Epidemiology and major subtypes of congenital heart defects in Hunan Province, China.

Congenital heart defects (CHDs) are the most common birth defects (BDs) and account for nearly one-third of all BDs. The aim of this article was to investigate the epidemiology and major subtypes of CHDs in Hunan Province, China in the last 5 years.CHD surveillance data from 2012 to 2016 were collected from 52 registered hospitals in Hunan. The prevalence rates of CHDs, incidence rates of CHDs combined with other BDs, and rates of termination of pregnancy (TOP) for CHDs among different regions, infant sexes, and maternal ages were calculated for both early fetuses (<28 weeks of gestation) and perinatal infants (PIs) (between 28 weeks of gestation and 7 days after birth). Both the constituent ratio and prevalence rates were computed among subtypes.CHDs were found in 6289 out of 673,060 births. The overall prevalence was 93.44 per 10,000 PIs, with 19.27 and 74.17 per 10,000 in early fetuses and PIs, respectively. The risks of CHDs were higher in infants from urban areas than those from rural areas during the whole gestation and were higher in male infants than in female infants during the perinatal period. The total prevalence of CHDs increased significantly with maternal age (χ trend = 141.84, P < .05). Among fetuses in early gestation, there were 288 cases (22.21%) of CHDs combined with other BDs and 1292 cases (99.61%) of TOP for CHD. The 3 major subtypes of CHDs were ventricular septal defect (VSD) (22.06%), Tetralogy of Fallot (TOF) (9.43%), and atrioventricular septal defect (AVSD) (6.69%). Among PIs, there were 1541 cases (30.87%) of CHD diagnosed before delivery and 1184 cases (76.83%) were TOP. The 3 major subtypes were atrial septal defect (ASD) (42.81%), patent ductus arteriosus (PDA) (16.07%), and VSDs (15.21%).The total prevalence of CHD in Hunan Province and the rate of TOP for CHD was high, especially for early-gestation fetuses. Pregnancies in urban women, male PIs, and maternal age were the risk factors for CHDs. Among early-gestation fetuses, the most common types were VSD, TOF, and ASD, and among PIs, the most common types were ASD, PDA, and VSD.

[Association rule regarding chronic disease-relevant risk factors for the adults in Haidian District].

OBJECTIVE: To investigate the association patterns of chronic disease-relevant risk factors for the adults in Haidian District.
 Methods: Data for chronic disease-relevant risk factors for 3 219 adults in Haidian District in 2014 were collected and analyzed. SPSS 18.0 was used for statistical description and logistic regression. SPSS Modeler 14.1 was used to explore the association among the chronic disease-relevant risk factors.
 Results: Among men, 5 patterns of chronic disease-relevant risk factors were identified, which suggested that heavy drinking, inadequate intake of fruit and vegetables, and physical inactivity were associated with smoking while inadequate intake of fruit and vegetables and smoking were associated with physical inactivity. Among women, one pattern of chronic disease-relevant risk factor was identified, which suggested that inadequate intake of fruit and vegetables was associated with physical inactivity.
 Conclusion: Chronic disease-relevant risk factors are intercorrelated among the adults in Haidian District. Information on patterns of chronic disease-relevant risk factors could assist interventions targeting multiple behaviors simultaneously.

Development and validation of brief scales to measure emotional and behavioural problems among Chinese adolescents.

OBJECTIVES: To develop and validate brief scales to measure common emotional and behavioural problems among adolescents in the examination-oriented education system and collectivistic culture of China. SETTING: Middle schools in Hunan province. PARTICIPANTS: 5442 middle school students aged 11-19 years were sampled. 4727 valid questionnaires were collected and used for validation of the scales. The final sample included 2408 boys and 2319 girls. PRIMARY AND SECONDARY OUTCOME MEASURES: The tools were assessed by the item response theory, classical test theory (reliability and construct validity) and differential item functioning. RESULTS: Four scales to measure anxiety, depression, study problem and sociality problem were established. Exploratory factor analysis showed that each scale had two solutions. Confirmatory factor analysis showed acceptable to good model fit for each scale. Internal consistency and test-retest reliability of all scales were above 0.7. Item response theory showed that all items had acceptable discrimination parameters and most items had appropriate difficulty parameters. 10 items demonstrated differential item functioning with respect to gender. CONCLUSIONS: Four brief scales were developed and validated among adolescents in middle schools of China. The scales have good psychometric properties with minor differential item functioning. They can be used in middle school settings, and will help school officials to assess the students' emotional/behavioural problems.

[Study on out-of-pocket expenditure and related factors among cancer inpatients with Hunan Provincial Urban Employee Basic Medical Insurance].

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION: OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.

Assessment of School-Based Quasi-Experimental Nutrition and Food Safety Health Education for Primary School Students in Two Poverty-Stricken Counties of West China.

BACKGROUND: Few studies on nutrition and food safety education intervention for students in remote areas of China were reported. The study aimed to assess the questionnaire used to measure the knowledge, attitude and behavior with respect to nutrition and food safety, and to evaluate the effectiveness of a quasi-experimental nutrition and food safety education intervention among primary school students in poverty-stricken counties of west China. METHODS: Twelve primary schools in west China were randomly selected from Zhen'an of Shaanxi province and Huize of Yunnan province. Six geographically dispersed schools were assigned to the intervention group in a nonrandom way. Knowledge, attitude and behavior questionnaire was developed, assessed, and used for outcome measurement. Students were investigated at baseline and the end of the study respectively without follow-up. Students in intervention group received targeted nutrition and food safety lectures 0.5 hour per week for two semesters. Item response theory was applied for assessment of questionnaire, and a two-level difference-in-differences model was applied to assess the effectiveness of the intervention. RESULTS: The Cronbach's alpha of the original questionnaire was 0.84. According to item response model, 22 knowledge items, 6 attitude items and 8 behavior items showed adequate discrimination parameter and were retained. 378 and 478 valid questionnaires were collected at baseline and the end point. Differences of demographic characteristics were statistically insignificant between the two groups. Two-level difference-in-differences models showed that health education improved 2.92 (95% CI: 2.06-3.78) and 2.92 (95% CI: 1.37-4.47) in knowledge and behavior scores respectively, but had no effect on attitude. CONCLUSION: The questionnaire met the psychometric standards and showed good internal consistence and discrimination power. The nutrition and food safety education was effective in improving the knowledge and behavior of primary school students in the two poverty-stricken counties of China.

Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China.

BACKGROUND: A national health literacy scale was developed in China in 2012, though no studies have validated it. In this investigation, we assessed the reliability, construct validity, and measurement invariance of that scale. METHODS: A population-based sample of 3731 participants in Hunan Province was used to validate the Chinese Resident Health Literacy Scale based on item response theory and classical test theory (including split-half coefficient, Cronbach's alpha, and confirmatory factor analysis). Measurement invariance was examined by differential item functioning. RESULTS: The overall Cronbach's alpha of the scale was 0.95 and Spearman-Brown coefficient 0.94. Confirmatory factor analysis showed that the test measured a unidimensional construct with three highly correlated factors. Highest discrimination was found among participants with limited to moderate health literacy. In all, 64 items were selected from the original scale based on factor loading, Pearson's correlation coefficient, and discrimination and difficulty parameters in item response theory. Measurement invariance was significant but slight. According to the two-level linear model, health literacy was associated with education level, occupation, and income. CONCLUSIONS: The 2012 national health literacy scale was validated, and 64 items were selected based on classical test theory and item response theory. The revised version of the scale has strong psychometric properties with minor measurement invariance.

[Effect of implementation of essential medicine system in the primary health care institution in China].

Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.

[Satisfaction degree in outpatients and the influential factors at national essential medicine system in primary health care institutions of Yiyang].

OBJECTIVE: To analyze the satisfaction degree in outpatients and influential factors at national essential medicine system in primary health care institution of Yiyang and to provide useful information for the sustainable development of the national essential medicine system in China.
 METHODS: A multi-stage random sampling method was conducted. A total of 525 outpatients were randomly selected in 21 primary health care institution. Their satisfaction degree on national essential medicine system were investigated through anonymous survey.
 RESULTS: Categories of medical institutions, age, education, medicare categories and occupation were influential factors, with statistical significance (P<0.05). 
 CONCLUSION: There's no difference among different class of outpatients' attitude on national essential medicine system. Categories of medical institutions, age, education, medicare categories and occupation are influential factors for outpatients' attitude.

[Comprehensive evaluation of sample data in medical research].

Comprehensive evaluation methods are generally used to assess the population data. When we need to estimate the sample data in special situations, the impacts brought by the sampling error should be considered. Due to lack of the accurate measurement for the sensitivity and stability in the comprehensive evaluation methods, sampling errors usually cannot be estimated in the sampling research. Monte Carlo simulation was used in this article to solve the probability of the ordering results, and the matlab programs were presented. Based on the simulated results, we change the conventional "absolute conclusion" of comprehensive evaluation methods to "probability results" for the sample data, and put forward a new sorting and ranking method for the results of comprehensive evaluation.

[Effect of nutrition and food safety education among middle school students in a poverty-stricken county in west China].

OBJECTIVE: To evaluate the effect of nutrition and food safety education among middle school students in a poverty-stricken county in west China, and to explore the better education model for further education. METHODS: Students of grade 7 to 9 were selected from 4 middle schools in the country through multi-stage cluster sampling for the questionnaire, and the schools were assigned into an intervention group or a control group. After students in the intervention schools completed one year nutrition and food safety education with the textbooks, students were chosen from the same 4 schools to finish the same questionnaire again. RESULTS: A total of 410 students from grade 7 to 9 were selected at the baseline study, and 474 students in the final study. The essential characteristics of the 2 groups were not statistically significant (P>0.05). In the baseline investigation, the differences in the scores on nutrition and food safety knowledge, attitude and practice between the 2 groups were not significant (P>0.05). In the final study, the scores on the knowledge, attitude of nutrition knowledge learning, and dietary habits among students in the intervention group were significantly higher than those in the control group (P<0.05). School-students mixed model demonstrated that the intervention was protective factor on scores of knowledge, in particular with nutrition related diseases and reasonable diet (P<0.05). But the intervention didn't affect the scores on attitude in both ways (P>0.05). CONCLUSION: Nutrition and food safety education can improve the nutrition and food safety knowledge effectively. The curriculum should be further standardized and different emphases should be set up to different grades to cultivate healthy diet behaviors.

Efficacy and safety of letosteine in the treatment of sputum thickening and expectoration difficulty in patients with respiratory diseases: a multicenter, randomized, double-masked, double dummy, positive drug parallel controlled trial.

This study aimed to compare the efficacy and safety of letosteine and ambroxol hydrochloride for the treatment of sputum thickening and expectoration difficulty due to either acute or chronic respiratory diseases. Patients (n = 240) were randomized to receive either letosteine + placebo (50 mg thrice daily, Group A) or ambroxol hydrochloride + placebo (30 mg thrice daily, Group B) orally for 5-14 days. The primary outcomes comprised the total effectiveness rate and the total improvement rate. Secondary outcomes included: post-treatment IgA level changes and post-treatment therapeutic evaluation scoring of clinical symptoms. The full analysis set (FAS) comprised 113 patients in Group A and 116 in Group B. The total effectiveness rates were 95.58% for Group A and 95.69% for Group B. The total improvement rates were 99.12% and 99.14% for Group A and Group B, respectively. There were no significant differences between the two groups for any of the primary or secondary outcomes in either the FAS or the per protocol populations (PPS; all P-values > 0.05). Letosteine and ambroxol hydrochloride provided equivalent efficacy and safety in the treatment of sputum thickening and expectoration difficulty due to either acute or chronic respiratory diseases.

[Effectiveness on the education and food safety programs among senior primary students in 2 counties from west China-a cluster randomized trial].

OBJECTIVE: To evaluate the effectiveness of nutrition and food safety educational programs on primary students from grade 4 to 6 in impoverished areas of Western China, under a school-based cluster-randomized trial. METHODS: Twelve primary schools were selected from 2 impoverished counties in West China and assigned to intervention or control groups, randomly, with 6 schools in each group. Self-rating knowledge, attitude and practice questionnaires were used at both baseline and final stages. Textbooks and supportive materials were designed according to the characteristics of baseline data. All students in the intervention group were treated with targeted nutrition and food safety lectures of 0.5 hour per week for 2 semesters. Generalized linear mixed effects model was applied to fit the random effects on individual and clusters as well as to fit the fixed effect of the programs. RESULTS: Three hundred seventy-eight students from grade 4 to 6 were randomly selected at the baseline study and the differences of scores on knowledge, attitude and practice between the 2 groups were statistically insignificant (P > 0.05). No cluster was lost during the trial. In the final investigation, 478 students were randomly selected at the individual level. Scores on knowledge, attitude and practice among students in the intervention group were significantly higher, when comparing to the control group (P < 0.01). At the cluster level, more schools in the intervention group showed significant changes on knowledge and practice, yet the change in attitude was less obvious. Data from the mixed-effects model demonstrated that the program served as an influential factor on scores related to knowledge after the intervention(P = 0.015)but did not affect the scores on related attitude or practice (P > 0.05). CONCLUSION: Lectures seemed to have improved the cognition of nutrition and food safety among primary students from grade 4 to 6. However, long-term observation and larger sample size were needed to evaluate the changes on attitude and practice among the students.

[Expert investigation on food safety standard system framework construction in China].

OBJECTIVE: Through investigating food safety standard framework among food safety experts, to summarize the basic elements and principles of food safety standard system, and provide policy advices for food safety standards framework. METHODS: A survey was carried out among 415 experts from government, professional institutions and the food industry/enterprises using the National Food Safety Standard System Construction Consultation Questionnaire designed in the name of the Secretariat of National Food Safety Standard Committee. RESULTS: Experts have different advices in each group about the principles of food product standards, food additive product standards, food related product standards, hygienic practice, test methods. According to the results, the best solution not only may reflect experts awareness of the work of food safety standards situation, but also provide advices for setting and revision of food safety standards for the next. CONCLUSION: Through experts investigation, the framework and guiding principles of food safety standard had been built.

[Status on knowledge, attitudes, behavior regarding nutrition and food safety among 4-6 grade students from Chinas' two poverty-stricken counties].

OBJECTIVE: To investigating knowledge, attitudes, current behavior among primary school students on nutrition and food safety in two State-level poverty-stricken counties, and to explore the best educational model on nutrition and food safety. METHODS: 478 pupils at 4-6 grades were selected, using the method of stratified cluster sampling and questionnaire. RESULTS: The average score on knowledge was 18.66 ± 3.75, with the qualified rate as 61.09% (the highest was 60.6%). The average score in the section of attitude was 5.82±1.50. More than 97% of the students agreed that it was necessary to receive knowledge on nutrition and food safety. The average score of behavior was 8.52±2.56. CONCLUSION: Rate of awareness on knowledge of nutrition and food safety had greatly improved among the students under study. Their habit tended to be more regular. However, we also noticed the gap between knowledge and behavior on this issue.

[Development of green hospitals home and abroad].

Green hospital construction is a new challenge for medical industry after global sustainable development strategy was put forward. The core connotation of green hospital includes green building, green healthcare, patient safety, and doctor-patient harmony. Many countries have established green building evaluation system to deal with energy crisis. Leadership in Energy and Environmental Design (LEED), Green Guide for Health Care (GGHC) in the U.S., and Evaluation System for Green Hospital Building (CSUS/GBC 2-2011) in China have guiding significance for the development of green hospitals in China. The evaluation system of green hospitals home and abroad still focuses on green building, and establishment of suitable synthesis evaluation system of green hospitals in China needs further research.

[A novel improved TOPSIS method and its application in medical science].

The TOPSIS method is a static comprehensive evaluation method for wide range applications. However, it encounters the reverse order problem in practical applications. Moreover, its evaluation value Ci only reflects the relative proximity of each evaluation object inside but not to the degree of closeness to the ideal optimal solution. The evaluation value is also limited to distinguish between the ranges of merit ranking. Since TOPSIS method has the wide range of applications, it is necessary to overcome the drawbacks of TOPSIS method. This article proposes a new improved TOPSIS method, which shows strict isotonicity and is more sensitive than the traditional TOPSIS method. The medical application based on this improved TOPSIS method is introduced.

[A prospective study on recurrent falls and related factors in elderly from the urban communities in Beijing].

OBJECTIVE: To investigate the incidence and risk factors for recurrent falls in community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district,Beijing in 2009. Data on recurrent falls within the past 12 months were collected through face-to-face interview, with both single factor analysis and logistic regression analysis used to explore the related factors on recurrent falls in the elderly. RESULTS: The incidence of recurrent falls among 472 older adults was 6.1% (29) within the past 12 months. Results from logistic regression analysis showed that factors as higher family monthly income(OR = 1.39, 95% CI:0.67-2.16), afraid of being fallen(OR = 2.23, 95% CI:1.47-3.85)and abnormal static balance(OR = 2.48, 95% CI:1.84-4.05)were risk factors, while bench height in the surrounding environment(OR = 0.49, 95% CI:0.21-1.12)and easiness of access to daily supplies (OR = 0.41, 95%CI:0.14-1.16)were protective factors for recurrent falls. CONCLUSION: The incidence of recurrent falls among the elderly from the communities in Beijing was high. Since falls could be caused by various factors, intervention should be targeting on risk factors in a multi-dimensional way.

[Novel dynamic TOPSIS method in evaluation for quality of medical care].

The quality of medical care shows characteristics of dynamic state with changes in time. However, many of appraisal and evaluation projects usually keep on the status of "past" or "present". Most of these models are static evaluation approach. In this study, besides the "past" and "present" status, we took one step further to unveil the future development trends of the medical therapeutical effects. Based on the index value and index increment, a dynamic TOPSIS method is presented. This method pays attention to both transverse and lengthwise information and can not only perform the evaluation on each time section but also can make the final dynamic evaluation. We applied this new method to the evaluation of quality of medical care, which was proved to be effective.

[Protective effect of SjC23-Hsp70 DNA vaccine and interleukin-12 on Schistosoma japonicum infection in water buffalos].

OBJECTIVE: To determine the immune-protective effect of Japan Schistosoma (Chinese mainland strain) 23 kD membrane protein-heat shock protein (SjC23-Hsp70) DNA vaccine plus adjuvantinduced interleukin-12 (IL-12) plasmid DNA on Schistosoma japonicum infection in water buffalos. METHODS: Forty-five health water buffalos (8-10 months old) in non-endemic area of schistosomiasis were randomly assigned into group A (SjC23-Hsp70+IL-12, 300 µg), group B (SjC23+IL-12, 300 µg) and group C (pVAX+IL-12, 300 µg), 15 in each group. Each buffalo was immuned by shoulder intramuscular injection for 3 times, at an interval of 28 days. Twenty-eight days after the last immunization, each buffalo was infected with 1000 Japan cercariae of Schistosoma. Fecal examinations were conducted 2 days and 1 day before the perfusion, and on the day of perfusion. The number of hatching miracidia and eggs per gram feces was recorded. Fifty-six days after the infection, the buffalos were sacrificed and perfused via the descending aorta. The recovered adult worms and eggs in the liver tissue were counted. RESULTS: We compared group A and B with group C: the estrogen reduction rate was 45.7% and 26.61%; bug reduction rate was 44.51% and 25.84%; the fecal egg reduction rate was 41.1% and 31.63%; the miracidium reduction rate was 48.11% and 38.07%; and the liver egg reduction rate was 43.39% and 31.95%. The above rates in group A were higher than those in group B (P<0.05). CONCLUSION: SjC23-Hsp70 DNA vaccine combined with IL-12 may have a significant immunoprotective effect on buffalos.

[Label identities and basic situation of health food in Changsha].

OBJECTIVE: To study the relevant information on the label of health food in Changsha, and provide scientific evidence for health food hygienic supervision. METHODS: Investigation was conducted in department stores, supermarkets, pharmacies, and wholesale markets in the 5 districts in Changsha with multistage stratified sampling method. Self designed basic information of health food questionnaire was used to investigate the quality of labels the health food products. RESULTS: Among the 408 random samples, the unidentified rates of label items were ranked in descending order: functional components (49.8%), unsuited community (27.9%), manufacturing date (23.0%), approval number and others (9.6%). The qualified rates of labels were different in different management types (χ(2)=59.793, P<0.05): the highest rate was in supermarkets (71.15%), followed by pharmacies (70.07%), shopping malls (57.47%), and wholesale markets (26.23%). CONCLUSION: The supervision of label identities of health food should be strengthened, especially for the health food in the wholesale markets.