Objective To explore the relationship between poor sleep quality and stoke.Methods A total of 738 stroke patients in Xuzhou city in 2013 were selected as the case group and age-and sex-matched healthy non-stroke subjects (n =738)as control group.The writer-designed general situation questionnaire and the Pittsburgh Sleep Quality Index(PSQI)analyses were conducted for a face-to-face investigation.Results No significant difference in mean age(66.1±10.9 and 65.8 ± 10.6,t =0.60,P =0.58)and in sex (50％ vs.50 ％) was found between two groups.There were statistically significant differences between case and control groups in baseline values of BMI(t=2.40,P =0.02),histories of hypertension(x2 =174.30,P =0.00),diabetes mellitus (x2 =27.20,P =0.00),coronary heart disease(x2 =115.60,P =0.00),smoking(x2 =6.10,P =0.01),drinking (x2 =7.30,P =0.01)and living stress(x2 =11.40,P =0.01).The PSQI sub-scores and PSQI total scores were higher in case group than in control group.The rate of poor sleep quality was higher in case group(279 cases,37.8 ％) than in control group(136 cases,18.4 ％) (x2 =6.10,P =0.01).Multivariate logistic analysis showed that,after adjusting for confounding factors of BMI,histories of hypertension,diabetes,coronary heart disease.smoking,drinking and living stress,the poor sleep quality in total male plus female was independent predictor variables for stroke[odds ratio(95 ％ CI) of 2.3 (1.8-3.0)],no matter their sex,with odds ratio (95 ％ CI) in male (2.5,1.7-3.7) or in female (2.2,1.5-3.2),respectively,but there was no significance difference in the odds ratio between male and female in case group(x2 =0.04,P=0.85).The risk stroke was 2.3 folds higher in poor sleep quality versus control in male plus female,with pure male or female of 2.5 or 2.2 folds.There was no significance difference between male and female in case group versus.the control(x2 =0.04,P=0.85).Conclusions Poor sleep quality is associated with the occurrence of stroke and may be a risk factor for stroke.

Objective To explore the hypertensive vulnerability of residents living in Xuzhou City to provide evidence for effective intervention. Methods Based on multi-stage stratified randomized sampling methed,a total of 4980 residents aged 15 to 69 years from 9 counties of Xuzhou City were selected and completed a standard questionnaire. Hypertensive vulnerability was compared by using Chi-square test. Results The prevalence of hypertension was 13.62% among 15 to 69 years old participants. The residents who had no idea of normal level of blood pressure accounted for 45. 26%. The residents who thought it was unnecessary to measure blood pressure every year since 35 year-old accounted for 29. 68%. Those who did not know individual's salt intake per day accounted for 57. 23%. The participants who had no information on hypertension prevention or control accounted for 21.53% and 12. 05%, respectively. The higher hypertensive vulnerability was associated with lower educational level or monthly income per capita; higher hypertensive vulnerability of patients is less than normal crowed. The rates of current smoking, alcohol consumption,salt over-intake and non-blood pressure measurement were 16. 45%, 11.10% ,30. 00%, and 32. 05% respectively. The higher educational level, higher monthly income per capita or older age crowd ,the lower rate of non-blood pressure measurement, the higher rate of alcohol consumption ; salt over-intake was different in different education levels ( χ2 = 23.37, P＜0. 05 ) ; the older age group were in a higher proportion of current smokers;the behavior vulnerabilities were no difference between the patients and normal crowds. Conclusion Hypertensive vulnerability of residents living in Xuzhou City is high. Hypertension education and healthy living style should be improved to effectively prevent the development of hypertension.

Objective To know social and demographic characteristics,behavioral characteristics,as well as knowledge-attitude-belief-practice(KABP) and its influential factors of rural community chronic obstructive pulmonary diseases(COPD) patients. Methods Cluster sampling all COPD patients of fangcun and mape township of tongshan county in 2007. A face-to-face interview was performed to investigate the COPD patients in their home,and t test,one-way analysis of variance and multiple linear regression were used to analyze the behavioral characteristics and K.ABE Results The main Patients were old person aged 60-80,with mean of(63 ± 15)years old. The active and passive smoking rate were 49.5% and 35.9%,respectively,and very significance between male and female Patients (X2 = 101. 365,P＜ 0. 05). 62. 9%abstained from smoking mainly owing to having COPD. About 31.9% of the patients had used the firewood and coal to cook for longer than 30 years. 24. 2% often built their body by exercise; however,only 8. 9%participated in convalescence. The mean KABP score of Patients was (38 ± 8). The Patients have lower knowledge to COPD, but give much more concerns to their own diseases. Univariate and multivariate analysis indicated that the main influential factors of COPD patients KABP were education, family attitude, income,sex and the distance between their homes and health stations. Conclusions Community COPD patients have high smoking rate,long firewood and coal cooking history,so active interventions should be took to those risk factors. KABP level of the COPD patients was not good, more health instructions including prevention,treatment and convalescing of COPD need to be gave to COPD patients.

Objective To evaluate perception and awareness of disease knowledge in patients with chronic obstructive pulmonary disease (COPD) in rural area of Xuzhou City. Methods Perception and awareness of COPD, including its nature, control, medication use, impact on their quality of life, experience of its acute exacerbation, and so on, in 392 patients with COPD were evaluated with self-designed ad hoc questionnaire. Proportion and percentage were used in statistical analysis. Results According to the GLOD standards, 58 of 392 patients with COPD could be classified as stage Ⅰ (14. 8%), 164 as stage Ⅱ (41.8%), 103 as stage Ⅲ (26.3%) and 67 as stage Ⅳ (17.1%), respectively. Only 14 patients (3.6%) had heard COPD, but all of them did not know the definition of COPD and its acute exacerbation. Lung function tests and health education had never been performed for all these patients. One hundred and twenty-six patients (32. 1%) did not understand that smoking is a risk factor for COPD, 343 patients (87. 5%) had never heard that COPD could be prevented and controlled. Only 95 patients (24. 2%) did regular physical exercises. Seventy-six patients (19. 4%) in stable stage did not take theophylline regularly, and none of them took inhalers or nebulizer drugs regularly or temporally, or oxygen therapy and pulmonary rehabilitation at home. During acute exacerbation, 261 patients (66.6%) could take theophyUine or analogous drugs and antibiotics. One hundred and five patients (26. 8%) were admitted to hospital during the past year due to respiratory symptoms. Physical activities were restrained in 224 patients (57.1%), 91 patients (23. 2%) had a little bit feeling of depression sometimes and social communication was impacted in 232 patients (59. 2%). Conclusions Patients with COPD in rural Xuzhan, Jiangsu province were poor in knowledge of COPD, and their treatment during stable stage and acute exacerbation did not meet the standards. COPD had significant impact on their daily life, and education and management for the patients should be strengthened.

Objective To study risk factors for high-normal blood pressure (HNBP) in residents of urban Xuzhou, Jiangsu province, China. Methods A cross-sectional survey was conducted among 17 500 residents in urban area of Xuzhou from June to December 2008 by cluster sampling with self-designed questionnaire to collect their demographic information and measurements of body height, weight and blood pressure. Data were approached to univariate and multivariate non-conditional logistic regression analysis. Results In total, 17 306 residents finished the survey, with an overall response rate of 98.9percent. Results of univariate analysis revealed that 13 variables such as living region, sex, age,occupation, annual average family income, history of dyslipidemia, smoking, alcohol drinking, intake of pork, and vegetables, daily length of sleeping, body mass index (BMI), abdominal obesity, all were related to HNBP ( P ＜ 0. 05 ). Results of multivariate logistic regression analysis showed that living region, sex,age, annual average family income, alcohol drinking, intake of vegetable, BMI, abdominal obesity all associated with HNBP (P＜0. 05). Conclusions Older age, history of alcohol drinking, increased BMI,abdominal obesity all are risk factors to prompt occurrence of HNBP, and intake of large amount of vegetables is its protective factor.

Objective To understand the prevalence and influencing factors of overweight and obesity in adult residents in Xuzhou City of Jiangsu Province,so as to provide scientific basis for health policies and intervention strategies.Methods A total of 39 445 participants were recruited by multi-stage random cluster sampling method,and health data were obtained through questionnaires and physical examinations.Results The prevalence of overweight and obesity was 34.60％ and 9.40％,respectively; and the standardized prevalence was 32.97％ and 8.67％.The prevalence of overweight or obesity in males was 36.73％ and 8.62％,in females 32.61％ and 10.13％.The prevalence of overweight or obesity was increased with age,although the prevalence of overweight was decreased after 55 years of age (18-:16.31％; 25-:27.38％; 35-:37.28％; 45-:41.55％; 55-:40.71％; 65-:37.64％; 75-:32.08％) and the prevalence of obesity was decreased after 75 years of age (18-:2.49％; 25-:6.41％; 35-:9.64％; 45-:11.24％; 55-:12.07％; 65-:12.45％; 75-:8.88％).There were significant difference of the prevalence of overweight/obesity by educational level (x2=178.41,P＜0.01; x2=243.59,P＜0.01),profession (x2=191.28,P＜0.01; x2=120.38,P＜0.01) and marital status (x2=431.67,P＜0.01; x2=118.43,P＜0.01).In Logistic regression,female,vegetable over-intake every day and current cigarette smoking were protective factors of overweight/obesity,while middle and old-age,alcohol drinking and big appetite were risk factors of overweight/obesity.Conclusions A higher morbidity rate of overweight/obesity was found in Xuzhou City,and comprehensive interventions should be taken for high risk populations.

Objective To explore the association between sleep quality and the increasing risk of type 2 diabetes mellitus (T2DM).Methods A total of 771 patients aged 25-70 years living in Xuzhou City of Jiangsu Province for at least 5 years were enrolled for the survey of risk factor related noninfectious chronic disease in 2013.In this investigation,those who suffered from other types of diabetes,neuropathy,other endocrine disease,cardiovascular,renal and hepatic dysfunction,dyspnea or cancer were excluded.To reduce the influence of confounding factors,another 771 participants were enrolled as controls.Each case was arranged to have a control who was matched in age (difference not more than 3 years),gender,residence and family history.All the participants were interviewed with self-designed questionnaire,and sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI) questionnaire.Student's t test,Chi-square and multivariate logistic regression were used for data analysis.Results The PSQI score in the T2DM patients vs.the controls were 5.15±2.40 vs.2.71 ± 1.93 (t=21.96,P＜0.01).The scores of sleep-related factors,including subjective poor sleep quality,bedtime resistance,short sleep duration,sleep efficiency,sleep disturbance,use of sleep medication and daytime dysfunction,of the T2DM patients were higher than those of the controls.The proportion of sleep related behaviors of the T2DM patients was higher,except for early awakening,cold feeling and nightmare.Poor sleep quality was associated with the increasing risk of T2DM (odds ratio 2.06,95％ CI 1.69-2.52).In multivariate logistic regression,when adjusted for confounding factors,the risk of T2DM was still increased (odds ratio 1.72,95％ CI 1.62-1.83).Sleep-related factors (e.g.subjective poor sleep quality,bedtime resistance,short sleep duration,sleep efficiency and sleep disturbance) were correlated with the risk of T2DM (odds ratio was 3.34,1.63,1.10,1.87 and 3.89,respectively).Conclusion Low quality of sleep may be strongly associated with an increased risk of T2DM.

Objective To explore the relationship between sleep quality and quality of life in patients with type 2 diabetes. Methods Multi-stage randomized cluster sampling was used in the survey and self-designed questionaire , Pittsburgh sleep quality index scale , diabetes specific quality of life scale and self-rating depression scale were adopted. Results The poor sleep quality rate was 33.6%. Compared with the group with 6~8 h sleep duration, the scores of physical function,psychological dimension,social relations and quality of life were higher in patients with < 6 h sleep duration (P < 0.01).The average quality of life score was significantly higher among the sleep disorder participants than the other groups(56.95 ± 14.57 vs 50.11 ± 11.08 vs 44.77 ± 9.61,P<0.01). After adjusting for age, gender, complications, course of disease and depression, etc. The correlation coefficient of sleep quality and quality of life was 3.92. Among them , the sleep quality and physical dimensions of the correlation coefficient is the largest(r=0.407,P<0.01). Conclusions It can be an effective method of improving their status of life quality by ameliorating their sleep quality , especially for the physical dimension.

Objective To explore the interaction of sleep quality and depression among patients with type 2 diabetes. Methods With multistage cluster sampling, all the participants were interviewed with self-designed questionnaire, diabetes-specific quality of life scale and self-rating depression scale, and Pittsburgh sleep quality index scale. Chi-square test was used for qualitative data. Risk factors were analyzed by means of multiple linear regression or logistic regression model. The indicator of interaction was calculated according to the delta method. Results There were 944 residents involved in the final analysis, including 365 males and 579 females. The average age was (64. 0 ± 10. 2) years. Compared with patients with type 2 diabetes mellitus( T2DM) who had good sleep quality and no depression symptoms, the risk of quality of life in those with good sleep quality but depression was 2. 75 (95% CI 1. 59-4. 77); and the risk of quality of life in those with poor sleep quality and no depression was 1. 55(95%CI 1. 03-2. 33). The risk of quality of life in those with poor sleep quality and depression was 4. 97(95% CI 2. 34-9. 63). Due to poor sleep quality and depression in patients with T2DM the combined interaction index was 2. 48 (95% CI 1. 44-4. 29), the relative excess risk was 3. 42(95% CI 2. 16-4. 67), and the attributable proportion was 0. 51(95% CI 0. 32-0. 70). Conclusion A combined interaction of poor sleep quality and depression in affecting the quality of life was found in type 2 diabetic patients. When both factors existed at the same time, the interaction effect of these 2 factors was greater than the single one.

Objective:To explore the effect of cognitive-behavioral therapy on psychological stress and quality of life in patients with pulmonary tuberculosis.Methods:According to two-level cluster random design 461 patients with tuberculosis from 20 communities in Pizhou county of Jiangsu province were selected in the study from September 2018 to November 2018. The intervention group received cognitive-behavioral therapy for two months, while control group received routine follow-up. Anxiety, depression and quality of life were assessed by GAD-7, PHQ-9 and SF-36 scales, respectively. At the same time, the comparison between the two groups was conducted by independent sample t test, and the difference between the two groups before and after treatment was analyzed by paired sample ttest. Results:A total of 454 participants were finally included in this analysis; there were 230 cases in the intervention group and 224 cases in the control group. In the intervention group the scores of anxiety and depression after intervention were significantly lower than the baseline scores [(7.57±5.27) vs. (5.93±2.56), t=-4.245, P<0.01; (8.13±6.01) vs. (6.02±2.67); t=-4.866, P<0.01], and the quality of life score was significantly higher than the baseline score [(58.46±12.71) vs. (74.31±13.22); t=13.108, P<0.01]; while in the control group there were no significant differences in the scores of anxiety, depression and quality of life after intervention, compared with those at baseline [(7.62±5.41) vs.(7.65±5.38); (8.00±5.84) vs. (8.07±5.91); (59.11±13.25) vs. (60.51±13.76); t=0.059, t=0.126, t=1.104, all P>0.05]. However, only for patients with mild and moderate anxiety and depression symptoms in the intervention group, the anxiety and depression scores were decreased after intervention [(7.29±1.21) vs. (5.54±1.71), (11.99±1.31) vs. (9.17±1.55); (7.01±1.47) vs. (4.42±1.22), (11.88±1.12) vs. (8.39±2.33); t=8.056, t=10.020, t=13.558, t=8.852,all P<0.01]. Conclusion:Cognitive-behavioral therapy can relieve the psychological pressure and improve the quality of life in pulmonary tuberculosis patients with mild or moderate anxiety/depression symptoms.