Objective This study was aimed at investigating the carrier rate of,and molecular variation in,α-andβ-globin gene mutations in Hunan Province.Methods We recruited 25,946 individuals attending premarital screening fr...Objective This study was aimed at investigating the carrier rate of,and molecular variation in,α-andβ-globin gene mutations in Hunan Province.Methods We recruited 25,946 individuals attending premarital screening from 42 districts and counties in all 14 cities of Hunan Province.Hematological screening was performed,and molecular parameters were assessed.Results The overall carrier rate of thalassemia was 7.1%,including 4.83%forα-thalassemia,2.15%forβ-thalassemia,and 0.12%for bothα-andβ-thalassemia.The highest carrier rate of thalassemia was in Yongzhou(14.57%).The most abundant genotype ofα-thalassemia andβ-thalassemia was-α^(3.7)/αα(50.23%)andβ^(IVS-Ⅱ-654)/β^(N)(28.23%),respectively.Fourα-globin mutations[CD108(ACC>AAC),CAP+29(G>C),Hb Agrinio and Hb Cervantes]and sixβ-globin mutations[CAP+8(C>T),IVS-Ⅱ-848(C>T),-56(G>C),beta nt-77(G>C),codon 20/21(-TGGA)and Hb Knossos]had not previously been identified in China.Furthermore,this study provides the first report of the carrier rates of abnormal hemoglobin variants andα-globin triplication in Hunan Province,which were 0.49%and 1.99%,respectively.Conclusion Our study demonstrates the high complexity and diversity of thalassemia gene mutations in the Hunan population.The results should facilitate genetic counselling and the prevention of severe thalassemia in this region.展开更多
Around 850 million people currently are affected by different types of kidney disorders.Up to 1 in 10 adults worldwide has chronic kidney disease(CKD),which is invariably irreversible and mostly progressive.The global...Around 850 million people currently are affected by different types of kidney disorders.Up to 1 in 10 adults worldwide has chronic kidney disease(CKD),which is invariably irreversible and mostly progressive.The global burden of CKD is increasing,and CKD is projected to become the fifth most common cause of years of life lost globally by 2040.If CKD remains uncontrolled and if the affected person survives the ravages of cardiovascular and other complications of the disease,CKD progresses to endstage kidney disease,where life cannot be sustained without dialysis therapy or kidney transplantation.Hence,CKD is a major cause of catastrophic health expenditure.展开更多
Previous studies have shown that exposure to black carbon(BC,a tracer of traffic-related air pollution)and psychosocial stress are both associated with adverse cardiac effects,but whether psychosocial stress could mod...Previous studies have shown that exposure to black carbon(BC,a tracer of traffic-related air pollution)and psychosocial stress are both associated with adverse cardiac effects,but whether psychosocial stress could modify the cardiac effects of BC is unclear.To investigate the potential modifying effect of psychosocial stress on the associations between acute exposure to BC and typical cardiac health variables,real-time personal 24 h measurements were conducted in a repeated-measure study among adults with elevated blood pressure(high-risk group)and a panel study among normal adults(low-risk group)in China.Measured cardiac health variables included ST-segment depression events,heart rate,and heart rate variability(HRV)variables.Perceived Stress Scale,State Anxiety Inventory and Self-rating Depression Scale were used to assess the recent psychosocial stress status of the participants,and a composite stress index was established based on these scales.Generalized linear mixed-effects model was used to analyze the associations between BC exposure and cardiac health variables and potential effect modification by psychosocial stress.A total of 9724 h measurements among 97 participants in the repeated-measure study and 20224 h measurements among 87 participants in the panel study were included in the final analysis.Acute BC exposure was significantly associated with increased ST-segment depression events and heart rate and decreases in HRV in both studies.The marginal effects of acute BC exposure on most cardiac health variables generally tended to be amplified under higher vs low levels of psychosocial stress in both studies,with the composite stress index apparently modifying the associations of BC exposure with most ST-segment depression events and HRV variables.These findings suggest that psychosocial stress may increase the participants’cardiac susceptibility to BC exposure,which could be helpful for the identification of susceptible individuals in the context of traffic-related air pollution.展开更多
AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHR...AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHRI) dataset of ambulatory care patients,inpatient claims,and the updated registry of beneficiaries from 2000 to 2008.A total of 615 532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000.Age-and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database(n = 614 871).The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status.The distributions of age,gender,occupation,income,and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models.Differences between the rates of selected comorbidities were also assessed in the two groups.RESULTS:Overall,60 734 diabetic patients and 48 116 control patients developed symptomatic GSD and underwent operations,resulting in cumulative operation rates of 9.87% and 7.83%,respectively.The age and gender distributions of both groups were similar,with a mean age of 60 years and a predominance of females.The diabetic group had a significantly higher prevalence of all comorbidities of interest.A higher incidence of symptomatic GSD was observed in females than in males in both groups.In the control group,females under the age of 64 had a significantly higher incidence of GSD than the corresponding males,but this difference was reduced with increasing age.The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years,respectively.Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group(12.35 vs 8.75 cases per 1000 person-years).CONCLUSION:The association of diabet展开更多
Background:Understanding willingness to undergo pulmonary function tests(PFTs)and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary...Background:Understanding willingness to undergo pulmonary function tests(PFTs)and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease(COPD).This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.Methods:We collected data from participants in the"Happy Breathing Program"in China.Participants who did not follow physicians’recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs.We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs.We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.Results:A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study.Out of these participants,7660(90.4%)were willing to undergo PFTs.Among those who were willing to undergo PFTs but actually did not,the main reasons for not doing so were geographical inaccessibility(n=3304,43.1%)and a lack of trust in primary healthcare institutions(n=2809,36.7%).Among the 815 participants who were unwilling to undergo PFTs,over half(n=447,54.8%)believed that they did not have health problems and would only consider PFTs when they felt unwell.In the multivariable regression,individuals who were≤54 years old,residing in rural townships,with a secondary educational level,with medical reimbursement,still working,with occupational exposure to dust,and aware of the abbreviation"COPD"were more willing to undergo PFTs.Conclusions:Willingness to undergo PFTs was high among high-risk populations.Policymakers may consider implementing strategies such as providing financial incentives,promoting education,and establishing community-based pro展开更多
Objective To evaluate levels of lead(Pb) and cadmium(Cd) in the breast milk in the second postpartum month,to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters,and t...Objective To evaluate levels of lead(Pb) and cadmium(Cd) in the breast milk in the second postpartum month,to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters,and to explore whether these levels affect the infants' physical status or the mothers' psychological status(postpartum depression).Methods A cross-sectional study was conducted between November 2009 and December 2010.Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital.The inclusion criteria were:voluntary to participate in this study,healthy,with no chronic disease,breastfeeding in the second postpartum month,living in a suburban but not non-industrial area of Nanjing,and not occupationally exposed to toxic metals.All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale(EPDS) to identify the risk of postpartum depression.Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy.The infants of these mothers were examined for their z scores of weight for age,length for age,head circumference for age,and body mass index for age.Results The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L,respectively.In 164(96.5%) of the 170 samples,Pb levels were higher than the limit reported by the World Health Organization(> 5 μg/L).Breast milk Cd level was > 1 μg/L in 54(31.8%) mothers.The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia(41.1 μg/L vs.37.9 μg/L,P = 0.050).The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers(0.88 μg/L vs.0.00 μg/L,P = 0.025).The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements(iron supplement:0.74 μg/L vs.0.00 μg/L,P = 0.025;vitamin supplement:0.78 μg/L vs.0.00 μg/L,P = 0.005).展开更多
With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been ...With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,d展开更多
BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and...BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.展开更多
Objective To investigate the blood lead levels （BLLs） in the duration of pregnancy and 6-12 weeks after delivery, and analyze the influencing factors of BLLs in healthy pregnant women. Methods Pregnant women were r...Objective To investigate the blood lead levels （BLLs） in the duration of pregnancy and 6-12 weeks after delivery, and analyze the influencing factors of BLLs in healthy pregnant women. Methods Pregnant women were recruited from September 2009 to February 2010 at the prenatal clinic in Nanjing Maternity and Child Health Care Hospital. Altogether 174 healthy pregnant women without pregnant or obstetric complications or abnormal pregnancy outcomes were enrolled as the gravida group, and 120 healthy non-pregnant women as the control group. BLLs during pregnancy were determined by flame atomic absorption spectroscopy. Results BLLs in all the three pregnancy trimesters and postpartum were 59.8±24.3, 55.4±20.1, 55.9±19.7, and 67.6±17.4 μ/L, respectively, and the mean BLL in control group was 67.5±21.3 μg/L. BLLs during all the three trimesters were lower in the gravida group than in the control group （P=0.043, 0.021, and 0.028）. Furthermore, occupations, nutrients supplementation, and time of house/apartment painted were associated with BLLs in pregnant women. Lead-related occupations, cosmetics use, and living in a house painted less than 1 year before are risk factors of high BLLs among pregnant women, while calcium, iron, zinc, and milk supplements are protective factors. Conclusion Supplementing calcium, iron, zinc, and milk, or avoiding contact with risk factors may help people, especially pregnant women, to reduce lead exposure.展开更多
OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the f...OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the factors contributing to the variations of effectiveness.METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to participate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension management knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness.RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs increased significantly from 62.87 ± 21.14 out of 100 in the pre-test to 88.30 ± 11.31 in the post-test by 25.43(95% confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36) in the pre-test and soared the most after training,up to 84.22 by 54.94%.Individual factors associated with disparities in the knowledge of hypertension management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being explained by factors at the regional level.CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the trainin展开更多
Interleukin-18 gene promoter polymorphisms are potential risk factors for ischemic cerebrovascular disease, and the –607C allele may increase ischemic stroke risk in the Han Chinese population. In the present study, ...Interleukin-18 gene promoter polymorphisms are potential risk factors for ischemic cerebrovascular disease, and the –607C allele may increase ischemic stroke risk in the Han Chinese population. In the present study, we recruited 291 patients with ischemic cerebrovascular disease from the Affiliated Hospital of Qingdao University Medical College, China, and 226 healthy controls. Both patients and controls were from the Han population in northern China. Immunoresonance scattering assays detected increased serum amyloid A protein, C-reactive protein, and interleukin-18 levels in ischemic cerebrovascular disease patients compared with healthy controls. Analysis of the –607C/A （rs1946518） polymorphism in the interleukin-18 gene promoter showed ischemic cerebrovascular disease patients exhibited increased frequencies of the CC genotype and C alleles than healthy controls. Genotype and allele frequencies of the interleukin-18 –137G/C （rs187238） polymorphism and the –13T/C （rs11024595） polymorphism in the 5＇-flanking region of serum amyloid A, showed no significant difference between the two groups. Multivariate logistic regression analysis on the interleukin-18 promoter A/C genetic locus, for correction of age, gender, history of smoking, hypertension, diabetes mellitus, hypercholesteremia, and an ischemic stroke family history, showed ischemic cerebrovascular disease risk in individuals without the A allele （C homozygotes） was 2.2-fold greater than in A allele carriers. Overall, our findings suggest that the –13T/C （rs11024595） polymorphism in the 5′-flanking region of serum amyloid A has no correlation with ischemic cerebrovascular disease, but the C allele of the –607C/A （rs1946518） polymorphism in the interleukin-18 promoter is a high-risk factor for ischemic cerebrovascular disease in the Han population of northern China. In addition, the A allele is likely a protective gene for ischemic cerebrovascular disease.展开更多
Background Knowledge on the impact of the temporary kindergarten closure policy under COVID-19 in 2020 on childhood overweight and obesity is inadequate.We aimed to examine differences in rates of overweight and obesi...Background Knowledge on the impact of the temporary kindergarten closure policy under COVID-19 in 2020 on childhood overweight and obesity is inadequate.We aimed to examine differences in rates of overweight and obesity from 2018 to 2021 among kindergarten children aged 3–7 years.Methods Overweight was defined as body mass index(BMI)>1 standard deviation(SD)for age and sex,and obesity was defined as BMI>2 SD for age and sex.Generalized linear mixed modeling was used for analysis.Results A total of 44,884 children and 71,216 growth data points from all 57 public kindergartens in Jiading District,Shanghai,China were analyzed.The rates of obesity from 2018 to 2021 were 6.9%,6.6%,9.5%,and 7.3%in boys and 2.8%,2.8%,4.5%,and 3.1%in girls,respectively.The rates of overweight from 2018 to 2021 were 14.3%,14.3%,18.2%,and 15.3%in boys and 10.6%,10.9%,13.9%,and 11.6%in girls.The rates of obesity and overweight among kindergarten children in 2020 were significantly higher than those in 2018,2019,and 2021.Compared to 2020,the odds ratios of the obesity rate in 2018,2019,and 2021 were 0.67[95%confidence interval(CI)=0.58–0.77,P<0.001],0.72(95%CI=0.64–0.80,P<0.001)and 0.81(95%CI=0.72–0.92,P=0.001),respectively.The odds ratios of the overweight rate in 2018,2019,and 2021 were 0.75(95%CI=0.69–0.82,P<0.001),0.78(95%CI=0.72–0.84,P<0.001),and 0.89(95%CI=0.81–0.97,P=0.008),respectively,compared to 2020.Conclusions The rates of overweight and obesity significantly increased among kindergarten children in 2020 after the 5-month kindergarten closure.It was critical to provide guidance to caregivers on fostering a healthy lifestyle for children at home under public health emergencies.展开更多
Background:In light of the shift to aiming for schistosomiasis elimination,the following are needed:data on reinfection patterns,participation,and sample submission adherence of all high-risk age groups to interventio...Background:In light of the shift to aiming for schistosomiasis elimination,the following are needed:data on reinfection patterns,participation,and sample submission adherence of all high-risk age groups to intervention strategies.This study was conducted to assess prevalence,reinfections along with consecutive participation,sample submission adherence,and effect of treatment on schistosomiasis prevalence in children aged five years and below in an endemic district in Zimbabwe,over one year.Methods:The study was conducted from February 2016-February 2017 in Madziwa area,Shamva district.Following community mobilisation,mothers brought their children aged 5 years and below for recruitment at baseline and also urine sample collection at baseline,3,6,9 and 12 months follow up surveys.At each time point,urine was tested for urogenital schistosomiasis by urine filtration and children found positive received treatment.Schistosoma haematobium prevalence,reinfections as well as children participation,and urine sample submission at each visit were assessed at each time point for one year.Results:Of the 535 children recruited from the five communities,169(31.6%)participated consecutively at all survey points.The highest mean number of samples submitted was 2.9 among communities and survey points.S.haematobium prevalence significantly reduced from 13.3%at baseline to 2.8%at 12 months for all participants and from 24.9%at baseline to 1.8%at 12 months(P<0.001)for participants coming at all-time points.Among the communities,the highest baseline prevalence was found in Chihuri for both the participants coming consecutively(38.5%,10/26)and all participants(20.4%,21/103).Reinfections were significantly high at 9 months follow up survey(P=0.021)and in Mupfure(P=0.003).New infections significantly decreased over time(P<0.001).Logistic regression analysis showed that the risk of acquiring schistosomiasis was high in some communities(P<0.05).Conclusions:S.haematobium infections and reinfections are seasonal and depend on micro-geograph展开更多
AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement.METHODS: We performed a retrospecti...AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement.METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ<sup>2</sup> test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group.RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely pr展开更多
Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menop...Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.展开更多
Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated ...Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.展开更多
Background:In the underdeveloped multi-ethnic regions of China,high tuberculosis(TB)burden and regional inequity in access to healthcare service increase the challenge of achieving the End TB goals.Among all the provi...Background:In the underdeveloped multi-ethnic regions of China,high tuberculosis(TB)burden and regional inequity in access to healthcare service increase the challenge of achieving the End TB goals.Among all the provinces,the highest TB burden is reported in Xinjiang,where ethnic minorities and older people have suffered most.However,current case-finding strategy is inadequate given the complex social determinants and suboptimal case detection rates.Thus,we developed an integrated TB control program to improve case detection and conducted a pilot in Xinjiang from 2014 to 2015.In this case study,we summarized the activities and key findings.We also shared the experiences and challenges of implementing interventions and provided recommendations to inform the TB control program in the future.Case presentation:The pilot interventions were implemented in one selected town in Yining based on local TB control programs.By applying tailor-made educational materials,outreach TB educational activities were conducted in diverse ways.In 22 Masjids,the trained imams promoted TB education to the Muslims,covering 20,440 persontimes in 88 delivered preaching sessions.In seven schools,1944 students were educated by the teachers and contributed to educating 6929 family members.In the village communities,13,073 residents participated in household education and screening.Among them,12,292 people aged under 65 years were investigated for suspicious pulmonary TB symptoms,where six TB patients were diagnosed out of 89 TB suspects;781 older people were mobilized for screening directly by chest X-ray,where 10 patients were diagnosed out of 692 participants.Supportive healthcare system,multi-sectoral cooperation and multi-channel financing mechanism were the successful experiences of implementation.The interventions were proved to be more effective than the previous performance:the number of TB suspects consulting doctors and patients detected increased by 50%and 26%,respectively.The potential challenges,implications and recommendations sh展开更多
Background： MicroRNAs （miRNAs） are key regulators during tumor initiation and progression. MicroRNA-375 （MiR-375） has been proven to play a tumor-suppressive role in various types of human malignancies; however, ...Background： MicroRNAs （miRNAs） are key regulators during tumor initiation and progression. MicroRNA-375 （MiR-375） has been proven to play a tumor-suppressive role in various types of human malignancies; however, its biological role in clear cell renal cell carcinoma （ccRCC） remains unclear. The purpose of this study was to explore the biologic role as well as the underlying mechanism of miR-375 in ccRCC progression. Methods： Quantitative polymerase chain reaction （qPCR） was applied to test the expression of miR-375 in tissues and cell lines by t-test. Functional experiments were used to investigate the biological role of miR-375 utilizing a gain-of-function strategy. The target of miR-375 was investigated by bioinformatic analysis and further verified by luciferase reporter assay, qPCR, Western blotting, and functional experiments in vitro. Results： Our study demonstrated that miR-375 was significantly downregulated in ccRCC tissues （cancer vs. normal, 0.804 ±0.079 vs. 1.784 ± 0.200, t = 5.531 P 〈 0.0001 ） and cell lines, and loss ofmiR-375 expression significantly associated with advanced Fuhrman nuclear grades （Grade Ⅲ and Ⅳ vs. Grade Ⅰ and Ⅱ, 1.000 ± 0.099 vs. 1.731 ± 0.189, t = 3.262 P = 0.003）. Functional studies demonstrated that miR-375 suppressed ccRCC cell proliferation, migration, and invasion （all P 〈 0.05 in both 786-0 and A498 cell lines）. Multiple miRNA target prediction algorithms indicated the well-studied oncogene YWHAZ as a direct target ofmiR-375, which was further confirmed by the luciferase reporter assay, qPCR, and Western blotting. Moreover, restoration of YWHAZ could rescue the antiproliferation effect ofmi R-375. Conclusions： The data provide the solid evidence that miR-375 plays a tumor-suppressive role in ccRCC progression, partially through regulating YWHAZ. This study expands the antitumor profile ofmiR-375, and supports its role as a potential therapeutic target in ccRCC treatment.展开更多
基金support ongoing meetings was provided by ISPOR-The Professional Society for Health Economics and Outcomes ResearchThe funders had no role in considering the study design or in the collection,analysis,interpretation of data,or writing of the report.Funding for DH and the Delphi Panel exercise was provided by 9363980 Canada Ine+1 种基金the NIHR Applied Research Collaboration(ARC)West Midlandsthe NIHR Health Protection Research Unit(HPRU)Gastrointestinal Infections,and the NIHR HPRU Genomics and Enabling data.
基金supported by the National Key Research and Development Program of China[2021YFC1005300]the science and technology innovation Program of Hunan Province—Major Scientific and Technological Projects for Collaborative Prevention and Control of Birth Defects in Hunan Province[2019SK1010 and 2019SK1011]Hunan Province Clinical Medical Technology Innovation Guidance Project"Screening,prevention and control of single gene disease carriers and panel research in childbearing age people in Hunan Province"[2021SK50602].
文摘Objective This study was aimed at investigating the carrier rate of,and molecular variation in,α-andβ-globin gene mutations in Hunan Province.Methods We recruited 25,946 individuals attending premarital screening from 42 districts and counties in all 14 cities of Hunan Province.Hematological screening was performed,and molecular parameters were assessed.Results The overall carrier rate of thalassemia was 7.1%,including 4.83%forα-thalassemia,2.15%forβ-thalassemia,and 0.12%for bothα-andβ-thalassemia.The highest carrier rate of thalassemia was in Yongzhou(14.57%).The most abundant genotype ofα-thalassemia andβ-thalassemia was-α^(3.7)/αα(50.23%)andβ^(IVS-Ⅱ-654)/β^(N)(28.23%),respectively.Fourα-globin mutations[CD108(ACC>AAC),CAP+29(G>C),Hb Agrinio and Hb Cervantes]and sixβ-globin mutations[CAP+8(C>T),IVS-Ⅱ-848(C>T),-56(G>C),beta nt-77(G>C),codon 20/21(-TGGA)and Hb Knossos]had not previously been identified in China.Furthermore,this study provides the first report of the carrier rates of abnormal hemoglobin variants andα-globin triplication in Hunan Province,which were 0.49%and 1.99%,respectively.Conclusion Our study demonstrates the high complexity and diversity of thalassemia gene mutations in the Hunan population.The results should facilitate genetic counselling and the prevention of severe thalassemia in this region.
文摘Around 850 million people currently are affected by different types of kidney disorders.Up to 1 in 10 adults worldwide has chronic kidney disease(CKD),which is invariably irreversible and mostly progressive.The global burden of CKD is increasing,and CKD is projected to become the fifth most common cause of years of life lost globally by 2040.If CKD remains uncontrolled and if the affected person survives the ravages of cardiovascular and other complications of the disease,CKD progresses to endstage kidney disease,where life cannot be sustained without dialysis therapy or kidney transplantation.Hence,CKD is a major cause of catastrophic health expenditure.
基金supported by the National Natural Science Foundation of China (82073509)the National Key Research and Development Program of China (2017YFC0211600,2017YFC0211601).
文摘Previous studies have shown that exposure to black carbon(BC,a tracer of traffic-related air pollution)and psychosocial stress are both associated with adverse cardiac effects,but whether psychosocial stress could modify the cardiac effects of BC is unclear.To investigate the potential modifying effect of psychosocial stress on the associations between acute exposure to BC and typical cardiac health variables,real-time personal 24 h measurements were conducted in a repeated-measure study among adults with elevated blood pressure(high-risk group)and a panel study among normal adults(low-risk group)in China.Measured cardiac health variables included ST-segment depression events,heart rate,and heart rate variability(HRV)variables.Perceived Stress Scale,State Anxiety Inventory and Self-rating Depression Scale were used to assess the recent psychosocial stress status of the participants,and a composite stress index was established based on these scales.Generalized linear mixed-effects model was used to analyze the associations between BC exposure and cardiac health variables and potential effect modification by psychosocial stress.A total of 9724 h measurements among 97 participants in the repeated-measure study and 20224 h measurements among 87 participants in the panel study were included in the final analysis.Acute BC exposure was significantly associated with increased ST-segment depression events and heart rate and decreases in HRV in both studies.The marginal effects of acute BC exposure on most cardiac health variables generally tended to be amplified under higher vs low levels of psychosocial stress in both studies,with the composite stress index apparently modifying the associations of BC exposure with most ST-segment depression events and HRV variables.These findings suggest that psychosocial stress may increase the participants’cardiac susceptibility to BC exposure,which could be helpful for the identification of susceptible individuals in the context of traffic-related air pollution.
基金Supported by The Cheng-Hsin General Hospital and National Yang-Ming University
文摘AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHRI) dataset of ambulatory care patients,inpatient claims,and the updated registry of beneficiaries from 2000 to 2008.A total of 615 532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000.Age-and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database(n = 614 871).The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status.The distributions of age,gender,occupation,income,and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models.Differences between the rates of selected comorbidities were also assessed in the two groups.RESULTS:Overall,60 734 diabetic patients and 48 116 control patients developed symptomatic GSD and underwent operations,resulting in cumulative operation rates of 9.87% and 7.83%,respectively.The age and gender distributions of both groups were similar,with a mean age of 60 years and a predominance of females.The diabetic group had a significantly higher prevalence of all comorbidities of interest.A higher incidence of symptomatic GSD was observed in females than in males in both groups.In the control group,females under the age of 64 had a significantly higher incidence of GSD than the corresponding males,but this difference was reduced with increasing age.The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years,respectively.Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group(12.35 vs 8.75 cases per 1000 person-years).CONCLUSION:The association of diabet
基金funding from the Strategic Research and Consulting Project of the Chinese Academy of Engineering(No.2022-XBZD-14)funding from the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2021-I2M-1-049).
文摘Background:Understanding willingness to undergo pulmonary function tests(PFTs)and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease(COPD).This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.Methods:We collected data from participants in the"Happy Breathing Program"in China.Participants who did not follow physicians’recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs.We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs.We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.Results:A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study.Out of these participants,7660(90.4%)were willing to undergo PFTs.Among those who were willing to undergo PFTs but actually did not,the main reasons for not doing so were geographical inaccessibility(n=3304,43.1%)and a lack of trust in primary healthcare institutions(n=2809,36.7%).Among the 815 participants who were unwilling to undergo PFTs,over half(n=447,54.8%)believed that they did not have health problems and would only consider PFTs when they felt unwell.In the multivariable regression,individuals who were≤54 years old,residing in rural townships,with a secondary educational level,with medical reimbursement,still working,with occupational exposure to dust,and aware of the abbreviation"COPD"were more willing to undergo PFTs.Conclusions:Willingness to undergo PFTs was high among high-risk populations.Policymakers may consider implementing strategies such as providing financial incentives,promoting education,and establishing community-based pro
基金supported by Nanjing Maternity and Child Health Care Hospital
文摘Objective To evaluate levels of lead(Pb) and cadmium(Cd) in the breast milk in the second postpartum month,to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters,and to explore whether these levels affect the infants' physical status or the mothers' psychological status(postpartum depression).Methods A cross-sectional study was conducted between November 2009 and December 2010.Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital.The inclusion criteria were:voluntary to participate in this study,healthy,with no chronic disease,breastfeeding in the second postpartum month,living in a suburban but not non-industrial area of Nanjing,and not occupationally exposed to toxic metals.All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale(EPDS) to identify the risk of postpartum depression.Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy.The infants of these mothers were examined for their z scores of weight for age,length for age,head circumference for age,and body mass index for age.Results The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L,respectively.In 164(96.5%) of the 170 samples,Pb levels were higher than the limit reported by the World Health Organization(> 5 μg/L).Breast milk Cd level was > 1 μg/L in 54(31.8%) mothers.The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia(41.1 μg/L vs.37.9 μg/L,P = 0.050).The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers(0.88 μg/L vs.0.00 μg/L,P = 0.025).The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements(iron supplement:0.74 μg/L vs.0.00 μg/L,P = 0.025;vitamin supplement:0.78 μg/L vs.0.00 μg/L,P = 0.005).
基金This scoping review was kindly supported by the Health and Medical Research Fund[Number:CU-15-C12]Food and Health Bureau,Hong Kong Special Administrative Region,China.
文摘With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,d
文摘BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.
基金supported by Nanjing Maternity and Child Health Care Hospital
文摘Objective To investigate the blood lead levels （BLLs） in the duration of pregnancy and 6-12 weeks after delivery, and analyze the influencing factors of BLLs in healthy pregnant women. Methods Pregnant women were recruited from September 2009 to February 2010 at the prenatal clinic in Nanjing Maternity and Child Health Care Hospital. Altogether 174 healthy pregnant women without pregnant or obstetric complications or abnormal pregnancy outcomes were enrolled as the gravida group, and 120 healthy non-pregnant women as the control group. BLLs during pregnancy were determined by flame atomic absorption spectroscopy. Results BLLs in all the three pregnancy trimesters and postpartum were 59.8±24.3, 55.4±20.1, 55.9±19.7, and 67.6±17.4 μ/L, respectively, and the mean BLL in control group was 67.5±21.3 μg/L. BLLs during all the three trimesters were lower in the gravida group than in the control group （P=0.043, 0.021, and 0.028）. Furthermore, occupations, nutrients supplementation, and time of house/apartment painted were associated with BLLs in pregnant women. Lead-related occupations, cosmetics use, and living in a house painted less than 1 year before are risk factors of high BLLs among pregnant women, while calcium, iron, zinc, and milk supplements are protective factors. Conclusion Supplementing calcium, iron, zinc, and milk, or avoiding contact with risk factors may help people, especially pregnant women, to reduce lead exposure.
文摘OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the factors contributing to the variations of effectiveness.METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to participate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension management knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness.RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs increased significantly from 62.87 ± 21.14 out of 100 in the pre-test to 88.30 ± 11.31 in the post-test by 25.43(95% confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36) in the pre-test and soared the most after training,up to 84.22 by 54.94%.Individual factors associated with disparities in the knowledge of hypertension management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being explained by factors at the regional level.CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the trainin
文摘Interleukin-18 gene promoter polymorphisms are potential risk factors for ischemic cerebrovascular disease, and the –607C allele may increase ischemic stroke risk in the Han Chinese population. In the present study, we recruited 291 patients with ischemic cerebrovascular disease from the Affiliated Hospital of Qingdao University Medical College, China, and 226 healthy controls. Both patients and controls were from the Han population in northern China. Immunoresonance scattering assays detected increased serum amyloid A protein, C-reactive protein, and interleukin-18 levels in ischemic cerebrovascular disease patients compared with healthy controls. Analysis of the –607C/A （rs1946518） polymorphism in the interleukin-18 gene promoter showed ischemic cerebrovascular disease patients exhibited increased frequencies of the CC genotype and C alleles than healthy controls. Genotype and allele frequencies of the interleukin-18 –137G/C （rs187238） polymorphism and the –13T/C （rs11024595） polymorphism in the 5＇-flanking region of serum amyloid A, showed no significant difference between the two groups. Multivariate logistic regression analysis on the interleukin-18 promoter A/C genetic locus, for correction of age, gender, history of smoking, hypertension, diabetes mellitus, hypercholesteremia, and an ischemic stroke family history, showed ischemic cerebrovascular disease risk in individuals without the A allele （C homozygotes） was 2.2-fold greater than in A allele carriers. Overall, our findings suggest that the –13T/C （rs11024595） polymorphism in the 5′-flanking region of serum amyloid A has no correlation with ischemic cerebrovascular disease, but the C allele of the –607C/A （rs1946518） polymorphism in the interleukin-18 promoter is a high-risk factor for ischemic cerebrovascular disease in the Han population of northern China. In addition, the A allele is likely a protective gene for ischemic cerebrovascular disease.
基金This study was funded by the Program of Public Health Outstanding Scholars,Jiading District,Shanghai Discipline Leadership Scholars,the Fifth Round of the Three-Year Public Health Action Plan of Shanghai Key Discipline Program(GWV-10.1-XK08)the Shanghai Municipal Public Health Outstanding Discipline Leadership Program(GWV-10.2-XD10).
文摘Background Knowledge on the impact of the temporary kindergarten closure policy under COVID-19 in 2020 on childhood overweight and obesity is inadequate.We aimed to examine differences in rates of overweight and obesity from 2018 to 2021 among kindergarten children aged 3–7 years.Methods Overweight was defined as body mass index(BMI)>1 standard deviation(SD)for age and sex,and obesity was defined as BMI>2 SD for age and sex.Generalized linear mixed modeling was used for analysis.Results A total of 44,884 children and 71,216 growth data points from all 57 public kindergartens in Jiading District,Shanghai,China were analyzed.The rates of obesity from 2018 to 2021 were 6.9%,6.6%,9.5%,and 7.3%in boys and 2.8%,2.8%,4.5%,and 3.1%in girls,respectively.The rates of overweight from 2018 to 2021 were 14.3%,14.3%,18.2%,and 15.3%in boys and 10.6%,10.9%,13.9%,and 11.6%in girls.The rates of obesity and overweight among kindergarten children in 2020 were significantly higher than those in 2018,2019,and 2021.Compared to 2020,the odds ratios of the obesity rate in 2018,2019,and 2021 were 0.67[95%confidence interval(CI)=0.58–0.77,P<0.001],0.72(95%CI=0.64–0.80,P<0.001)and 0.81(95%CI=0.72–0.92,P=0.001),respectively.The odds ratios of the overweight rate in 2018,2019,and 2021 were 0.75(95%CI=0.69–0.82,P<0.001),0.78(95%CI=0.72–0.84,P<0.001),and 0.89(95%CI=0.81–0.97,P=0.008),respectively,compared to 2020.Conclusions The rates of overweight and obesity significantly increased among kindergarten children in 2020 after the 5-month kindergarten closure.It was critical to provide guidance to caregivers on fostering a healthy lifestyle for children at home under public health emergencies.
基金This study was partly funded by Thrasher foundation(No.12440).
文摘Background:In light of the shift to aiming for schistosomiasis elimination,the following are needed:data on reinfection patterns,participation,and sample submission adherence of all high-risk age groups to intervention strategies.This study was conducted to assess prevalence,reinfections along with consecutive participation,sample submission adherence,and effect of treatment on schistosomiasis prevalence in children aged five years and below in an endemic district in Zimbabwe,over one year.Methods:The study was conducted from February 2016-February 2017 in Madziwa area,Shamva district.Following community mobilisation,mothers brought their children aged 5 years and below for recruitment at baseline and also urine sample collection at baseline,3,6,9 and 12 months follow up surveys.At each time point,urine was tested for urogenital schistosomiasis by urine filtration and children found positive received treatment.Schistosoma haematobium prevalence,reinfections as well as children participation,and urine sample submission at each visit were assessed at each time point for one year.Results:Of the 535 children recruited from the five communities,169(31.6%)participated consecutively at all survey points.The highest mean number of samples submitted was 2.9 among communities and survey points.S.haematobium prevalence significantly reduced from 13.3%at baseline to 2.8%at 12 months for all participants and from 24.9%at baseline to 1.8%at 12 months(P<0.001)for participants coming at all-time points.Among the communities,the highest baseline prevalence was found in Chihuri for both the participants coming consecutively(38.5%,10/26)and all participants(20.4%,21/103).Reinfections were significantly high at 9 months follow up survey(P=0.021)and in Mupfure(P=0.003).New infections significantly decreased over time(P<0.001).Logistic regression analysis showed that the risk of acquiring schistosomiasis was high in some communities(P<0.05).Conclusions:S.haematobium infections and reinfections are seasonal and depend on micro-geograph
基金Supported by(in part)by resources from the Veterans Affairs(VA) Cooperative Studies Program Epidemiology Center-Durham,the Puget Sound VA Health Care System,and the VA Office of Public Health and Human Health Pathogens
文摘AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement.METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ<sup>2</sup> test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group.RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely pr
基金supported by Chinese Medical Foundation (CMF, No. 313.2215)
文摘Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.
文摘Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.
基金The project was supported by the China-WHO Biennial Collaborative Projects 2014-2015 and TB control programs in Xinjiang Uygur Autonomous Region.
文摘Background:In the underdeveloped multi-ethnic regions of China,high tuberculosis(TB)burden and regional inequity in access to healthcare service increase the challenge of achieving the End TB goals.Among all the provinces,the highest TB burden is reported in Xinjiang,where ethnic minorities and older people have suffered most.However,current case-finding strategy is inadequate given the complex social determinants and suboptimal case detection rates.Thus,we developed an integrated TB control program to improve case detection and conducted a pilot in Xinjiang from 2014 to 2015.In this case study,we summarized the activities and key findings.We also shared the experiences and challenges of implementing interventions and provided recommendations to inform the TB control program in the future.Case presentation:The pilot interventions were implemented in one selected town in Yining based on local TB control programs.By applying tailor-made educational materials,outreach TB educational activities were conducted in diverse ways.In 22 Masjids,the trained imams promoted TB education to the Muslims,covering 20,440 persontimes in 88 delivered preaching sessions.In seven schools,1944 students were educated by the teachers and contributed to educating 6929 family members.In the village communities,13,073 residents participated in household education and screening.Among them,12,292 people aged under 65 years were investigated for suspicious pulmonary TB symptoms,where six TB patients were diagnosed out of 89 TB suspects;781 older people were mobilized for screening directly by chest X-ray,where 10 patients were diagnosed out of 692 participants.Supportive healthcare system,multi-sectoral cooperation and multi-channel financing mechanism were the successful experiences of implementation.The interventions were proved to be more effective than the previous performance:the number of TB suspects consulting doctors and patients detected increased by 50%and 26%,respectively.The potential challenges,implications and recommendations sh
基金This work was supported by the grants from the National Natural Science Foundation of China （No. 81702521） and Provincial Natural Science Foundation of Shandong （No. ZR2017PH019 and No. ZR2018BH018）.
文摘Background： MicroRNAs （miRNAs） are key regulators during tumor initiation and progression. MicroRNA-375 （MiR-375） has been proven to play a tumor-suppressive role in various types of human malignancies; however, its biological role in clear cell renal cell carcinoma （ccRCC） remains unclear. The purpose of this study was to explore the biologic role as well as the underlying mechanism of miR-375 in ccRCC progression. Methods： Quantitative polymerase chain reaction （qPCR） was applied to test the expression of miR-375 in tissues and cell lines by t-test. Functional experiments were used to investigate the biological role of miR-375 utilizing a gain-of-function strategy. The target of miR-375 was investigated by bioinformatic analysis and further verified by luciferase reporter assay, qPCR, Western blotting, and functional experiments in vitro. Results： Our study demonstrated that miR-375 was significantly downregulated in ccRCC tissues （cancer vs. normal, 0.804 ±0.079 vs. 1.784 ± 0.200, t = 5.531 P 〈 0.0001 ） and cell lines, and loss ofmiR-375 expression significantly associated with advanced Fuhrman nuclear grades （Grade Ⅲ and Ⅳ vs. Grade Ⅰ and Ⅱ, 1.000 ± 0.099 vs. 1.731 ± 0.189, t = 3.262 P = 0.003）. Functional studies demonstrated that miR-375 suppressed ccRCC cell proliferation, migration, and invasion （all P 〈 0.05 in both 786-0 and A498 cell lines）. Multiple miRNA target prediction algorithms indicated the well-studied oncogene YWHAZ as a direct target ofmiR-375, which was further confirmed by the luciferase reporter assay, qPCR, and Western blotting. Moreover, restoration of YWHAZ could rescue the antiproliferation effect ofmi R-375. Conclusions： The data provide the solid evidence that miR-375 plays a tumor-suppressive role in ccRCC progression, partially through regulating YWHAZ. This study expands the antitumor profile ofmiR-375, and supports its role as a potential therapeutic target in ccRCC treatment.
