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1.
Background
The burden of non-communicable diseases burden in China is enormous, with tobacco consumption a leading risk factor for the most prevalent NCDs. Therefore, understanding pattern of socioeconomic equalities of tobacco consumption will help to design targeted public health control measures. We aimed to investigate who tends to consume most tobacco in China.Methods
Nationally representative data from the 2013 China Health and Retirement Longitudinal Study (CHARLS) included smoking information on 17?663 respondents aged 45 years and older. Smoking prevalence and smoking quantities were defined to capture tobacco consumption. Using concentration index (defined as twice the area between the concentration curve and the line of equality), we estimated income-related inequality of tobacco consumption grouped by gender. The inequality of tobacco consumption was further decomposed into each determinant's specific contribution on using probit regression analysis and Ordinary Least Squares (OLS) regression models.Findings
About 16·03% of respondents consumed tobacco. By sex, 8449 men (29·65%) and 9213 women (3·54%) consumed tobacco. Furthermore, we found a significant pro-rich inequality of tobacco consumption. The concentration index of smoking incidence was 0·0438 (0·0412 for men; ?0·0393 for women). The concentration index of smoking quantities among people who smoke was 0·0385 (0·0333 for men; 0·0381 for women), whereas the concentration index of smoking quantities in the whole population was 0·0748 (0·0675 for men; ?0·0044 for women). Most of the inequality can be explained by education attainments, age, geographical areas, and economic status.Interpretation
Sex, education attainments, age, geographical areas, and economic status were strong predictors of tobacco consumption in China. Public health policies need to be targeted towards the less educated people and elderly people. Both the pattern and magnitude of inequality varied greatly between men and women, and public policies for tobacco control in men should be strengthened at southern-central and northern areas of China, whereas public policies for women should be strengthened in the eastern and northeastern areas of China.Funding
Research Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), and National Program for Support of Top-notch Young Professionals and China Medical Board (15-227). 相似文献2.
Background
In 2009, China officially launched the New Health Care Reform. This study aimed to measure the occurrence of catastrophic health expenditure of households with at least one member diagnosed with chronic diseases (hereafter referred to as chronic households) in Shaanxi Province before and after the reform, and explore the influence of the New Health Care Reform on catastrophic health expenditure.Methods
The data were from the fourth and fifth National Household Health Service Surveys of Shaanxi Province. In total, 1942 chronic households in 2008 (954 in urban areas and 988 in rural areas) and 7704 households in 2013 (2870 in urban areas and 4834 in rural areas) were selected for analysis. WHO's method was used to estimate catastrophic health expenditure, which was defined as an out-of-pocket payment for health care equal to or higher than 40% of a household's capacity to pay. A multilevel logistic regression model was used to explore the influence of the New Health Care Reform on the presence of catastrophic health expenditure. We used the concentration index to measure the income-related inequality in catastrophic health expenditure.Findings
In rural areas, the proportion of households incurring catastrophic health expenditure dropped (288 [29%] households in 2008 vs 1142 (24%) in 2013; χ2 13·517, p=0·00024). However, in urban areas, the proportion of households suffering from catastrophic health expenditure increased (183 [19%] households in 2008 vs 716 [25%] in 2013; χ2 13.235, p=0·00027). After controlling for confounding variables (eg, commercial insurance, household size, having elderly members, having children, household economic status, and age, gender, education, marital status, and employment status of household head), the random-intercept logistic regression model showed a significant interaction term between year and geographic location, implying that the influence of the New Health Care Reform on catastrophic health expenditure differed between urban and rural areas. From 2008 to 2013, the concentration index of catastrophic health expenditure in rural areas increased from ?0·4572 to ?0·5499 (difference ?0·0927, Z ?2·22, p=0·026).Interpretation
Our study suggested that the implementation of the New Health Care Reform might not have been effective in reducing catastrophic health expenditure for households of patients with chronic diseases, especially in urban areas. Additionally, the income inequality of catastrophic health expenditure was greater in 2013 than in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts to develop the current health insurance system and optimise the hierarchical health-care system are required to improve protection against catastrophic health expenditure.Funding
Xi'an Jiaotong University (grant number GG1K004). 相似文献3.
Youfa Wang Zhongliang Zhou Yaling Zhao Ruhai Bai Xing Wang Xiaomin Sun Weidong Qu Yaogang Wang Hong Yan 《Lancet》2017
Background
In 2015, China launched the Belt and Road Initiative (BRI; also known as the Silk Road Economic Belt and the 21st-Century Maritime Silk Road), a trade and infrastructure network to promote international collaboration. We aimed to compare health burden, health-care facilities, and resources among countries participating in the BRI, to help understand health needs, develop health promotion programmes, and facilitate collaboration on global health.Methods
In a mixed methods study, data from 1990 to 2015 were collected from the WHO, UN, and World Bank database for key health indicators and social, economic, and environmental factors (eg, gross domestic product) for China and 65 other countries participating in the BRI. We used linear and logistic regression and multilevel models in the analysis, examining impact associations of the selected health indicators and social, economic, and environmental factors.Findings
We noted large variation and shifts over time in patterns of disease burden, availability of health-care facilities (eg, numbers of doctors, nurses, hospitals, and beds), and context factors across the 66 countries. During 2000–14, life expectancy increased in almost all countries except for Iraq and Syria, by 3·9 years on average. Life expectancy was positively associated with gross domestic product per person, stronger in higher quintiles. Since 1990, mortality in children younger than 5 years has declined by 74%, from 62 deaths per 1000 livebirths in 1990 to 16 per 1000 livebirths in 2015, an annual fall of 3·0%. Economic, social, and environmental factors were closely associated with health indicators and health-care facilities and the disparities in them.Interpretation
Large variations exist in disease burden, availability of health-care facilities, and economic, social, and environmental factors across the BRI countries. This initiative provides good opportunities to study the effect of context factors and international collaboration on health outcomes.Funding
Chinese Medical Board (GNL 16-262), Xi'an Jiaotong University. 相似文献4.
Background
To relieve patients' financial burden, China has established three basic health insurances: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). However, because the insured rich have more opportunity to access health care, more subsidies might be paid to them rather than the poor. We analysed the income-related benefit equity of health insurance for patients with chronic diseases to investigate who benefits most from government health insurance in China.Methods
We used data from the second phase of the China Health and Retirement Longitudinal Study (CHARLS), collected in 2013. Benefit incidence (use of inpatient care or not), benefit degree 1 (measured by subsidy paid by the basic health insurances for inpatients), and benefit degree 2 (measured by reimbursement paid by health insurances for all patients with chronic diseases, such as cancer, hypertension, and diabetes) were deployed to indicate the benefits from the health insurances. We used the decomposition of the concentration index to analyse income-related horizontal inequity of benefit incidence and benefit degree.Findings
There were 9728 patients identified for the analysis. The benefit incidence for patients with chronic diseases were 15·42% for those covered by UEBMI, 11·99% for those covered by URBMI, and 12·73% for those covered by NRCMS, while the subsidies paid by the three health insurances for inpatients (benefit degree 1) were ¥6457, ¥3127, and ¥2718, respectively, and for patients with chronic diseases (benefit degree 2) were ¥860, ¥307, and ¥279, respectively. By decomposing the concentration index, the income-related horizontal inequities of benefit incidence were 0·0868 for UEBMI, 0·1904 for URBMI, and 0·1495 for NRCMS. The horizontal inequities of benefit degree 1 and benefit degree 2 were 0·1880 and 0·4194 for UEBMI, 0·1186 and 0·3764 for URBMI, and 0·0900 and 0·2862 for NRCMS.Interpretation
With same health-care needs, high-income patients with chronic diseases benefit more than low-income patients in each of China's basic health insurances. Improvement of benefit equity should be a concern of health insurance policy development.Funding
Research Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), National Program for Support of Top-Notch Young Professionals, China Medical Board (15-227). 相似文献5.
Background
There is an increasing amount of data over the effect of folic acid and B vitamins (vitamin B6 and B12) on cardiovascular disease, but whether supplementation with folic acid and B vitamins can reduce the risk of cardiovascular disease among middle-aged and elderly patients remains unclear. We conducted this meta-analysis to assess the efficacy of folic acid supplementation in the prevention of cardiovascular disease.Methods
We searched PubMed and Web of Science for randomised controlled trials published between Jan 1, 1980, and Sept 1, 2015. We used relative risk (RR) with 95% CIs as a measure of effect of folic acid supplementation on the risk of cardiovascular disease. Data were independently extracted and sorted by two investigators to assess their quality. The results were pooled with a randomised-effects model using Stata 12.0 software. We used forest plots to analyse the effect of B vitamins as well as folic acid.Findings
We included 22 randomised controlled trials reporting data on 79?564 participants. All participants were aged 45 years or older (ie, middle-aged or elderly). Supplementation with both folic acid and B vitamins together was not associated with any significant reduction in the risk of cardiovascular events (RR 0·98, 95% CI 0·92 to 1·03, p=0·353), myocardial infarction (1·00, 0·93 to 1·08, p=0·940), or total mortality (1·00, 0·94 to 1·06, p=0·778). However, a beneficial effect was observed for stroke, with supplementation with folic acid and B vitamins reducing the risk by 12% (RR 0·88, 95% CI 0·80 to 0·97, p=0·001). Moreover, we found that folic acid only could reduce the risk of cardiovascular events by 11% (RR 0·89, 95% CI 0·80 to 0·98, p=0·016) and the risk of stroke by 20% (0·80, 0·69 to 0·93, p=0·003). The level of homocysteine was reduced by 0·72 μmol/L (95% CI ?1·00 to ?0·44, p<0·0001).Interpretation
Supplementation with folic acid with or without B vitamins is more beneficial for stroke than for other cardiovascular outcomes in middle-aged and elderly patients.Funding
2012 Chinese Nutrition Society Nutrition Research Foundation—DSM Research Fund (2014-014); the Research Program of Shaanxi Soft Science (2015KRM117); the National High-Level Talents Special Support Plan (“Thousands of People Plan”); Shaanxi Provincial Youth Star of Science and Technology in 2016; and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007). 相似文献6.
Background
Fragmentation in health insurance schemes adversely affects health equity. To achieve universal health coverage by 2020, China has implemented comprehensive reforms to improve health insurance. China has three basic health insurance schemes: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). However, little research has compared the effects of different health insurance schemes on the equity of health-related quality of life. This study aimed to compare the equity of health-related quality of life of residents under any two of the schemes.Methods
Our analysis used cross-sectional survey data from the 5th National Health Services Survey of Shaanxi Province, China, with a coarsened exact matching method to control for confounding factors. We included a matched sample of 6802 respondents between UEBMI and URBMI, 34?169 respondents between UEBMI and NRCMS, and 36?928 respondents between URBMI and NRCMS. Health-related quality of life was measured by three-level EuroQol five-dimensions (EQ-5D-3L) based on the Chinese-specific value set. We adopted a concentration index to assess health equity and its contributing factors. In this study, the horizontal inequity index of health-related quality of life was obtained by removing the contributions of unavoidable variables (such as gender and age) from the overall concentration index of health-related quality of life. A positive (or negative) horizontal inequity index of health-related quality of life indicated pro-rich (or pro-poor) inequity.Findings
After matching, the mean EQ-5D utility scores were 0·9589 (SD 0·0036) and 0·9449 (0·0062) in UEBMI and URBMI, 0·9579 (0·0036) and 0·9473 (0·0016) in UEBMI and NRCMS, and 0·9505 (0·0055) and 0·9605 (0·0013) in URBMI and NRCMS, respectively. Horizontal inequity indexes were 0·0036 and 0·0045 in UEBMI and URBMI, 0·0035 and 0·0058 in UEBMI and NRCMS, and 0·0053 and 0·0052 in URBMI and NRCMS, respectively, which were mainly explained by age, educational and economic statuses. For example, between UEBMI and NRCMS, we found that age (52·15%), educational status (19·88%), and economic status (19·78%) made the largest contributions to explain the inequality of health-related quality of life for the insured residents of UEBMI.Interpretation
Our findings highlight the need to consolidate all three schemes with uniform administration, merged funding pools, and matched benefit packages. Strategies to reduce the factors that contribute to health inequity (eg, to facilitate health conditions of elderly people, narrow the economic gap, and reduce educational inequity) are essential. This study will provide evidence-based strategies on consolidating the fragmented health schemes towards reducing health inequity in both China and other developing countries.Funding
Research Program of Shaanxi Soft Science (2015KRM117), National High-Level Talents Special Support Plan (“Thousands of People Plan”), Shaanxi Provincial Youth Star of Science and Technology in 2016, and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007). 相似文献7.
Background
The annual number of newly licensed doctors is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health-care market during a time period. Since the implementation of the Law on Practicing Doctors in 1999, the Chinese Government has established its medical licensure system to both regulate medical professions and improve the quality of health-care services. We aimed to analyse the trend and structure of newly licensed doctors since the establishment of its medical licensure system.Methods
We analysed a unique census dataset that provides the headcount of newly licensed doctors in China between 2005 and 2015. We also review a short history of medical licensing system reform in China since the 1990s.Findings
The annual number of first-time licensed doctors in China increased from 159?489 in 2005 to 221?639 in 2015. Until 2015, more than 50% of newly licensed doctors had not received equivalent medical education of a bachelor degree or higher. In 2005, about 51% of China's newly licensed doctors were women, whereas in 2015, 56% newly licensed doctors were women.Interpretation
Our findings could inform policy making in human resources for health in at least two aspects. First, the heterogeneity of medical education of entering doctors needs to draw more attention of policy makers. The second policy implication is, however, that the feminisation of physician in China is becoming more apparent, and the consequences still require more rigorous examinations.Funding
None. 相似文献8.
Nicolas Orsi Tathagata Dasgupta Michele Cummings Julius Adebayo Vinay Sharma Jeremy Gunawardena Sarah Field 《Lancet》2017
Background
Conception assisted by intracytoplasmic sperm injection (ICSI) requires oocyte stripping for morphological evaluation of maturity status. However, this approach prevents further maturation and poorly predicts fertilisability, so more robust assessment strategies are needed. Given that cytokines orchestrate oocyte development, we aimed to assess the association of follicular fluid cytokine profiles with maturation stage and develop predictive machine learning-based methods to identify those with the greatest fertilisation potential.Methods
In this retrospective study, follicular fluid was collected at oocyte retrieval from 64 women and linked to oocyte maturity status or fate—namely, germinal vesicle (n=26), metaphase I (51), metaphase II not fertilised (51), and metaphase II fertilised (84). 51 follicular fluid cytokines were profiled by multiplex immunoassay. Machine learning-based classifiers to predict oocyte fertilisability were subjected to iterative feature reduction to a threshold suitable for developing a clinically viable assessment of oocyte maturity. Women gave written, informed consent.Findings
Cytokine profiles varied dynamically throughout maturation. When applied to naive samples with known outcome, classifiers developed using tumour necrosis factor-related apoptosis-inducing ligand and interleukin 18 profiles alone correctly discriminated 89% of metaphase II not fertilised oocytes (ie, those with the highest fertilisability) with high confidence from all other maturation stages.Interpretation
These classifiers offer the prospect of cost-effective, point-of-care testing, and streamlined ICSI-based workflows. This assessment circumvents stripping such that immature or low fertilisability oocytes could benefit from in-vitro maturation and increase the pool of usable oocytes. Further studies will confirm the robustness of these classifiers in women with a broader morbidity spectrum and their translational value across a range of clinical settings.Funding
Infertility Research Trust. 相似文献9.
Sean Sylvia Hao Xue Chengchao Zhou Yaojiang Shi Hongmei Yi Huan Zhou Scott Rozelle Madhukar Pai Jishnu Das 《Lancet》2017
Background
Future progress against tuberculosis in China will likely rely on improved detection, particularly in rural areas where prevalence remains high. The ability of rural providers to correctly diagnose Tuberculosis is largely unknown, as are the potential effects on tuberculosis patients of health-system reforms promoting initial contact with grassroots providers.Methods
We employed unannounced standardised patients presenting with classic pulmonary tuberculosis symptoms in a representative survey of village, township, and county level providers in three provinces and assessed provider management of standardised patients against international and national standards of care. We then measured the gap between knowledge and practice by comparing doctor care of standardised patients to their performance in clinical vignettes of an identical presumptive tuberculosis case. Finally, we simulated the management of patients at the health-system level under alternative managed care policies accounting for provider referrals.Findings
In July, 2015, we successfully completed 274 standardised patient interactions. Of 46 interactions in village clinics, 13 (28%) were correctly managed (95% CI 17–43%), compared with 79 (38%) of 207 in township health centers (32–45%) and 19 (90%) of 21 in county hospitals (71–97%). The same providers were 45 percentage points (95% CI 37–53%) more likely to correctly manage the same case in vignettes. Under existing policy, which allows patients to freely choose initial providers, simulations suggest that 40% (95% CI 34–47%) of patients encountering the health system are correctly managed. This would reduce to 16% with gatekeeping from village clinics and to 37% from township centers.Interpretation
We uncovered important quality deficits among grassroots providers in the management of a case of presumptive tuberculosis and a large gap between provider knowledge and practice. In view of the current quality of care, reforms encouraging first contact in village clinics could reduce the rate of detection of patients with tuberculosis.Funding
Fundamental Research Funds for the Central Universities and the Research Funds of Renmin University of China (2015030245), the 111 Project (B16031), the National Science Foundation of China (71473152), and the Department of Science and Technology of Shandong Province (BS2012SF010). 相似文献10.
Christian Lambert Eva Zeestraten Owen Williams Philip Benjamin Andrew Lawrence Robin Morris Andrew Mackinnon Thomas Barrick Hugh Markus 《Lancet》2017
Background
Sporadic cerebral small vessel disease is an important cause of vascular dementia, and is a syndrome of cognitive impairment with evidence of vascular brain damage. At post-mortem examination pure vascular dementia is rare, with coexisting Alzheimer's disease pathology in 95% of cases. We aimed to use MRI to characterise the structural abnormalities during the preclinical phase of vascular dementia in symptomatic small vessel disease, and use these characteristics to accurately predict the development of future dementia.Methods
121 adults with symptomatic small vessel disease were initially recruited to the St George's Cognition and Neuroimaging in Stroke (SCANS) study and followed up longitudinally for 5 years, with 22 individuals converting to dementia. Baseline T1-weighted MRI data were acquired for all 121 partcipants. Voxel-based morphometry was used to identify differences in patients with preclinical vascular dementia. Support vector machines were then used to predict future dementia from the baseline scans. Anatomical endophenotypes were defined using cluster ward linkage.Findings
We found reduced grey matter density in the left striatum and hippocampus, and more white matter hyperintensities in the frontal white matter, in preclinical dementia. Future dementia could be predicted with a balanced accuracy of 73%. Four anatomical subtypes were identified. In one of them, patients were younger than those in the other three groups and had the highest levels of vascular damage; they also had milder cognitive impairment but rapid deterioration in processing speed and executive function, consistent with primary vascular dementia. The other groups had progressively less vascular damage and increasing memory impairment consistent with more Alzheimer's like pathology. The rates of hippocampal atrophy supported these groupings, with the vascular group resembling the cohort that did not develop dementia, and the Alzheimer's like group demonstrating more global hippocampal atrophy.Interpretation
We show that baseline MRI can reliably predict preclinical vascular dementia, with 73% of patients converting to dementia within 5 years. MRI can identify distinct anatomical endophenotypes representing a spectrum between vascular and Alzheimer's like pathology. This work provides a way to accurately stratify patients by use of a baseline MRI scan, and has utility in future clinical trials designed to slow or prevent the onset of dementia in these high-risk cohorts.Funding
The SCANS study was supported by the Wellcome Trust (grant 081589). Patient recruitment was supported by the National Institute for Health Research (NIHR) Clinical Stroke Research Network. 相似文献11.
Background
Ethnic minorities have greatly increased rates of schizophrenia. The risk is most pronounced when individuals are living in areas with few people of the same ethnicity as them. Amygdala hyperactivity has been linked to paranoid symptoms in psychosis, and increased levels of paranoia have been observed in ethnic minority individuals. White individuals show an increased amygdala response when viewing black faces; however, whether a similar effect is seen in black individuals is not clear.Methods
20 individuals of white British ethnicity, and 20 of black ethnicity underwent a 3T MRI scan while viewing faces of black and white ethnicity. Participants were aged 18–45 years, with no history of mental illness. Population density, indices of multiple deprivation, and percentage own-group ethnic density were obtained from the 2011 census. Neighbourhood segregation was quantified with the Index of Dissimilarity method. Ethics approval was granted by the West London National Research Ethics Service Committee.Findings
At the within-group level, both groups individually showed greater right amygdala activation to the out-group faces (white ethnicity t=2·08, p=0·02; black ethnicity t=2·38, p=0·015). Between groups, the black ethnicity group showed a greater increase in right amygdala activation for the white faces compared with baseline than did the white ethnicity group (t=1·84, p=0·038). Within the black ethnicity group, amygdala reactivity to white faces showed significant correlations with measures of neighbourhood population density (r=0·61, p=0·01), segregation (r=0·71, p=0·003), deprivation (r=0·67, p=0·04), and own-group ethnic density (r=–0·51, p=0·04).Interpretation
We have shown for the first time, to our knowledge, increased amygdala response to white faces in individuals of black ethnicity. Significant correlations were observed between amygdala response and neighbourhood variables associated with increased psychosis risk. This finding has relevance for our understanding of the increased rates of paranoia and psychotic disorders in ethnic minority individuals. Further research in patient populations will help clarify aetiological relevance.Funding
National Institute for Health Research, Medical Research Council, Wellcome Trust. 相似文献12.
Background
Chinese coal miners are at high risk of occupational disease becausethey work underground during most of the daylight hours and are exposed to weight-bearing activity. But data concerning bone mineral density (BMD) and risk factors of BMD is lacking. We aim to identify the factors associated with low bone BMD in coal miners.Methods
Measurements were taken at the lumbar spine and proximal femur using DXA (OSTEOCORE-2 Vision, Medilink, France). Demographic, lifestyle, physical, and occupational characteristics were collected through standardised questionnaires. Univariate, multivariate, and multiple regression were performed.Findings
We recruited 1650 coal miners aged 30–60 years from Kailuan, a city in Hebei province of China, from May to November, 2011. 51 miners (10%) older than 50 years were osteoporotic, and 191 miners (36%) had osteopenia at the lumbar spine. Four miners (1%) were osteoporotic, and 134 miners (25%) had osteopenia at the femoral neck. Pearson correlation showed that lumbar spine and femoral neck BMD correlated positively with weight (r=0·155, p<0·0001; r=0·194, p<0·0001) and body-mass index (BMI; r=0·108, p<0·0001; r=0·177, p<0·0001). Number of years of work (r=–0·134, p<0·0001) and age (r=–0·116, p<0·0001) were negatively correlated with femoral neck BMD. On multiple regression analysis, BMI was the only independent predictor of lumbar spine BMD (η2=0·005, p<0·0001), whereas both BMI (η2=0·007, p<0·0001) and years of work (η2=0·003, p<0·01) were independent predictors of femoral neck BMD.Interpretation
Age, low BMI, and long duration of work are risk factors for low BMD of coal miners in China, along with low calcium supplements intake, less time of sun exposure, smoking, and drinking history.Funding
Specific Research Project of Health Pro bono Sectors, Ministry of Health, China (201002014). 相似文献13.
Sunil Bhopal Deepali Verma Gauri Divan Zelee Hill Jane Barlow Reetabrata Roy Betty Kirkwood 《Lancet》2017
Background
SPRING-ELS (Early Life Stress) is a substudy of the SPRING cluster randomised controlled trial that is assessing a home visits programme in rural India promoting early child development and growth. Early life stress interferes with healthy child development so our aim was to evaluate its role in the SPRING causal pathway. We report findings from the preparatory phase of SPRING-ELS.Methods
To develop an explanatory model of early life stress in the community, 45 mothers of children under 2 years old took part in eight focus group discussions. To determine potential barriers to sampling, in-depth interviews were done with five mothers and two barbers (to understand cultural beliefs about young children's hair). In addition, five focus group discussions were done with mothers, grandmothers, and barbers. Salivary and hair cortisol (to assess diurnal rhythm and chronic stress) were measured in 13 children aged 11–13 months. The SPRING trial is registered with ClinicalTrials.gov, number NCT02059863.Findings
Causes of stress included violence, poverty, poor hygiene, neglect and poor care, maternal stress, and carer alcoholism. Consequences included a range of physical and mental adversity. Improved caregiving was seen as the most important prevention method. However, in contrast to previous research, stress was seen to affect older children, who have a better understanding of their environment, than younger infants. Taking saliva samples was straightforward. Mothers preferred to be helped by assessors to take these samples rather than doing it themselves. However, hair sampling was challenging. There are many cultural beliefs surrounding young children's hair and a child's first haircut is a ceremonial occasion: rates of refusal were high (four of 13 families refused). Sample size was adjusted accordingly.Interpretation
Measuring early life stress in the community is feasible and acceptable. Careful introduction in the community has achieved a 14% refusal rate to take hair samples despite major cultural barriers. These stress measures have been integrated into SPRING outcome assessments, which are being performed with a total of 1200 children. Each assessment is done over 2 days when a child reaches 1 year of age. 60 children are being assessed at home each week using salivary and hair cortisol measurments and questionnaires of environmental stressors developed using findings from our explanatory model. To our knowledge, SPRING is the first large child health intervention trial to include measures of early life stress and the first time that hair cortisol will be assessed in South Asian children.Funding
Wellcome Trust research training fellowship to SB (grant number 107818/Z/15/Z). 相似文献14.
Background
Non-optimal blood lipid profiles are a major modifiable risk factor for cardiovascular diseases. We aimed to understand trends in blood lipid profiles for 12 middle-income and high-income countries in four continents.Methods
We pooled studies that had measured blood lipids in representative samples of the general population. For this analysis, we used data for individuals aged 30–59 years only. Studies were from Australia, Belgium, China, Czech Republic, Finland, Germany, Italy, Japan, Norway, South Korea, the UK, and the USA. Using weighted linear regression, we estimated trends in mean total cholesterol, HDL cholesterol, non-HDL cholesterol, and mean total-to-HDL cholesterol ratio by country, sex, and age-group from 1973 to 2013.Findings
We pooled 267 studies, with 2·3 million participants. Over four decades, mean total and non-HDL cholesterol levels decreased in high-income western countries from high levels, whereas they increased from low levels in China and Japan. Over the same period, changes in mean HDL cholesterol and mean total-to-HDL cholesterol ratio were more heterogeneous. Mean HDL cholesterol increased substantially in Belgium, Japan, and the UK; the increase of more than 0·1 mmol/L per decade in Japanese women led to a decrease in mean total-to-HDL cholesterol ratio despite increases in mean total cholesterol. By contrast, mean HDL cholesterol declined by about 0·05–0·1 mmol/L per decade in Germany and Norway, with stagnation or possible increases in mean total-to-HDL cholesterol ratio despite declines in both mean total and non-HDL cholesterol.Interpretation
Over the past 40 years, blood lipid profiles have changed in important ways. There has been convergence in mean total and non-HDL cholesterol in high-income western and East Asian countries, whereas mean HDL cholesterol and total-to-HDL cholesterol ratio show heterogeneous trends. This study underscores the importance of analysing entire lipid profiles.Funding
Wellcome Trust. 相似文献15.
Yu-Lan Zhao Han-Huan Luo Xin-Tian Zhang Zashi Bianba Lin Li Qian Wang Lei Guo Dian Wang Yong-Ge Ze Shan Zheng 《Lancet》2017
Background
The rural and urban integration health-care system is a new and improved health-care system in Tibet, China. The aim of this study was to investigate whether these improvements might alter the clinical–pathologic characteristics of Tibetan female with breast cancer in Tibet.Methods
This was a single-centre cross-sectional study at Tibet Autonomous Region People's Hospital. We included Tibetan adult women who had been treated for breast cancer in this hospital between Jan 1, 1973, and Dec 31, 2015. The inclusion criteria were: (1) Tibetan adult woman living in Tibet; (2) histopathology or cytopathology, or both, confirming primary breast cancer; and (3) all the treatments were finished in this hospital. The Ethics Committee of TAR People's Hospital passed this project (ID Num: ME-TBHP-15-1). Patient consent was not required according to the routine. χ2 test and logistic regression were applied, using age group and census register as the two covariates.Findings
We included 273 patients with breast cancer in the final analysis. 14 patients were in the free health-care system, 183 patients had medical insurance combined with a rural cooperative health-care system, and 76 were in a rural and urban integration health-care system. We found a decrease in tumour size (>2 cm vs 2cm; odds ratio 0·117; 95% CI 0·036–0·383) and a decrease in the proportion patients who had invasion (0·460; 0·265–0·797) among women in the rural and urban integration health–care system. The proportion of patients in early stage cancer (5·737; 1·117–29·468) and advanced stage cancer (3·917; 1·406–10·914) increased in the rural and urban integration health–care system.Interpretation
This was the first report about Tibetan women with breast cancer in Tibet. Except for advanced stage breast cancer, the clinical–pathological characteristics of Tibetan women with breast cancer improved during different health-care systems. The overall management in patients with breast cancer in advanced stage might be one of the emphases in the rural and urban integration health-care system. Information and selection bias might be the limitations of this study.Funding
Natural Science Foundation of Tibet Autonomous Region (2015ZR-13-61). 相似文献16.
Oana Mitrofan Tamsin Ford Sarah Byford Dasha Nicholls Hristina Petkova Jonathan Kelly Eve Edwards 《Lancet》2017
Background
In the UK, young people with eating disorders have different care pathways—general to highly specialised—depending on geographical location. A clear consensus on the most cost-effective and most valued treatment pathway is currently lacking. This study aimed to identify the most beneficial aspects of care through the perspectives of young people and their parents. We aimed to add depth to a parallel investigation of the cost-effectiveness of UK community-based eating disorder pathways.Methods
This qualitative study recruited participants and used online focus groups through Beat (Beating Eating Disorders, a UK National Charity). 19 young women aged 16–25 years with an existing or past eating disorder and 11 parents participated in four and two focus groups, respectively. The sample size was informed by saturation of themes. Data were analysed using thematic analysis. All participants provided written informed consent. The study was approved by the University of Exeter Medical School Research Ethics Committee.Findings
Focus group discussions showed that seven features were essential for a good level of care: professionals' knowledge of eating disorders and care pathways, and early provision of psychoeducation to young people and their families; a holistic approach balancing physical and psychological aspects of care from referral and early intervention to recovery and relapse prevention; early, rapid access to services including crisis and out-of-hours support; peer support for young people and support for family members; consistency and continuity, especially around interprofessional communication and transition from child to adult services; long-term view focusing on recovery and lifelong skills to facilitate relapse prevention; and an individually tailored, flexible approach.Interpretation
To our knowledge, this is the first exploration through online focus groups of patients' perspectives of UK-based eating disorder pathways. Our findings suggest that no existing pathway is more beneficial; rather, a cluster of features are perceived as essential for a good level of care across services. Although small, our study collated the views of both young people and parents from various geographical locations, and covered a wide range of health-care services.Funding
None. 相似文献17.
Background
Coronary artery bypass graft (CABG) surgery is one of the major surgeries requiring long-term stay in hospital. This generally leads to the detrimental effects of bed-rest, including dependency in self-care, transfer, and locomotion. Our aim was to compare the effect of high-frequency and low-frequency exercise therapy in patients who had undergone CABG.Methods
Patients who had undergone CABG were recruited from PSG Medical College and Hospital, Coimbatore, India, between Jan 1 and March 31, 2006. Functional Independence Measure (FIM) and modified Borg Rating of Perceived Exertion (RPE) were used to assess functional outcome. In a quasi-experimental design, patients received either high-frequency exercise therapy (exercise three times a day for 10 days, group 1), or low-frequency exercise therapy (once a day for 10 days, group 2). Data were analysed with paired t tests.Findings
30 patients were recruited (15 in each group). Mean FIM was 75 (SD 1·77) in group 1 and 64 (1·65) in group 2. There was a significant difference between the pretest and post-test FIM values in group 1 patients (49·07 [2·43] vs 124·07 [1·75], p<0·0001) but not in group 2 patients. The RPE in group 1 and group 2 was 6·3 (0·62) and 4·2 (0·7), respectively.Interpretation
Patients given high-frequency exercise thearpy had a significant improvement in their physical activity, but low-frequency exercise did not lead to significantly improved changes. In conclusion, the high-frequency exercise therapy improves the functional ability of patients with CABG.Funding
None. 相似文献18.
Background
Epigallocathechin-3-gallate (EGCG), the major bioactive polyphenol in green tea, has anticarcinogenic properties in vitro and in vivo. Several recent reports have shown that EGCG affects the expression of human papillomavirus (HPV)-encoded E6 and E7, two oncoproteins required for HPV-driven oncogenesis. Here, we aimed to explore the effects of EGCG on keratinocyte proliferation and differentiation, in addition to HPV18 replication, in a three-dimensional organotypic raft culture system.Methods
Organotypic raft cultures of HPV18-infected keratinocytes cultured at the air–liquid interface for 10 days were treated with EGCG for an additional 10 days before fixation and processing. Raft sections were stained with antibodies specific for various cell proliferation and keratinocyte differentiation markers in addition to tumour suppressor genes. Western blotting was performed on EGCG-treated cells to measure the level of HPV18 E6 and E7 protein expression.Findings
EGCG treatment blocked the ability of HPV18-positive keratinocytes to generate hyperplastic epithelium in raft culture. EGCG reduced cell proliferation as assessed by bromodeoxyuridine label incorporation and Ki67 staining; it upregulated expression of several tumour suppressor genes (p53 [TP53], p21, pRb), and impaired productive viral replication (as assessed by HPV18 E4 protein expression), but did not have an effect on keratinocyte differentiation. In culture, EGCG treatment promoted degradation of the E6 and E7 proteins and restored tumour suppressor gene expression.Interpretation
The results of our preclinical study suggest that EGCG inhibits the proliferation of HPV18-infected keratinocytes by enhancing the turnover and degradation of the E6 and E7 proteins, resulting in re-expression of several key tumour suppressor genes. These findings suggest that EGCG could potentially reverse the dysplastic changes induced by oncogenic HPV strains and could be used clinically to treat HPV-induced neoplasia.Funding
Cancer Research UK. 相似文献19.
Fanfan Chan Niannian Chen Jianrong He Jinhua Lu Fanghua Liu Weidong Li Wanqing Xiao Songying Shen Mingyang Yuan Kar Keung Cheng Huimin Xia Ben Willem Mol Xiu Qiu 《Lancet》2017