AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi...AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.展开更多
Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with...Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.展开更多
Background: Hazardous alcohol consumption and associated harms are high among young uni- versity students. The university environment is conducive to excessive alcohol consumption with studies finding young university...Background: Hazardous alcohol consumption and associated harms are high among young uni- versity students. The university environment is conducive to excessive alcohol consumption with studies finding young university students to drink alcohol at higher levels than their non-university peers. Methods: A random sample of 18 - 24-year-old undergraduate, internal university students completed a survey (n = 2465) to investigate differences in self-reported personal, second-hand and witnessed alcohol-related harms, alcohol expectancies, pre-loading, and friends’ alcohol consumption between low risk and hazardous drinkers. Univariate and multivariate analyses are reported. Results: Almost 40% of students who had consumed alcohol in the past year reported drinking at hazardous levels. Univariate analyses found students who reported hazardous drinking reported significantly higher scores relating to experienced, second-hand, witnessed and academic problems compared to low risk drinkers. Hazardous drinkers were also more likely to pre-load, to drink at higher levels when pre-loading, have more friends who drank alcohol, have more friends who drank at hazardous levels and to score higher on alcohol expectancies. However both low risk and hazardous drinkers experienced a range of harms due to their own drinking including hangover (71.2%), unprotected sex (19.3%), regretted sex (16.8%) and drink-driving (17%). Looking after an intoxicated student (34.3%) and witnessing someone pass out (37.5%) were issues for all drinkers. Experienced alcohol related harms, academic problems, alcohol expectancies, close friends’ level of alcohol consumption, pre-loading in the last four weeks and level of consumption when pre-loading were predictors of hazardous drinking (p < 0.001). Conclusion: Young undergraduate university students are at risk of a range of academic, social, emotional and physical harms associated with their own and other students’ alcohol consumption. There is a need for integrated programs to address university drinking culture and effect positive changes.展开更多
AIM:To examine the possible association between gastrointestinal symptoms and anxiety and depression in type 2 diabetes mellitus(T2DM).METHODS:The study was a matched case-control study based on a face to face intervi...AIM:To examine the possible association between gastrointestinal symptoms and anxiety and depression in type 2 diabetes mellitus(T2DM).METHODS:The study was a matched case-control study based on a face to face interview with designed diagnostic screening questionnaires for gastrointestinal(GI) symptoms and T2DM,Patient Health Questionnaire(PHQ-9) for depression and General Anxiety Disorders(GAD-7) for anxiety.The questionnaire consisted of questions about symptoms and signs of anxiety and depression disorders.Also,socio-demographic characteristics,life style habits and the family history of patients were collected.It was carried out from June 2010 to May 2011 among Qatari and other Arab nationals over 20 years of age at Primary Health Care Centers of the Supreme Council of Health,Qatar,including patients with diabetes mellitus and healthy subjects over 20 years of age.RESULTS:In the studied sample,most of the studied T2DM patients with GI symptoms(39.3%) and healthy subjects(33.3%) were in the age group 45-54 years(P < 0.001).The prevalence of severe depression(9.5% vs 4.4%,P < 0.001) and anxiety(26.3% vs 13.7%,P < 0.001) was significantly higher in T2DM patients with GI symptoms than in general population.Obesity(35.7% vs 31.2%) and being overweight(47.9% vs 42.8%) were significantly higher in T2DM patients with GI symptoms than in healthy subjects(P = 0.001).Mental health severity score was higher in T2DM patients with GI symptoms than in healthy subjects;depression(8.2 ± 3.7 vs 6.0 ± 3.6) and anxiety(7.6 ± 3.3 vs 6.0 ± 3.7).The most significant GI symptom which was considerably different from controls was early satiety [odds ratio(OR) = 10.8,P = 0.009] in depressed T2DM patients and loose/watery stools(OR = 2.79,P = 0.029) for severe anxiety.Anxiety was observed more than depression in T2DM patients with GI symptoms.CONCLUSION:Gastrointestinal symptoms were significantly associated with depression and anxiety in T2DM patients,especially anxiety disorders.展开更多
The development of digital platforms is transforming caregiver-patient interactions and the dissemination of knowledge.Obtaining information from the Internet has become a habit for many patients and must be considere...The development of digital platforms is transforming caregiver-patient interactions and the dissemination of knowledge.Obtaining information from the Internet has become a habit for many patients and must be considered by caregivers.Thus,understanding the use of digital tools by patients is a public health issue.The Sav-AQ study aims to understand patterns of use by women with breast cancer and the role of health professionals.Sav-AQ is an exploratory feasibility study with a mixed design,exploring patient and healthcare experience before and after the integration of a specific website into their care pathways.The research is based on the digital platform“My Breast Cancer Network”,which was built by and for patients with breast cancer.A group of 30 breast cancer patients and six healthcare professionals using the platform were followed.The results show that for all users,the activity on the website decreases over time.At the beginning of the course,patients were more assiduous,which can be explained by the search for elements related to an unknown care pathway.The results also show that technical skills to use the platform are necessary for patients and must be accompanied by a health professional.It is of interest to devise a larger study to assessing the impact of such a platform on patient healthcare uptake and health skills development.展开更多
Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and...Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.展开更多
Objective To identify the association between PLIN 1237 polymorphism and obesity in Chinese Han adults. Methods A total of 994 adults （157 obese subjects, 322 overweight subjects, and 515 normal controls） were recru...Objective To identify the association between PLIN 1237 polymorphism and obesity in Chinese Han adults. Methods A total of 994 adults （157 obese subjects, 322 overweight subjects, and 515 normal controls） were recruited from two rural communities. PLIN 1237 polymorphism was genotyped by polymerase chain reaction-restriction-fragment-length-polymorphism （PCR-RFLP）. Association between PLIN polymorphisms and obesity status was estimated by ordinal logistic regression. Results The three genotypes of,PLIN 1237 were detected with a percentage of 54.3%, 37.1%, and 8.6% in TT, TC, and CC genotypes, respectively. For the PLIN 1237 polymorphism locus, the frequency of alleles T and C was 0.73 and 0.27, respectively. The PLIN 1237 polymorphisms were in Hardy-Weinberg equilibrium. PLIN 1237 polymorphism was not associated with obesity. The odds ratio for overweight or obesity for the CC＋TC genotype was 0.8（0.4, 1.4） in women （P=-0.4） and 0.6 （0.3, 1.3） in men （P=-0.2） after adjustment for age, education, household income and alcohol consumption, smoking, and physicalactivity. Conclusion Chinese Han adults have a lower frequency of variant-allele C in PLIN1237. PLIN1237 T〉C polymorphism is not significantly associated with obesity in northern Chinese adults.展开更多
Background: The high consanguinity in Middle East increases the risk of genetic diseases, including primary immunodeficiency diseases (PID). Objectives: This study was aimed at determining the rate of positive family ...Background: The high consanguinity in Middle East increases the risk of genetic diseases, including primary immunodeficiency diseases (PID). Objectives: This study was aimed at determining the rate of positive family history of PID, the overall rate and type of consanguinity, and their effects on delay age during diagnosis of PID. Materials and methods: A retrospective analysis was conducted on 131 children with PID (aged 0 - 14 years) managed at Hamad General Hospital during 1998-2012. Results: Data on 131 patients (75 males & 56 females) of 82 families was analyzed. The most common phenotype of PID was predominantly antibody deficiency (23.7%). The onset age was 24.01 months and delay age 18.7 months. Family history of PID was 66.4% (38.7% in predominantly antibody deficiency and 100% in diseases of immune dysregulation). Positive family history significantly (p = 0.004) reduced the delay age of PID diagnosis by 52.9%. The consanguinity rate was 61.1% (32.3% in the predominantly antibody ID to 96% in the phagocyte defects group), where paternal cousin ranked the highest type (57.5%). Conclusions: This study indicates that family history is common in children with PID and helpful in reducing the delay age. Consanguinity among families of affected children is also high (higher than healthy population). Paternal parallel cousin marriages are the most common type of consanguinity. For a practicing physician, family history is a simple and useful tool when suspecting PID in children. Primary prevention of PID in Middle East communities should consider consanguinity reduction through public awareness and education and premarital counseling programs.展开更多
Introduction: Ataxia telangiectasia (AT) is a rare disease characterized by immunodeficiency and neurological manifestations. Ataxia, resulting from cerebella atrophy, runs a progressive incapacitating course. Clinica...Introduction: Ataxia telangiectasia (AT) is a rare disease characterized by immunodeficiency and neurological manifestations. Ataxia, resulting from cerebella atrophy, runs a progressive incapacitating course. Clinical monitoring of the disease course is mandatory for early treatment. Aim: To study clinical severity of AT and correlate it with the degree of cerebellar atrophy. Patients and Methods: We retrospectively studied all children (less than 14 years) with AT seen at Hamad General Hospital Clinics between 1998-2013. We collected basic demographic data, parental consan-guinity, family history, AT clinical severity scores, and reviewed CBC with differential counts;alpha-fetoprotein, serum immunoglobulins and lymphocyte subsets. Cranial MRI scans of each subject were reviewed by a neuroradiologist. Cerebellar atrophy was visually and semi-quantitatively scored. Results: We analyzed data on 18 AT children (10 males and 8 females), mean age of 76.9 months. 77.8% had a positive family history of AT and 41.7% parental consanguinity. Lymphopenia was observed in 77.8% and high serum alpha-fetoprotein in 87.5% of children. Clinical severity of ataxia was 17.1 ± 8.4 (mean ± SD);86.7% of patients were moderate-severe. MRI cerebellar atrophy score was 1.9 ± 1.3 (mean ± SD), and moderate in 51% of patients. AT clinical severity score correlated (coefficient r = 0.566) but not statistically significant p = 0.088) with MRI cerebellar atrophy scores. Conclusions: Moderate to severe ataxia and marked cerebellar atrophy are quite common in AT children. There is a correlation between AT clinical severity and cerebellar atrophy. Larger prospective studies might further determine the significance of our observations and help practicing practitioners monitor the progression of the disease.展开更多
No study has been conducted to determine the relationship between RTC （road traffic crashes） and depression, anxiety and stress scale （DASS-21）, tiredness, fatigues and sleeping. The aim of the present study was t...No study has been conducted to determine the relationship between RTC （road traffic crashes） and depression, anxiety and stress scale （DASS-21）, tiredness, fatigues and sleeping. The aim of the present study was to examine the effect of aggressive driver behaviour, fatigue and sleeping on RTC comparison between commercial taxi and minibus/van/pick-up cars drivers. A cross-sectional study included a representative sample of 2,300 drivers of which 1,786 drivers （77.6%） agreed to participate. The Manchester DBQ （Driver Behaviour Questionnaire） was used to measure the aberrant driving behaviours leading to accidents. The study is based on the measurement using the depression anxiety stress scales （DASS-21）. Participants completed a DASS-21 questionnaire with items related to socio-demographic information, BMI （body mass index）, driving experience, fatigue, sleeping, adherence to traffic laws （including speed limits and wearing seat belt）, and drivers＇ driving records. Univariate and multivariate statistical analyses were performed. In a representative sampling, the age distribution of the participants ranged from 25 to 65 years with the mean age 38.3±10.2 and the mean annual mileage （km） per month was 14,587±1,741 （p 〈 0.001）. There was a significant difference found between both group minibus/van/pick-up and commercial taxi drivers regarding of their age group （p 〈 0.001）, education （p = 0.003）, history of accident （p = 0.003）, seat belt use （p = 0.022） time of accident （p = 0.005）; crossing red light （p 〈 0.001）, excessive speed limits （p = 0.002）, BMI group （p = 0.022）, physical activity （p = 0.003）, annual mileage in km （p 〈 0.001）, number of working days （p = 0.010） and hours （p = 0.030）; number of sleeping hours （p = 0.025）, CD music listening （p = 0.010）, mobile phone use （p = 0.001）, soft drinking （p = 0.002） and cigarette smoking habit （p 〈 0.001）. When the history of RTC was assessed, minibus/van/pick-ups were more likely to be involved in accidents compared to commercial taxi drivers and there was a highly statistically significant difference between both groups. Furthermore, minibus/van/pick-up drivers have more sleeping disorders and fatigue severity compared to commercial taxi drivers. This study revealed that minibus/van/pick-up drivers exhibited more depression, anxiety and stress symptoms compared to commercial taxi drivers. DASS-21 variables were found to contribute significantly to the explanation of the RTC involvement rate. Chronic fatigue and acute sleepiness, and overtime or heavy work-load on car drivers significantly increases the risk of a car crash which a car occupant can be injured or killed. Reductions in RTC may be achieved if fewer people drive when they have fatigue or are sleepy or have been deprived of sleep or drive during rush hours.展开更多
BACKGROUND The hepatoprotective effects of phytochemicals are controversial.A dietary phytochemical index(DPI)has been suggested as an alternative method for quantifying the phytochemical content of foods.AIM To asses...BACKGROUND The hepatoprotective effects of phytochemicals are controversial.A dietary phytochemical index(DPI)has been suggested as an alternative method for quantifying the phytochemical content of foods.AIM To assess the DPI in relation to liver function tests among a representative sample of Iranian adults.METHODS A total of 5111 participants aged 35-70 years old were included in this cross-sectional study by a multistage cluster random sampling method.Dietary intakes were collected by a validated and reliable food frequency questionnaire with 121 items.DPI was calculated by the percent of daily energy intake taken from phytochemical-rich foods.Fasting serum concentrations of alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and gamma glutamyl transferase(GGT)were determined.Linear regression was used to investigate the association between DPI and levels of liver enzymes using crude and adjusted models.RESULTS There was an inverse association between DPI score and serum ALP in the crude model(β=-0.05;P<0.001).This association remained significant after adjustment for body mass index,age,smoking,energy intake,history of diabetes,and education(β=-0.03;P=0.01).No significant associations were found between DPI score and serum levels of AST,ALT,and GGT.The individuals with the highest DPI scores consumed significantly higher amounts of fruits,vegetables,legumes,nuts,and cereals,yet were shown to have significantly higher serum total cholesterol and low-density lipoprotein cholesterol,as well as several other metabolic abnormalities.CONCLUSION Higher adherence to phytochemical-rich foods was associated with lower levels of ALP,but no change in other liver enzymes.Those with higher DPI scores also consumed food items associated with a healthier overall dietary pattern;however,they also presented several unexpected metabolic derangements.Additional randomised trials are needed to better determine the effects of phytochemical-rich foods on liver function.展开更多
Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determin...Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determine and compare the effects of topical patients with sand compared with control related to Gonarthrosis, LBP, knee, and Carpal Tunnel Syndrome pain. Methods: This is a prospective case and control designed study based on 101 pain case with Sand and 101 control subjects. The interventional groups in addition either topical sand or without sand 2 months after the intervention were assessed. We assessed tolerability of an established pain perception scale by the Numeric Rating Scale (NRS). Categorical variables were compared using the chi-square (χ<sup>2</sup>) test. The paired t-test was used to compare the two groups before and after the intervention. One-way analysis of variance (ANOVA) was employed for comparison of several group means. Results: The study was based on 202 patients, 41 males (20.3%) and 161 females (79.7%). There were statistically significant differences between subjects with and without Sand in term of Gonarthrosis, Rheumatoid Arthritis LBP, knee, and Carpal Tunnel Syndrome pain (p = 0.033). Majority of patients were over age 55 years old (55%) and females 78 (77.2%). The mean score of total pain experience before and after the intervention was 7.41 ± 1.1 for black sand, and 4.24 ± 2.38 for without sand as control group. The mean scores of these 5 groups were highly significant before and after the intervention (p There was statistically highly significant in regarding subjects with Sand as compared with those before Sand after treatment mean score specifically with gonarthrosis before pain 7.23 ± 1.86 vs after treatment 4.54 ± 2.18 p < 0.001;rheumatoid arthritis before 8.28 ± 1.48 vs after treatment 4.80 ± 3.71 p < 0.001;Low Back Pain before 8.42 ± 1.83 vs after treatment 4.37 ± 1.52 p < 0.001;knee pain before 8.93 ± 0.89 vs after treatment 4.24 ± 0.24 p < 0.001;Carpal Tunnel Syndrome before 7.664 ± 1.04 vs after treatment 4.26 ± 1.03 p Conclusion: The current study has revealed that the topical treatments with sand could have a significant effect on the perception of pain compared to those in the control group with respect of gonarthrosis, rheumatoid arthritis, LBP, knee, and Carpal Tunnel Syndrome pain .展开更多
Background:Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear.This study aimed to investigate associations of individual a...Background:Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear.This study aimed to investigate associations of individual and combined lifestyle factors(LFs)with the incidence risk and long-term prognosis of pneumonia hospitalization.Methods:Using data from the China Kadoorie Biobank study,we used the multistate models to investigate the role of five high-risk LFs,including smoking,excessive alcohol drinking,unhealthy dietary habits,physical inactivity,and unhealthy body shape,alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease(CVD,regarded as a reference outcome),and subsequently to mortality.Results:Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death,but with different risk estimates.The greater the number of high-risk LFs,the higher the risk of developing pneumonia and long-term mortality risk after pneumonia,with the strength of associations comparable to that of LFs and CVD.Compared to participants with 0-1 high-risk LF,the adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43(1.28-1.60)and 1.98(1.61-2.42),respectively.Correspondingly,the respective HRs(95%CIs)for transitions from baseline to CVD and from CVD to death were 2.00(1.89-2.11)and 1.44(1.30-1.59),respectively.The risk estimates changed slightly when further adjusting for the presence of major chronic diseases.Conclusion:In this Chinese population,unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.展开更多
Background： A few studies have been conducted to determine the relationship between road motor vehicle crashes （MVC） and serious injuries related to tiredness, fatigues and sleeping. Aim： To determine the effects ...Background： A few studies have been conducted to determine the relationship between road motor vehicle crashes （MVC） and serious injuries related to tiredness, fatigues and sleeping. Aim： To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Design and setting： Population-based case and control study conducted at the accident emergency departments of hospitals and roads. Subjects： 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. Methods： The Manchester driver behaviour questionnaire （DBQ） measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale （FSS） and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws （such as speed limits and seat belt）, and drivers＇ driving records. Results： In a representative sampling, participant＇s age ranged from 25 to 65 and the mean and standard deviation were 36.5 _＋ 7.8 for cases and 37.0 4- 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit （p = 0.017）. Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group （p 〈 0.001）. Further, cases had higher prevalence of Epworth sleeping disorders （p 〈 0.001） and fatigue severity （p - 0.003） compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. Conclusion： The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.展开更多
Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to compre...Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to comprehensively examine such associations across different regions in China.Methods Based on the China Kadoorie Biobank study,the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer.Muscle mass and grip strength were measured using calibrated instruments.Arm muscle quality was defined as the ratio of grip strength to arm muscle mass.Low muscle mass,grip strength,and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index,grip strength,and arm muscle quality,respectively.Cox proportional hazards models yielded hazard ratios(HRs)and 95%confidence intervals(CIs)for risks of all-cause mortality in relation to muscle mass,strength,and quality.Results During a median follow-up of 3.98 years,739 participants died.The HR(95%CI)of all-cause mortality risk was 1.28(1.08–1.51)for low appendicular muscle mass index,1.38(1.16–1.62)for low total muscle mass index,1.68(1.41–2.00)for low grip strength,and 1.41(1.20–1.66)for low arm muscle quality in models adjusted for sociodemographic characteristics,lifestyle factors,and medical histories.Conclusion Low muscle mass,grip strength,and arm muscle quality are all associated with short-term increased risks of mortality,indicating the importance of maintaining normal muscle mass,strength,and quality for general Chinese adults.展开更多
Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-...Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-European countries,including China.We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.Methods:Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training(n=28,490)and testing sets(n=72,150).Ten previously developed PRSs were evaluated,and new ones were developed using clumping and thresholding or LDpred method.The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set.Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms.Prediction of the 10-year first CAD events was assessed using hazard ratios(HRs)and measures of model discrimination,calibration,and net reclassification improvement(NRI).Hard CAD(nonfatal I21-I23 and fatal I20-I25)and soft CAD(all fatal or nonfatal I20-I25)were analyzed separately.Results:In the testing set,1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years.The HR per standard deviation of the optimal PRS was 1.26(95%CI:1.19-1.33)for hard CAD.Based on a traditional CAD risk prediction model containing only non-laboratory-based information,the addition of PRS for hard CAD increased Harrell’s C index by 0.001(-0.001 to 0.003)in women and 0.003(0.001 to 0.005)in men.Among the different high-risk thresholds ranging from 1%to 10%,the highest categorical NRI was 3.2%(95%CI:0.4-6.0%)at a high-risk threshold of 10.0%in women.The association of the PRS with soft CAD was much weaker than with hard CAD,leading to minimal or no improvement in the soft CAD model.Conclusions:In this Chinese population sample,the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD.Therefore,this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.展开更多
Background:Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases.However,the effect of spicy food intake on the incidence of vascular diseases in the Chinese populat...Background:Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases.However,the effect of spicy food intake on the incidence of vascular diseases in the Chinese population remains unclear.This study was conducted to explore this association.Methods:This study was performed using the large-scale China Kadoorie Biobank(CKB)prospective cohort of 486,335 participants.The primary outcomes were vascular disease,ischemic heart disease(IHD),major coronary events(MCEs),cerebrovascular disease,stroke,and non-stroke cerebrovascular disease.A Cox proportional hazards regression model was used to assess the association between spicy food consumption and incident vascular diseases.Subgroup analysis was also performed to evaluate the heterogeneity of the association between spicy food consumption and the risk of vascular disease stratified by several basic characteristics.In addition,the joint effects of spicy food consumption and the healthy lifestyle score on the risk of vascular disease were also evaluated,and sensitivity analyses were performed to assess the reliability of the association results.Results:During a median follow-up time of 12.1 years,a total of 136,125 patients with vascular disease,46,689 patients with IHD,10,097 patients with MCEs,80,114 patients with cerebrovascular disease,56,726 patients with stroke,and 40,098 patients with non-stroke cerebrovascular disease were identified.Participants who consumed spicy food 1–2 days/week(hazard ratio[HR]=0.95,95%confidence interval[95%CI]=[0.93,0.97],P<0.001),3–5 days/week(HR=0.96,95%CI=[0.94,0.99],P=0.003),and 6–7 days/week(HR=0.97,95%CI=[0.95,0.99],P=0.002)had a significantly lower risk of vascular disease than those who consumed spicy food less than once a week(P trend<0.001),especially in those who were younger and living in rural areas.Notably,the disease-based subgroup analysis indicated that the inverse associations remained in IHD(P trend=0.011)and MCEs(P trend=0.002)risk.Intriguingly,there was an interaction effect between spicy food consumption and the healthy lifestyle score on the risk of IHD(P interaction=0.037).Conclusions:Our findings support an inverse association between spicy food consumption and vascular disease in the Chinese population,which may provide additional dietary guidance for the prevention of vascular diseases.展开更多
Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and afte...Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and after-discharge management characteristics and prognosis for stroke types in China.Methods A nationwide registry recruited 14244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008,recording presenting characteristics,diagnostic procedures and in-hospital treatment.After hospital discharge,patients were followed up for 6 months.Conventional statistical methods were used to examine the patterns of management and prognosis.Results Overall,68.7%,26.9%and 4.4%were ischaemic stroke(IS),intracerebral haemorrhage(ICH),and subarachnoid haemorrhage(SAH),respectively.Only 20%were managed in a dedicated stroke unit.Among IS,1.3%received thrombolysis within 3 hours after symptom onset,whereas the proportions of receiving in-hospital antiplatelet therapy,neuroprotective agents and traditional Chinese medicines(TCM)were 88.4%,69.7%and 70.6%,respectively.For ICH,63.3%and 36.3%received neuroprotective agents and TCM in hospital,respectively.At discharge,70.7%and 38.0%of the patients with IS were given antiplatelet and statin therapies,respectively,decreasing to 64.8%and 23.9%,respectively,at 6 months.In-hospital mortality was 3.2%,9.3%and 10.1%for IS,ICH and SAH,respectively,with a further 8.6%,18.2%and 22.0%,respectively,died by 6 month.Meanwhile,in-hospital recurrence rate was 2.6%,1.9%and 7.2%for IS,ICH and SAH,respectively,with a further 8.0%,5.1%and 7.5%,respectively,recurred by 6 month.Conclusions In China,the mortality rate of stroke is lower than that reported from west populations,though most strokes are not managed in specialised stroke unit.There is widespread use of some unproven therapies but limited proven treatments,especially after discharge,leading to unnecessary recurrent risks.展开更多
Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimor...Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.展开更多
Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients ...Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.Methods:The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China.We stepwisely selected the predictors using logistic regression model.Then we tested the model validity through P-P graph,area under the receiver operating characteristic curve(AUROC),ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.Results:The final prediction model involved 14 independent variables,including age,sex,location(urban/rural),region,educational background,smoking status,smoking amount(pack-years),years of exposure to air pollution by cooking fuel,family history of COPD,history of tuberculosis,body mass index,shortness of breath,sputum and wheeze.The model showed an area under curve(AUC)of 0.72(95%confidence interval[CI]:0.72-0.73)for detecting undiagnosed COPD patients,with the cutoff of predicted probability of COPD=0.22,presenting a sensitivity of 70.13%and a specificity of 62.25%.The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68(95%CI:0.66-0.69).Moreover,the ten-fold cross validation reported an AUC of 0.72(95%CI:0.71-0.73),and the external validation presented an AUC of 0.69(95%CI:0.68-0.71).Conclusion:This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.展开更多
基金Supported by Qatar Diabetic Association and Qatar National Research Fund, QNRF UREP 07-099-3-023
文摘AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.
基金supported by National Natural Science Foundation of China(82192900,82192901,82192904,81941018,and 91846303)Peking University Medicine Seed Fund for Interdisciplinary Research(BMU2022MX025)+5 种基金the Fundamental Research Funds for the Central Universitiessupported by a grant from the Kadoorie Charitable Foundation in Hong Kongsupported by grants from the UK Wellcome Trust(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)the National Key R&D Program of China(2016YFC0900500)National Natural Science Foundation of China(81390540)Chinese Ministry of Science and Technology(2011BAI09B01)。
文摘Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.
文摘Background: Hazardous alcohol consumption and associated harms are high among young uni- versity students. The university environment is conducive to excessive alcohol consumption with studies finding young university students to drink alcohol at higher levels than their non-university peers. Methods: A random sample of 18 - 24-year-old undergraduate, internal university students completed a survey (n = 2465) to investigate differences in self-reported personal, second-hand and witnessed alcohol-related harms, alcohol expectancies, pre-loading, and friends’ alcohol consumption between low risk and hazardous drinkers. Univariate and multivariate analyses are reported. Results: Almost 40% of students who had consumed alcohol in the past year reported drinking at hazardous levels. Univariate analyses found students who reported hazardous drinking reported significantly higher scores relating to experienced, second-hand, witnessed and academic problems compared to low risk drinkers. Hazardous drinkers were also more likely to pre-load, to drink at higher levels when pre-loading, have more friends who drank alcohol, have more friends who drank at hazardous levels and to score higher on alcohol expectancies. However both low risk and hazardous drinkers experienced a range of harms due to their own drinking including hangover (71.2%), unprotected sex (19.3%), regretted sex (16.8%) and drink-driving (17%). Looking after an intoxicated student (34.3%) and witnessing someone pass out (37.5%) were issues for all drinkers. Experienced alcohol related harms, academic problems, alcohol expectancies, close friends’ level of alcohol consumption, pre-loading in the last four weeks and level of consumption when pre-loading were predictors of hazardous drinking (p < 0.001). Conclusion: Young undergraduate university students are at risk of a range of academic, social, emotional and physical harms associated with their own and other students’ alcohol consumption. There is a need for integrated programs to address university drinking culture and effect positive changes.
基金Supported by The Qatar Diabetic Association and Qatar National Research Fund- QNRF NPRP 30-6-7-38
文摘AIM:To examine the possible association between gastrointestinal symptoms and anxiety and depression in type 2 diabetes mellitus(T2DM).METHODS:The study was a matched case-control study based on a face to face interview with designed diagnostic screening questionnaires for gastrointestinal(GI) symptoms and T2DM,Patient Health Questionnaire(PHQ-9) for depression and General Anxiety Disorders(GAD-7) for anxiety.The questionnaire consisted of questions about symptoms and signs of anxiety and depression disorders.Also,socio-demographic characteristics,life style habits and the family history of patients were collected.It was carried out from June 2010 to May 2011 among Qatari and other Arab nationals over 20 years of age at Primary Health Care Centers of the Supreme Council of Health,Qatar,including patients with diabetes mellitus and healthy subjects over 20 years of age.RESULTS:In the studied sample,most of the studied T2DM patients with GI symptoms(39.3%) and healthy subjects(33.3%) were in the age group 45-54 years(P < 0.001).The prevalence of severe depression(9.5% vs 4.4%,P < 0.001) and anxiety(26.3% vs 13.7%,P < 0.001) was significantly higher in T2DM patients with GI symptoms than in general population.Obesity(35.7% vs 31.2%) and being overweight(47.9% vs 42.8%) were significantly higher in T2DM patients with GI symptoms than in healthy subjects(P = 0.001).Mental health severity score was higher in T2DM patients with GI symptoms than in healthy subjects;depression(8.2 ± 3.7 vs 6.0 ± 3.6) and anxiety(7.6 ± 3.3 vs 6.0 ± 3.7).The most significant GI symptom which was considerably different from controls was early satiety [odds ratio(OR) = 10.8,P = 0.009] in depressed T2DM patients and loose/watery stools(OR = 2.79,P = 0.029) for severe anxiety.Anxiety was observed more than depression in T2DM patients with GI symptoms.CONCLUSION:Gastrointestinal symptoms were significantly associated with depression and anxiety in T2DM patients,especially anxiety disorders.
文摘The development of digital platforms is transforming caregiver-patient interactions and the dissemination of knowledge.Obtaining information from the Internet has become a habit for many patients and must be considered by caregivers.Thus,understanding the use of digital tools by patients is a public health issue.The Sav-AQ study aims to understand patterns of use by women with breast cancer and the role of health professionals.Sav-AQ is an exploratory feasibility study with a mixed design,exploring patient and healthcare experience before and after the integration of a specific website into their care pathways.The research is based on the digital platform“My Breast Cancer Network”,which was built by and for patients with breast cancer.A group of 30 breast cancer patients and six healthcare professionals using the platform were followed.The results show that for all users,the activity on the website decreases over time.At the beginning of the course,patients were more assiduous,which can be explained by the search for elements related to an unknown care pathway.The results also show that technical skills to use the platform are necessary for patients and must be accompanied by a health professional.It is of interest to devise a larger study to assessing the impact of such a platform on patient healthcare uptake and health skills development.
基金supported by grants from the National Natural Science Foundation of China(Nos.91846303 and 81941018)The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong,China.The long-term follow-up is supported by grants(Nos.2016YFC0900500,2016YFC0900501,and 2016YFC0900504)+3 种基金from the National Key Research and Development Program of China,and Chinese Ministry of Science and Technology(No.2011BAI09B01)Dr.Pang acknowledged support from the China Postdoctoral Science Foundation(Nos.2019TQ0008 and 2020M670071)the Peking University Medicine Fund of Fostering Young Scholars’Scientific&Technological Innovation(No.BMU2022 RCZX022)the Fundamental Research Funds for the Central Universities,and the Peking University Start-up Grant(No.BMU2022PY014)
文摘Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.
基金supported by the National Science Foundation of China (No. 30671805)Henan Innovation Project for University Prominent Research Talents (No. 2006KYCX010)
文摘Objective To identify the association between PLIN 1237 polymorphism and obesity in Chinese Han adults. Methods A total of 994 adults （157 obese subjects, 322 overweight subjects, and 515 normal controls） were recruited from two rural communities. PLIN 1237 polymorphism was genotyped by polymerase chain reaction-restriction-fragment-length-polymorphism （PCR-RFLP）. Association between PLIN polymorphisms and obesity status was estimated by ordinal logistic regression. Results The three genotypes of,PLIN 1237 were detected with a percentage of 54.3%, 37.1%, and 8.6% in TT, TC, and CC genotypes, respectively. For the PLIN 1237 polymorphism locus, the frequency of alleles T and C was 0.73 and 0.27, respectively. The PLIN 1237 polymorphisms were in Hardy-Weinberg equilibrium. PLIN 1237 polymorphism was not associated with obesity. The odds ratio for overweight or obesity for the CC＋TC genotype was 0.8（0.4, 1.4） in women （P=-0.4） and 0.6 （0.3, 1.3） in men （P=-0.2） after adjustment for age, education, household income and alcohol consumption, smoking, and physicalactivity. Conclusion Chinese Han adults have a lower frequency of variant-allele C in PLIN1237. PLIN1237 T〉C polymorphism is not significantly associated with obesity in northern Chinese adults.
文摘Background: The high consanguinity in Middle East increases the risk of genetic diseases, including primary immunodeficiency diseases (PID). Objectives: This study was aimed at determining the rate of positive family history of PID, the overall rate and type of consanguinity, and their effects on delay age during diagnosis of PID. Materials and methods: A retrospective analysis was conducted on 131 children with PID (aged 0 - 14 years) managed at Hamad General Hospital during 1998-2012. Results: Data on 131 patients (75 males & 56 females) of 82 families was analyzed. The most common phenotype of PID was predominantly antibody deficiency (23.7%). The onset age was 24.01 months and delay age 18.7 months. Family history of PID was 66.4% (38.7% in predominantly antibody deficiency and 100% in diseases of immune dysregulation). Positive family history significantly (p = 0.004) reduced the delay age of PID diagnosis by 52.9%. The consanguinity rate was 61.1% (32.3% in the predominantly antibody ID to 96% in the phagocyte defects group), where paternal cousin ranked the highest type (57.5%). Conclusions: This study indicates that family history is common in children with PID and helpful in reducing the delay age. Consanguinity among families of affected children is also high (higher than healthy population). Paternal parallel cousin marriages are the most common type of consanguinity. For a practicing physician, family history is a simple and useful tool when suspecting PID in children. Primary prevention of PID in Middle East communities should consider consanguinity reduction through public awareness and education and premarital counseling programs.
文摘Introduction: Ataxia telangiectasia (AT) is a rare disease characterized by immunodeficiency and neurological manifestations. Ataxia, resulting from cerebella atrophy, runs a progressive incapacitating course. Clinical monitoring of the disease course is mandatory for early treatment. Aim: To study clinical severity of AT and correlate it with the degree of cerebellar atrophy. Patients and Methods: We retrospectively studied all children (less than 14 years) with AT seen at Hamad General Hospital Clinics between 1998-2013. We collected basic demographic data, parental consan-guinity, family history, AT clinical severity scores, and reviewed CBC with differential counts;alpha-fetoprotein, serum immunoglobulins and lymphocyte subsets. Cranial MRI scans of each subject were reviewed by a neuroradiologist. Cerebellar atrophy was visually and semi-quantitatively scored. Results: We analyzed data on 18 AT children (10 males and 8 females), mean age of 76.9 months. 77.8% had a positive family history of AT and 41.7% parental consanguinity. Lymphopenia was observed in 77.8% and high serum alpha-fetoprotein in 87.5% of children. Clinical severity of ataxia was 17.1 ± 8.4 (mean ± SD);86.7% of patients were moderate-severe. MRI cerebellar atrophy score was 1.9 ± 1.3 (mean ± SD), and moderate in 51% of patients. AT clinical severity score correlated (coefficient r = 0.566) but not statistically significant p = 0.088) with MRI cerebellar atrophy scores. Conclusions: Moderate to severe ataxia and marked cerebellar atrophy are quite common in AT children. There is a correlation between AT clinical severity and cerebellar atrophy. Larger prospective studies might further determine the significance of our observations and help practicing practitioners monitor the progression of the disease.
文摘No study has been conducted to determine the relationship between RTC （road traffic crashes） and depression, anxiety and stress scale （DASS-21）, tiredness, fatigues and sleeping. The aim of the present study was to examine the effect of aggressive driver behaviour, fatigue and sleeping on RTC comparison between commercial taxi and minibus/van/pick-up cars drivers. A cross-sectional study included a representative sample of 2,300 drivers of which 1,786 drivers （77.6%） agreed to participate. The Manchester DBQ （Driver Behaviour Questionnaire） was used to measure the aberrant driving behaviours leading to accidents. The study is based on the measurement using the depression anxiety stress scales （DASS-21）. Participants completed a DASS-21 questionnaire with items related to socio-demographic information, BMI （body mass index）, driving experience, fatigue, sleeping, adherence to traffic laws （including speed limits and wearing seat belt）, and drivers＇ driving records. Univariate and multivariate statistical analyses were performed. In a representative sampling, the age distribution of the participants ranged from 25 to 65 years with the mean age 38.3±10.2 and the mean annual mileage （km） per month was 14,587±1,741 （p 〈 0.001）. There was a significant difference found between both group minibus/van/pick-up and commercial taxi drivers regarding of their age group （p 〈 0.001）, education （p = 0.003）, history of accident （p = 0.003）, seat belt use （p = 0.022） time of accident （p = 0.005）; crossing red light （p 〈 0.001）, excessive speed limits （p = 0.002）, BMI group （p = 0.022）, physical activity （p = 0.003）, annual mileage in km （p 〈 0.001）, number of working days （p = 0.010） and hours （p = 0.030）; number of sleeping hours （p = 0.025）, CD music listening （p = 0.010）, mobile phone use （p = 0.001）, soft drinking （p = 0.002） and cigarette smoking habit （p 〈 0.001）. When the history of RTC was assessed, minibus/van/pick-ups were more likely to be involved in accidents compared to commercial taxi drivers and there was a highly statistically significant difference between both groups. Furthermore, minibus/van/pick-up drivers have more sleeping disorders and fatigue severity compared to commercial taxi drivers. This study revealed that minibus/van/pick-up drivers exhibited more depression, anxiety and stress symptoms compared to commercial taxi drivers. DASS-21 variables were found to contribute significantly to the explanation of the RTC involvement rate. Chronic fatigue and acute sleepiness, and overtime or heavy work-load on car drivers significantly increases the risk of a car crash which a car occupant can be injured or killed. Reductions in RTC may be achieved if fewer people drive when they have fatigue or are sleepy or have been deprived of sleep or drive during rush hours.
文摘BACKGROUND The hepatoprotective effects of phytochemicals are controversial.A dietary phytochemical index(DPI)has been suggested as an alternative method for quantifying the phytochemical content of foods.AIM To assess the DPI in relation to liver function tests among a representative sample of Iranian adults.METHODS A total of 5111 participants aged 35-70 years old were included in this cross-sectional study by a multistage cluster random sampling method.Dietary intakes were collected by a validated and reliable food frequency questionnaire with 121 items.DPI was calculated by the percent of daily energy intake taken from phytochemical-rich foods.Fasting serum concentrations of alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and gamma glutamyl transferase(GGT)were determined.Linear regression was used to investigate the association between DPI and levels of liver enzymes using crude and adjusted models.RESULTS There was an inverse association between DPI score and serum ALP in the crude model(β=-0.05;P<0.001).This association remained significant after adjustment for body mass index,age,smoking,energy intake,history of diabetes,and education(β=-0.03;P=0.01).No significant associations were found between DPI score and serum levels of AST,ALT,and GGT.The individuals with the highest DPI scores consumed significantly higher amounts of fruits,vegetables,legumes,nuts,and cereals,yet were shown to have significantly higher serum total cholesterol and low-density lipoprotein cholesterol,as well as several other metabolic abnormalities.CONCLUSION Higher adherence to phytochemical-rich foods was associated with lower levels of ALP,but no change in other liver enzymes.Those with higher DPI scores also consumed food items associated with a healthier overall dietary pattern;however,they also presented several unexpected metabolic derangements.Additional randomised trials are needed to better determine the effects of phytochemical-rich foods on liver function.
文摘Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determine and compare the effects of topical patients with sand compared with control related to Gonarthrosis, LBP, knee, and Carpal Tunnel Syndrome pain. Methods: This is a prospective case and control designed study based on 101 pain case with Sand and 101 control subjects. The interventional groups in addition either topical sand or without sand 2 months after the intervention were assessed. We assessed tolerability of an established pain perception scale by the Numeric Rating Scale (NRS). Categorical variables were compared using the chi-square (χ<sup>2</sup>) test. The paired t-test was used to compare the two groups before and after the intervention. One-way analysis of variance (ANOVA) was employed for comparison of several group means. Results: The study was based on 202 patients, 41 males (20.3%) and 161 females (79.7%). There were statistically significant differences between subjects with and without Sand in term of Gonarthrosis, Rheumatoid Arthritis LBP, knee, and Carpal Tunnel Syndrome pain (p = 0.033). Majority of patients were over age 55 years old (55%) and females 78 (77.2%). The mean score of total pain experience before and after the intervention was 7.41 ± 1.1 for black sand, and 4.24 ± 2.38 for without sand as control group. The mean scores of these 5 groups were highly significant before and after the intervention (p There was statistically highly significant in regarding subjects with Sand as compared with those before Sand after treatment mean score specifically with gonarthrosis before pain 7.23 ± 1.86 vs after treatment 4.54 ± 2.18 p < 0.001;rheumatoid arthritis before 8.28 ± 1.48 vs after treatment 4.80 ± 3.71 p < 0.001;Low Back Pain before 8.42 ± 1.83 vs after treatment 4.37 ± 1.52 p < 0.001;knee pain before 8.93 ± 0.89 vs after treatment 4.24 ± 0.24 p < 0.001;Carpal Tunnel Syndrome before 7.664 ± 1.04 vs after treatment 4.26 ± 1.03 p Conclusion: The current study has revealed that the topical treatments with sand could have a significant effect on the perception of pain compared to those in the control group with respect of gonarthrosis, rheumatoid arthritis, LBP, knee, and Carpal Tunnel Syndrome pain .
基金This work was supported by grants from the National Natural Science Foundation of China(Nos.82388102,82192904,82404336,and 82192900)the Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2023ZD0510100)+4 种基金the Kadoorie Charitable Foundation in Hong Kong,the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)the National Key R&D Program of China(No.2016YFC0900500)the National Natural Science Foundation of China(Nos.81390540,91846303,and 81941018)the Chinese Ministry of Science and Technology(No.2011BAI09B01)the High-Level Talents Research Start-Up Project of Fujian Medical University(No.XRCZX2023014).
文摘Background:Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear.This study aimed to investigate associations of individual and combined lifestyle factors(LFs)with the incidence risk and long-term prognosis of pneumonia hospitalization.Methods:Using data from the China Kadoorie Biobank study,we used the multistate models to investigate the role of five high-risk LFs,including smoking,excessive alcohol drinking,unhealthy dietary habits,physical inactivity,and unhealthy body shape,alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease(CVD,regarded as a reference outcome),and subsequently to mortality.Results:Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death,but with different risk estimates.The greater the number of high-risk LFs,the higher the risk of developing pneumonia and long-term mortality risk after pneumonia,with the strength of associations comparable to that of LFs and CVD.Compared to participants with 0-1 high-risk LF,the adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43(1.28-1.60)and 1.98(1.61-2.42),respectively.Correspondingly,the respective HRs(95%CIs)for transitions from baseline to CVD and from CVD to death were 2.00(1.89-2.11)and 1.44(1.30-1.59),respectively.The risk estimates changed slightly when further adjusting for the presence of major chronic diseases.Conclusion:In this Chinese population,unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
文摘Background： A few studies have been conducted to determine the relationship between road motor vehicle crashes （MVC） and serious injuries related to tiredness, fatigues and sleeping. Aim： To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Design and setting： Population-based case and control study conducted at the accident emergency departments of hospitals and roads. Subjects： 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. Methods： The Manchester driver behaviour questionnaire （DBQ） measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale （FSS） and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws （such as speed limits and seat belt）, and drivers＇ driving records. Results： In a representative sampling, participant＇s age ranged from 25 to 65 and the mean and standard deviation were 36.5 _＋ 7.8 for cases and 37.0 4- 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit （p = 0.017）. Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group （p 〈 0.001）. Further, cases had higher prevalence of Epworth sleeping disorders （p 〈 0.001） and fatigue severity （p - 0.003） compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. Conclusion： The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.
基金This work was supported by grants from the Natural Science Foundation of China (Nos. 81941018, 91846303) , and the National Key Research and Development Program of China (Nos. 2016YFC0900500, 2016YFC0900501, 2016YFC0900504) . The CKB baseline survey was supported by a grant from the Kadoorie Charitable Foundation in Hong Kong of China.
文摘Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to comprehensively examine such associations across different regions in China.Methods Based on the China Kadoorie Biobank study,the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer.Muscle mass and grip strength were measured using calibrated instruments.Arm muscle quality was defined as the ratio of grip strength to arm muscle mass.Low muscle mass,grip strength,and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index,grip strength,and arm muscle quality,respectively.Cox proportional hazards models yielded hazard ratios(HRs)and 95%confidence intervals(CIs)for risks of all-cause mortality in relation to muscle mass,strength,and quality.Results During a median follow-up of 3.98 years,739 participants died.The HR(95%CI)of all-cause mortality risk was 1.28(1.08–1.51)for low appendicular muscle mass index,1.38(1.16–1.62)for low total muscle mass index,1.68(1.41–2.00)for low grip strength,and 1.41(1.20–1.66)for low arm muscle quality in models adjusted for sociodemographic characteristics,lifestyle factors,and medical histories.Conclusion Low muscle mass,grip strength,and arm muscle quality are all associated with short-term increased risks of mortality,indicating the importance of maintaining normal muscle mass,strength,and quality for general Chinese adults.
基金supported by grants from the National Natural Science Foundation of China(Nos.82192904,82192901,82192900,and 91846303)The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong.The long-term follow-up is supported by grants from the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)+2 种基金the National Key Research and Development Program of China(No.2016 YFC0900500)National Natural Science Foundation of China(No.81390540)Chinese Ministry of Science and Technology(No.2011BAI09B01).
文摘Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-European countries,including China.We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.Methods:Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training(n=28,490)and testing sets(n=72,150).Ten previously developed PRSs were evaluated,and new ones were developed using clumping and thresholding or LDpred method.The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set.Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms.Prediction of the 10-year first CAD events was assessed using hazard ratios(HRs)and measures of model discrimination,calibration,and net reclassification improvement(NRI).Hard CAD(nonfatal I21-I23 and fatal I20-I25)and soft CAD(all fatal or nonfatal I20-I25)were analyzed separately.Results:In the testing set,1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years.The HR per standard deviation of the optimal PRS was 1.26(95%CI:1.19-1.33)for hard CAD.Based on a traditional CAD risk prediction model containing only non-laboratory-based information,the addition of PRS for hard CAD increased Harrell’s C index by 0.001(-0.001 to 0.003)in women and 0.003(0.001 to 0.005)in men.Among the different high-risk thresholds ranging from 1%to 10%,the highest categorical NRI was 3.2%(95%CI:0.4-6.0%)at a high-risk threshold of 10.0%in women.The association of the PRS with soft CAD was much weaker than with hard CAD,leading to minimal or no improvement in the soft CAD model.Conclusions:In this Chinese population sample,the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD.Therefore,this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.
基金This work was supported by the National Natural Science Foundation of China(Project Nos.82173620 and 82373690 to Y.Z.and 82204156 to D.Y.)This study was also funded by the Priority Academic Program Development of Jiangsu Higher Education Institution(PAPD).
文摘Background:Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases.However,the effect of spicy food intake on the incidence of vascular diseases in the Chinese population remains unclear.This study was conducted to explore this association.Methods:This study was performed using the large-scale China Kadoorie Biobank(CKB)prospective cohort of 486,335 participants.The primary outcomes were vascular disease,ischemic heart disease(IHD),major coronary events(MCEs),cerebrovascular disease,stroke,and non-stroke cerebrovascular disease.A Cox proportional hazards regression model was used to assess the association between spicy food consumption and incident vascular diseases.Subgroup analysis was also performed to evaluate the heterogeneity of the association between spicy food consumption and the risk of vascular disease stratified by several basic characteristics.In addition,the joint effects of spicy food consumption and the healthy lifestyle score on the risk of vascular disease were also evaluated,and sensitivity analyses were performed to assess the reliability of the association results.Results:During a median follow-up time of 12.1 years,a total of 136,125 patients with vascular disease,46,689 patients with IHD,10,097 patients with MCEs,80,114 patients with cerebrovascular disease,56,726 patients with stroke,and 40,098 patients with non-stroke cerebrovascular disease were identified.Participants who consumed spicy food 1–2 days/week(hazard ratio[HR]=0.95,95%confidence interval[95%CI]=[0.93,0.97],P<0.001),3–5 days/week(HR=0.96,95%CI=[0.94,0.99],P=0.003),and 6–7 days/week(HR=0.97,95%CI=[0.95,0.99],P=0.002)had a significantly lower risk of vascular disease than those who consumed spicy food less than once a week(P trend<0.001),especially in those who were younger and living in rural areas.Notably,the disease-based subgroup analysis indicated that the inverse associations remained in IHD(P trend=0.011)and MCEs(P trend=0.002)risk.Intriguingly,there was an interaction effect between spicy food consumption and the healthy lifestyle score on the risk of IHD(P interaction=0.037).Conclusions:Our findings support an inverse association between spicy food consumption and vascular disease in the Chinese population,which may provide additional dietary guidance for the prevention of vascular diseases.
基金National Key R&D Plan of the Ministry of Science and Technology of China(2016YFC1301604,2017YFC1307702)National Natural Science Foundation of China(81870907)+1 种基金Ministry of Science and Technology and the Ministry of Health of China(2006BA101A11 and 2009CB521905)Beijing Municipal Administration of Hospitals’Mission Plan(SML20150502).
文摘Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and after-discharge management characteristics and prognosis for stroke types in China.Methods A nationwide registry recruited 14244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008,recording presenting characteristics,diagnostic procedures and in-hospital treatment.After hospital discharge,patients were followed up for 6 months.Conventional statistical methods were used to examine the patterns of management and prognosis.Results Overall,68.7%,26.9%and 4.4%were ischaemic stroke(IS),intracerebral haemorrhage(ICH),and subarachnoid haemorrhage(SAH),respectively.Only 20%were managed in a dedicated stroke unit.Among IS,1.3%received thrombolysis within 3 hours after symptom onset,whereas the proportions of receiving in-hospital antiplatelet therapy,neuroprotective agents and traditional Chinese medicines(TCM)were 88.4%,69.7%and 70.6%,respectively.For ICH,63.3%and 36.3%received neuroprotective agents and TCM in hospital,respectively.At discharge,70.7%and 38.0%of the patients with IS were given antiplatelet and statin therapies,respectively,decreasing to 64.8%and 23.9%,respectively,at 6 months.In-hospital mortality was 3.2%,9.3%and 10.1%for IS,ICH and SAH,respectively,with a further 8.6%,18.2%and 22.0%,respectively,died by 6 month.Meanwhile,in-hospital recurrence rate was 2.6%,1.9%and 7.2%for IS,ICH and SAH,respectively,with a further 8.0%,5.1%and 7.5%,respectively,recurred by 6 month.Conclusions In China,the mortality rate of stroke is lower than that reported from west populations,though most strokes are not managed in specialised stroke unit.There is widespread use of some unproven therapies but limited proven treatments,especially after discharge,leading to unnecessary recurrent risks.
基金supported by grants from the National Natural Science Foundation of China(No.81941018)The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong,China.The long-term follow-up is supported by grants from the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)+2 种基金grants from the National Key R&D Program of China(Nos.2016YFC0900500 and 2016YFC1303904)National Natural Science Foundation of China(No.81390540)Chinese Ministry of Science and Technology(No.2011BAI09B01)。
文摘Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
基金supported by the National Key Research&Development Program of China(Nos.2016YFC1303904 and 2016YFC0900500)National Natural Science Foundation of China(Nos.81941018,91846303,and 91843302)
文摘Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.Methods:The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China.We stepwisely selected the predictors using logistic regression model.Then we tested the model validity through P-P graph,area under the receiver operating characteristic curve(AUROC),ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.Results:The final prediction model involved 14 independent variables,including age,sex,location(urban/rural),region,educational background,smoking status,smoking amount(pack-years),years of exposure to air pollution by cooking fuel,family history of COPD,history of tuberculosis,body mass index,shortness of breath,sputum and wheeze.The model showed an area under curve(AUC)of 0.72(95%confidence interval[CI]:0.72-0.73)for detecting undiagnosed COPD patients,with the cutoff of predicted probability of COPD=0.22,presenting a sensitivity of 70.13%and a specificity of 62.25%.The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68(95%CI:0.66-0.69).Moreover,the ten-fold cross validation reported an AUC of 0.72(95%CI:0.71-0.73),and the external validation presented an AUC of 0.69(95%CI:0.68-0.71).Conclusion:This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.
