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Hypertension is a leading cause of death worldwide; data on hypertension among ethnic minorities in China are sparse. This study aimed to estimate hypertension prevalence, awareness, treatment, and control in a Kazakh population, and to assess the association between salt intake and the above measures. A cross-sectional survey was conducted among Kazakh adults (≥30 years old) in the town of Hongdun, Altay, Xinjiang. Survey procedures included a questionnaire, physical measurement, and laboratory tests. Of 1805 eligible individuals, 1668 (92.4%) were included in the analysis. After adjustment for gender, age, and occupation, prevalence of hypertension was 45.5%. The proportions with awareness, treatment, control, or medication-control were 61.0%, 28.8%, 2.9% and 10.1%, respectively. Higher prevalence was seen among nomads and farmers (50.7% and 44.6%, respectively). However, the proportions with treatment or control were lower than seen among urban citizens. Hypertension prevalence was higher in those with higher salt intake (p = 0.0008). In contrast, the proportions with awareness (p = 0.0389), treatment (p = 0.0010), control (p = 0.0503), and medication-control (p = 0.2012) reduced as salt intake increased. In conclusion, hypertension prevalence is high in this population, but the proportions with awareness, treatment, or control are sub-optimal. Public health interventions that improve hypertension prevention and control, particularly among nomads, is needed.

Uncontrolled hypertension is an independent risk factor for cardiovascular disease and is the leading cause of mortality in haemodialysis patients. The aim of this study was to examine the effectiveness of self-management support (SMS) for blood pressure (BP) control and health behaviours.We conducted a cluster randomized controlled trial (RCT) in which 90 adult haemodialysis patients were assigned to either an SMS or common intervention (CI) group. The SMS group received an intervention consisting of self-management education and motivational interviewing. The CI group received standard care and routine health education. The primary outcome was the BP monitored before each haemodialysis. Secondary outcomes included salt intake (measured using a balance formula), home BP monitoring (HBPM) (assessed using two self-administered questions), and medication adherence (measured using the Medication-taking Behavior Scale). Data were collected at baseline and at 1, 3 and 6 months post-intervention.The SMS group showed continuous reductions in systolic BP from baseline: -9.2, -8.7, and -8.4 mmHg at 1, 3 and 6 months after the intervention, respectively (P0.01). Compared with the CI group, the SMS group had a greater decrease in systolic BP at 1 month: -5.9 mmHg (P = 0.0388), but no significant difference was found at 3 or 6 months (P0.05). SMS patients showed an improvement in health behaviours relative to baseline (less salt intake, more consistent HBPM, and greater medication adherence) (P0.05).Self-management support obtained short-term success in improving salt restriction, regular performance of HBPM and medication adherence, which led to better BP control.

Background The development of endovascular technology has led to the introduction of fenestrated endovascular repair (f-EVAR) to treat pararenal abdominal aortic aneurysms (PRAAAs) that have been deemed unsuitable for standard endovascular repair. We performed a systematic review and meta-analysis of data from the literature to determine the outcomes of the fenestrated technology. Methods The MEDLINE, EMBASE, and Cochrane databases were searched to identify all studies published in English between January 1996 and May 2011 that reported on f-EVAR for PRAAAs. Separate meta-analyses were performed for primary outcomes (i.e., 30-day mortality, technical success rate, primary target vessel patency rate, and 12-month patency rate) and secondary outcomes (i.e., reintervention rate, target renal artery occlusion rate, and postoperative permanent dialysis rate). Subgroup analyses were performed to determine whether there were differences in outcomes between varying types of studies (prospective or retrospective). Regression analyses were performed to explore associations between outcomes and varying factors (i.e., mid-date of study, study size, and procedure time). Results Twelve studies conducted between 2006 and 2011 and consisting of a total of 776 cases of f-EVAR were enrolled. The pooled estimate for 30-day mortality was 2.52% (95% confidence interval [CI]: 1.55–4.08). Technical success was measured to be 92.8% (95% CI: 87.5–96.0). Primary target vessel patency was 98.3% (95% CI: 97.4–98.8). Twelve-month target vessel patency was 94.5% (95% CI: 92.1–96.2). The postoperative reintervention rate was 17.6% (95% CI: 12.0–25.1). The target renal artery occlusion rate was 6.1% (95% CI: 4.1–8.8). The postoperative permanent dialysis rate was 2.6% (95% CI: 1.5–4.4). Subgroup analyses found no significant differences between the major outcomes of the retrospective studies and the prospective studies. Regression analyses suggested that large series had higher 12-month target vessel patency rates than small series. Conclusions This study revealed that f-EVAR treatment for PRAAAs has acceptable early and mid-term outcomes.

Social and public health scientists are increasingly interested in applying system dynamics theory to improve understanding and to harness the forces of change within complex, multilevel systems that affect community intervention implementation, effects, and sustainability. Building a system dynamics model based on ethnographic case study has the advantage of using empirically documented contextual factors and processes of change in a real-world and real-time setting that can then be tested in the same and other settings. System dynamics modeling offers great promise for addressing persistent problems like HIV and other sexually transmitted epidemics, particularly in complex rapidly developing countries such as China. We generated a system dynamics model of a multilevel intervention we conducted to promote female condoms for HIV/sexually transmitted infection (STI) prevention among Chinese women in sex work establishments. The model reflects factors and forces affecting the study's intervention, implementation, and effects. To build this conceptual model, we drew on our experiences and findings from this intensive, longitudinal mixed-ethnographic and quantitative four-town comparative case study (2007-2012) of the sex work establishments, the intervention conducted in them, and factors likely to explain variation in process and outcomes in the four towns. Multiple feedback loops in the sex work establishments, women's social networks, and the health organization responsible for implementing HIV/STI interventions in each town and at the town level directly or indirectly influenced the female condom intervention. We present the conceptual system dynamics model and discuss how further testing in this and other settings can inform future community interventions to reduce HIV and STIs.

The authors used a cluster analysis approach to investigate which female sex workers (FSW) are preferential targets for female condom (FC) intervention programs in southern China. Cross-sectional 6-month (N = 316) and 12-month (N = 217) postintervention surveys of FSW were analyzed. Based on FC attitudes and beliefs, initially suggesting FC use to a partner, practicing insertion, total times ever used, and willingness to use in the future, cluster analysis apportioned women into two clusters, with 50.6% and 58.1% of participants in the likely future FC users group at 6 months and 12 months, respectively. Likely future FC users tended to be from boarding houses, older, currently or previously married, experienced with childbirth, with current multiple sex partners, longer history of sex work, and more unprotected sexual encounters. Focusing FC programs on sectors of the community with more FSW who are likely to use FC may be more costeffective for enhancing FC acceptability and usage. Since the first Chinese AIDS case was diagnosed in 1985, mainland China had a reported cumulative total of 780,000 people living with HIV by the end of 2011; of those, 46.5% were infected through heterosexual transmission and 17.4% through homosexual transmission (Ministry of Health of the People's Republic of China

Introduction Total knee arthroplasty (TKA) has been regarded as a most painful orthopaedic surgery. Although many surgeons sequentially use parecoxib and celecoxib as a routine strategy for postoperative pain control after TKA, high quality evidence is still lacking to prove the effect of this sequential regimen, especially at the medium-term follow-up. The purpose of this study, therefore, is to evaluate efficacy and safety of postoperative intravenous parecoxib sodium followed by oral celecoxib in patients with osteoarthritis (OA) undergoing TKA. The hypothesis is that compared to placebo with opioids as rescue treatment, sequential use of parecoxib and celecoxib can achieve less morphine consumption over the postoperative 2 weeks, as well as better pain control, quicker functional recovery in the postoperative 6 weeks and less opioid-related adverse events during the 12-week recovery phase. Methods and analysis This study is designed as a multicentre, randomised, double-blind, parallel-group and placebo-controlled trial. The target sample size is 246. All participants who meet the study inclusion and exclusion criteria will be randomly assigned in a 1:1 ratio to either the parecoxib/celecoxib group or placebo group. The randomisation and allocation will be study site based. The study will consist of three phases: an initial screening phase; a 6-week double-blind treatment phase; and a 6-week follow-up phase. The primary end point is cumulative opioid consumption during 2 weeks postoperation. Secondary end points consist of the postoperative visual analogue scale score, knee joint function, quality of life, local skin temperature, erythrocyte sedimentation rate, C reactive protein, cytokines and blood coagulation parameters. Safety end points will be monitored too. Ethics and dissemination Ethics approval for this study has been obtained from the Ethics Committee, Peking Union Medical College Hospital, China (Protocol number: S-572) Study results will be available as published manuscripts and presentations at national and international meetings. Trial registration number NCT02198924.

OBJECTIVE This study aimed to assess the trend of human fecundity over time in China. METHODS This retrospective study was conducted in Tongliao, China. Couples who were married during the time period between January 1, 1981 and December 31, 2003 were considered eligible for this study. A total of 27,413 individuals provided valid information via house-to-house interviews. The 12-month cumulative pregnancy rate (CPR) and annual percentage change were used as the outcome measurements. RESULTS There was a significant increase in the CPR over the five successive time groups. A break point in 1988 divided the entire study period into two distinct segments: 1981-1988, during which the CPR increased from 72.2% to 84.2%, and 1988-2003, during which the CPR increased from 84.2% to 87.2%. CONCLUSIONS The findings were unlikely to be the result of biases, and could not be explained by increased medical treatment for infertility and changes in the prevalence of sexually transmitted diseases. Dramatic societal and behavioral changes due to the unique family planning policy and economic reform policies in China might have been the plausible reason for the results.

Data management refers to a set of procedures including the collection, integration, and validation of research data. As an essential part of research, data management is necessary in order to obtain accurate and reliable data, to ensure research integrity and replication, to conduct the research in an efficient manner, to ensure the security of data, and finally to comply with regulatory requirements/guidelines.

Background A relationship of blood uric acid (UA) with hypertension and cardiovascular risk is under debate thus salt intake is hypothesized to contribute to such associations. Methods In this cross-sectional study, stratified cluster random sampling elicited a sample of 1805 Kazakhs with 92.4% compliance. Hypertension and moderate-or-high total cardiovascular risk (mTCR) were defined according to guidelines. Sodium intake was assessed by urinary sodium excretion. Prevalence ratios (PRs) were used to express associations of UA with hypertension and mTCR. Results In the highest tertile of sodium intake in women, the adjusted PRs (95% confidence intervals) of low to high quartiles compared with the lowest quartile of UA, were 1.22(0.78–1.91), 1.18(0.75–1.85), and 1.65(1.09–2.51) for hypertension and 1.19(0.74–1.90), 1.39(0.91–2.11), and 1.65(1.10–2.47) for mTCR (P for trend

OBJECTIVE To compare the pharmacokinetic (PK) profiles and evaluate the PK interaction of hydrochlorothiazide (HCTZ) used alone and in combination with benazepril (BENA) or valsartan (VAL) in healthy Chinese volunteers. MATERIALS AND METHODS Data from two Phase I clinical trials (Study A and Study B) were combined and analyzed. Study A was an open, randomized, three-period crossover study. Eligible healthy male Chinese volunteers were randomly assigned to receive a single dose of the HCTZ (25 mg), BENA (20 mg) or HCTZ/BENA (25/20 mg). Study B was an open randomized, two-period crossover study of VAL/HCTZ (160/12.5 mg) in two formulations. A 7-day washout period was designed between alternate formulations in both studies. Multiple blood samples were collected up to 48 h post-dose, and plasma concentrations of HCTZ were analyzed using high performance liquid chromatography with tandem mass spectrometric detection (HPLC-MS/MS) system. Adverse events (AEs) were monitored and documented throughout the study period. RESULTS 12 subjects completed Study A and 18 subjects completed Study B. Mean maximum plasma concentration (C(max)) was 168, 121 and 418 ng/ml and mean exposure (AUC(0-48 h)) was 1,160, 955 and 2,801 ng × h/ml following a single dose of HCTZ (25 mg) alone, BENA/HCTZ (20/25 mg) and VAL/HCTZ (160/12.5 mg), respectively. There was significant decrease in C(max) (90% confidence interval: 64.4 - 78.0%) and AUC(0-48 h) (90% confidence interval: 75.9 - 89.5%) of HCTZ with BENA co-administration, whereas concomitant VAL with HCTZ led to significant increase (approximate 1.5-fold) in C(max) and AUC(0-48 h) of plasma HCTZ even without dose normalizing. The apparent terminal half-life (t(1/2)) and the time to C(max) (tmax) were unchanged between the two studies. Overall, HCTZ alone as well as in combination with BENA and VAL was well tolerated within the scope of the current studies in Chinese health volunteers. CONCLUSIONS BENA decreased the bioavailability of HCTZ in Chinese healthy volunteers while VAL greatly increased the concentration of HCTZ in plasma during coadministration. The combination of HCTZ with BENA or VAL was safe and well tolerated.

Background: We assessed the effects of smoking and smoking cessation on life expectancy and active life expectancy among persons aged 55 years or older in Beijing.Methods: This study included 1593 men and 1664 women who participated in the Beijing Longitudinal Study of Aging, which commenced in 1992 and had 4 survey waves up to year 2000. An abridged life table was used to estimate life expectancy, in which age-specific mortality and age-specific disability rates were adjusted by using a discrete-time hazard model to control confounders.Results: The mean ages (SD) for men and women were 70.1 (9.25) and 70.2 (8.72) years, respectively; mortality and disability rates during follow-up were 34.7% and 8.0%, respectively. In both sexes, never smokers had the highest life expectancy and active life expectancy across ages, as compared with current and former smokers. Current heavy smokers had a shorter life expectancy and a shorter active life expectancy than light smokers. Among former smokers, male long-term quitters had a longer life expectancy and longer active life expectancy than short-term quitters, but this was not the case in women.Conclusions: Older adults remain at higher risk of mortality and morbidity from smoking and can expect to live a longer and healthier life after smoking cessation.

Objectives The aim of this study was to analyze the technical success and long-term patency of the endovascular treatment of TransAtlantic Inter-Society Consensus (TASC) C and D aorto-iliac arterial lesions. Methods All studies reporting original series of patients published in English between 2000 and 2010 were enrolled into meta-analysis. Separate meta-analyses were performed for groups with immediate technical success, 12-month patency, and long-term outcomes. Subgroup analyses were performed to determine if there were differences in outcomes between patients with varying types of lesions (TASC C or D lesions) or between different stenting strategies, including primary or selective stenting. Results Sixteen articles consisting of 958 patients were enrolled in this meta-analysis. The pooled estimate for technical success was 92.8% (95% confidence interval [CI], 89.8%-95.0%, 749 cases). Primary patency at 12 months was 88.7% (95% CI, 85.9%-91.0%, 787 cases). Subgroup analyses demonstrated a technical success rate of 93.7% (95% CI, 88.9%-96.5%) and a 12-month primary patency rate of 89.6% (95% CI, 84.8%-93.0%) for TASC C lesions. For TASC D lesions, these rates were 90.1% (95% CI, 76.6%-96.2%) and 87.3% (95% CI, 82.5%-90.9%), respectively. The technical success and 12-month primary patency rates for primary stenting were 94.2% (95% CI, 91.8%-95.9%) and 92.1% (95% CI, 89.0%-94.3%), respectively; for selective stenting, these rates were 88.0% (95% CI, 67.9%-96.2%) and 82.9% (95% CI, 72.2%-90.0%), respectively. The long-term, primary patency rates for patients receiving primary stenting were significantly better than those receiving selective stenting. Publication bias was not significant for these analyses. Conclusions This study demonstrates that early and midterm outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with a better patency for primary stenting than selective stenting.

Background The fast ageing of the general population in China will increase the demand for blood products, which may lead to a severe imbalance between blood supply and demand. This study aims to predict the changes in blood supply and demand by 2035 in China. Methods Based on data from the China Statistical Yearbook (2016), blood transfusion industry development report of China (2016 and 2017), and blood demand information of a tertiary hospital the per person blood supply and demand for different age groups were calculated, which were then, together with the predicted population structure, used to predict blood supply and demand trends between 2015 and 2035. All predictions were made assuming a relatively stable per capita blood supply and demand, enabling the influence of demographic changes on future blood supply and demand to be analysed. Sensitivity analysis was conducted to assess the impact of some other factors on the predicted blood supply and demand. Findings According to our predictions, blood demand was likely to exceed supply at around 2016, and the widening gap between supply and demand would reach 2·5 × 106 L by 2035, with a 15% decrease in blood supply and a 43% increase in demand. In addition, the magnitude of increase in blood demand is predicted to rise with age groups, with the highest growth rate in blood demand predicted in the 80 years and above age group (123%). After taking a 5·95% blood discard rate into consideration, the gap is predicted to increase to 2·8 × 106 L by 2035. The results of sensitivity analysis reveal the annual increase in blood supply required to meet blood demand in the next 20 years, with a lowest predicted rate of 1·64%. and a highest predicted rate of 2·25%. Interpretation Compared with other developed countries, China will come under even greater pressure of the imbalance between blood supply and demand and it is imperative to implement new strategies and measures to solve future blood supply and demand problems. Funding This work was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS) (number 2016-I2M-3-024).

Following publication of the results of the National Lung Screening Trial in the United States, a randomized controlled trial in Italy (ITALUNG) and two simulation studies in China reported similar findings in 2017 favoring lung cancer screening with low-dose computed tomography among smokers. With such advances in lung cancer screening, worldwide interest has gradually shifted from evaluating whether refining lung cancer screening protocols is effective in preventing deaths. However, there are several practical problems to be resolved, including the balance of enrollment criteria and cost effectiveness, precise measurements to reduce false positive findings, risk-based optimization of screening frequency, challenges associated with cancer heterogeneity, strategies to combine image screening with novel biomarkers, dynamic monitoring of the natural history of cancer, accurate identification and diagnosis of cases among huge populations, and the impact of tobacco control policy and environment protection. As one in three individuals with lung cancer worldwide resides in China, these questions pose great challenges as well as research opportunities for population screening programs in China.

Objectives To provide a more accurate estimate of early smoking-attributable mortality and potential years of life lost using data from a representative study of 103 study areas in China. Methods Two datasets were employed as follows. Firstly, retrospective national mortality survey data, which included a population of 67 million in 103 study areas, and about 1 million adults who died in 1986–1988; secondly, nationally representative case-control comparative data was extracted from the survey data to measure the effect of smoking on age trends in smoking-attributable mortality. Potential years of life lost, and sex differences in life expectancy in smokers and non-smokers in the total population aged 35 and over were also estimated. Results Tobacco caused 11.2% (16.0% of men and 3.7% of women) of total deaths in 1987, and more than two-thirds of these excess deaths occurred between the ages of 50 and 74 years, but only less than 5% excess deaths occurred at ages under 50. Although life expectancies varied with region or sex differences, the years of life lost attributable to smoking was almost the same. Smokers at age 35 lost about 3 years of life expectancy in comparison with never smokers. The study also confirmed that more than 50% of the sex difference in life expectancy was accounted for by smoking. Conclusion Fully understanding the consequences of smoking in relation to mortality can clarify its effects on the health and longevity of the entire population.

Purpose To examine age-related effects of smoking on lung cancer mortality in a large population-based case-control study that was incorporated into a nationwide retrospective survey of mortality in China. Methods Two data sets were pooled for this analysis: national mortality survey data and data from a nationwide case-control comparison. These pooled data were used to calculate age-specific lung cancer death rates by smoking status and expected years of lost life expectancy for each smoking-associated death. Results There was a significant excess of deaths (54% of urban deaths, 51% of rural deaths) at 35 to 69 years of age among male smokers and the average loss of life expectancy per smoking-associated death at these ages was 18.3 years. For women ages 35 to 69 years of age, 29% and 11% excess lung cancer mortality was observed in urban and rural smokers, respectively, with an average loss of life expectancy per smoking-associated death of 21.3 years. Conclusions Tobacco smoking was associated with a large number of deaths from lung cancer. Utilizing information from a population-based retrospective mortality survey for conducting an analytic epidemiological study of main determinants of disease is feasible and can generate important results.

An innovative population-based case-control study was conducted in a national mortality survey to assess the hazards of tobacco use on esophageal cancer among Chinese men. Cases were 19,734 males aged 35 years or older, who died of esophageal cancer during 1986-1988. Controls were 104,846 male living spouses of the same age when their wife died (of any cause) during the same period in the same county or city. The absolute esophageal cancer death rates were higher in smokers than those in nonsmokers in all geographical groups. The relative risks for esophageal cancer were 1.88 (95% CI: 1.73-2.05) and 1.39 (95% CI: 1.28-1.50) in urban and rural men, respectively, after adjustment for other relevant covariates including age group (5 years) and locality. When the calculation was restricted to men aged 35-69, the risk ratios for current cigarette smokers increased significantly with increasing number of cigarettes smoked daily and duration of smoking. Tobacco use, in any form, is an important risk factor for esophageal cancer in Chinese men. Selecting living spouses as controls is a unique and useful approach in the design of case-control studies of cigarette smoking.

Widely used (18)F 2'-deoxy-2'-fluoro-d-glucose (FDG) positron emission tomography (PET) can be problematic with false positives in cancer imaging. This study aims to investigate the diagnostic accuracy of a candidate PET tracer, (18)F 2',3'-dideoxy-3'-fluoro-2-thiothymidine (FLT), in diagnosing pulmonary lesions compared with FDG.After comprehensive search and study selection, a meta-analysis was performed on data from 548 patients pooled from 17 studies for evaluating FLT accuracy, in which data from 351 patients pooled from ten double-tracer studies was used for direct comparison with FDG. Weighted sensitivity and specificity were used as main indicators of test performance. Individual data was extracted and patient subgroup analyses were performed.Overall, direct comparisons showed lower sensitivity (0.80 vs. 0.89) yet higher specificity (0.82 vs. 0.66) for FLT compared with FDG (both p0.01). Patient subgroup analysis showed FLT was less sensitive than FDG in detecting lung cancers staged as T1 or T2, and those ≤2.0 cm in diameter (0.81 vs. 0.93, and 0.53 vs. 0.78, respectively, both p0.05), but was comparable for cancers staged as T3 or T4, and those2.0 cm in diameter (0.95 vs. 1.00, 0.96 vs. 0.88, both p0.05). For benignities, FLT performed better compared with FDG in ruling out inflammation-based lesions (0.57 vs. 0.32, p0.05), and demonstrated greater specificity regardless of lesion sizes.Although FLT cannot replace FDG in detecting small and early lung cancers, it may help to prevent patients with larger or inflammatory lesions from cancer misdiagnosis or even over-treatment.

Objectives: This study examined the influence of depressive symptoms on the prevalence of physical disability in a cohort study of Beijing elderly (1992–2000) and analyses the role of some confounding variables in this relationship. Methods: A cohort of 1828 elderly aged 55 and older who were initially free of any physical disability was followed up for 8 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability on activities of daily living (BADL and IADL) was measured in 1994, 1997, and 2000 respectively. Results: The cumulative percentages of persons who developed BADL disability and IADL disability during each follow-up interview was significantly greater among depressed than non-depressed individuals. Compare with the 1525 non-depressed individuals, the 303 depressed individuals had a relative risk (95% confidence interval) of 2.52 (2.02, 4.82) for BADL disability and 4.98 (2.46, 10.09) for IADL disability, respectively. Although adjustment for confounding factors reduced the risk to 2.20 (1.33, 3.62) and 4.29 (2.08, 8.86), the detrimental effect of depression on disability remained significant. The items of IADL which connected physical activity had higher impairment among depressed individuals. Conclusions: Depression in elderly persons may increase the risk for prevalent disability. It is very important for elders to prevent and reduce depression for improving the quality of their life and physical function.

Little information is available concerning the sex differences in the effects of BMI on blood pressure. The aim of the present study was to examine the effects of BMI on blood pressure, focusing on the sex differences. Seven sets of cross-sectional data were obtained from annual health examinations (1994 through 2000) for residents aged 40 and older living in Tsunagi area, a small village in southern part of Kumamoto Prefecture, Japan. Although age-adjusted mean BP levels and prevalence of hypertension were higher in the higher levels of BMI in both sexes, the significance of obesity (BMI≥25), as a strong predictor of hypertension, was more evident in women than in men. The risks of hypertension among women were substantially lower in less than 25 of BMI than in 25 or greater BMI, but this was not the case for men. For men, weight control for preventing hypertension should be taken into account even below 25 of BMI over weight level. This trend remined stable and consistent through all survey years. These data in dicate that obesity as a predictor of hypertension should have different standards between men and women, which is very important for determinations of clinical diagnosis and reducing incidence of associated metabolic diseases.

To describe changes in activities of daily living (ADL) of community-dwelling Beijing elderly people, observed for 8 years, and to identify the demographic characteristics that predict the functional change. Four sets of interview data from 1992 to 2000 were used to evaluate changes among Beijing elderly aged 55 years and over. Results revealed that prevalence of disability increased from 3.9% to 7.1% during the 8 years of follow-up with the average increasing rate of disability was 0.41% per year. Meanwhile an increasing likelihood of recovery from disability is observed with age and time. Women, aged 75 or more, experienced higher disability than men though it was in the opposite for younger ages. In addition, certain demographic subgroups (such as women, unmarried, illiterate and living in non urban area) appeared to be at higher risk for ADL impaired. The patterns of ADL change is in both the direction of improvement and declination. Demographic variables emerged as a significant predictor in estimating functional outcomes. Furthermore, it is recommended that the demarcation factor for the evaluation of ADL should be 75 years of age.

Kazakh is a typical transnational ethnic group with the Eurasian lineage. It is the main ethnic group in Kazakhstan, and one of the ethnic minorities in China, Russia, Turkeymore than 40 other countries and regions. There are an approximately 1.25 million Kazak populations in China, of which 96.4% is located in northern Xinjiang [1]. For thousands of years, China's Kazakh people are mainly active in raising livestock on the prairie grasslands.With the development of the urbanization, Kazak people naturally formed three different subgroups with different occupation backgrounds (i.e., nomads, farmers, and urban residents). When cardiovascular disease (CVD) risk factors are more prevalent in urban China, little is known about the prevalence about this ethnic group. To investigate the prevalence of CVD conventional risk factors among Kazakh individuals of different occupational backgrounds the baseline data of The Xinjiang Altay Kazakh Heart Study (XAKHS) was used.

Introduction: Kazak’s hypertension ranks fifth with regard to morbidity among the 56 Chinese ethnic groups. Kazaks, are the main ethnic group in Kazakhstan, and represent a sizable ethnic minority in China and Russia. For thousands of years, China’s Kazak people are mainly active in raising livestock on the prairie grasslands in northwest China, and have developed a unique culture and lifestyle. In order to establish whether this distinct feature affects the prevalence of hypertension in this population, we undertook a population-based study which involved in three occupational backgrounds (herdsman, farmer, non-manual worker) in Xinjiang, China. We hypothesized that any variation in the effect of hypertension is based on the genetic homogeneity. Methods: A prospective cohort design was used, with 1670 participants (aged 30-92 years) from seven villages and town city recruited by a stratified random clustering sampling procedure in Hong-Dun town, Altay region Xinjiang from Jan to Mar 2013. All participants completed the survey and physical examination using standardized procedures. The overall response rate for completing both was 92.5%. Results: Compared with farmers and non-manual workers, herdsmen had the highest prevalence of hypertension and the lower rates of treatment and control (Tab). High-salt diet (air-dried beef and milky-tea) intake and low intake of fruits and vegetables were more common in the nomadic group and a dose-response relationship was observed between hypertension and occupation (Fig). Furthermore, the prevalence of hypertension within each occupational group was more common in lower socioeconomic status based on educational attainment and economic measures. Conclusion: Unlike the previous epidemic of hypertension in developed countries which was driven mainly by urbanization, these data highlight the need for careful monitoring and control of hypertension risk factors in rural residents, especially groups such as the Kazak nomads who have a greater degree of marginalization in modern China.

Objective To explore the sociodemographic patterning of risk factors for cardiovascular disease (CVD) in three isolated-based subgroups of the Uyghur population in Xinjiang, China. Design A cross-sectional study. Between 2005 and 2008, a non-probability sampling design method was used to select three specific groups of the Uyghur rural populations based on their potential socioeconomic status (ie, isolated, semi-isolated and open-environment status). Setting Three communities (named Desert, Turpan and Yuli Rob) in Southern Xinjiang autonomous region, China. Participants 1656 people were included in this study. The inclusion criteria were that all participants were 18 years or older, they were descendants of at least three generations living in the same region, and there was no history of intermarriage. Main outcome measures The prevalence of CVD risk factors (ie, tobacco use, alcohol use, obesity, dyslipidemia, hypertension, diabetes, etc) was assessed. Results Compared with the Desert and Turpan communities, Yuli Rob had the highest levels of obesity, dyslipidemia and hypertension, and the Desert had the lowest levels of CVD risk factors. Age standardisation slightly altered the estimates, though the patterns remained unchanged. Some unique characteristics were also found. For example, the Desert group displayed significantly lower high-density lipoprotein cholesterol (HDLC) level compared with Yuli Rob and Turpan groups. The mean values were 0.63, 1.06 and 1.45 mmol/l for men and 0.64, 1.22 and 1.51 mmol/l for women (p

BACKGROUND The female condom (FC) is an effective tool for dual protection, but it remains underused. Individual and contextual reasons need to be explored. OBJECTIVE The aim of this study was to compare individual and contextual characteristics of FC multitime users, 1-time users, and nonusers among women in the sex industry of 4 study sites in China. METHODS A standardized 1-year FC intervention along with male condoms was implemented through outreach to sex establishments. Three serial cross-sectional surveys were conducted at baseline and after each of two 6-month intervention phases. RESULTS A total of 445, 437, and 290 eligible women were interviewed at 3 cross-sectional surveys, respectively. At the first and second postintervention surveys, 83.3% and 81.7% of women reported knowing about FC, and 28.8% and 36.6% had used FC at least once. Women who used FC multiple times reported less unprotected sex than nonusers in the last 30 days (3.0% vs. 17.2% at first and 3.2% vs. 16.8% at second postintervention survey, P < 0.01). Polytomous logistic regression showed that both 1-time and multitime users were more likely to come from one particular site (approximately 3 times more than the reference site). Higher intervention scores (adjusted odds ratio, 1.8-4.0) and working in boarding houses (adjusted odds ratio, 3.4) were associated with FC use. CONCLUSIONS Adding FC into male-condom-only intervention may reduce unprotected sex among women in sex establishments in rural and small urban areas of China. Adoption of FC may be related not only to intervention exposure but also to contextual factors associated with study site and type of sex establishments.

Objectives To portray the stage characteristics of lung cancers detected in CT screenings, and explore whether there’s universal stage superiority over other methods for various pathological types using available data worldwide in a meta-analysis approach. Materials and Methods EMBASE and MEDLINE were searched for studies on lung cancer CT screening in natural populations through July 2015 without language or other filters. Twenty-four studies (8 trials and 16 cohorts) involving 1875 CT-detected lung cancer patients were enrolled and assessed by QUADAS-2. Pathology-confirmed stage information was carefully extracted by two reviewers. Stage I or limited stage proportions were pooled by random effect model with Freeman-Tukey double arcsine transformation. Results Pooled stage I cancer proportion in CT screenings was 73.2% (95% confidence interval: 68.6%, 77.5%), with a significant rising trend (Ptrend0.05), and 46.5% (P0.05). Conclusion CT screening can detect more early stage non-small cell lung cancers, but not all of them could be beneficial as there are a considerable number of indolent ones such as bronchioloalveolar adenocarcinomas. Still, current evidence is lacking regarding small cell lung cancers.

Changes in sexual attitudes and behaviors and resurgence of the sex industry in China have increased concerns about HIV/AIDS and sexually transmitted infections (STI) epidemics. Little attention has been paid to the significant and growing sex industry in rural China. Promotion of barrier protection in this context is most effective to prevent STIs and pregnancy. The female condom (FC) is a barrier method that gives women more autonomy in its application, and has other advantages, but has been little promoted and tested in high risk contexts in China. The China/US Women's Health Project was designed to promote FC use in addition to male condoms (MC) through outreach intervention conducted in sex work establishments in rural and small urban towns in southern China, using the original prototype FC1. The study used quantitative and qualitative methods to document the pre-intervention context, intervention delivery process, and post-intervention outcomes of FC use. In this paper we compare post-intervention FC users and non-users in the first study sites, two rural towns in a single county in Hainan Province. Examination of cross-sectional six-month and 12-month surveys indicated that, despite relatively high MC use, about one-third of the women in sex work establishments in these rural towns had adopted FC at each post-intervention survey. Compared with non-users, FC users were more likely to be freelance women in boarding houses, more sexually experienced, married with children, more sexually active in the prior month, and more exposed to the intervention. The rural context hampered intervention implementation, particularly the significant limits in health and human resources available to manage prevention of HIV/STIs among women in the sex industry. These challenges highlight the need to better understand the context of the rural sex industry and capacity of local resources for better prevention efforts and the benefits that new prevention technologies like FC can offer.

Summary Objectives To describe female condom (FC) use, male condom (MC) use and overall levels of protected sex before, during and after FC education and promotion (using the original prototype FC) combined with MC promotion among female sex workers in three rural or small urban settings in southern China. Study design The 1-year FC intervention was conducted by local health workers through outreach to establishments where sex work is conducted. Three serial cross-sectional surveys were conducted in each study town before, during and after the intervention along with process documentation throughout the intervention period. Methods Cross-sectional data from pre-intervention (baseline) and 6-month and 12-month post-intervention surveys from three study sites are used in a descriptive comparison of the context of the sex industry, outreach in two phases of intervention, and FC adoption after the intensive intervention phase in each site. Results Approximately 75–80% of eligible women working in sex establishments, varying from 74 to 155 participants for each survey, were recruited from three study sites. After introduction and promotion of the FC along with the MC during the community public health intervention, between one-fifth and one-half of the study participants had tried the FC in the three study sites by the time of the 6-month and 12-month cross-sectional surveys. Among them, 10–30% had used the FC more than once. FC awareness increased following the intervention with much less variation across the three study sites. At baseline, 31–54% of participants across the three sites reported 100% protected sex in the last 30 days with all types of partners. At one of the sites with relatively low MC use before the intervention, the proportion of women reporting 100% protected sex in the last 30 days increased by 15%, and the proportion reporting nil protected sex in the last 30 days decreased by 13% between baseline and 12-month post-intervention surveys. More complex profiles of FC and MC use and protected sex were shown at the other two study sites, where a higher level of protection had been reached before the project started. Conclusions Different levels of FC adoption were identified after the 1-year FC promotion intervention through outreach to sex establishments. The input, output and outcomes of the intervention may be associated with women’s demographic and risk characteristics, the local capacities of intervention staff, and other contextual factors. Further analysis of these factors will help establish the role of the FC in increasing protected sex, and provide insight into how to achieve greater FC use.

Purpose: To assess the validation of a novel control selection design by comparing the consistency between the new design and a routine design in a large case-control study that was incorporated into a nationwide mortality survey in China. Methods: A nationwide mortality study was conducted during 1989-1991. Surviving spouses or other relatives of all adults who died during 1986-1988 provided detailed information about their own as well as the deceased person's smoking history. In this study, 130,079 males who died of various smoking-related cancers at age 35 or over were taken as cases, while 103,248 male surviving spouses (same age range with cases) of women who died during the same period and 49,331 males who died from causes other than those related to smoking were used as control group 1 and control group 2, respectively. Consistency in the results when comparing cases with each of the control groups was assessed. Results: Consistency in the results was observed in the analyses using different control groups although cancer deaths varied with region and age. Equivalence could be ascertained using a 15% criterion in most cancer deaths which had high death rates in urban areas, but they were uncertain for most cancers in rural areas irrespective of whether the hypothesis testing showed significant differences or not. Conclusions: Sex-matched living spouse control design as an alternative control selection for a case-control study is valid and feasible, and the basic principles of the equivalence study are also supported by epidemiological survey data.

Background/Purpose We assessed the effect of smoking on death from chronic obstructive pulmonary disease (COPD) in China by employing a large population-based, case-spouse control study design using data from a nationwide survey of mortality. Methods During 1989-1991, a nationwide retrospective survey of mortality was conducted in China. For approximately 1,000,000 adults dying from all causes during 1986-1988, their surviving spouses or other informants provided detailed information about their own as well as the deceased person's smoking history. For this study, 183,393 individuals who died of COPD at age ≥ 40 years were taken as cases, while 272,984 sex-matched surviving spouses of subjects who died from any cause were taken as controls. Results COPD death rates for smokers were more than twice as high as those of non-smokers, with a dose-response risk pattern, despite the fact that COPD death rates varied widely by region and age. Tobacco accounted for 41.4% of COPD deaths in men, but only 13.5% of those in women, who had a lower rate of smoking. Conclusion A case-spouse control study, as an alternative design, is valid and feasible in utilizing information from population-based, retrospective mortality survey data for an analytical epidemiological study of disease etiology.

Background The purpose of this study was to evaluate the efficacy and safety of three nevirapine-based antiretroviral treatments for adult antiretroviral-naïve Chinese patients with HIV-1 infection. Methodology This was a prospective, multicenter study. 198 antiretroviral-naïve HIV-1 positive subjects with CD4 lymphocyte counts between 100/ul and 350/ul and plasma HIV-1 RNA levels more than 500 copies/ml were randomized to start three NVP-based antiretroviral treatments: group A, NVP+AZT+ddI; group B, NVP+3TC+d4T; group C, NVP+AZT+3TC. Viral responses, immunologic responses, adverse events and drug resistence were monitored at baseline and the end of week 4, 12, 24, 36, 52. Viralogical response and immunological response were also comparaed in different strata of baseline CD4 T lymphocyte counts and plasma HIV-1 RNA concentrations. At baseline, the plasma HIV-1 RNA was 4.44±0.68, 4.52±0.71 and 4.41±0.63 lg copies/ml in group A, B and C respectively (p = 0.628). At the end of the study, the plasma viral load reached 2.54±1.11, 1.89±0.46 and 1.92±0.58 lg copies/ml in group A, B and C respectively (p200/ul (subgroup H). But in subgroup L, viral response rate of three groups has no significant statistic difference. There were no statistically significant differences among three groups in immunological response wthin any of the CD4 or pVL strata. 3 out of 193 patients with available genotype at baseline showed primary drug resistant. Of 26 patients with virologic failure, 17 patients showed secondary drug resistant, 16 subjects in group A and 1 subject in group B. Logistic regression analysis indicated that presence of hepatotoxicity was associated with HCV-Ab positive (OR = 2.096, 95%CI: 1.106–3.973, P = 0.023) and higher CD4 baseline (CD4 count >250/ul)(OR = 2.096, 95%CI: 1.07–4.107, P = 0.031). Conclusion Our findings strongly support the use of 3TC+d4T and 3TC+AZT as the nucleoside analogue combination in NVP-based antiretroviral therapy. The regimen of AZT+ddI+NVP produced poor virological response especially in the stratum of CD4 count more than 200/ul. More patients showed secondary drug resistant in this arm too. Patients with HCV-Ab+ and CD4 count >250/ul appear to have significantly high risk of hepatoxicity. Trial Registration ClinicalTrials.gov NCT00618176

The objectives of this study were to measure the potential acceptability of a hypothetical microbicide among women in sex establishments in rural areas of Southern China and demographic, behavioral, and social context factors likely to affect microbicide acceptability.This was a cross-sectional survey, using a quota sampling, among 300 women from sex establishments in 3 rural towns. An interviewer-administered standardized questionnaire was used to measure the acceptability score of hypothetical microbicides' characteristics, as well as sexual relationships and behaviors and other contextual factors.Findings showed a generally positive response to microbicides, indicated by an acceptability index score of 2.89 (SD, 0.56, scale of 1-4) in the overall sample. Multivariate analysis shows that the acceptability score varied significantly by study sites, type of sex-work establishments, marital status, sex partner type, vaginal product experience, locus of control by partners, and locus of control by chance.Microbicides may be acceptable among sex workers in rural settings in China; however, contextual factors should be carefully considered in education and promotion of microbicides in the future.

Objectives: The purpose of this study was to test the hypothesis that ADL disability affects the risk of onset of depressive symptoms and the role of possible confounding variables in this relation. Methods: The data was obtained from the Beijing Longitudinal Study of Aging, a community-based cohort study of 3,257 elderly, aged 55 through 99 years, who were assessed four times at an 8-year interval. ADL disability and depressive symptoms were assessed by self-reported measures. Results: Compared with non-disabled persons, the disabled persons were associated with an increased risk of onset depression (RR=7.28 for urban, R=2.22 for non-urban). Although an adjustment for possible confounders reduced the risk for depression association with the disability, the detrimental effect of disability remained significantly present. This excess risk is partly explained by the lower satisfation with economy and poor perceived health status of the disabled elderly. Conclusions: Disability among elderly may significantly increase the risk for depressive symptoms.

The objective of this study was to examine the association between body mass index (BMI) and blood pressure. Two sets of cross-sectional data were obtained from annual health examinations for adults aged 40 years and over (n=1,327 in 1993; n=1,302 in 2000) in Tsunagi area of Kumamoto Prefecture, Japan. BMI was associated with mean blood pressure and with prevalence of hypertension both in 1993 and 2000. The association was independent of age, smoking status and alcohol consumption. A significant increase in risk of hypertension was found in most categories of BMI 25.0 and above, and a greater than three fold increase in those with BMI of 27 and above compared with those with BMI of 18.5–22.9. Although mean blood pressure and prevalence of hypertension sharply decreased in 2000 compared with that in 1993, BMI was positively and independently associated with increased blood pressure.

The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change.Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management.The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends.Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.

Background Cigarette smoking is a prominent risk factor for a wide range of diseases. The current study aimed to evaluate the impact of smoking on deaths from major smoking-related diseases (neoplasms, vascular diseases and respiratory diseases) in Chinese adults by estimating the potential gains in life expectancy (LE) that would accrue from eliminating deaths from these diseases, and to determine the contribution of each disease to the reduction in LE associated with smoking. Methods Two cohorts of Chinese smokers and non-smokers were constructed from a retrospective national mortality survey that had been conducted in 1989–1991 and included one million all-cause deaths among adults during 1986–1988 in 103 geographical regions. For each cohort, potential gains in LE by eliminating deaths from each major smoking-related disease were estimated. The contributions of each disease to smoking-associated reduction in LE were assessed using the LE decomposition approach. Results Among the major smoking-related diseases, it was estimated that elimination of vascular diseases would provide the greatest potential gain in LE (years), regardless of smoking status. The gains for smokers versus non-smokers in populations of urban men, urban women, rural men and rural women aged 35 years were 3.5 vs. 4.3, 3.8 vs. 4.1, 2.4 vs. 3.0, and 2.6 vs. 2.9 years, respectively. Respiratory diseases contributed most to smoking-associated LE reductions in urban women, rural men and rural women of 43.6%, 46.4%, and 62.9%, respectively. In urban men, neoplasms contributed most to smoking-associated LE reduction, their contribution being estimated as 45.8%. Conclusions Respiratory disease has the greatest influence on the LE reduction associated with smoking. Thus, smoking prevention could significantly reduce deaths from respiratory disease and improve LE.