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We aimed to develop a risk prediction model for gestational diabetes mellitus (GDM) based on the common maternal demographics and routine clinical variables in Chinese population.Individual information was collected from December 2018 to October 2019 by a pretested questionnaire on demographics, medical and family history, and lifestyle factors. Multivariable logistic regression was performed to establish a predictive model for GDM by variables in pre- and early pregnancy. The consistency and discriminative validity of the model were evaluated by Hosmer-Lemeshow goodness-of-fit testing and ROC curve analysis. Internal validation was appraised by fivefold cross-validation. Clinical utility was assessed by decision curve analysis.Total 3263 pregnant women were included with 17.2% prevalence of GDM. The model equation was: LogitP = -11.432 + 0.065 × maternal age (years) + 0.061 × pre-pregnancy BMI (kg/mThe predictive model of GDM exhibited well acceptable predictive ability, discriminative performance, and clinical utilities. The project was registered in clinicaltrial.gov.com with identifier of NCT03922087.

Objective In the context of aging, Chinese families consisting of more than three generations (grandparents, parents, children) are the norm. The second generation (parents) and other family members may establish a downward (contact only with children) or two-way multi-generational relationship (contact with children and grandparents). These multi-generational relationships may have the potential effect on multimorbidity burden and healthy life expectancy in the second generation, but less is known about the direction and intensity of this effect. This study aims to explore this potential effect. Methods We obtained longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which included 6,768 people. Cox proportional hazards regression was used to assess the association between multi-generational relationships and the number of multimorbidity. The Markov multi-state transition model was used to analyze the relationship between multi-generational relationships and the severity of multimorbidity. The multistate life table was used to calculate healthy life expectancy for different multi-generational relationships. Results The risk of multimorbidity in two-way multi-generational relationship was 0.830 (95% CIs: 0.715, 0.963) times higher than that in downward multi-generational relationship. For mild multimorbidity burden, downward and two-way multi-generational relationship may prevent aggravation of burden. For severe multimorbidity burden, two-way multi-generational relationship may aggravate the burden. Compared with two-way multi-generational relationship, the second generations with downward multi-generational relationship has a higher healthy life expectancy at all ages. Conclusion In Chinese families with more than three generations, the second generations with severe multimorbidity burden may aggravate the condition by providing support to elderly grandparents, and the support provided by offspring to the second generations plays a vital positive role in improving the quality of life and narrowing the gap between healthy life expectancy and life expectancy.

Quantitative attribution of the burden of disease due to population aging is an important part of setting meaningful global health priorities. This study comprehensively examines the burden of disease attributable to population aging in 188 countries from 1990 to 2019, incorporates a comprehensive range of diseases, and projects the burden of disease due to population aging till 2050.We extracted data from 1990 to 2019 for 188 countries from the Global Burden of Disease Study 2019. We decomposed the change in disease burden into the contribution of the age structure of the population, population size, and age-specific disability-adjusted life years (DALYs) rates due to all other reasons. We used the Bayesian age-period-cohort model to evaluate the effects of age on temporal trends, and then to predict the possible disease burden in 2050.At the global level, the change in total DALYs associated with age structure, population size, and all other reasons is 27.4%, 16.8%, and 89.4% (absolute level of DALYs attributable to age structure: -15.20 million, 9.32 million, and -49.58 million) of the absolute level of DALYs gap between 2019 and 1990. The absolute level of DALYs changes attributable to age structure for communicable, maternal, neonatal, and nutritional diseases were negative in all income groups from 1990 to 2019. For non-communicable diseases, the contribution was positive except in the low-income group. For injuries, the contribution was positive in lower-middle-income groups and low-income groups. By 2050, DALY rates decreased in all income groups, if compared to 2019. However, a total of 132 countries may see a gradual increase of all-cause DALYs attributable to population aging.The direction and intensity of the effects of population aging on the burden of disease vary by region and disease, with huge implications for global health in the future.

ObjectivesThis study aimed to explore the relationship of maternal thyroid function and thyroid resistance parameters with neonatal thyroid-stimulating hormone (TSH).MethodsThis work was a longitudinal study. Singleton pregnant women without a history of thyroid disorders were recruited in their first prenatal visit from October 2018 to June 2020. Maternal thyroid markers including TSH, free triiodothyronine (FT3), free thyroxine (FT4), and neonatal TSH were tested in the clinical laboratory of the hospital by electrochemiluminescence immunoassay. Thyroid resistance indices including Thyroid Feedback Quantile-based Index (TFQI), TSH index (TSHI), and thyrotroph T4 resistance index (TT4RI) were estimated in accordance with maternal FT4 and TSH levels. Multivariable linear and logistic regression was applied to explore the associations of maternal thyroid indices with infantile TSH level.ResultsA total of 3,210 mothers and 2,991 newborns with valid TSH data were included for analysis. Multivariable linear regression indicated that maternal thyroid variables were significantly and positively associated with neonatal TSH levels with standardized coefficients of 0.085 for TSH, 0.102 for FT3, 0.100 for FT4, 0.076 for TSHI, 0.087 for TFQI, and 0.089 for TT4RI (all P < 0.001). Compared with the lowest quartile, the highest quartile of TSHI [odds ratio (OR) = 1.590, 95% CI: 0.928–2.724; Ptrend = 0.025], TFQI (OR = 1.746, 95% CI: 1.005–3.034; Ptrend = 0.016), and TT4RI (OR = 1.730, 95% CI: 1.021–2.934; Ptrend = 0.030) were significantly associated with an increased risk of elevated neonatal TSH (>5 mIU/L) in a dose–response manner.ConclusionThe longitudinal data demonstrated that maternal thyroid resistance indices and thyroid hormones in the first half of gestation were positively associated with neonatal TSH levels. The findings offered an additionally practical recommendation to improve the current screening algorithms for congenital hypothyroidism.

Most studies on the associations of blood pressure (BP) with cardiovascular disease (CVD) risk were based on single or average BP levels. Knowledge on the association between BP trajectories and CVD in middle-aged individuals who are not on antihypertensive medication may inform the care of individuals in this group whose BPs are not controlled.Eight thousand nine hundred and sixty-nine participants aged 50-70 years, without CVD at baseline and not taking antihypertensive medication throughout the study, were included. Four time-points data from the Guangzhou Biobank Cohort Study were used to identify BP trajectories using latent class mixed model. Cox regression was used to investigate the association of BP trajectories with fatal and nonfatal CVD till April 2021.Three SBP trajectories were identified: 'low-slow-increase' characterized by SBP from 110 to 125 mmHg (86.5%); 'low-increase' from 110 to 150 mmHg (8.1%) and 'moderate-increase' from 125 to 155 mmHg (5.4%). Compared with the low-slow-increase group, the moderate-increase had the highest risk of CVD (hazard ratio = 1.76, 95% confidence interval = 1.34-2.29), ischemic heart disease (1.77, 1.01-3.09), myocardial infarction (3.52, 1.58-7.85), all strokes (1.88, 1.37-2.60), ischemic stroke (1.65, 1.10-2.49), haemorrhagic stroke (3.98, 1.30-12.12) and CVD mortality (2.41, 1.55-3.76). Higher risks of CVD (1.27, 1.01-1.61) and ischemic stroke (1.49, 1.07-2.09) in the low-increase group were also found.Most people between 50 and 70 years of age and not taking antihypertensive medication maintained a slow increase SBP trajectory over a follow-up period of approximately 7 years. However, those whose SBPs increased from low and moderate levels were associated with higher CVD risks.

This paper quantifies the potential gains in health-adjusted life expectancy for people aged 30-70 years (HALEWe extracted data from the Global Burden of Disease Study 2019 for four major non-communicable diseases (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 2010 to 2019. Estimates of the potential gains in HALEIn all scenarios, the high-income group has the greatest potential gains in HALEReducing premature death and disability from four major NCDs at once and attaching equal importance to each lead to a sizable improvement in HALE

BackgroundThe United Nations Sustainable Development Goals (SDGs) target 3.4 aims to reduce premature mortality attributable to non-communicable diseases (NCDs) by one-third of their 2015 levels by 2030. Although meeting this target leads to longevity, survivors may suffer from long-term disability caused by NCDs. This paper quantifies the potential gains in health-adjusted life expectancy for people aged 30-70 years (HALE[30–70)) by examining the reductions in disability in addition to premature mortality. Additionally, we also assessed the feasibility of meeting the SDGs target 3.4.MethodsWe extracted data from the Global Burden of Disease Study 2019 for all NCDs and four major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 1990 to 2019. Bayesian age-period-cohort models were used to predict possible premature mortality in 2030. The life table was used to estimate the unconditional probability of death and HALE[30–70). Estimates of the potential gains in HALE[30–70) were based on three alternative future scenarios: a) eliminating all premature deaths and disability from a specific cause, b) meeting SDGs target 3.4, and survivors’ disability is eliminated, and c) meeting SDGs target 3.4, but survivors remain disabled for the rest of their lives.ResultsIn 2030, the unconditional probability of premature mortality for four major NCDs in most countries remained at more than two-thirds of the 2015 baseline. In all scenarios, the high-income group has the greatest potential gains in HALE[30–70), above the global average of HALE[30–70). In scenario A, the potential gains in HALE[30–70) of reducing premature mortality for four major NCDs are significantly lower than those for all NCDs (range of difference for all income groups: 2.88 - 3.27 years). In scenarios B and C, the potential gains of HALE[30–70) in reducing premature mortality for all NCDs and the four major NCDs are similar (scenario B: 0.14 - 0.22, scenario C: 0.05 - 0.19). In scenarios A and B, countries from the high-income group have the greatest potential gains in HALE[30–70) from cancer intervention, whilst countries from the other income groups result in a greater possible HALE[30–70) gains from cardiovascular diseases control. In scenario C, countries from each income group have the largest potential gains in HALE[30–70) from diabetes reduction and chronic respiratory diseases prevention.ConclusionsAchieving SDGs target 3.4 remains challenging for most countries. The elimination of disability among the population who benefit from the target could lead to a sizable improvement in HALE[30–70). Reducing premature death and disability at once and attaching equal importance to each to in line with the WHO goal of “leaving no one behind”.

Improvement in the quality of life is reflected in the narrowing of the gap between health-adjusted life expectancy (HALE) and life expectancy (LE). The effect of megacity expansion on narrowing the gap is rarely reported. This study aimed to disclose this potential relationship.Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou, China, from 2010 to 2020. Joinpoint regression was used to evaluate the temporal trend. Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants.Although LE and HALE in megacities are increasing steadily, their gap is widening. Socio-economic and health services are guaranteed to narrow this gap. Increasing personal wealth, a growing number of newborns and healthy immigrants, high urbanization, and healthy aging have helped in narrowing this gap.In megacities, parallel LE and HALE growth should be highly considered to narrow their gap. Multiple social determinants need to be integrated as a whole to formulate public health plans.

Objective To develop and validate an index to quantify the multimorbidity burden in Chinese middle-aged and older community-dwelling individuals. Methods We included 20,035 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS) and 19,297 individuals aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Health outcomes of physical functioning (PF), basic and instrumental activities of daily living (ADL and IADL) and mortality were obtained. Based on self-reported disease status, we calculated five commonly used western multimorbidity indexes for CHARLS baseline participants. The one that predicted the health outcomes the best was selected and then modified through a linear mixed model using the repeated individual data in CHARLS. The performance of the modified index was internally and externally evaluated with CHARLS and CLHLS data. Results The multimorbidity-weighted index (MWI) performed the best among the five indexes. In the modified Chinese multimorbidity-weighted index (CMWI), the weights of the diseases varied greatly (range 0.2–5.1). The top three diseases with the highest impact were stroke, memory-related diseases and cancer, corresponding to weights of 5.1, 4.3 and 3.4, respectively. Compared with the MWI, the CMWI showed better model fits for PF and IADL with larger R2 and smaller Akaike information criterion, and comparable prediction performances for ADL, IADL and mortality (e.g. the same predictive accuracy of 0.80 for ADL disability). Conclusion The CMWI is an adequate index to quantify the multimorbidity burden for Chinese middle-aged and older community-dwelling individuals. It can be directly computed via disease status examined in regular community health check-ups to facilitate health management.

Background Perfluoroalkyl substances (PFASs) are synthetic chemicals widely used in industry and for commercial products. Their immunomodulatory effects are a growing health concern in children. Hand, Foot and Mouth Disease (HFMD) is a common childhood viral infection, and increased incidence of which has parallel the rise in PFAS exposure in the Asia-Pacific region. Objective We conducted the first study to assess whether prenatal exposure to PFAS was associated with a reduction in HFMD virus antibodies in infants. Methods We enrolled 201 mother-infant pairs from the Guangzhou Birth Cohort Study from July to October 2013. High performance liquid chromatography-mass spectrometry was employed to determine concentrations of specific PFAS isomers in cord blood. Neutralizing antibodies titers were measured against two HFMD viruses, enterovirus 71 (EV71) and coxsackievirus A 16 (CA16), in cord blood serum and blood serum at three months of age. Results Higher umbilical cord blood PFAS concentrations were associated with lower EV71 and CA16 antibody concentrations. A doubling in the composite sum of cord blood PFASs in three month old infants was associated with significant increase in the risk of HFMD antibody concentration below clinical protection level (≥1:8 titers) for CA16 (odds ratio, OR: 2.74 [95% confidence interval (CI): 1.33, 5.61] and for EV71 (OR = 4.55, 95% CI: 1.45, 4.28). This association was higher in boys at three months of age for CA16. Conclusions Our findings suggest that cord blood PFAS exposure is associated with lower HFMD antibody in infancy. Given the widespread nature of PFAS exposures and the high global incidence of HFMD globally, these findings have substantial public health implications and therefore, these associations need to be replicated in a larger study to more definitively address the risk.

Body mass index (BMI) and waist circumference (WC) are two common ways to measure obesity. There is a debate, however, about which of these two measures are more closely associated with elevated blood pressure (BP). The aim of this study is to investigate the prevalence of obesity and whether BMI and WC is better associated with elevated BP in children and adolescents. A representative sample of 8613 Chinese youth aged 7-17 years from seven cities in Northeastern China was selected and measurements of height, weight, WC, BP were taken from 2012 to 2013. The average age of the children was 11.3±2.3years. The prevalence of overweight/obese and abdominal obesity in the subjects was 35% and 44.8%, respectively. We found that both BMI and WC were significantly associated with elevated BP. An increase of 1kgm-2 in BMI was associated with a 1.10 (1.08-1.12, 95% CI) increased risk of an elevated BP diagnosis in boys, and a 1.14 (1.11-1.16, 95% CI) increased risk in girls. Meanwhile, a 1cm increase in WC correlated with a 1.03 (1.02-1.04, 95% CI) and a 1.05 (1.04-1.06, 95% CI) increased risk of higher BP in boys and girls, respectively. Compared to the normal-weight youth, subjects with elevated BMI (BMI>85th) had higher risk of elevated BP (OR: 2.42, 95% CI: 2.13-2.75) than that of in elevated WC participants (OR: 2.00, 95% CI: 1.77-2.27). Therefore, BMI may associate better with elevated BP than WC in Chinese youth in our Seven Northeastern Cities study.

Background: Little information exists on whether gender or asthma status modifies the effects of secondhand smoke (SHS) exposure on lung function. Objective: To evaluate whether gender or asthma status modifies the association of SHS exposure with lung function. Methods: A total of 6,740 children (average 11.6 years) were recruited from 24 districts of 7 cities in northeast China in 2012. SHS exposure included exposure to environmental and maternal smoking both in utero and during early childhood (postnatal). Lung function was measured using electronic spirometers. Two-step regressions were used to analyze the association between SHS and lung function. Results: In utero and postnatal exposure to SHS was independently associated with decreased lung function in both genders; however, this association was greater among males. For example, when exposed to maternal smoking during pregnancy, the adjusted odds ratio (aOR) for decreased forced vital capacity (FVC) was 6.46 (95% confidence interval [CI]: 2.58-16.17) among males, while only 2.16 (95% CI: 0.96-4.88) among females. More positive associations between SHS exposure and decreased lung function were detected among nonasthmatic compared with asthmatic children. Nonasthmatics had significantly larger deficits from in utero exposure to maternal smoking, which concerned decreased lung FVC function (aOR = 2.58, 95% CI: 1.28-5.21) and decreased lung forced expiratory volume in 1 s (FEV1) function (aOR = 2.32, 95% CI: 1.01-5.33). A similar pattern was also observed for the associations between SHS exposure and continuous pulmonary function test measurements. Conclusions: SHS exposure was associated with decreased lung function. Males and nonasthmatics seem to be more susceptible than their respective counterparts.

Background The first one-arm phase II trial aimed to evaluate and predict efficacy and safety of S-1 plus oral leucovorin (S-1/LV) as first-line chemotherapy for patients with advanced gastric cancer (AGC), using S-1 pharmacogenetic pathway approach. Patients and methods A total of 39 patients orally took S-1 at conventional dose and LV simultaneously at a dose of 25 mg twice daily for a week, within a 2-week cycle. The primary endpoint was overall response rate (ORR), while the secondary endpoints were progression-free survival (PFS), time to failure (TTF), overall survival (OS), disease control rate (DCR), and adverse events (AEs). Peripheral blood was sampled prospectively for baseline expression of dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), thymidine phosphorylase (TP), and thymidylate synthase (TS), CYP2A6 gene polymorphisms, and 5-FU pharmacokinetics. Results The ORR and DCR were 41.0 and 76.9%. The median PFS, TTF, and OS were 4.13, 3.70, and 11.40 months. Grade 3–4 AEs occurred in only 13 patients, and grade 4 AEs occurred in only 1 of them. High OPRT/TS and peritoneal metastasis (vs. liver metastasis) independently predicted responding. High OPRT/DPD independently predicted grade 3–4 AEs. High AUC0–24h of 5-FU and metastatic/recurrent sites ≤2 (vs. >3) independently predicted prolonged PFS. Low baseline plasmic DPD independently predicted prolonged OS. Conclusions Two-week, oral S-1/LV regimen demonstrated promising efficacy and safety as first-line chemotherapy for AGC. ClinicalTrials.gov identifier NCT02090153

Background Healthcare workers are often exposed to stressful working conditions at work which affect their quality of life. The study investigated the relationship between psychosocial risk factors, stress, burnout, and quality of life among primary healthcare workers in general medical practice in Qingyuan and Chaozhou cities in Guangdong province. Method The cross-sectional study was conducted in 108 primary health facilities including 36 community health centers (CHCs) across two developing cities in Guangdong province. A total of 873 healthcare workers completed the questionnaires. Quality of life was evaluated using The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and psychological risk factors were evaluated by the Copenhagen Psychosocial Questionnaire (COPSOQ). General quality of life and the quality of life domains were transformed into a score range from minimum 0 to 100 maximum. Higher scores indicated better quality of life and vice versa. Significant associations were verified using multiple regression analysis. Results Poor quality of life was observed in 74.6% of healthcare workers surveyed. General poor quality of life was significantly higher among workers who reported higher burnout (Beta = − 0.331, p Conclusions Primary healthcare workers in developing cities in China have a highly demanding and strained working environment and poor quality of life. Reducing job stress and improving work conditions may ultimately improve the well-being of primary healthcare workers.

BACKGROUND Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. OBJECTIVE This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. METHODS A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. RESULTS A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; PPPPPPPPPPPP=.02). In addition, they had a lower positive sentiment score (beta=−0.8306; PP CONCLUSIONS The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time.

Epidemiological studies have reported inconsistent and inconclusive associations between long-term exposure to ambient air pollution and lung function in children from Europe and America, where air pollution levels were typically low. The aim of the present study is to examine the relationship between air pollutants and lung function in children selected from heavily industrialized and polluted cities in northeastern China. During 2012, 6740 boys and girls aged 7–14 years were recruited in 24 districts of seven northeastern cities. Portable electronic spirometers were used to measure lung function. Four-year average concentrations of particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were measured at monitoring stations in the 24 districts. Two-staged regression models were used in the data analysis, controlling for covariates. Overall, for all subjects, the increased odds of lung function impairment associated with exposure to air pollutants, ranged from 5% (adjusted odds ratio [aOR] = 1.05; 95% confidence interval [CI] = 1.01, 1.10) for FVC

Background Per United Nations’ Sustainable Development Goals, Nepal is aspiring to achieve universal and equitable access to safe and affordable drinking water and provide access to adequate and equitable sanitation for all by 2030. For these goals to be accomplished, it is important to understand the country’s geographical heterogeneity and inequality of access to its drinking-water supply and sanitation (WSS) so that resource allocation and disease control can be optimized. We aimed 1) to estimate spatial heterogeneity of access to improved WSS among the overall Nepalese population at a high resolution; 2) to explore inequality within and between relevant Nepalese administrative levels; and 3) to identify the specific administrative areas in greatest need of policy attention. Methods We extracted cluster-sample data on the use of the water supply and sanitation that included 10,826 surveyed households from the 2011 Nepal Demographic and Health Survey, then used a Gaussian kernel density estimation with adaptive bandwidths to estimate the distribution of access to improved WSS conditions over a grid at 1 × 1 km. The Gini coefficient was calculated for the measurement of inequality in the distribution of improved WSS; the Theil L measure and Theil T index were applied to account for the decomposition of inequality. Results 57% of Nepalese had access to improved sanitation (range: 18.1% in Mahottari to 100% in Kathmandu) and 92% to drinking-water (range: 41.7% in Doti to 100% in Bara). The most unequal districts in Gini coefficient among improved sanitation were Saptari, Sindhuli, Banke, Bajura and Achham (range: 0.276 to 0.316); and Sankhuwasabha, Arghakhanchi, Gulmi, Bhojpur, Kathmandu (range: 0.110 to 0.137) among improved drinking-water. Both the Theil L and Theil T showed that within-province inequality was substantially greater than between-province inequality; while within-district inequality was less than between-district inequality. The inequality of several districts was higher than what is calculated by regression of the Gini coefficient and our estimates. Conclusions This study showed considerable geographical heterogeneity and inequality not evidenced in previous national statistics. Our findings may be useful in prioritizing resources to reduce inequality and expand the coverage of improved water supply and sanitation in Nepal.

To estimate the lung cancer burden that may be attributable to ambient fine particulate matter (PM2.5) pollution in Guangzhou city in China from 2005 to 2013.The data regarding PM2.5 exposure were obtained from the 'Ambient air pollution exposure estimation for the Global Burden of Disease 2013' dataset at 0.1° ×0.1° spatial resolution. Disability-adjusted life years (DALYs) were estimated based on the information of mortality and incidence of lung cancer. Comparative risk analysis and integrated exposure-response function were used to estimate attributed disease burden.The population-weighted average concentration of PM2.5 was increased by 34.6% between 1990 and 2013, from 38.37 μg/m3 to 51.31 μg/m3. The lung cancer DALYs in both men and women were increased by 36.2% from 2005 to 2013. The PM2.5 attributed lung cancer DALYs increased from 12105.0 (8181.0 for males and 3924.0 for females) in 2005 to 16489.3 (11291.7 for males and 5197.6 for females) in 2013. An average of 23.1% lung cancer burden was attributable to PM2.5 pollution in 2013.PM2.5 has caused serious but under-appreciated public health burden in Guangzhou and the trend deteriorates. Effective strategies are needed to tackle this major public health problem.

There is conflicting evidence concerning platelet status and hepatocellular carcinoma (HCC) prognosis. We evaluated the prognostic value of platelet-based indices, including platelet count, platelet/lymphocyte ratio (PLR), and aspartate aminotransferase to platelet ratio index (APRI) in HCC after hepatic resection. We retrospectively reviewed 332 patients with HCC treated with hepatectomy between 2006 and 2009. Preoperative platelet count, as well as demographic, clinical, and pathologic data, were analyzed. Both disease-free survival (DFS) and overall survival (OS) were significantly improved for patients with low platelet count, PLR, and APRI compared to patients with elevated values. On multivariate analysis, APRI, tumor size ≥5 cm, noncapsulation, and multiple tumors were all associated with both poor DFS and OS. The 1-, 3-, and 5-year DFS rates were 52, 36, and 32 % for patients with APRI

Introduction Metabolic syndrome (MetS) is a public health problem in postmenopausal women. Whole soy foods are rich in unsaturated fats, high quality plant protein and various bioactive phytochemicals that may have a beneficial role in the management of MetS. The aim of the study is to examine the effect of whole soy replacement diet on the features of MetS among postmenopausal women. Methods and analysis This will be a 12-month, randomised, single-blind, parallel controlled trial among 208 postmenopausal women at risk of MetS or with early MetS. After 4 weeks9 run-in, subjects will be randomly allocated to one of two intervention groups, whole soy replacement group or control group, each for 12 months. Subjects in the whole soy group will be required to include four servings of whole soy foods (containing 25 g soy protein) into their daily diet iso-calorically, replacing red or processed meat and high fat dairy products. Subjects in the control group will remain on a usual diet. The outcome measures will include metabolic parameters as well as a 10-year risk for ischaemic cardiovascular disease. We hypothesise that the whole soy substitution diet will notably improve features of MetS in postmenopausal women at risk of MetS or with early MetS. The study will have both theoretical and practical significance. If proven effective, the application of the whole soy replacement diet model will be a safe, practical and economical strategy for MetS prevention and treatment. Ethics and dissemination Ethics approval has been obtained from the Ethics Committee of the Chinese University of Hong Kong. The results will be disseminated via conference presentations and papers in academic peer reviewed journals. Data files will be deposited in an accessible repository. Trial registration number NCT02610322.

A new sesquiterpene, namely suberosoid (1), was isolated from the South China Sea gorgonian coral Subergorgia suberosa. The chemical structure of 1 was established as an unusual sesquiterpene containing 4-methylenecyclohex-2-enone system, by extensive analyses of NMR spectroscopy and high-resolution mass spectrometry. Suberosoid (1) exhibited cytotoxic effect against HeLa cell lines with IC50 value being 10.6 μM.

Aims and objectives This study examines the relationship between hospital work environments and job satisfaction, job-related burnout and intention to leave among nurses in Guangdong province, China.

Aims/Introduction: Although long-acting insulin analogs are recommended in type 2 diabetics failing on oral agents, their efficacy is uncertain. Here we compared the efficacy and safety of regimens based on long-acting insulin analogs with other preparations in insulin-naive type 2 diabetics failing on oral agents. Materials and Methods: Data from 9548 participants in 22 English studies were included. Most of the studies were of short to medium duration and of low quality. Results: In terms of decreasing hemoglobin A1c, long-acting insulin analogs were not statistically significant to rapid-acting insulin analogs or intermediate neutral protamine Hagedorn (NPH) insulin or glucagon-like peptide-1 (GLP-1) analogs, and the differences between long-acting and biphasic insulin analogs were marginal. Compared with rapid-acting insulin analogs, long-acting insulin analogs were similar in the incidence of total hypoglycemia, and the superiority in less weight gain was inconsistent. Relative to biphasic insulin analogs, long-acting insulin analogs were associated with lower incidence of total hypoglycemia and less weight gain. Compared with NPH insulin, long-acting insulin analogs were associated with lower incidence of total and nocturnal hypoglycemia. Relative to GLP-1 analogs, long-acting insulin analogs were associated with lower incidence of treatment related adverse events but with greater weight gain. Conclusions: For type 2 diabetics failing on oral agents, initiating long-acting insulin analogues seems to provide glycemic control similar to rapid-acting insulin analogs or NPH insulin or glucagon-like peptide-1 analogs and slightly inferior to biphasic insulin analogs with fewer side-effects. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00187.x, 2011)

To investigate and compare the effects of phacoemulsification as an initial procedure to control intraocular pressure (IOP) in eyes with acute primary angle closure (APAC) and chronic primary angle-closure glaucoma (CPACG) with coexisting cataracts and peripheral anterior synechiae (PAS) of greater than 180 degrees.Prospective, cross-sectional study.Thirteen patients (13 eyes) with APAC and 10 patients (10 eyes) with CPACG were enrolled in the study. IOP control in the 2 groups was compared at final follow-up. Other outcome measures included visual acuity, anterior chamber depth, gonioscopic appearance, and complications.The postoperative IOP was reduced in both the APAC and CPACG groups. As assessed at last follow-up (median 6 mo), IOP in the APAC group was significantly lower than that in the CPACG group. The absolute success rate was 100% in the APAC group and 80% in the CPACG group. The number of hypotensive medications decreased in both APAC and CPACG group. The postoperative degree of PAS was relieved in 11 of 12 eyes with APAC and 5 of 9 eyes with CPACG.Initial phacoemulsification performed to provide short-term control of IOP is more efficacious in patients with APAC than in those with CPACG, especially when PAS is greater than 180 degrees.

To evaluate the potential effect of interaction between breastfeeding and environmental tobacco smoke (ETS) exposure on respiratory health, we studied 31 049 children (aged 2-14 years) from 25 districts of seven cities in northeast China. Parents of the children completed standardized questionnaires that characterized the children's histories of respiratory symptoms and illness, feeding methods, ETS exposure, and other associated risk factors. Breastfeeding was defined as having been mainly breastfed for 3 months or more. The results showed that the association of ETS exposure with childhood respiratory conditions/diseases was modified by breastfeeding, and the association for nonbreastfed children was stronger than that for breastfed children. In particular, for nonbreastfed children, the odds ratios (ORs) for the effect of current ETS exposure asthma was 1.71 (95% CI: 1.43-2.05); however, the OR for breastfed children was 1.33 (95% CI: 1.20-1.48), indicating that the interactions between breastfeeding and current ETS exposure on asthma were statistically significant (P = 0.019). When stratified by school (kindergarten vs. elementary school), breastfeeding was more protective for asthma-related symptoms among children from kindergarten. In conclusion, this study shows that breastfeeding is associated with smaller associations between ETS exposure and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of ETS.

Little information is available concerning the association between sleep quality and blood pressure (BP) in Chinese individuals. This study evaluated the association between sleep quality, as determined by the Pittsburgh sleep quality index (PSQI), and hypertension in a rural Chinese population. Using a multistage cluster and random sampling method, a representative sample of 9404 adults aged 20-93 years in northeastern China was selected from 2012 to 2013. Sleep quality was assessed by PSQI, and trained observers measured BP. A sleep disorder (SD) was diagnosed for any participant with a score of 6 or greater. Overall, 1218 male participants (25.53%) and 1261 female participants (27.22%) were defined as having SDs. Compared with the normal subjects, participants with hypertension had higher global PSQI scores and subscores in all elements. The odds ratios (ORs) of hypertension, systolic hypertension and diastolic hypertension among participants with SDs were 2.38 (95% confidence interval (CI): 2.13-2.65), 2.52 (95% CI: 2.26-2.80) and 1.93 (95% CI: 1.74-2.14) in contrast to the reference group, respectively. The risk for hypertension in poor sleepers with subscores over 0 in all of the elements was significantly increased, with ORs ranging from 1.16 (95% CI: 1.04-2.30) to 3.88 (95% CI: 1.24-12.16). The global PSQI score and its components were associated with hypertension and high BP.

Background Little information exists regarding the interaction effects of obesity with long-term air pollution exposure on cardiovascular diseases (CVDs) and stroke in areas of high pollution. The aim of the present study is to examine whether obesity modifies CVD-related associations among people living in an industrial province of northeast China. Methods We studied 24,845 Chinese adults, aged 18 to 74 years old, from three Northeastern Chinese cities in 2009 utilizing a cross-sectional study design. Body weight and height were measured by trained observers. Overweight and obesity were defined as a body mass index (BMI) between 25–29.9 and ≥ 30 kg/m 2 , respectively. Prevalence rate and related risk factors of cardiovascular and cerebrovascular diseases were investigated by a questionnaire. Three-year (2006–2008) average concentrations of particulate matter (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), and ozone (O 3 ) were measured by fixed monitoring stations. All the participants lived within 1 km of air monitoring sites. Two-level logistic regression (personal level and district-specific pollutant level) was used to examine these effects, controlling for covariates. Results We observed significant interactions between exposure and obesity on CVDs and stroke. The associations between annual pollutant concentrations and CVDs and stroke were strongest in obese subjects (OR 1.15–1.47 for stroke, 1.33–1.59 for CVDs), less strong in overweight subjects (OR 1.22–1.35 for stroke, 1.07–1.13 for CVDs), and weakest in normal weight subjects (OR ranged from 0.98–1.01 for stroke, 0.93–1.15 for CVDs). When stratified by gender, these interactions were significant only in women. Conclusions Study findings indicate that being overweight and obese may enhance the effects of air pollution on the prevalence of CVDs and stroke in Northeastern metropolitan China. Further studies will be needed to investigate the temporality of BMI relative to exposure and onset of disease.

Low level of immunity for SARS-CoV among well healthcare workers reinforces the need for infection control measures in hospitals to prevent epidemics., To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics.

AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer. METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias. RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage II-III disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively. CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.

To understand the infection status and epidemiological features of HBV in permanent residents of Shenzhen city.A multi-stage stratified random sampling method was performed for questionnaire survey to permanently-registered residents of 1-59 years old in Luohu and Baoan district of Shenzhen in 2010, and blood samples of the subjects were collected. Hepatitis B virus-related surface antigen (HBsAg) and hepatitis B virus surface antibody (anti-HBs) were detected with ELISA.The total 3771 studied population showed 252 HBsAg positive and 2712 anti-HBs positive residents with the standardization prevalence as 9.73% and 72.83% , respectively. The difference of the prevalence of HBsAg and anti-HBs between males and females were not statistically significant (P0.05). The prevalence of HBsAg was reduced with increasing age. The differences of the prevalence of HBsAg between Shenzhen permanent registered and non-permanent registered population were not significant, but the prevalence of anti-HBs in Permanent registered residents (78.32%) was higher than in non-permanent (66.03%, χ(2) = 41.613, P0.001). The prevalence of HBsAg was significantly different in various occupational and educational levels. Peasants had the highest prevalence (24.13%) and medical workers had the highest prevalence of anti-HBs (89.10% ). People with junior high school education had the highest prevalence of HBsAg (12.76%) and the lowest of anti-HBs (62.45%). Population with high-level education had the highest prevalence of anti-HBs(81.00% average). The prevalence of HBsAg was over 10% in people who were born in Shenzhen and Guangdong province, and the anti-HBs was the highest in Shenzhen population with the prevalence as 74.48% and 76.47% , respectively.In the Shenzhen resident population, the overall prevalence of HBV was lower than the average level of Guangdong province, but higher than the national wide.

The authors regret the misspelling of co-author ‘Kahee A. Mohammed’. The authors would like to apologise for any inconvenience caused.

The purpose of this study was to explore the spatial clustering, specific clustering areas, as well as changing trend of clustering areas of hand-foot-mouth disease (HFMD).Exploratory spatial data analysis (ESDA) was used to conduct spatial statistical analyses for the HFMD using 2008 - 2011 data at both provincial and county/district levels.The Global Moran's I coefficients appeared to be 0.3336, 0.6074, 0.3372, 0.4620 and 0.4367 for 2008 - 2011 and for the combined 4 years, respectively. The corresponding P-values were 0.002, 0.001, 0.004, 0.001 and 0.001 respectively, when using the Monte Carlo tests with all the P-values less than 0.05. Moran's I coefficients ranged between 0.3 and 0.7, showing the appearance of moderate or higher clustering nature. Based on the results from nationwide analyses on clustering areas at the county/district levels between 2008 and 2011 (Moran's I = 0.5198, P = 0.001), it appeared a moderate clustering nature. When local autocorrelation analysis was applied at the provincial level, 3 hot spot areas in Beijing, Tianjin and Shanghai cities in 2008; 7 hot spot areas in Beijing, Tianjin, Hebei, Shanxi, Shanghai, Jiangsu and Shandong in 2009; four hot spot areas: Beijing, Tianjin, Guangdong and Guangxi; five hot spot areas: Fujian, Jiangxi, Hunan, Guangdong and Guangxi in 2011, were discovered. 390 hot-spot counties/districts were found through local autocorrelation analyses using the three-year data of 2008 to 2010.Spatial clustering nature of HFMD incidence between 2008 and 2011 in China appeared to be moderate or high, with the clustered areas a north to south shifting trend. However, further investigation was in need to address this changing trend.

Trabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.This is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.After 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.Phacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

This study examines the relationship between hospital work environments and job satisfaction, job-related burnout and intention to leave among nurses in Guangdong province, China.The nursing shortage is an urgent global problem and also of concern in China. Studies in Western countries have shown that better work environments are associated with higher nurse satisfaction and lower burnout, thereby improving retention and lowering turnover rates. However, there is little research on the relationship between nurse work environments and nurse outcomes in China.This is a cross-sectional study. Survey data were collected from 1104 bedside nurses in 89 medical, surgical and intensive care units in 21 hospitals across the Guangdong province in China.Stratified convenience sampling was used to select hospitals, and systematic sampling was used to select units. All staff nurses working on participating units were surveyed. The China Hospital Nurse Survey, including the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory, was employed to collect data from nurses. Statistical significance level was set at 0·05.Thirty-seven per cent of the nurses experienced high burnout, and 54% were dissatisfied with their jobs. Improving nurses' work environments from poor to better was associated with a 50% decrease in job dissatisfaction and a 33% decrease in job-related burnout among nurses.Burnout and job dissatisfaction are high among hospital nurses in Guangdong province, China. Better work environments for nurses were associated with decreased job dissatisfaction and job-related burnout, which may successfully address the nursing shortage in China.The findings of this study indicate that improving work environments is essential to deal with the nursing shortage; the findings provide motivation for nurse managers and policy makers to improve work environments of hospital nurses in China.

To identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010.Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years.Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P0.005), but not 2009 to 2008.Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.

Early intensive insulin therapies in newly diagnosed type 2 diabetic patients may improve beta-cell function and yield prolonged glycemic remissions. This study was performed to evaluate the relationship between the glycemic remission and beta-cell function and assess the variables predictive of long-term near-normoglycemic remission.Eighty-four newly diagnosed type 2 diabetic patients were treated with 2-week continuous subcutaneous insulin infusion (CSII) and followed up longitudinally. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, hemoglobin A1c (HbA1c) and insulin were measured at baseline, after CSII and at 2-year visit. The patients who maintained glycemic control for two years were defined as the remission group and those who relapsed before the 2-year visit were the non-remission group.The duration to be diagnosed of the patients (from the time that patients began to have diabetic symptoms until diagnosis) in the remission group was shorter than that in the non-remission group (1.00 month vs 4.38 months, P = 0.040). The increase of the acute insulin response (AIR) was maintained after 2 years in the remission group compared with AIR measured immediately after intervention (413.05 pmol*L(-1)*min(-1) vs 408.99 pmol*L(-1)*min(-1), P = 0.820). While AIR in the non-remission group significantly declined (74.71 pmol*L(-1)*min(-1) vs 335.64 pmol*L(-1)*min(-1), P = 0.030). Cox model showed that a shorter duration to be diagnosed positively affected the duration of near-nomoglycemic remission with an odds ratio (OR) 1.019, P = 0.038, while fasting plasma glucose (FPG) and post-breakfast plasma glucose (PPG) after CSII were the risk factors (OR 1.397, P = 0.024 and OR 1.187, P = 0.035, respectively).The near-normoglycemic remission is closely associated with long-term maintenance of beta-cell function and occurs more commonly in patients with shorter duration to be diagnosed and better glycemic control during CSII.

To evaluate the reliability and validity of parent proxy-report scales of Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) Generic Core Scales, the Chinese Version.3493 school students aged 6-18 years were recruited using multistage cluster sampling method. Health-related quality of life was assessed using the above-mentioned PedsQL 4.0 scales. The internal consistency was assessed, using Cronbach's a coefficient, while its validity was tested through correlation analysis, t-test and exploratory factor analysis.The internal consistency reliability for Total Scale Score (Cronbach's alpha = 0.90), Physical Health Summary Score (alpha= 0.81), and Psychosocial Health Summary Score (alpha= 0.89) were excellent. Six major factors were extracted by factor analysis which basically matched the designed structure of the original version accounting for nearly 66% of the variance. The total Scale Score significantly decreased by 3.5 to 13.3 (P0.05) in children and adolescents who had diseases including cold, skin hypersensitiveness, food allergy, courbature or arthralgia, breathlessness with a frequency of 6 times or more per year or had asthma as compared to those with lower frequency (or = 5 times/y) of the diseases or without asthma. We found moderate to high correlations between items and the subscales. Correlation coefficients ranged between 0.45 to 0.84 (P0.01).The reliability and validity of the parent proxy-report scales of PedsQL 4.0 Generic Core Scales of the Chinese Version were as good as the original version. Our findings suggested that the scales could be applied to evaluate the health-related quality of life in childhood children in similar Chinese regions to Guangzhou.

Background The deleterious biological effects of low-level, long-term exposure to heavy metals are well known, and children are the most susceptible population. Dabaoshan Mine in the southeast of Guangdong Province is at high risk of discharging multi-metals pollutants into a local river (Hengshihe) and the surrounding area. The present study aimed to estimate relationships between measured multi-metal exposures and the presence of behavioural problems for the school-aged children in the polluted area. Methods A cross-sectional study was performed. Children aged 7–16 years living in three villages of the Hengshihe area with different degrees of heavy-metal pollution participated in this study. Local environmental samples (water and crops) and children's hair were collected, and concentrations of heavy metals were determined. The Child Behaviour Check-list (CBCL) was used to assess the presence of behaviour problems. General linear regression was used to analyze the contribution of hair metals to each CBCL subscale with adjustment for socio-demographic confounding factors. Results Multiple regression analyses revealed significant effects of hair lead, cadmium and zinc levels on CBCL subscales. Log-transformed hair lead, cadmium and zinc levels accounted for an incremental of 8% to 15% variance in anxious/depressed, withdrawn, somatic complaints, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. The concurrent log-transformed hair lead and zinc levels were strongly associated with all subscales while the concurrent log-transformed hair cadmium was only significantly associated with withdrawn, social problems and attention problems. Conclusion This study reveals that heavy metal exposure was associated with increased risk of behavioral problems for school-aged children.

To investigate the effect of different S-mephenytoin 4'-hydroxylase (CYP2C19) genotype on the eradication rate of Helicobacter pylori (Hp) by different rabeprazole-based triple therapy in Chinese.128 subjects with Hp positive gastritis or peptic ulcers were randomly assigned to receive 10 mg rabeprazole twice daily with 1000 mg amoxicillin twice daily and 500 mg clarithromycin (RAC group) or 400 mg metronidazole (RAM group) twice daily for 1 week. The CYP2C19 genotype (homozygous extensive metabolizer, hom-Ems; heterozygous extensive metabolizer, het-Ems; or poor metabolizer, PMs) was determined by the polymerase chain reaction-restriction fragment length polymorphism method. More than 4 weeks after completion of treatment, Hp status was assessed by (13)C-urea breath test.The hom-Ems, het-Ems and PMs were 30.5%, 50.0% and 19.5% in 128 subjects, respectively. The eradication rates in the rabeprazole-amoxicillin-clarithromycin (RAC) for clarithromycin-sensitive strains and rabeprazole-amoxicillin-metronidazole (RAM) for metronidazole-sensitive strains groups were 98.1% and 91.3%, respectively, on a per protocol basis. It decreased significantly eradication rates of Hp because the prevalence of primary antimicrobial resistance was 66.8% for metronidazole. When the statistical significance of each parameter associated with treatment outcome was assessed with logistic regression analysis, CYP2C19 genetic polymorphism did not show significant effect on the efficacy of anti-Hp therapy with rabeprazole-based triple regimens.The efficacy of rabeprazole-based triple regimens is less affected by the CYP2C19 genotype, the RAC regimen can be considered in Chinese.