Geographical variability in survival of European children with central nervous system tumours

Survival for childhood central nervous system (CNS) tumours varies across Europe, partly because of the difficulty of distinguishing malignant from non-malignant disease. This study examines bias in CNS tumours survival analysis to obtain the reliable and comparable survival figures.We analysed survival data for about 15,000 children (age <15) diagnosed with CNS between 2000 and 2007, from 71 population-based cancer registries in 27 countries. We selected high-quality data based on registry-specific data quality indicators and recorded observed 1-year and 5-year survival by countries and CNS entity.We provided age-adjusted survival and used a Cox model to calculate the hazard ratios (HRs) of death, adjusting by age, site and grading by country.Recording of non-malignant lesions, use of appropriate morphology codes and completeness of life status follow-up differed among registries. Five-year survival by countries varied less when non-malignant tumours were included, with rates between 79.5% and 42.8%. The HRs of dying, for registries with good data, adjusting by age and grading, were between 0.7 and 1.2; differences were similar when site (supra- and infra-tentorial) was included.Several sources of bias affect the correct definition of CNS tumours, the completeness of incidence series and the goodness of follow-up. The European Network of Cancer Registries needs to improve childhood cancer registration and stress the need to update the International Classification for Cancer. Since survival differences persisted even when restricting the analysis to registries with satisfactory data, and since diagnosis of CNS tumours is difficult and treatment complex, national plans must aim for the revision of the diagnosis and the coordination of care, with adequate national and international networks.     

Metabolic syndrome and the risk of adverse cardiovascular events in patients with myocardial infarction with non-obstructive coronary arteries

Background and aimsMetabolic syndrome (MeS) is recognized as a significant predictor of poor outcomes in coronary artery disease. However, its prognostic implications in myocardial infarction with non-obstructive coronary arteries (MINOCA) have not been examined. We aimed at investigating the role of MeS on the clinical outcomes in MINOCA patients.Methods and resultsPatients diagnosed with MINOCA between 2015 and 2019 were included. MeS was defined according to modified NCEP-ATPIII criteria. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression analysis was used to evaluate the correlation between MeS and the hazard of MACE. The integrated discrimination improvement (IDI) and net reclassification index (NRI) were performed to assess MeS incremental predictive value. Of 281 MINOCA patients, 83 (29.5%) patients satisfied the MeS criteria. During a median follow-up duration of 28 months, MINOCA patients with MeS had a notably higher rate of MACE than those without MeS (30.1% vs. 17.6%, respectively P = 0.020). Cox regression analysis revealed that MeS was associated with an increased hazard of MACE (adjusted HR 2.126; 95% CI: 1.193–3.787, P = 0.010). When each component of MeS was analyzed as a categorized variable separately, only high fasting blood glucose and BMI ≥25 kg/m² were associated with an increased hazard of MACE. Moreover, MeS had an incremental predictive ability for MACE when added to a model with clinical risk factors.ConclusionMeS is relatively common in patients with MINOCA. The presence of MeS significantly increased the hazard of MACE among the MINOCA population.     

基于降秩回归的血压相关膳食模式与老年人认知受损的关系

目的 研究血压相关的膳食模式与老年人认知受损的关系。方法 对营养与慢性病家庭队列≥ 60岁的研究对象进行2015年随访,收集调查对象人口学变量、行为生活方式及健康状况,利用食物频率表问卷（FFQ）收集膳食摄入信息,采用简易心理状况量表评定认知功能。进行健康体检,测定血压、身高和体重等指标。收集空腹静脉血样用于血脂等生物指标的分析。选择SBP和DBP作为反应变量,利用降秩回归法,提取血压相关的膳食模式,并利用多因素logistic回归模型,分析血压相关膳食模式评分与认知受损的关系。结果 提取了2种与血压相关的膳食模式,分别为蔬菜摄入较多、肉类蛋类和糕点摄入较少的膳食模式（模式1）和肉类、豆制品、白酒和油炸食品摄入量较多、奶类摄入较少的膳食模式（模式2）。但仅有模式1与认知受损风险之间呈正向显著关系,相比该模式最低的四分位数,该模式最高的四分位数组患有认知受损的风险显著增加（OR=1.94,95%CI：1.21~3.11,P<0.01）,且呈线性趋势（P=0.002）;而膳食模式2与认知受损风险无显著关系（P>0.05）。结论 血压相关膳食模式评分与认知受损风险呈显著正向关系。     

我国40岁及以上人群慢性呼吸系统疾病症状流行现况及影响因素研究

目的 了解我国≥ 40岁人群慢性呼吸系统疾病症状（咳嗽、咳痰、持续性咳嗽和持续性咳痰）的流行现况,并探讨其影响因素。方法 2010年中国慢性病及其危险因素监测项目在31个省（自治区、直辖市）和新疆生产建设兵团开展的162个监测点,采用多阶段整群随机抽样方法,选取其中≥ 40岁人群56 066名作为研究对象。对样本进行复杂加权后分性别计算咳嗽、咳痰、持续性咳嗽和持续性咳痰的流行率,并用χ²检验进行比较组间差异,采用多因素logistic回归模型分析其影响因素。结果 2010年我国≥ 40岁人群中,男性的咳嗽率、持续性咳嗽率、咳痰率和持续性咳痰率均显著高于女性（P<0.01）;慢性呼吸系统症状流行率与年龄、烟龄和吸烟量呈正相关（P<0.01）,与文化程度呈负相关（P<0.01）。多因素logistic回归分析显示性别、年龄、文化程度、吸烟、地区、城乡是慢性呼吸系统疾病症状流行的影响因素。结论 我国≥ 40岁人群慢性呼吸系统疾病症状普遍流行,主要危险因素为年龄、地区以及吸烟。     

中国2010年糖尿病疾病负担

目的了解中国糖尿病疾病负担现状。方法利用全国疾病监测系统死因监测和中国慢性病及其危险因素监测数据,估计2010年中国糖尿病伤残调整寿命年(DALY),并分析其在不同人群和地区间的差异。结果2010年中国居民糖尿病每千人DALY值为19.12人年,其中男性(18.30人年)略低于女性(19.97人年)。DALY的年龄分布呈倒“U'',形,主要集中在15~79岁居民,其中45~60岁人群最高(30.39人年);DALY的城乡分布以城市(17.83人年)高于农村(17.03人年),并以东部(22.28人年)、中部(19.62人年)、西部(15.34人年)地区依次递减。结论目前中国糖尿病疾病负担已相当严重,且劳动力人群负担较高,并存在一定程度的地区分布不公平性。     

Comparison of Salt-Related Knowledge and Behaviors Status of WeChat Users between 2019 and 2020

In order to identify the status of salt-related knowledge and behavior of the residents who were active in WeChat software between 2019 and 2020, 10-day salt-related surveys were conducted in 2019 and 2020 based on the WeChat public platform of China Healthy Lifestyle for All Campaign. Distribution and scores of salt-related knowledge, salt reduction behavior and high-salt intake behavior between 2019 and 2020 were compared. Data of 2109 participants in 2019 and 12,732 participants in 2020 were left for analysis. Overall, 88.2% of participants in 2019 had a willingness to reduce the amount of cooking salt in their households, significantly lower than 90.2% in 2020 (p-value < 0.05). In 2019 and 2020, over 80% of the participants knew fine dried noodles contain salt, but less than 30% knew ice cream contains salt. Over 78% of participants chose 5 g or 6 g for the maximum daily salt intake of healthy adults, and about 98% of participants knew that excessive salt intake would increase the risk of hypertension in both years. The percentage of participants who used salt measuring spoons asked restaurants to use less salt, read the sodium content on the nutrition facts table, chose foods with low sodium content and regularly used low-sodium salt, were 36.1%, 45.0%, 44.1%, 40.3% and 35.8% in 2019, and the percentage increased significantly to 46.4%, 49.2%, 50.8%, 47.1% and 43.4% in 2020 (all p-value < 0.05). The percentage of people regularly eating pickled mustard tubers, salted vegetables and sauce foods or using high-salt condiments also increased from 2019 to 2020. The median of salt-related knowledge scores, salt reduction behavior scores and high-salt intake behavior scores were 11, 2, 5 points in 2019, and 10, 3, 5 points in 2020, respectively. Compared to 2019, the salt-related knowledge score was relatively lower, while the salt reduction behavior score and high-salt intake behavior score were relatively higher in 2020. Besides, the score of salt-related knowledge and behaviors differed in different gender, age and hypertension groups. The COVID-19 epidemic may have influenced the salt-related knowledge and behaviors status of WeChat users in China. Promotion and education of salt-related knowledge and online behavior intervention are still needed, particularly for male and hypertension patients in the future.     

The association of diabetes mellitus with carotid atherosclerosis and arterial stiffness in the Corinthia study

Background and aimsEvaluation of arterial stiffness and carotid atherosclerotic burden can provide important prognostic information regarding the risk of future cardiovascular events. The aim of this study was to assess these vascular properties in patients with diabetes mellitus (DM).Methods and resultsIn the context of the observational “Corinthia” study, we analyzed 1757 participants with determined DM status. Carotid ultrasonography was performed to evaluate intima-media thickness (cIMT) and carotid plaque burden. Arterial stiffness was estimated via assessment of carotid-to-femoral pulse wave velocity (cfPWV). Individuals with DM had increased mean cIMT, maximum cIMT, carotid plaque burden, and cfPWV compared to those without DM. After multivariable regression analysis, the presence of DM was still associated with significantly increased mean cIMT (by 0.074 mm, p = .004), maximum cIMT (by 0.134 mm, p = .007), cfPWV (by 0.929 m/s, p < .001), and a higher prevalence of carotid plaques (odds ratio 1.52, 95% confidence intervals 1.11, 2.10, p = .01). In a propensity score-matched cohort, mean cIMT, maximum cIMT, and carotid plaque burden were significantly higher in individuals with DM. Analysis according to territory of cIMT measurement displayed substantial differences in left (DM: 1.32 ± 0.78 mm vs. no DM: 1.20 ± 0.66 mm, p = .04) and right carotid bulbs (DM: 1.33 ± 0.82 mm vs. no DM: 1.18 ± 0.69 mm, p = .02) with respect to DM status while non-significant variations were observed in left (DM: 0.98 ± 0.49 mm vs. no DM: 0.91 ± 0.35 mm, p = .06) and right common carotid artery (DM: 0.95 ± 0.50 mm vs. no DM: 0.92 ± 0.40 mm, p = .36).ConclusionsDiabetes mellitus is associated with increased cfPWV and cIMT, with more pronounced lesions in the carotid bulb.     

Trends in maternal mortality in the United States

Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.