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Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China

Por: Guo · Y. · Xie · X. · Lei · L. · Zhou · H. · Deng · S. · Xu · Y. · Liu · Z. · Bao · J. · Peng · J. · Huang · C.
Objective

To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons.

Methods

We performed a time-series analysis based on generalised linear models to study the short-term exposure–response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations.

Results

For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0–3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter.

Conclusions

Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.

What hinders congenital ectopia lentis patients follow-up visits? A qualitative study

Por: Lin · J. · Gong · N. · Cao · Q. · Zhou · Y. · Cai · Y. · Jin · G. · Young · C. A. · Yang · J. · Wang · Y. · Zheng · D.
Objectives

The aim of our study is to give insight into congenital ectopia lentis (CEL) patients’ care-seeking behaviour and explore the factors affecting their follow-up visits.

Design

Cross-sectional study; in-depth and face-to-face semistructured interview.

Setting

A large-scale ophthalmology hospital in China.

Participants

35 patients with CEL and their parents from May 2017 to August 2017.

Main outcome measures

Themes and categories. The interviews were audio-recorded, transcribed verbatim, coded and analysed using grounded theory. Data collection was closed when new themes did not emerge in subsequent dialogues.

Results

The factors affecting the timely visits included insufficient awareness of CEL, shame on hereditary disease, lack of effective doctor–patient communication, lack of reliable information online and daily stressors.

Conclusion

Continuing medical education of severe and rare disease, reforming the pattern of medical education, constructing an interactive platform of the disease on the internet and improving healthcare policy are effective ways to improve the diagnosis and treatment status of CEL in China.

Human amniotic membrane allograft, a novel treatment for chronic diabetic foot ulcers: A systematic review and meta‐analysis of randomised controlled trials

Abstract

To evaluate the efficacy and safety of human amniotic membrane (HAM) allograft in treating chronic diabetic foot ulcers (DFUs), a comprehensive search of randomised controlled trials in MEDLINE, EMBASE, PubMed, CENTRAL and Web of Science was conducted to December 7, 2019. Two reviewers independently screened the studies, extracted data, and evaluated the quality of studies. The primary outcome was the proportion of complete healing. The secondary outcomes were mean time to complete healing and adverse events. Statistical analyses were performed using RevMan 5.3. We identified 257 articles, of which 7 articles (465 participants) were included in the meta‐analysis. The proportion of complete wound healing in HAM plus standard of care (SOC) group was 3.88 times as high as that in SOC alone (RR: 3.88 [95% CI: 2.34, 6.44]) at 6 weeks, and 2.01 times at 12 weeks (RR: 2.01 [95%CI: 1.45, 2.77]). The intervention group had a significantly shorter time to complete healing (MD: −30.33 days, [95% CI: −37.95, −22.72]). The number needed to treat within 6 weeks was 2.3 ([95% CI: 1.8, 3.1]). No significant difference was shown in adverse events. Results were consistent in a sensitivity analysis. Hence, HAM plus SOC is effective and safe in treating chronic DFUs.

Development of screening tools to predict the risk of recurrence and related complications following anal fistula surgery: protocol for a prospective cohort study

Por: Mei · Z. · Li · Y. · Zhang · Z. · Zhou · H. · Liu · S. · Han · Y. · Du · P. · Qin · X. · Shao · Z. · Ge · M. · Wang · Q. · Yang · W.
Introduction

Postoperative recurrence and related complications are common and related to poor outcomes in patients with anal fistula (AF). Due to being associated with short-term and long-term cure rates, perioperative complications have received widespread attention following AF surgery. This study aims to identify a set of predictive factors to develop risk prediction models for recurrence and related complications following AF surgery. We plan to develop and validate risk prediction models, using information collected through a WeChat patient-reported questionnaire system combined with clinical, laboratory and imaging findings from the perioperative period until 3–6 months following AF surgery.

Methods and analysis

This is a prospective hospital-based cohort study using a linked database of collected health data as well as the follow-up outcomes for all adult patients who suffered from AF at a tertiary referral hospital in Shanghai, China. We will perform logistic regression models to predict anal fistula recurrence (AFR) as well as related complications (eg, wound haemorrhage, faecal impaction, urinary retention, delayed wound healing and unplanned hospitalisation) during and after AF surgery, and machine learning approaches will also be applied to develop risk prediction models. This prospective study aims to develop the first risk prediction models for AFR and related complications using multidimensional variables. These tools can be used to warn, motivate and empower patients to avoid some modifiable risk factors to prevent postoperative complications early. This study will also provide alternative tools for the early screening of high-risk patients with AFR and related complications, helping surgeons better understand the aetiology and outcomes of AF in an earlier stage.

Ethics and dissemination

The study was approved by the Institutional Review Board of Shuguang Hospital affiliated with Shanghai University of Traditional Chinese Medicine (approval number: 2019-699-54-01). The results of this study will be submitted to international scientific peer-reviewed journals or conferences in surgery, anorectal surgery or anorectal diseases.

Trial registration number

ChiCTR1900025069; Pre-results.

Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study

Abstract

Aims and objectives

To explore patients’ understanding of the role of an advanced practice nurse (APN).

Background

The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore.

Methods

An exploratory descriptive qualitative design using semi‐structured face‐to‐face individual interviews was undertaken (November 2017–March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to.

Findings

The multi‐ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs.

Conclusion

A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN‐led services, they may gain confidence in APNs’ skills and knowledge.

Relevance to clinical practice

When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

Predictors of rehospitalization for community‐dwelling older adults with chronic heart failure: A structural equation model

Abstract

Aims

To examine the effects of health literacy, activities of daily living, frailty and self‐care on rehospitalization for older adults with chronic heart failure using a structural equation model.

Design

This was a cross‐sectional study.

Methods

Two hundred and seventy‐one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants.

Findings

The proposed model revealed a good fit to the data (χ 2/d.f.  = 2.39, root mean square error of approximation = 0.06, goodness of fit index = 0.93, comparative fit index = 0.91, normed fit index = 0.91). Health literacy (β = 0.21), activities of daily living (β = 0.43), frailty (β = 0.29) and self‐care (β = 0.40) directly affected the rehospitalization of older patients with chronic heart failure. Health literacy (β = 0.19), activities of daily living (β = 0.36) and frailty (β = 0.33) indirectly affected rehospitalization through self‐care. Frailty (β = 0.16) indirectly affected rehospitalization by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalization; the effect values were 0.43 and 0.57, respectively.

Conclusion

Community‐dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self‐care were eligible for rehospitalization. Self‐care and activities of daily living were considered mediators between rehospitalization and its predictors. A future longitudinal study is required to validate the results.

Impact

Tailored and targeted measures aiming to enhance self‐care and activities of daily living have been developed for older patients with chronic heart failure because they are not only predictors but also mediators. Assessment of health literacy level of this population is the first step before developing health education. Frailty of patients with chronic heart failure should be reduced to a minimum level.

Changes in pregnancy-related serum biomarkers early in gestation are associated with later development of preeclampsia

by Shiying Hao, Jin You, Lin Chen, Hui Zhao, Yujuan Huang, Le Zheng, Lu Tian, Ivana Maric, Xin Liu, Tian Li, Ylayaly K. Bianco, Virginia D. Winn, Nima Aghaeepour, Brice Gaudilliere, Martin S. Angst, Xin Zhou, Yu-Ming Li, Lihong Mo, Ronald J. Wong, Gary M. Shaw, David K. Stevenson, Harvey J. Cohen, Doff B. Mcelhinney, Karl G. Sylvester, Xuefeng B. Ling

Background

Placental protein expression plays a crucial role during pregnancy. We hypothesized that: (1) circulating levels of pregnancy-associated, placenta-related proteins throughout gestation reflect the temporal progression of the uncomplicated, full-term pregnancy, and can effectively estimate gestational ages (GAs); and (2) preeclampsia (PE) is associated with disruptions in these protein levels early in gestation; and can identify impending PE. We also compared gestational profiles of proteins in the human and mouse, using pregnant heme oxygenase-1 (HO-1) heterozygote (Het) mice, a mouse model reflecting PE-like symptoms.

Methods

Serum levels of placenta-related proteins–leptin (LEP), chorionic somatomammotropin hormone like 1 (CSHL1), elabela (ELA), activin A, soluble fms-like tyrosine kinase 1 (sFlt-1), and placental growth factor (PlGF)–were quantified by ELISA in blood serially collected throughout human pregnancies (20 normal subjects with 66 samples, and 20 subjects who developed PE with 61 samples). Multivariate analysis was performed to estimate the GA in normal pregnancy. Mean-squared errors of GA estimations were used to identify impending PE. The human protein profiles were then compared with those in the pregnant HO-1 Het mice.

Results

An elastic net-based gestational dating model was developed (R2 = 0.76) and validated (R2 = 0.61) using serum levels of the 6 proteins measured at various GAs from women with normal uncomplicated pregnancies. In women who developed PE, the model was not (R2 = -0.17) associated with GA. Deviations from the model estimations were observed in women who developed PE (P = 0.01). The model developed with 5 proteins (ELA excluded) performed similarly from sera from normal human (R2 = 0.68) and WT mouse (R2 = 0.85) pregnancies. Disruptions of this model were observed in both human PE-associated (R2 = 0.27) and mouse HO-1 Het (R2 = 0.30) pregnancies. LEP outperformed sFlt-1 and PlGF in differentiating impending PE at early human and late mouse GAs.

Conclusions

Serum placenta-related protein profiles are temporally regulated throughout normal pregnancies and significantly disrupted in women who develop PE. LEP changes earlier than the well-established biomarkers (sFlt-1 and PlGF). There may be evidence of a causative action of HO-1 deficiency in LEP upregulation in a PE-like murine model.

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study

Por: Tuxun · M. · Zhao · Q. · Xiang · Y. · Liu · F. · Shan · C.-F. · Zhou · X.-R. · Song · N. · Waisiding · A. · Zhang · X.-H. · Aihemaiti · G. · Yang · Y.-N. · Li · X.-M.
Objectives

A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI).

Design

A single-centre, prospective cohort study.

Setting

The First Affiliated Hospital of Xinjiang Medical University.

Method

A total of 615 patients with STEMI postprimary PCI were enrolled. WCC and TB were collected at admission. Logistic regression was used to determine the combined equation. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), which composed of cardiac death, cardiac shock, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), severe cardiac insufficiency, non-fatal myocardial infarction, angina pectoris readmission, severe cardiac insufficiency (cardiac III–IV level), stent restenosis and target vessels revascularisation during the hospitalisation and 36 months follow-up period.

Result

77 patients occurred in MACE during the hospitalisation (17 in-hospital mortality). WCC and TB were taken as an independent variables to make a category of logistic regression analysis of in-hospital MACE, the logistic regression model was: logit (P)=–8.00+0.265 WCC+0.077 TB, the combination of WCC and TB was more valuable on evaluating the in-hospital mortality (area under the curve 0.804, 95% CI 0.678 to 0.929, p

Conclusion

The combination of WCC and TB is an independent predictor for in-hospital outcomes in patients with STEMI than single detection.

Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai

Por: Zhou · Z. · Ye · J. · Teng · J. · Liu · H. · Cheng · X. · Sun · Y. · Su · Y. · Chi · H. · Wang · F. · Yang · C. · Jin · W.
Objective

This study aimed to characterise rheumatic manifestations and autoantibodies in 432 patients diagnosed with infective endocarditis (IE) in Shanghai.

Design, setting and participants

A retrospective study was conducted in Ruijin Hospital from 1997 to 2017. The clinical and laboratory characteristics of a total of 432 patients were analysed. In addition, the differences between patients with positive and negative antineutrophil cytoplasmic antibodies (ANCA) and antiphospholipid (aPL) antibodies as well as the survival rates of these patients were compared.

Results

A total of 432 patients, including 278 male patients and 154 female patients, were included. The mean age of the patients was 46±16 years. A total of 346 patients (80%) had cardiac surgery, and 55 patients (13%) died in the hospital. Among the IE patients, 104 were tested for either ANCA or aPL and were analysed in different groups. Twenty-one (24%) positive ANCA patients were proteinase 3-ANCA positive. Compared with the ANCA-negative group, patients with positive ANCA had higher IgM (p=0.048), lower haemoglobin (p=0.001) and a higher likelihood of arthritis (p=0.003). Twenty-one (40%) aPL-positive patients had a higher erythrocyte sedimentation rate than was found in the aPL-negative group (p=0.003). In addition, the survival rate of the ANCA-positive IE patients was lower (p=0.032) than that of the ANCA-negative group, while there was no difference between patients with or without aPL antibodies (p=0.728).

Conclusion

This study supports the claim that rheumatic manifestations and autoantibodies are frequently present in patients with IE and might lead to early misdiagnosis. Physicians should pay more attention to the measurement of autoantibodies in these patients.

Relationship between critical thinking disposition and research competence among clinical nurses: A cross‐sectional study

Abstract

Aims and Objectives

To explore the relationship between critical thinking disposition and research competence among clinical nurses.

Background

The development of the nursing discipline and evidence‐based practice calls for research competence and critical thinking disposition among clinical nurses. The verification of the relationship between critical thinking disposition and research competence could make contributions to promoting related knowledge building and providing practical implications for nurses, nurse educators and nurse managers. However, there is a lack of evidence exploring the relationship between critical thinking disposition and research competence in clinical nurses.

Design

A cross‐sectional study.

Methods

A total of 156 clinical nurses from two tertiary hospitals participated in this study. The Chinese Version of Critical Thinking Disposition Inventory and Research Competence Scale for Clinical Nurses were used to measure critical thinking disposition and nursing research competence, respectively. Data were collected in September 2017. Descriptive statistics, bivariate correlation and linear regression were used to analyse data. The STROBE checklist was used in reporting this study.

Results

The clinical nurses surveyed showed a positive inclination to general critical thinking but reported an overall low level of nursing research competence. A moderate degree of positive correlation was found between critical thinking disposition and research competence among clinical nurses. Educational degree was also found as an influencing factor of nursing research competence of clinical nurses.

Conclusion

The critical thinking disposition of clinical nurses is positively related to their research competence.

Relevance to clinical practice

Nurses with a passion for nursing research should pay attention to improving their critical thinking dispositions. Nurse educators and managers should provide better learning, working and research environments and more supports to cultivate critical thinking disposition and improve nursing research competence in nursing research education and practice.

A town level comprehensive intervention study to reduce salt intake in China: protocol for a cluster randomised controlled trial

Por: Xu · J. · Tang · B. · Liu · M. · Bai · Y. · Yan · W. · Zhou · X. · Xu · Z. · He · J. · Jin · D. · Sun · J. · Li · Y. · He · F. J. · MacGregor · G. A. · Wu · J. · Zhang · P.
Introduction

Salt intake in China (12 g/day) is more than twice the upper limit recommended by the WHO (5 g/day). To reduce salt intake, Action on Salt China (ASC) was launched in 2017. As one of four randomised controlled trials (RCTs) in the ASC programme, a comprehensive intervention study was designed to test whether all the components of the interventions adopted by other RCTs are acceptable, scalable and effective when provided to a region in the real world.

Methods and analysis

Using a cluster RCT design, 2688 participants were selected from 48 towns (clusters) in 12 counties in 6 provinces and assigned to the intervention group or the control group. Randomisation was performed after the baseline survey was completed. Information on salt-related knowledge, attitude and practice (KAP), blood pressure and 24-hour urinary sodium were collected. The intervention includes government engagement, health education and other intervention components targeting restaurants, home cooks and primary school students and their families that have been used in other RCTs. The control group will not receive the intervention. The project will be followed up for 2 years, with the intervention being carried out for the first year only. The primary outcome is salt intake measured by 24-hour urinary sodium excretion after 1 year. The secondary outcomes are the long-lasting effectiveness on salt intake and blood pressure measured by the same method, as well as salt-related KAP and blood pressure at the 1-year and 2-year follow-ups. Process evaluation and health economics analysis will be conducted as well.

Ethics and dissemination

The study was reviewed and approved by the Institutional Review Board of the National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, and Queen Mary Research Ethics Committee. Results will be disseminated through presentations, publications and social media.

Trial registration number

ChiCTR1800018119

Core competencies in neurocritical care training in China: consensus developed by a national Delphi consensus survey combined with nominal group technique

Objectives

To define the core competencies essential for specialist training in neurocritical care in China.

Design

Modified Delphi method and nominal group (NG) technique.

Setting

National.

Participants

A total of 1094 respondents from 33 provinces in China participated in the online survey. A NG of 11 members was organised by the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians and the National Center for Healthcare Quality Management in Neurological Diseases.

Results

1094 respondents from 33 provinces in China participated in the online survey. A formal list containing 329 statements was generated for the rating by a NG. After five rounds of NG meetings and one round of comments and iterative review, 198 core competencies (54 on neurological diseases, 64 on general medical diseases, 42 on monitoring of practical procedures, 20 on professionalism and system management, five on ethical and legal aspects, three on the principles of research and certification and 10 on scoring systems) formed the final list.

Conclusion

By using consensus techniques, we have developed a list of core competencies for neurocritical care training, which may serve as a reference for future specialist training programmes in China.

Selective debridement of burn wounds using hydrosurgery system

Abstract

In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial‐thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.

Path analysis from physical activity to quality of life among dementia patients: A dual‐path mediating model 痴呆症患者体力活动到生活质量的路径分析:双路径中介模型

Abstract

Aims

To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.

Design

A descriptive, cross‐sectional design.

Methods

Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients’ club were recruited. A total of 216 valid questionnaires were collected from November 2018 ‐ March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.

Results

Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.

Conclusion

The results showed that physical activity was a promising non‐pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.

Impact

The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

目的

阐明痴呆症患者体力活动、日常生活活动、抑郁与生活质量的具体影响路径。

设计

描述性横向设计。

方法

从五所三级综合医院和一家痴呆症患者俱乐部招募痴呆症患者及其看护人员。自2018年11月至2019年3月,共收集到216份有效问卷。采用Mplus 7.0进行路径分析,以验证体力活动、日常生活活动、抑郁与生活质量之间的因果关系。

结果

大多数痴呆症患者的体力活动水平较低,生活质量较差。改进后的模型与情况相符,并表明体力活动对生活质量有间接的积极影响,其中介作用是日常生活活动和抑郁。

结论

结果表明,体力活动是一种改善痴呆症患者日常生活活动表现、减轻抑郁症状、提高生活质量的非药理学方法,具有广阔的前景。

影响

本项研究结果有助于提高患者和专业人士对体力活动的认识。本项研究有助于了解体力活动对痴呆症患者生活质量的影响。此外,这项研究还为研究人员明确痴呆症患者各影响变量之间的因果关系提供了新的研究角度。

Impact of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: protocol for a multicentre prospective study

Por: Li · D. · Dong · W. · Liu · Y. · Wang · J. · Mu · Y. · Zhou · H. · Wang · J. · Zhou · S. · Chen · Y.
Introduction

Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation.

Methods and analysis

A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR

Ethics and dissemination

The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov registry (NCT03413410).

Occurrence and multilocus genotyping of <i>Giardia duodenalis</i> from post-weaned dairy calves in Sichuan province, China

by Jiaming Dan, Xueping Zhang, Zhihua Ren, Liqin Wang, Suizhong Cao, Liuhong Shen, Junliang Deng, Zhicai Zuo, Shumin Yu, Ya Wang, Xiaoping Ma, Haifeng Liu, Ziyao Zhou, Yanchun Hu, Hualin Fu, Changliang He, Yi Geng, Xiaobin Gu, Guangneng Peng, Zhijun Zhong

Giardia duodenalis is a zoonotic parasitic protist and poses a threat to human and animal health. This study investigated the occurrence of G. duodenalis infection in post-weaned calves from Sichuan province, China. Faecal samples were collected from a total of 306 post-weaned calves (3–12 months old) from 10 farms, including 4 intensive feeding farms and 6 free-ranging farms. The overall infection rate of G. duodenalis was 41.2% (126/306) based on the PCR results at any of the three genetic loci: beta-giardin (bg), triose-phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes. Giardia duodenalis assemblages E (n = 115, 91.3%), A (n = 3, 2.4%), and A mixed with E (n = 8, 6.3%) were identified among the 126 positive specimens. Multilocus sequence typing of G. duodenalis revealed 34 assemblage E multilocus genotypes (MLGs), 1 assemblage A MLG and 7 mixed assemblage (A and E) MLGs. The eBURST data showed a high degree of genetic diversity within assemblage E MLGs. The phylogenetic tree revealed that MLG E3 was the primary MLG subtype in Sichuan province and also the most widely distributed in China.

A school-based, multi-faceted health promotion programme to prevent obesity among children: protocol of a cluster-randomised controlled trial (the DECIDE-Children study)

Por: Liu · Z. · Wu · Y. · Niu · W.-Y. · Feng · X. · Lin · Y. · Gao · A. · Zhang · F. · Fang · H. · GAO · P. · Li · H.-J. · Wang · H. · the study team for the DECIDE-children study · Wang · Liu · Lin · Feng · Li · Zhou · Li · Jin · Li · Cheng · Di Wang · Song · Zhou · Xu · Song · Gao · Chen · Shang
Introduction

Obesity is a public health concern that is becoming increasingly more serious worldwide. Effective and sustainable childhood obesity prevention strategies may help to reduce the prevalence of obesity and may have an impact on lifelong health. However, few such strategies have been rigorously evaluated for Chinese children in different regions of China.

Methods and analysis

The Diet, ExerCIse and CarDiovascular hEalth-Children is a cluster-randomised controlled trial that aims to assess the effectiveness and sustainability of a school-based, multi-faceted intervention to prevent obesity among Grade 4 primary school students (8–10 years old) in China. Twenty-four schools (approximately 1200 students) from above average, average and below average developed regions in China will be randomised to an intervention (12 schools) or usual practice (12 schools) group. The intervention will last for one school year (9 months) and consists of activities towards students, parents and school environment. A smartphone application will be used to assist in providing information on, monitoring and providing feedback on the behaviours and body weight of the students. Data will be collected at baseline, 4 months, 9 months and 21 months. The primary outcome will be the difference between groups in the change in students’ body mass index at 9 months after the baseline investigation. The secondary outcomes will include the differences between groups in the changes in anthropometric measures, diet, physical activity levels and other measures at the follow-up visits. A variety of process evaluation methods will be used to evaluate the implementation process of the complex intervention.

Ethics and dissemination

This study was approved by the Peking University Institution Review Board (IRB00001052-18021). The results will be disseminated through publication in peer-reviewed journals, presentations at conferences and in lay summaries provided to school staff and participants.

Trial registration number

NCT03665857.

Awareness of family health history in a predominantly young adult population

by Sarina Madhavan, Emily Bullis, Rachel Myers, Chris J. Zhou, Elise M. Cai, Anu Sharma, Shreya Bhatia, Lori A. Orlando, Susanne B. Haga

Family health history (FHH) is a key predictor of health risk and is universally important in preventive care. However, patients may not be aware of the importance of FHH, and thus, may fail to accurately or completely share FHH with health providers, thereby limiting its utility. In this study, we conducted an online survey of 294 young adults and employees based at a US university setting regarding their knowledge, sharing behaviors, and perceived importance of FHH, and use of electronic clinical tools to document and update FHH. We also evaluated two educational interventions (written and video) to promote knowledge about FHH and its importance to health. We found that 93% of respondents were highly aware of their FHH, though only 39% reported collecting it and 4% using an online FHH tool. Seventy-three percent of respondents, particularly women, had shared FHH with their doctor when prompted, and fewer had shared it with family members. Participants in the video group were significantly more likely to understand the benefits of FHH than those in the written group (p = 0.02). In summary, educational resources, either video or written, will be helpful to promote FHH collection, sharing, and use of online FHH tools.

Resilience among stroke survivors: A cohort study of the first 6 months 中风幸存者的恢复能力:前6个月的定群研究

Abstract

Aims

To explore (a) resilience among patients over the first 6 months following a first ischaemic stroke; (b) factors associated with resilience at hospitalization, 1, 3, and 6 months postdischarge; (c) baseline predictors of resilience at 6 months postdischarge.

Design

a cohort study.

Methods

From February 2017–January 2018, 217 patients presenting at two hospitals with a first ischaemic stroke were recruited. Their resilience, medical coping styles, general self‐efficacy, functional independency, socio‐demographic, and clinical data were assessed while they were still in hospital (baseline) and at 1, 3, and 6 months after discharge.

Results

Resilience among stroke patients decreased significantly 1 month after hospital discharge and remained stable. Predictors of resilience were as follows: self‐efficacy and resignation at baseline; number of children, functional independency, general self‐efficacy, and resignation at 1 month; and religion, resignation, self‐efficacy, confrontation at 3 months and 6 months. The baseline factors that predicted resilience at 6 months were income level, religion, stroke severity at discharge, self‐efficacy, and resignation.

Conclusion

Stroke survivors experienced a significant decrease in resilience from hospitalization until 1‐month postdischarge. Factors contributing to resilience after a stroke varied across time. Self‐efficacy and coping styles were particularly important and contributed to long‐term resilience.

Impact

Understanding resilience among stroke survivors is needed to inform the development of interventions to enhance the psychological recovery of survivors. The levels of resilience among stroke survivors were low compared with those in the normal older population. Nurses should provide greater psychological support during hospitalization to stroke survivors and especially to those with lower income, higher stroke severity at discharge, no religion, lower self‐efficacy, or who use resignation as a coping strategy as those survivors may have lower resilience 6 months later. Future studies are needed to test interventions designed to change or modify stroke survivors' coping styles and promote self‐efficacy, thereby enhancing higher resilience.

目的

探讨(a)首发缺血性中风后患者前6个月的恢复能力;(b)出院后1、3和6个月再次住院时影响恢复能力相关因素;(c)出院后6个月恢复能力的基线预测指标。

设计

定群研究。

方法

从2017年2月至2018年1月,在两家医院共招募了217名首发缺血性中风患者。并对他们在住院期间(基线)和出院后1、3和6个月的恢复能力、医疗应对方式、一般自我效能感、功能独立性、社会人口学和临床数据进行评估。

结果

中风患者出院后1个月恢复能力明显下降,并保持稳定。恢复能力的预测指标如下:基线时的自我效能感和辞职打算;1个月时的子女陪护人数、功能独立性、一般自我效能感和子女人数;3个月和6个月时的宗教信仰、辞职打算、自我效能感和对抗。预测6个月时的恢复能力的基线因素包括收入水平、宗教信仰、出院时中风严重程度、自我效能感和辞职打算。

结论

从住院到出院后1个月,中风幸存者的恢复能力明显下降。影响中风后恢复能力的因素随时间而变化。自我效能感和应对方式尤其重要,对长期恢复能力有一定影响。

影响

有必要了解中风幸存者的恢复能力,以便制定干预措施,提高幸存者的心理康复能力。与正常老年人相比,中风幸存者的恢复能力水平较低。护士应在中风幸存者住院期间为其提供更大的心理支持,尤其是那些收入较低、出院时中风严重程度较高、无宗教信仰、自我效能感较低的患者,或是那些将辞职作为应对策略的患者,因为此类幸存者在6个月后的恢复能力可能较低。

未来需要进行进一步的研究,以对旨在改变中风幸存者应对方式并提高自我效能感的干预措施进行检验,从而提高恢复能力。

Association of high-sensitivity C-reactive protein in middle-aged and elderly Chinese people with hyperuricaemia and risk of coronary heart disease: a cross-sectional study

Por: Xie · M. · Xie · D. · Yang · Y. · Zhang · Y. · Li · K. · Zhou · B. · Yang · Z. · Ding · X. · Li · H.
Objectives

Patients with hyperuricaemia are at relatively high risk of developing coronary heart disease (CHD). The purpose of this study was to examine the relationship between high-sensitivity C-reactive protein (hs-CRP) and CHD risk in a middle-aged and elderly population with hyperuricaemia.

Design

A cross-sectional study.

Setting and participants

This study was conducted in a health examination centre of China. Participants were diagnosed with hyperuricaemia based on uric acid concentrations. Specifically, males with a uric acid concentration ≥416 μmol/L were included, as well as females with a concentration ≥360 μmol/L.

Main outcome measures

10-year CHD risk for each individual was evaluated using Framingham risk score based on the Adult Treatment Panel III charts.

Results

A total of 517 patients with hyperuricaemia (438 males and 79 females) aged from 40 to 85 years old were included in the present study. 193 (37.3%) patients were defined with relatively high 10-year CHD risk. Compared with the lowest quintile, the crude ORs of relatively high 10-year CHD risks were 1.43 (95% CI 0.78 to 2.63, p=0.245), 2.05 (95% CI 1.14 to 3.67, p=0.016), 2.77 (95% CI 1.54 to 4.98, p=0.001), 2.12 (95% CI 1.18 to 3.80, p=0.012) in the second, third, fourth and fifth quintiles of serum hs-CRP level, respectively (p for trend=0.057). The multivariable-adjusted ORs of relatively high 10-year CHD risk were 1.40 (95% CI 0.75 to 2.61, p=0.291) in the second, 2.05 (95% CI 1.13 to 3.72, p=0.019) in the third, 2.69 (95% CI 1.47 to 4.89, p=0.001) in the fourth and 2.10 (95% CI 1.15 to 3.84, p=0.016) in the fifth quintile of serum hs-CRP level when compared with the lowest quintile (p for trend=0.068).

Conclusion

This study showed that ORs of relatively high 10-year CHD risk were raised in patients with hyperuricaemia with higher serum hs-CRP level; however, there was a not significant but borderline trend association and that more research is needed.

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