genetically predicted serum metabolites were associated with the risk of sarcopenia (P_IVW < 0.05). Two metabolites showed the overlapped association with sarcopenia and its related traits, which were isovalerylcarnitine (sarcopenia: odds ratio [OR] = 4.00, 95% confidence interval [CI] = 1.11~14.52, P_IVW = 0.034; appendicular lean mass: β = −0.45 kg, 95% CI = −0.81~−0.09, P_IVW = 0.015; grip strength: β = −1.51 kg, 95% CI = −2.31~−0.71, P_IVW = 2.19 × 10⁻⁴) and docosapentaenoate (sarcopenia: OR = 0.16, 95% CI = 0.03~0.83, P_IVW = 0.029; appendicular lean mass: β = −0.45 kg, 95% CI = 0.08~0.81, P_IVW = 0.016). Twenty-seven metabolites were suggestive associated with appendicular lean mass or grip strength. This MR study provided evidence for the potential effects of metabolites on sarcopenia.

Objective: To examine efficacy and safety of tramadol for knee or hip osteoarthritis (OA).Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched up to May 2020 for randomized controlled trials (RCTs) comparing any of the following interventions: tramadol 100 mg/day, 200 mg/day, and 300 mg/day, and placebo for knee or hip OA. Pain and function were measured at or near 12 weeks for efficacy. Gastrointestinal, cardiovascular, and central nervous system (CNS) adverse events (AEs), and withdrawals were measured for safety. Bayesian network meta‐analysis was conducted.Results: Six RCTs (3,611 participants) were included. Tramadol 100 mg/day (standardized mean difference [SMD] –0.16 [95% confidence interval (95% CI) –0.34, 0.00]), 200 mg/day (SMD –0.21 [95% CI –0.37, –0.06]), and 300 mg/day (SMD –0.30 [95% CI –0.48, –0.14]) were statistically more effective than placebo in pain relief, but only tramadol 300 mg/day was better than placebo in functional improvement (SMD –0.24 [95% CI –0.47, –0.03]). Tramadol 100 mg/day (relative risk [RR] 2.29 [95% credible interval (CrI) 1.22, 4.25]), 200 mg/day (RR 4.35 [95% CrI 2.31, 8.01]), and 300 mg/day (RR 6.02 [95% CrI 3.22, 11.1]) involved a higher risk of gastrointestinal AEs. Similarly, tramadol 100–300 mg/day showed a higher risk of CNS AEs and withdrawals. However, the risk of cardiovascular AEs remained unclear.Conclusion: Only tramadol 300 mg/day showed minimal improvement in pain and function but with increasing AEs compared with placebo. Tramadol may not be sufficiently recommended for knee or hip OA based on the presented evidence, especially in patients with the risk of gastrointestinal and CNS AEs.

Evidence suggests that excessive screen time in early childhood is related to children’s physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0–7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose–response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

Background: Quality is the most important factor of satisfaction However, the existing URRBMI index model lacks the decomposition of the connotation of perceived quality and cannot provide a reference for quality improvement and satisfaction promotion.Objective: This study aims to construct a Satisfaction Index Model for Chinese Urban and Rural Residents Basic Medical Insurance (SIM-URRBMI) with accurate and detailed measurement of perceived quality and give a feasible and scientific suggestion for URRBMI or insurance for other countries in the world.Methods: Based on the theoretical framework of The American Customer Satisfaction Index (ACSI), the connotation of perceived quality was refined by literature review and expert consultation to form a pool of alternative measurement variables. A three-stage randomized stratified cluster sampling was adopted to select the main decision makers for pupils’ URRBMI in 8 primary schools from Changsha City. Both Classic Test Theory (CTT) and Item Response Theory (IRT) were used for selection of the measurement variables. The model’s reliability and validity were tested using partial least square (PLS) related methods.Results: A total of 1909 respondents who had insurance for their children were investigated with the initial questionnaire. The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. Among the three explanatory variables of public satisfaction, perceived quality had the largest total effect (0.737). The variable with greatest effect among the five first-order latent variables on perceived quality was quality of the medical insurance policy (0.472).Conclusions: The revised SIM-URRBMI consists of 11 latent variables and 28 measurement variables with good reliability and validity. It provides accurate assessment of perceived quality, which will greatly help performance improvement. Perceived quality is crucial to public satisfaction, especially, the most important aspects are policies regarding medical insurance reimbursement (basic coverage scope, coinsurance, deductible).

Background: At present, whether to use the World Health Organization’s (WHO) growth standards or native growth standards to assess the nutritional status in a given population is unclear. This study aimed to compare the differences between the WHO’s growth standards and China’s growth standards in assessing the nutritional status of children aged 0~36 months. Methods: We used z-scores to evaluate the nutritional status of children. The weight-for-age z-scores (WAZs), length/height-for-age z-scores (LAZ/HAZs), and weight-for-length/height z-scores (WLZ/WHZs) were calculated using the WHO’s growth standards and China’s growth standards. MeNemar’s test was used to compare the nutritional status of children. Results: The results in this study showed that there were differences between the WHO’s standards and China’s standards in assessing children’s nutritional status except for stunting and obesity. The prevalence of underweight assessed using China’s standards was higher than when using the WHO’s standards (except when 3 and 36 months old). The prevalence of wasting was significantly higher when assessed using China’s standards than when using the WHO’s standards from 12 to 36 months. The prevalence of overweight was higher when assessed using the WHO’s standards from 3 to 8 months. Conclusions: Both the WHO’s and China’s growth standards are useful measures in assessing children’s nutritional status but with key significant differences. Therefore, caution should be taken in selecting appropriate measures in a given population.