Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

This study aimed to explore the gender specificity of spousal concordance in the development of chronic diseases among middle-aged and older Chinese couples. Data of 3420 couples were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression was used to analyze the incidence of chronic disease development over 4 years, conditional on the spousal baseline chronic disease status; and stepwise adjusting for the couples’ sociodemographic characteristics (i.e., age, education, retirement status and household income), and their individual lifestyle (i.e., smoking, drinking, exercise, social participation and BMI) all measured at baseline. The incidence of chronic diseases after 4 years of follow-up was 22.95% in the husbands (605/2636) and 24.71% in the wives (623/2521). Taking the couples’ baseline sociodemographic and lifestyle covariates into account, husbands whose wife had chronic diseases at baseline showed an increased risk of developing chronic diseases over 4 years (ORadjusted = 1.24, 95%CI: 1.02, 1.51), but this risk was not statistically-significant for wives (ORadjusted = 0.88, 95%CI: 0.71, 1.08). Our study identified gender specificity of spousal concordance in the development of chronic diseases among middle-aged and older Chinese couples. This finding may contribute to the design of couple-based intervention for disease prevention and management for community-dwelling older adults.

Background: Public health workers at China CDCs and primary health care institutes (PHI) constitute one of the main workforces for implementing prevention and control measures to contain the COVID-19 epidemic, but their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of frontline public health workers in China during the epidemic. Methods: Between February 18 to March 1, 2020, we conducted a cross-sectional survey among 2,313 CDC workers and 4,004 PHI workers in ve provinces across China experiencing different scales of COVID-19 epidemic. We interviewed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health by self-constructed questionnaire and standardized measurements. To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3%, 19.0%, and 9.8%, respectively, among public health workers (27.1%, 20.6% and 15.0% among CDC workers; and 17.5%, 17.9% and 6.8% among PHI workers). The majority (71.6%) participated in both eld and non-eld work and gave immense efforts. Nearly 20.0% have worked all night for more than 3 days and 45.3% had worked during the whole period of Chinese New Year. Three risk factors and two protective factors were found independently associated with all three health outcomes in our nal multivariate models, including working all night for >3 days (ORm=1.67~1.75, p<0.001), concerns about being infected at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), starting COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and capability to persist for more than 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusion: Chinese public health workers gave immense efforts and personal sacri ces to curb the COVID-19 epidemic and were exposed to risk of mental health problems. Efforts should be taken to improve the working condition and health status of public health workers to maintain the morale and effectiveness of public health workers in the ght against the epidemic. health workers involved in the epidemic containment efforts, (2) the roles and job functions they played, (3) the challenges associated with their work, and (4) factors that were associated with their mental and physical health. Methods Study design This cross-sectional study was conducted from February 18 to March 1, 2020. Data was collected from ve provinces (Hubei, Guangdong, Sichuan, Jiangsu and Gansu) which were purposely selected to cover different levels of epidemic severity de ned by numbers of reported cases (by March 5, 2020, 67466, 1351, 539, 631, and 102 COVID-19 cases were reported in the selected ve provinces), and to cover different regions of the country (center, southern, western, eastern, and northern). In each province, 3-5 cities were...

Background Increasingly, older Chinese adults from rural areas are moving to urban areas to live with their children who have already migrated to these areas. However, few studies have examined this pattern of migration and its effects on cognitive function. We aimed to investigate the association between domestic rural-to-urban migration and the trajectories of cognitive function in older Chinese adults, as well as the factors contributing to these association. Methods Data for this study were drawn from three waves of the China Health and Retirement Longitudinal Study. Migrants were defined as participants who had rural hukou status (under China’s household registration system) but resided in an urban area. Cognitive functions were measured using an adapted Chinese version of the Mini-Mental State Examination. We used multilevel linear regression models to examine the association between internal migration and cognitive function trajectories. Results The study included 3876 Chinese adults aged ≥60 years at baseline. Compared with their rural non-migrant counterparts, migrants (n = 850) had higher levels of education and reported more interactions with family. Additionally, female migrants were more likely to participate in leisure activities. All cognitive function scores declined over time, but no significant differences were observed in rates of cognitive decline between migrants and non-migrants, regardless of sex. Female migrants exhibited significantly better performance in terms of total cognition (β = 0.77, P < .001) and mental status (β = 0.68, P < .001) than female non-migrants, whereas no inter-group difference was observed regarding memory (β = 0.09, P > .05). Among the male subjects, no significant differences in cognitive function levels were observed between migrants and non-migrants. A series of adjusted models revealed that psychosocial factors such as residing with children, caring for grandchildren, depression and participation in leisure activities partly explained the association between migration and cognition in women. Conclusions Rural-to-urban migration was positively associated with cognitive functions only in women. However, this pattern did not affect the rate of cognitive decline in either sex. Our findings provide directions for tailored interventions improving cognitive functions of older adults and rural non-migrating older adults, especially female non-migrants.

Background Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China. Methods The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status. Results Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues. Conclusions ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.