The China Patient-centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective heart failure study design.

INTRODUCTION: Heart failure (HF) is a leading cause of hospitalisation in China, which is experiencing a rapid increase in cardiovascular disease prevalence. Yet, little is known about current burden of disease, quality of care and treatment outcomes of HF in China. The objective of this paper is to describe the study methodology, data collection and abstraction, and progress to date of the China Patient-centered Evaluative Assessment of Cardiac Events 5 Retrospective Heart Failure Study (China PEACE 5r-HF). METHODS AND ANALYSIS: The China PEACE 5r-HF Study will examine a nationally representative sample of more than 10 000 patient records hospitalised for HF in 2015 in China. The study is a retrospective cohort study. Patients have been selected using a two-stage sampling design stratified by economic-geographical regions. We will collect patient characteristics, diagnostic testing, treatments and in-hospital outcomes, including death and complications, and charges of hospitalisation. Data quality will be monitored by a central coordinating centre and will address case ascertainment, data abstraction and data management. As of October 2017, we have sampled 15 538 medical records from 189 hospitals, and have received 15 057 (96.9%) of these for data collection, and completed data abstraction and quality control on 7971. ETHICS AND DISSEMINATION: The Central Ethics Committee at the Chinese National Center for Cardiovascular Diseases approved the study. All collaborating hospitals accepted central ethics committee approval with the exception of 15 hospitals, which obtained local approval by internal ethics committees. Findings will be disseminated in future peer-reviewed papers and will serve as a foundation for improving the care for HF in China. TRIAL REGISTRATION NUMBER: NCT02877914.

The primary health-care system in China.

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.

[Prospective cohort study on the relationship between smoking cessation and cancer risk in males].

OBJECTIVE: To investigate the effect of smoking cessation on the risk of cancer among male subjects. METHODS: Participants of this study were derived from the workers in Kailuan Group who took the health check-up examination in its 11 affiliated hospitals. The check-up examinations were given biennially based on uniformed standard. From May 2006 to December 2011, health examinations were given for 3 rounds and a total of 104 809 male workers involved. The date of being enrolled in this study was defined as that of taking first check-up, and the date of end-of-observation was defined as that of cancer diagnosis, death or end of follow-up. INCLUSION CRITERIA: age ≥18 while being enrolled in this study, and there was no information missing in the questionnaire for age (or date of birth), smoking status, the age of starting smoking, the age of quitting smoking, and smoking amount. The information of smoking status was collected by questionnaires, and the information of newly-diagnosed cancer cases was obtained by follow-up. After adjusted for age, education background, drinking habits, working environment and BMI, multi-variate Cox proportional hazard regression models were used to analyze the association between smoking cessation and cancer risk (all sites of cancers, smoking-related cancers, and lung cancer) by calculating the values of HR (hazard ratio) and 95% CI (confidence interval). RESULTS: Totally, 104 809 subjects were followed up for 450 639.6 person-years, including 46 013 smokers (43.90%), 51 624 never-smokers (49.26%), and 7 172 smoking quitters (6.84%). Among all these subjects, 1 323 were diagnosed as cancer cases, including 1 082 smoking-related cancers, of which 378 were lung cancer cases. The results showed that, compared with never-smokers, smokers had increased risks for all sites of cancers (HR=1.38, 95% CI: 1.20- 1.59), smoking-related cancers (HR=1.45, 95% CI: 1.24- 1.69) and lung cancer (HR=1.70, 95% CI: 1.31- 2.21). While compared with the smokers, smoking quitters had decreased risk of lung cancer (HR=0.36, 95% CI: 0.20- 0.65). For the smokers with smoking history ≥20 pack-years, HR (95% CI) of lung cancer incidence was 0.09 (0.01- 0.65). For people age ≥60 smoke quitter, HR (95% CI) of lung cancer incidence was 0.33 (0.16- 0.68). For people who quit ≥10 years, HR (95% CI) of lung cancer incidence was 0.19(0.06- 0.58). CONCLUSION: Smoking cessation might decrease the risk of lung cancer among male smokers. The risk of lung cancer was lower among the smoking quitters with longer history of smoking, older age, and longer years of quitting smoking.

[Effect of maximum blood pressure when discharged from the hospital on the prognosis among patients with acute ischemic stroke].

OBJECTIVE: To investigate the relationship between maximum blood pressure and the prognosis after discharged from the hospital, among patients with ischemic stroke. METHODS: A cohort study was conducted which including 471 cases of ischemic stroke patients that were collected from February 2014 to December 2014 at the Second Affiliated Hospital of Harbin Medical University. Values of everyday blood pressure were measured on each patient at the first six days after admitted to the hospital. Maximum blood pressure value of the 6 days was taken as an indicator of the blood pressure levels. The ability on daily living was measured by the modified Rankin score (mRs). Data were analyzed by Chi-square test, t test and multivariate logistic regression analysis. RESULTS: Confounding factors would include age, gender, culture, physical activity, income, smoking, alcohol, hypertension, diabetes, coronary heart disease, stroke history, hospitalization mRs, lipid parameters, homocysteine and blood sugar and were adjusted. Results from multivariate logistic regression analysis showed that the maximum SBP was associated with adverse outcomes. Compared with 140-159 mmHg for SBP, OR (95% CI) was 2.51 (1.30-4.85) for 160-179 mmHg, OR (95% CI) was 2.68 (1.27-5.65) for those pressure levels higher than 180 mmHg, after multiple factors were adjusted. Compared with 90-99 mmHg for DBP, OR (95% CI) was 1.92 (1.00-3.67) for 100-109 mmHg, OR (95% CI) was 2.78 (1.35-5.69) for the ones higher than 110 mmHg. CONCLUSION: Maximum blood pressure during hospitalization might be associated with adverse outcome of ischemic stroke patients.