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Introduction: Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method: We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. Results: Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P < 0.001), and in decreasing opioid consumption (WMD −4.14; 95% CI −8.00, −0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD −0.59; 95% CI, −1.06, −0.12; P = 0.014) and during the first 24 hours after surgery (WMD −0.90; 95% CI −1.27, −0.53; P < 0.001), and in decreasing opioid consumption (WMD − 4.59; 95% CI −5.76, −3.42; P < 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference −0.80; 95% CI − 1.34, −0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043). Conclusion: Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long‐term benefit for preventing postoperative depression and postmastectomy pain syndrome. [ABSTRACT FROM AUTHOR]

Background: Drowning among children of migrant workers is a major, though neglected public health issue in China.Methods: A randomised controlled trial was used to examine the potential impact of viewing a preventive health poster with/without geo-located drowning events on perceptions of drowning risk among Chinese migrant children. A total of 752 children from three schools in Jiangbei district were selected by multi-stage sampling and randomly assigned to the intervention (n = 380) or control (n = 372). Multilevel models were used to analyse changes in responses to the following questions after viewing the assigned poster for 10 min: (1) "Do you believe that drowning is a serious health problem in Ningbo city?"; (2) "Do you believe that there are lots of drowning-risk waters around you?"; (3) "Do you believe that the likelihood of your accessing a drowning-risk water is great?"; and (4) "Would you intend to avoid accessing to those drowning-risk waters when being exposed?"Results: At baseline there were no significant differences between the intervention and control groups in perceptions of drowning risk or covariates. Following the intervention, participants that viewed the geo-specific poster were more likely to respond more favourably to the first three questions (p < 0.001) than those who viewed the standard poster. However, there was no substantive difference between the geo-specific or standard poster in terms of changing intentions to avoid drowning hotspots (p = 0.214).Conclusions: Use of 'geo-located' information added value to the effectiveness of a drowning prevention poster for enhancing awareness of drowning hotspots among children of migrant workers.Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-16008979 (Retrospectively registered) (The date of trial registration: Aug 5, 2016, the date of enrolment of the first participant: Nov 10, 2015). [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between diabetic retinopathy, neuropathy and low ankle-brachial index in mild-to-moderate chronic kidney disease of type 2 diabetic patients. Methods: We enrolled 875 type 2 diabetic patients who were divided into two phenotypes (with or without albuminuria) and stratified into three groups (stage 1 with estimated glomerular filtration rate ⩾ 90 mL/min/1.73 m2, stage 2 with estimated glomerular filtration rate of 60–89, stage 3 with estimated glomerular filtration rate of 30–59). The prevalence of diabetic retinopathy, neuropathy and low ankle-brachial index was compared and the risk factors of renal impairment were determined. Results: Among chronic kidney disease stages, the prevalence of diabetic retinopathy increased from 42.5%, 56.6% to 66.7% in albuminuric subjects and from 29.4%, 33.0% to 50.0% with no significant trend in normoalbuminuric subjects (p = 0.005, 0.007 and 0.399 compared with albuminuric subjects in each stage). There was a significantly increased prevalence of low ankle-brachial index (17.5%, 22.6% and 44.4%) in normoalbuminuric subjects but no significant trend in albuminuric subjects. Diabetic retinopathy (odds ratio = 2.474, 95% confidence interval = 1.009–6.068) was an independent risk factor of declining kidney function in albuminuric patients. Conclusion: The prevalence of diabetic retinopathy was graded according to the estimated glomerular filtration rate declining in albuminuric patients while the prevalence of low ankle-brachial index was gradually increased in normoalbuminuric patients, indicating the diverse underlying mechanisms of mild to moderate chronic kidney disease between these two phenotypes. [ABSTRACT FROM AUTHOR]

Injuries have emerged as a crucial public health concern in China. Data were obtained from the death registry system in Ningbo during 2004-2013. Mortality rates resulting from all injuries and the 6 most common types of injuries were analyzed to identify time trends using linear regression models on both the absolute scale and log scale. A decreased male to female ratio and increasing age were observed among the total injury deaths. The annual all-injury mortality rates declined considerably during the observation period. Injury mortality rates for motor vehicle traffic crashes, drowning, and suicide all showed a deceasing trend; however, only mortality from falls showed an increasing trend. There was a sharp increasing trend among females, with a disproportionate number of falls. The injury patterns in Ningbo are mostly comparable to those in high-income countries. Appropriate preventive strategies should be urgently tailored to control this aggressive evolution in older individuals and females., (© 2016 APJPH.)

The purpose of this study was to determine the incidence and potential risk factors for nonfatal drowning among migrant workers' children in China. We conducted a cross-sectional survey of students from third to ninth grade at five Migrant Workers' Children schools in Ningbo, China in 2014. General information and a history of nonfatal drowning was obtained from self-reported questionnaires by migrant students. A multivariate logistic regression model was used to identify potential risk factors. A total 3,859 students were included in the current study. Of these, 13.4% had experienced a nonfatal drowning accident (15.2% for males, 11.2% for females). Most nonfatal drowning occurred in natural water settings. Diving into unknown water without adult supervision had the greatest association with history of nonfatal drowning [odds ratio (OR) = 1.97; 95% confidential interval (CI): 1.31-2.95], followed by fishing in water (OR = 1.50; 95% CI: 1.05-2.14), swimming or playing in water (OR = 1.47; 95% CI: 1.02-2.12), and trying to rescue peers in the water if they were drowning (OR = 1.31; 95% CI: 1.04-1.64). There were factors associated with a lower risk of drowing: having a parent accompany the child to school (OR = 0.69; 95% CI: 0.51-0.93),understanding the the danger of swimming alone (OR = 0.69; 95% CI: 0.48-0.99) and having a knowledge about water safety (OR = 0.98; 95% CI: 0.98-0.99). The study population was at inceased risk for nonfatal drowning. Preventive measures, such as improved water-safety knowledge, decreasing risky water-related activities and better supervision of children need to be developed and tested to decrease the risk of nonfatal drowning among the study population.