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Objective To describe the occurrence of general surgical complications and establish prediction models for different types of complications based on a multicenter cohort study. Methods Based on Modern Surgery and Anesthesia Safety Management System Construction and Promotion(MSCP), patients who underwent general surgery in 4 hospitals from January to June 2015 and from January to June 2016 were selected as participants, and perioperative data of patients were collected. Logistic regression was used to identify risk factors and predict complications. Results Among 19 223 patients, 830(4.32%) had complications. Among participants who had complications, 371(44.70%) had incision complications, 190(22.89%) had fistula complications, 310(37.35%) had infection complications, 161(19.40%) had failure complications, and 104(12.5%) died. There were significant differences in the risk factors of different types of complications. The risk factors of incision,infection and failure covered the whole perioperative period, while fistula complications mainly focused on the difficulty of surgery and postoperative treatment, and for death outcomes, postoperative risk factors were more severe than preoperative risk factors. The areas under the curves of prediction were between 0.80-0.93. Conclusions In general surgery, different types of complications have different risk factors. The targeted prediction model can avoid the rough simplification of complications and fuzzy influence of each factor, and can provide reference for the prevention of complications.

Background: The current guidelines for managing screen‐detected pulmonary nodules offer rule‐based recommendations for immediate diagnostic work‐up or follow‐up at intervals of 3, 6, or 12 months. Customized visit plans are lacking. Purpose: To develop individualized screening schedules using reinforcement learning (RL) and evaluate the effectiveness of RL‐based policy models. Methods: Using a nested case–control design, we retrospectively identified 308 patients with cancer who had positive screening results in at least two screening rounds in the National Lung Screening Trial. We established a control group that included cancer‐free patients with nodules, matched (1:1) according to the year of cancer diagnosis. By generating 10,164 sequence decision episodes, we trained RL‐based policy models, incorporating nodule diameter alone, combined with nodule appearance (attenuation and margin) and/or patient information (age, sex, smoking status, pack‐years, and family history). We calculated rates of misdiagnosis, missed diagnosis, and delayed diagnosis, and compared the performance of RL‐based policy models with rule‐based follow‐up protocols (National Comprehensive Cancer Network guideline; China Guideline for the Screening and Early Detection of Lung Cancer). Results: We identified significant interactions between certain variables (e.g., nodule shape and patient smoking pack‐years, beyond those considered in guideline protocols) and the selection of follow‐up testing intervals, thereby impacting the quality of the decision sequence. In validation, one RL‐based policy model achieved rates of 12.3% for misdiagnosis, 9.7% for missed diagnosis, and 11.7% for delayed diagnosis. Compared with the two rule‐based protocols, the three best‐performing RL‐based policy models consistently demonstrated optimal performance for specific patient subgroups based on disease characteristics (benign or malignant), nodule phenotypes (size, shape, and attenuation), and individual attributes. Conclusions: This study highlights the potential of using an RL‐based approach that is both clinically interpretable and performance‐robust to develop personalized lung cancer screening schedules. Our findings present opportunities for enhancing the current cancer screening system. [ABSTRACT FROM AUTHOR]

Objective To estimate the long-term effect of the changing demography in China on blood supply and demand. Methods We developed a predictive model to estimate blood supply and demand during 2017-2036 in mainland China and in 31 province-level regions. Model parameters were obtained from World Population Prospects, China statistical yearbook 2016, China's report on blood safety and records from a large tertiary hospital. Our main assumptions were stable age-specific per capita blood supply and demand over time. Findings We estimated that the change in demographic structure between 2016 (baseline year) and 2036 would result in a 16.0% decrease in blood supply (from 43.2 million units of 200 mL to 36.3 million units) and a 33.1% increase in demand (from 43.2 million units to 57.5 million units). In 2036, there would be an estimated shortage of 21.2 million units. An annual increase in supply between 0.9% and 1.8% is required to maintain a balance in blood supply and demand. This increase is not enough for every region as regional differences will increase, e.g. a blood demand/supply ratio > 1.45 by 2036 is predicted in regions with large populations older than 65 years. Sensitivity analyses showed that increasing donations by 4.0% annually by people aged 18-34 years or decreasing the overall blood discard rate from 5.0% to 2.0% would not offset but help reduce the blood shortage. Conclusion Multidimensional strategies and tailored, coordinated actions are needed to deal with growing pressures on blood services because of China's ageing population. Objectif Estimer I'effet a long terme de revolution demographique en Chine sur l'approvisionnement et la demande en produits sanguins. Methodes Nous avons elabore un modele de prevision pour estimer l'approvisionnement et la demande en produits sanguins en Chine continentale et dans 31 provinces entre 2017 et 2036. Les parametres du modele ont ete definis a partir des Perspectives de la population mondiale, de l'Annuaire statistique 2016 de la Chine, du Rapport de la Chine sur la securite transfusionnelle et des dossiers d'un important hopital de soins tertiaires. Nous sommes partis de l'hypothese que l'approvisionnement et la demande en produits sanguins par habitant et par groupe d'age etaient stables dans le temps. Resultats Nous avons estime que Revolution de la structure demographique entre 2016 (annee de reference) et 2036 entrainerait une diminution de l'approvisionnement en produits sanguins de 16,0% (de 43,2 millions d'unites de 200 mL a 36,3 millions d'unites) et une augmentation de la demande de 33,1% (de 43,2 millions d'unites a 57,5 millions d'unites). Nous estimons qu'en 2036, il manquera 21,2 millions d'unites. Une augmentation annuelle de l'approvisionnement de 0,9% a 1,8% est necessaire pour maintenir un equilibre entre l'approvisionnement et la demande en produits sanguins. Cette augmentation n'est pas suffisante pour toutes les regions, car les differences regionales vont s'accentuer. Par exemple, un rapport demande/approvisionnement en produits sanguins [greater than or equal to] 1,45 d'ici a 2036 est prevu dans les regions qui comptent un nombre eleve d'habitants ages de plus de 65 ans. Les analyses de sensibilite ont montre qu'une augmentation des dons de 4,0% chaque annee par des individus ages de 18 a 34 ans ou une diminution du taux global de rejet de produits sanguins de 5,0% a 2,0% ne permettrait pas de reduire a neant la penurie de produits sanguins, mais aiderait a la resorber. Conclusion Des strategies multidimensionnelles et des actions adaptees et concertees sont necessaires pour faire face aux pressions croissantes qui pesent sur les services de transfusion sanguine en raison du vieillissement de la population chinoise. Conclusion Se necesitan estrategias multidimensionales y acciones coordinadas y adaptadas para hacer frente a la creciente presion sobre los servicios de transfusion de sangre debido al envejecimiento de la poblacion de China. Objetivo Estimar el efecto a largo plazo de los cambios demograficos en China sobre la oferta y la demanda de sangre. Metodos Se desarrollo un modelo predictivo para estimar la oferta y la demanda de sangre durante el periodo en China continental y en 31 provincias. Los parametros del modelo se obtuvieron de World Population Prospects (Perspectivas mundiales de poblacion), China statistical yearbook 2016 (Anuario estadistico de China 2016), China's report on blood safety (Informe de China sobre seguridad de la sangre) y de registros de un gran hospital terciario. Los supuestos principales eran la estabilidad de la oferta y la demanda de sangre per capita especifica de la edad a lo largo del tiempo. Resultados Se estimo que el cambio en la estructura demografica entre 2016 (ano inicial) y 2036 resultaria en una disminucion del 16,0% en el suministro de sangre (de 43,2 millones de unidades de 200 ml a 36,3 millones de unidades) y un aumento del 33,1% en la demanda (de 43,2 millones de unidades a 57,5 millones de unidades). En 2036, habria una escasez estimada de 21,2 millones de unidades. Se requiere un aumento anual de la oferta de entre el 0,9% y el 1,8% para mantener un equilibrio entre la oferta y la demanda de sangre. Este aumento no es suficiente para todas las regiones, ya que las diferencias regionales aumentaran, por ejemplo, se pronostica una relacion entre la demanda y la oferta de sangre [mayor que o igual a] = 1,45 para el ano 2036 en regiones con grandes poblaciones mayores de 65 anos. Los analisis de sensibilidad mostraron que el aumento de las donaciones en un 4,0% anual por parte de las personas de 18 a 34 anos o la disminucion de la tasa general de descarte de sangre del 5,0% al 2,0% no compensaria sino que ayudaria a reducir la escasez de sangre., Introduction Maintaining a safe and adequate supply of blood for health services is an important responsibility of every World Health Organization Member State. (1,2) Demographic changes are a threat to [...]

Little is known about the association between surface water quality and cancer incidence, especially in China. Drinking water quality has been linked to the incidence of several cancers in individual-level studies. However, few studies have attempted to examine multiple pollutants and multiple cancers at population level. This study used water monitoring and population-level cancer data from across China to examine spatial associations between water pollutants and types of cancer. We found a "dose–response" relationship between the number of pollutants present at high levels and cancer incidence. These results provide evidence of a nationwide spatial association between water quality and cancer in China. The precise relationship varies with cancers and pollutants. However, the overall consistency of the "dose–response" relationship suggests that surface water quality is an important factor in cancer incidence. Our findings highlight new issues such as the changing effects when different pollutants co-exist and an increasing number of new cancer cases partially attributable to poor water quality. Our work also points to some ways to deal with these challenges. [ABSTRACT FROM AUTHOR]

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.