Background: Epidemiological studies suggest that proxies of higher lifetime estrogen exposure are associated with better cognitive function in postmenopausal women, but this has not been found consistently. Objective: To determine whether reproductive history, an important modifier of estrogen exposure across the lifetime, is associated with risk of cognitive impairment in postmenopausal women. Methods: We analyzed the baseline data from Zhejiang Major Public Health Surveillance Program (ZPHS) including 4,796 postmenopausal women. Cognitive impairment was assessed through the application of Mini-Mental State Examination questionnaire. Logistic regression models, controlled for an extensive range of potential confounders, were generated to examine the associations between women’s reproductive history and risk of cognitive impairment in their later life. Results: The length of reproductive period was inversely associated with risk of cognitive impairment (p = 0.001). Odds ratio (OR) of cognitive impairment were 1.316 (95% CI 1.095∼1.582) for women with 5 or more times of full-term pregnancies, compared with those with 1∼4 times of full-term pregnancies. Women without incomplete pregnancy had a significant higher risk of cognitive impairment (OR = 1.194, 95% CI 1.000∼1.429), compared with the reference (1∼2 times of incomplete pregnancies). Oral contraceptive use (OR = 0.489, 95% CI 0.263∼0.910) and intrauterine device (IUD) use (OR = 0.684, 95% CI 0.575∼0.815) were associated with significantly reduced risk of cognitive impairment. Conclusion: Our results indicated that shorter reproductive period, higher number of full-term pregnancies and no incomplete pregnancy history were associated with an increased risk of cognitive impairment. In contrast, oral contraceptive and IUD use corresponded to reduced risk of cognitive impairment.

Depression is one of the main health concerns in elders which could lead to many negative outcomes. Eating alone is an emerging issue in elders in China and would become more serious along with the fast course of industrialization and urbanization, as well as population aging. However, their relationship was seldom researched. Using a two-stage cluster sampling strategy, an investigation was conducted in 2014 among 9,361 permanent residents aged 60 years and above in Zhejiang Province, China. Totally, 7,968 cognitively normal elders were included in our analysis. Multilevel logistic regression was used to explore the association between eating arrangement (number of companions in mealtime) and depressive symptom as well as the association between eating alone and depressive symptom in relation to living alone. In our sample, 17.1 % of the elders ate alone and 8.7 % had depressive symptom. We observed a distinct inverse association between eating arrangement (number of companions in mealtime) and geriatric depressive symptom (female: OR = 1.12, P = 0.027; aged 60–74 years: OR = 1.16, P = 0.002), after adjustment for demography, socioeconomic status, social relation, health behaviors, underlying conditions and living alone. We then introduced a combined variable of eating alone and living alone and examined its relationship with depressive symptom. We found that compared with elders who ate and lived with others, those who ate alone but lived with others had a significant increased odds of depressive symptom (female: OR = 1.62, P = 0.027; aged 60–74 years: OR = 1.59, P = 0.025). Our results suggested that a lack of companionship in mealtime might be independently associated with geriatric depressive symptom for females and those aged 60–74 years. What’s more, eating alone might be a stronger factor associated with depressive symptom than living alone. We recommend interventions to be performed in encouraging elders especially females and those aged 60–74 years to eat with others. Longitudinal studies in different populations which focus on this topic are required to better understand this issue.

Objectives: To investigate the associations between body mass index (BMI), waist-to-hip ratio (WHR) and cognitive function among Chinese elderly. Design: Cross-sectional study. Setting: Community. Participants: Data were obtained from the baseline survey of a community-based cohort in Zhejiang Province, and 9326 persons aged 60 years and older were enrolled. Primary outcome measures: We investigated the association between BMI and cognition, and then explored the association between WHR and cognition across different quartiles of BMI. Results: A sample of 9087 persons was used in this study, including 4375 men and 4712 women. Higher WHR increased cognitive impairment risk in those with BMI >25.3 kg/m ² (OR (per 0.1 increase) 1.39; 95% CI 1.13 to 1.70). No statistically significant association was found in other BMI categories. Conclusions: Higher WHR could increase the risk of cognitive impairment among elderly with BMI >25.3 kg/m ² . Our results suggest that it could be of benefit to the elderly with high BMI to control WHR.

(1) The objective of this study was to assess the risk perceptions, attitudes, knowledge, and behaviors related to typhoon among rural residents in Zhejiang province of China. A cross-sectional study was conducted among rural residents in Zhejiang province, China. Information was collected from 659 participants using a structured questionnaire. Univariate analysis and multivariable analysis were used to analyze the data. Participants were most concerned about property damage, followed by their health and life. Television, short message service (SMS), relatives and friends were the most common information sources. Most people had not been educated with disaster prevention measures. The complementary log–log (CLL) model showed that understanding typhoon warning signal, preparation time, risk perception of health damage and life threat, and fears of typhoon were independent predictors of adoption of coping behaviors. We found that: 1. Residents’ risk perception of health and life threat caused by typhoon is inadequate; 2. There is a gap between residents’ cognition or knowledge and behavior in rural areas; 3. The government should further make strategies to develop educational activities, in order to eliminate the gap and improve the ability of preparing for typhoon among rural residents.

The third wave of H7N9 cases in China emerged in the second half of 2014. This study was conducted to identify the risk trends of H7N9 virus in human infections and environment contamination. A surveillance program for H7N9 virus has been conducted in all 90 counties in Zhejiang since March 2013. All H7N9 cases were reported by hospitals through the China Information System for Disease Control and Prevention. Sampling sites for environment specimens were randomly selected by a multi-stage sampling strategy. Poultry-related workers for serological surveillance were randomly selected from the sampling sites for environmental specimens in the first quarter of each year. rRT-PCR and viral isolation were performed to identify H7N9 virus. A hemagglutination inhibition assay was conducted to detect possible H7N9 infection among poultry-related workers. A total of 170 H7N9 cases were identified in Zhejiang from 20 March 2013 to 28 February 2015. The proportion of rural cases increased from 42.2 % (19/45) to 67.7 % (21/31) with progression of the three epidemics (P < 0.05). In 32 % (161/503) of towns and 16.0 % (238/1488) of surveyed premises, H7N9 virus was detected in the environment. The positive rate of environmental specimens was 6.1 % (868/14207). In addition, 912 poultry-related workers were recruited and 3.7 % (34) of them tested positive for H7N9 antibodies. Positive detection of H7N9 virus during environmental surveillance increased from the first to third wave (P < 0.05). Almost all positive rates of environmental surveillance were higher in urban than rural in the second wave (P < 0.05), however they were higher in rural area in the third wave (P < 0.05). Our study highlights that the severity of poultry-related environmental contamination by H7N9 virus is intensifying. We strongly recommend that the local government stop illegal trading immediately and close live poultry markets in the territory. Poultry operations in slaughtering plants must be supervised rigorously. Prior to the closure of live poultry markets, daily cleaning and disinfecting of areas potentially contaminated by H7N9 virus, centralized collection and disposal of trash, designating certain days as market rest days, banning overnight poultry storage and other measures should be strictly carried out in both urban and rural areas.