Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients / 中南大学学报(医学版)

OBJECTIVES@#To analyze the cost-effectiveness of the Morse Fall Scale by clinical big data for nurses in the prevention of falls in hospitalized patients.@*METHODS@#A total of 59 358 hospitalized patients, who came from the Third Xiangya Hospital of Central South University in 1 year before nurses were trained by the Morse Fall Scale, served as a control, including 26 862 males and 32 496 females. While the 66 203 hospitalized patients served as an observation group in 1 year after nurses were trained by the Morse Fall Scale, including 29 881 males and 36 322 females. The time spent by clinical nurses in the fall-risk assessment and the fall number were recorded in the 2 groups, and the relationship was analyzed between the Morse Fall Scale assessment and the clinical ending along with the labor cost of nursing. The cost-effectiveness was analyzed. In addition, the incidence of fall in the observation group was compared between the falling high-risk patients and the non-high-risk patients.@*RESULTS@#The Morse Fall Scale showed that the incidences of fall in the observation group and the control group were 3.39/100 000 and 3.82/100 000,respectively, there was no significant difference between the 2 groups (@*CONCLUSIONS@#The evaluation of the Morse Fall Scale has a certain effect, but it is limited in the prevention of falls in adult hospitalized patients, and the cost-effectiveness analysis is not good. It is recommended to implement the intervention measures for high-risk patients after the assessment, which may improve the management level and efficiency of fall prevention.

Effect of adverse childhood experiences and DNA methylation on male sexual orientation / 中南大学学报(医学版)

The causes for male sexual orientation are complicated, which have not yet been clarified. Recent years have witnessed fruitful progress in the field of biology, while the impact of environment has received little attention. Adverse childhood experiences (ACEs), identified as a special environment in the early stage of development, can affect the individual phenotype by DNA methylation. Given the relationships among male sexual orientation, ACEs, and DNA methylation, as well as based on the existing theory, this article proposes the model "ACEs-DNA methylation-male sexual orientation"from the perspective of environment and epigenetics, aiming to provide a theoretical basis for future research.

Influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai / 中南大学学报(医学版)

Objective:To explore the influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai,and to explore the relevant policy for reasonable control of hospitalization costs.Methods:A total of 10 065 patients with malignant tumors were enrolled in this study.The multiple linear regression analysis was used to seek the determinants for hospitalization cost of malignant tumor patients during the final phase.Results:The median length of hospital stay was 43 days for the patients,with an average age of (70.73±12.87) years.Among them 61.66％ of hospitalized patients were male and the median hospitalization cost of malignancy was 55 447.84 yuan.Hospitalization cost showed the linear regression relationship with type of health care,hospital level,hospital types,tumor types,length of hospital stay,surgery,age,gender,and time from hospital admission to death.Conclusion:Proximity to death in malignant tumor patients is an important factor for the hospitalization cost.Medical resources should be allocated rationally,and the comprehensive measures should be taken to control the cost reasonably.

Prevalence and influential factors for asthma among adults in Chinese / 中南大学学报(医学版)

Objective:To analyze the prevalence and influential factors for asthma among adults in Chinese.Methods:Chinese residents aged ≥ 18 years in 12 regions were enrolled to estimate the prevalence of asthma in adults with different characteristics.Multivariate logistic regression analysis were adopted to determine the influential factors for asthma based on the China Health and Nutrition Survey in 2009 and 2011.Results:The prevalence of asthma was 1.25％ (95％CI 1.06％ to 1.43％) among the entire adult population in China.There were significant differences in terms of age,gender,regions,city and countryside,smoking,body mass index (BMI),education levels,marriage and subjective wellbeing (SWB)(all P＜0.05).Compared with normal people,the risk of asthma complicated with hypertension,diabetes,myocardial infarction and stroke was significantly increased (P＜0.01).The multiple logistic regression analysis showed that the influential factors for asthma included age (OR=1.042,95％CI 1.032 to 1.053),gender (male OR=1.533,95％CI 1.080 to 2.167),regions (Beijing OR=2.470,95％CI 1.155 to 5.308),urban area (OR=1.355,95％CI 1.026 to 1.786),BMI (OR=1.021,95％CI 1.000 to 1.037),smoking (OR=1.428,95％CI 1.028 to 1.989),drinking (OR=0.711,95％CI 0.976),education level (OR=0.964,95％CI 0.930 to 0.999),poor short-term health status (OR=5.295,95％CI 4.055 to 6.934),well-being (lowest OR=2.219,95％CI 1.272 to 3.887),playing games (OR=2.732,95％CI 1.023 to 6.088) and watching TV (OR=1.695,95％CI 1.036 to 2.941).Conclusion:Adult asthma is associated with multiple factors including age,gender,lifestyle,social environment,etc.

Efficacy of health education on patients with hip replacement based on the Internet / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of health education on patients with hip replacement based on the Internet, and to establish a new health education model through modern technology.@*METHODS@#A total of 300 patients with hip replacement from March to August, 2015 were enrolled in this study. The participants were divided into a control group and an experimental group according to months surgeries performed. Traditional education was applied in the control group while the multimedia source material plus the Internet platform of Joint Registration System were applied in the experimental group. Levels of anxiety, degree of satisfaction, and postoperative complications were analyzed.@*RESULTS@#The levels of knowledge, attitude and behavior compliance in the patients of the experimental group were significantly improved, while the levels of postoperative anxiety were decreased compared with those in the control group (P<0.05).@*CONCLUSION@#Education based on the Internet platform of Joint Registration System and the computer video could improve patients' knowledge, attitude, and behavior, which is worthy of clinical spread.

Evaluation index system for equalization of basic public health services / 中南大学学报(医学版)

OBJECTIVE@#To establish the evaluation index system for equalization of basic public health services and to test its value in practice.@*METHODS@#We developed the index system through expert scored evaluation and then chose a city in Hunan for the research object. The sources of data and the methods of collection for each indicator were identified. The reliability and validity of index system was tested. The methods of AHP (analytic hierarchy process) and TOPSIS (technique for order preference by similarity to an ideal solution) were applied to comprehensively evaluate the public health services among nine counties in the city.@*RESULTS@#The Cronbach's alpha coefficient, which described reliability test result on evaluation index system for equalization of basic public health services, was 0.750. The cumulative contribution rate reached 89.32% after validity test with extraction of 5 common factors through factor-analysis. The sorting results from AHP or TOPSIS method are very close except two districts.@*CONCLUSION@#Evaluation index system for equalization of basic public health services established in this study is in good validity and reliability, which can be objectively applied to analyze the current status of basic public health services.

Meta-analysis of association between organophosphorus pesticides and aplastic anemia / 中华流行病学杂志

Objective To evaluate the association between organophosphorus pesticides and aplastic anemia,and provide scientific evidence for the primary prevention of aplastic anemia.Methods The published papers of case control studies on the association between organophosphorus pesticides and aplastic anemia from January 1990 to August 2014 were collected from Chinese BioMedical Literature Base (CBM),Chinese National Knowledge Infrastructure (CNKI),PubMed and EMBASE.The papers which met the inclusion criteria were evaluated.The pooled odds ratios (OR) and 95％ confidence interval (CI) of organophosphorus pesticides were calculated with software Review Manager 5.0.Subgroup analysis were conducted for different population and different usage of organophosphorus pesticides.Results A total of 9 papers were selected,involving 5 833 subjects (1 404 cases and 4 429 controls).The results showed that organophosphorus pesticides could increase the risk of aplastic anemia (OR=1.97,95％ CI:1.60-2.44).Subgroup analysis showed that Asian (OR=2.01,95％CI:1.52-2.66) had higher risk of aplastic anemia than American or European(OR=1.93,95％CI:1.39-2.67).Using pure organophosphorus pesticides (OR=2.15,95％ CI:1.60-2.88) was more prone to cause aplastic anemia than using the mixture of organophosphorus pesticides (OR=1.82,95％ CI:1.34-2.47).Conclusion The analysis indicated that organophosphorus pesticides might be a risk factor for aplastic anemia.Reducing organophosphorus pesticides exposure in daily life and industrial or agricultural production could prevent the incidence of aplastic anemia.

Relationship between dietary vitamin C and Type 2 diabetes / 中南大学学报(医学版)

OBJECTIVE@#To examine the correlation between dietary vitamin C intake and Type 2 diabetes.
@*METHODS@#A total of 5 168 participants from Xiangya Hospital, Central South University were randomly selected. According to the vitamin C intake, the participants were divided into 5 groups: a Q1 group (n=1 033), a Q2 group (n=1 034), a Q3 group (n=1 034), a Q4 group (n=1 034) and a Q5 group (n=1 033). They were also divided into a Type 2 diabetes group (n=502) and a non-diabetes group (n=4 666). The height, weight, and blood pressure were measured, and vitamin C intake and other dairy consumption were evaluated using a food frequency questionnaire and fasting plasma glucose (FPG). The analysis of variance (ANOVA), Chi-square test, Mann-Whitney U test and logistic regression model were used to analyze the relationship between dietary vitamin C and Type 2 diabetes.
@*RESULTS@#The univariate analysis showed that there were significant differences in the vitamin C consumption in energy intake, activity level, dietary fiber intake, nutritional supplementation status, drinking or not drinking, education level among the different vitamin C intake groups (all P154.78 mg/d) in comparison with the lowest level (≤ 63.26 mg/d). The results suggested that the vitamin C intake was inversely associated with the Type 2 diabetes (r=-0.029, P<0.05).
@*CONCLUSION@#There is a significant negative correlation between the dietary vitamin C intake and the risk of Type 2 diabetes.

Risk factors for type 2 diabetes complicated with hypertension in adult residents in Liuyang / 中南大学学报(医学版)

OBJECTIVE@#To investigate the risk factors for type 2 diabetes complicated with hypertension in adult residents in Liuyang, Hunan Province, P. R. China.
@*METHODS@#The residents aged at or over 18 were selected through a method of multi-stage cluster random sampling from 10 towns in Liuyang. Questionnaires, physical measurements and laboratory tests were conducted. Type 2 diabetes complicated with hypertension were served as an experimental group, while simple diabetes, non-diabetes and non-hypertension (healthy control), or non-complication and healthy group (simple hypertension, simple diabetes, and healthy group) were served as control group, respectively. Three kinds of logistic regression model were used to analyze the risk factors for type 2 diabetes complicated with hypertension.
@*RESULTS@#A total of 5 669 residents were included in the analysis, and the response rate was 97.74%. The results showed that the prevalence of type 2 diabetes complicated with hypertension of residents at or over 18 years old in Liuyang was 2.6% (95%CI: 2.2%, 3.1%). Logistic regression analyses demonstrated that for people at or over 60 years old, obesity and abnormal triglyceride were the independent risk factors for type 2 diabetes complicated with hypertension.
@*CONCLUSION@#Aging, obesity and abnormal triglyceride can increase the risk of type 2 diabetes complicated with hypertension in adult residents in Liuyang.

Construction of evaluation index system for equalization of basic public health services / 中南大学学报(医学版)

OBJECTIVE@#To develop a scientific and effective evaluation index system for equalization of basic public health services.@*METHODS@#Through 2 rounds of expert evaluation, based on the relative importance of expert scoring on each index, index was screened according to the scores of mean and coefficient of variation and the weight were determined.@*RESULTS@#The two rounds of consulting experts response rates were more than 90%, and the average authority coefficients were 0.779 and 0.781. The coordination coefficients were 0.229 and 0.349. The evaluation index system of basic public health services was composed of 3 first level, 17 second level and 47 third level indicators after 2 rounds of consultation.@*CONCLUSION@#The evaluation index system of basic public health services is reasonable, and it can be used to evaluate the equalization of basic public health services.

Prevalence and risk factors of type 2 diabetes in the adults in Haikou city, Hainan Island, China

Type 2 diabetes mellitus [T2DM] occurs around the world with high prevalence and causes serious physical harm and economic burden to the afflicted. Haikou City is China's southernmost tropical island city, which has not been previously studied for its T2DM prevalence. The objective of the study in employing a cross-sectional survey is to discuss the epidemiologic status of T2DM in Haikou City and to analyze the possible determinants. A total of 12,000 community residents over 18 years old from four districts in Haikou City were stratified-randomly sampled. A questionnaire survey and physical examination were conducted. Data entry and statistical analysis were performed using SPSS17.0 software. The prevalence of T2DM in Haikou City was 5.3% [5.15% for males and 5.46% for females]. According to the multivariate analysis, the positive factors mainly associated with T2DM in the city included family history, Waist-to-Hip Ratio [WHR], triglycerides, low high-density lipoproteins [HDL], and blood pressure. For both men and women, family history was the highest independent risk factor associated with T2DM [OR= 47.128]. The T2DM risk increased with increasing metabolic aggregate. The prevalence of T2DM for the community population of Haikou City was low. The possible risk factors included age, occupation, BMI, waist circumference, WHR, overweight, systemic obesity, central obesity, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoproteins, family history, and HDL

Meta-analysis of proximal femoral nail anti-rotation versus dynamic hip screw in the treatment of trochanteric fractures / 中南大学学报(医学版)

OBJECTIVE@#To compare the efficacy of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) in the treatment of trochanteric fractures in adults.@*METHODS@#Reports of studies using randomized controlled trials (RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved (up to December 5, 2011) from the Cochrane Library, MEDLINE, Elsevier, the Chinese Biomedical Database, Wanfang Data,and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman? 5.0 was used for data-analysis.@*RESULTS@#Thirteen RCTs involving 958 cases were included in the Meta-analysis. The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery [WMD = -21.38, 95%CI (-33.05,-9.26), P<0.05], intra-operative blood loss [WMD = -176.36, 95%CI (-232.20, -120.52), P<0.05], the rate of post-operative complication [RR=0.46, 95%CI (0.31, 0.70), P<0.05], the rate of post-operative fixation failure[RR=0.27, 95%CI(0.11,0.62), P<0.05].@*CONCLUSION@#PFNA for intertrochanteric fractures is superior to DHS in regards to the mean duration of surgery, mean intra-operative blood loss, the rate of post-operative complication, and the rate of post-operative fixation failure. But there is not enough evidence to show any difference between PFNA and DHS in regards to the mean duration of hospital, the mean duration of fracture healing, the rate of post-operative fracture, the rate of post-operative coxa vara, the rate of postoperative superficial wound infection, the rate of other post-operative complications or the Harris score after surgery.

Attitude of elementary and middle school students and their parents toward children affected by HIV/AIDS and its determinants / 中南大学学报(医学版)

OBJECTIVE@#To describe the attitude of elementary and middle school students and their parents toward children affected by HIV/AIDS and to analyze the determinants of such attitude.@*METHODS@#A cross-sectional study with the stratified cluster sampling method was conducted to interview elementary and middle school students and their parents, and questionnaires were distributed to collect information about the basic characteristics, HIV/AIDS knowledge and attitude toward children affected by HIV/AIDS. Student's t-test, ANOVA and multilevel model were used to analyze the data.@*RESULTS@#A total of 732 students and their parents finished the questionnaires. The students' and parents' awareness rates were 77.56% (95% CI: 63.08% - 92.05%)and 81.76% (95% CI: 72.33% - 91.20%), respectively. Questions with the lowest proportion of positive attitude included separating the children affected by HIV/AIDS and not studying with those children in the same class. Gender (b =-1.15, P =0.016) and knowledge (b =1.26, P <0.001) of students, as well as attitude (b =0.40, P <0.001) of parents were associated with the students' attitude, while parents' knowledge (b =0.93, P <0.001) was associated with parents' attitude.@*CONCLUSION@#Discrimination towards children affected by HIV/AIDS exists among students and their parents. HIV/AIDS knowledge education helps to improve the students' and parents' caring and supporting attitude toward children affected by HIV/AIDS.

Epidemiological study on hemorrhagic fever with renal syndrome in flood areas / 中南大学学报(医学版)

Objective To investigate the infection of hemorrhagic fever with renal syndrome (HFRS) in host animals and inapparent infection of HFRS in general population in Dongting Lake areas after floods. Methods The night trapping method was used to capture rodents. The immunofluorescence assays were used to detect the hantavirus (HV) antigens and antibodies in rodents lung and in the serum of general population. Nonconditional logistic regression was applied to analyze risk factors for inapparent infection with HV. Results In flood region,draw-near flood region and new migration region,rodent density was 6.95%,6.28%, and 8.67%, respectively, and the virus-carrying rate in rodents was 15.07%,9.25%, and 4.47%, respectively. The virus-carrying rat index was the highest in flood region (0.10). Apodemus agrarius was the dominant species. The standardized positive rate of HV antibody in general population from above mentioned regions was 4.49%, 3.11%, and 3.13%, respectively. There was no significant difference among different age or gender groups. The results of logistic regression analysis indicated that people who were involved in construction of water conservancy facilities in winter or practice of rat extermination at home were the principal factors related to inapparent infection with HV. Conclusion The virus-carrying rate in main host animals of HV in the 3 regions is high, whereas the positive rate of HV antibody is low in general population. Comprehensive measures should be taken to prevent and control HFRS, such as reinforcing surveillance of HFRS, strengthening deratization, and preventive inoculation.

Association between posttraumatic stress disorder and preflood behavioral characteristics among children aged 7-15 years in Hunan, China

To explore the relationship between posttraumatic stress disorder [PTSD] and preflood behavioral characteristics among children aged 7-15 years in Hunan, China. In 2000, a retrospective study was carried out among children who had been exposed to the 1998 floods in Hunan. A multistage sampling method was used to select subjects from the flood-affected areas. A structured questionnaire administered to the children selected was used to diagnose PTSD based on the DSM-IV criteria. A parent questionnaire was used to measure preflood behavioral characteristics related to health, behavioral, and habit problems. The association between PTSD and preflood behavioral characteristics was assessed using chi[2]-tests and multivariate logistic regression. A total of 7,038 children from 13,450 households, aged 7-15 years, were investigated. The overall prevalence of PTSD was 2.05%. Generally, the PTSD-positive rate increased with increasing scores for behavioral characteristics. Preflood behavioral characteristics are an important factor influencing the prevalence of PTSD among children exposed to floods. It is therefore necessary to give special attention to children with behavioral problems in order to reduce the psychological impact of floods

Cost-benefit of expanding cervical cancer screening / 中南大学学报(医学版)

OBJECTIVE@#To estimate the benefit and cost of increasing the coverage of cervical cancer screening.@*METHODS@#Using an eleven year conventional screening data (universal strategy) and a representative population sample (expanding strategy) to analyze the health and economic impact.@*RESULTS@#The screening coverage for all 30-59 women in Liuyang was increased from 7.20% to 66.67%. Early detection cases were increased from 20 to 45, and life years saved in one screening term increased from 103.46 years to 925.83 years with expanding strategy as compared with the conventional strategy. The incremental cost per life year saved was 6 917.07 Yuan. The benefit/cost ratio was 1.80:1 at the screening coverage of 66.67%, which was higher than that of the conventional strategy (1.40:1). Both strategies were cost-effective.@*CONCLUSION@#With various uncertainties and data limitations, expanding screening coverage is more effective than conventional strategy, and more benefit is obtained when the number of early detection cases increases.

Epidemiological study on leptospirosa infection of host animals and healthy population in flood areas / 中南大学学报(医学版)

OBJECTIVE@#To investigate the infection of leptospirosa of host animals and the immune level of healthy population in flood areas.@*METHODS@#Korth culture was used to culture leptospira for rodent kidney and oxen urine sample. The serogroups of leptospira and leptospira antibody were tested by microscopic agglutination test (MAT).@*RESULTS@#In flood regions, draw-near-flood region, and new migration region, rodent density was 6.95%, 6.28%, and 8.67%, respectively. The positive rates of rodent with leptospira was 4.63%, 1.35%, and 3.13%, respectively. Leptospira positive rates of oxen urine were 5.88%, 5.98%, and 1.75%, respectively. The main serogroup of leptospira was Icterhamorrhagic and Canicola serogroup. The positive rates of leptospirosa antibody in healthy population was 45.91%, 62.30%, and 58.67%in these 3 regions respectively, which was significantly higher than the average level in China. The dominant serogroups of leptospira in health population were icterhamorrhagic, autumnalis, canicola, pomona and bataviae. The positive rate of antibody had no difference among different age groups.@*CONCLUSION@#The main host animals are rodents and oxen infected with leptospira and the positive rate of leptospira antibody is high in healthy population in the study area. The dominant serogroups in host animals are similar to that in healthy population, which is mostly icterhaemorrhagic.

Analysis of the prognostic factors in patients with primary superficial transitional cell carcinoma of bladder / 中华泌尿外科杂志

Objective To evaluate the prognostic factors affecting recurrence,progression,bladder preservation,metastasis and cancer specific survival in patients with primary superficial transitional cell carcinoma of bladder. Methods Using Kaplan Meier method,Log rank test and Cox proportional hazards model,the retrospective survival analysis was performed in 198 patients with primary superficial transitional cell carcinoma of bladder. Results The mean follow up period was 79.76 months.The recurrence rates at 3 ,5 ,10 year were (28.75?0.78)%,(35.70?0.16)%,and (42.83?0.00)%,respectively.The main variables affecting recurrence were the duration of symptoms,histological grades and intra operative blood transfusion.The progression rates at 3 ,5 ,10 year were(8.89?0.33)%,(15.16?0.16)%,and (23.88?0.00)%,respectively.The main variables affecting progression were intra operative blood transfusion,histological grades,the number of reexaminations and recurrence free period (RFP).The rates of bladder preservation at 3 ,5 ,10 year were(94.68?0.23)%,(93.87?0.00)%,(91.51?0.00)%,respectively. The main variable affecting bladder preservation was RFP. The metastasis rates at 3 ,5 ,10 year were (8.25?0.22)%,(11.24?0.00)%,(28.94?0.00)%,respectively.The main variables affecting metastasis were tumor multifocality, hydronephrosis,microscopic growth pattern and RFP. The cancer specific survival at 3 ,5 ,10 year were (95.02?0.00)%,(90.70?0.46)%,(77.14?1.06)%,respectively.The variables that could predict cancer specific survival were microscopic growth pattern and RFP. Conclusions By cancer specific survival analysis of the follow up data,we can well identify the main prognostic factors from numerous ones,and also can design the therapeutic and follow up strategies for primary superficial transitional cell carcinoma of bladder.