Nationwide survey of physicians' familiarity and awareness of diabetes guidelines in China: a cross-sectional study.

OBJECTIVE: This study aims to investigate physicians' familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines. DESIGN: A cross-sectional study. SETTING: An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians. PARTICIPANTS: 1150 physicians from 192 cities across 30 provinces in China provided complete data. RESULTS: Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics. CONCLUSIONS: Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians' awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.

Association between intrahepatic triglyceride content in subjects with metabolically healthy abdominal obesity and risks of pre-diabetes plus diabetes: an observational study.

OBJECTIVE: We aimed to evaluate the association of intrahepatic triglyceride (IHTG) content in subjects with metabolically healthy abdominal obesity (MHAO) on risks of pre-diabetes plus diabetes. DESIGN: Cross-sectional survey. SETTING: Lianqian community, the First Affiliated Hospital of Xiamen University, Xiamen, China. PARTICIPANTS: Among 1523 community-living healthy adults aged 40 years or older with abdominal obesity recruited at baseline, 428 subjects who underwent IHTG content measurement were selected. OUTCOME MEASURES: Risk of pre-diabetes plus diabetes. RESULTS: Non-alcoholic fatty liver disease (NAFLD) was diagnosed as 203 (69.1%) in MHAO and 121 (90.3%) in metabolically unhealthy abdominal obesity (MUAO) (p<0.001). The prevalence rates of pre-diabetes plus diabetes were 81.1%, 88.8% and 90.9% across the tertiles of IHTG content (p=0.037). Both MUAO (vs MHAO) and NAFLD (vs non-NAFLD) were independently associated with increased risks of pre-diabetes plus diabetes, the adjusted ORs (95% CIs) were 10.90 (3.15 to 37.69, p<0.001) and 3.02 (1.47 to 6.20, p=0.003), respectively. Higher IHTG content was significantly associated with increased risk of pre-diabetes plus diabetes with the adjusted OR (95% CI) of per SD increase of IHTG content of 1.62 (1.07 to 2.46, p=0.024). And there was a significantly positive trend between increasing categories of IHTG content tertiles and excessive risks of pre-diabetes plus diabetes (trend test p value=0.011). Stratified analyses showed similar results on the associations of NAFLD and IHTG content with risks of pre-diabetes plus diabetes for subjects with MHAO but not for those with MUAO. CONCLUSIONS: NAFLD and higher IHTG content were independently associated with increased risks of pre-diabetes plus diabetes in MHAO subjects. NAFLD or quantity of liver fat should be considered as additional criterion when defining and diagnosing MHO. Screening of NAFLD and intervention to reduce liver fat should be strengthened even for those seemly metabolically healthy obese.

Joint associations of metabolically healthy abdominal obesity and non-alcoholic fatty liver disease with prediabetes and diabetes in Chinese adults.

INTRODUCTION: We aimed to evaluate the joint associations of metabolically healthy abdominal obesity (MHAO) with non-alcoholic fatty liver disease (NAFLD) on risks of diabetes and prediabetes. RESEARCH DESIGN AND METHODS: Baseline information of 1318 adults with abdominal obesity (waist circumference ≥90 cm for men and 80 cm for women) from an ongoing cohort study in Xiamen, China were analyzed. Metabolic health was identified as none of the criteria of metabolism syndrome, except for obesity, was met. RESULTS: MHAO and metabolically unhealthy abdominal obesity (MUAO) were identified on 173 (13.1%) and 1145 (86.9%) subjects. NAFLD was further diagnosed on 60 (34.7%) in MHAO and 721 (63.0%) in MUAO groups (p<0.001). Both MUAO (vs MHAO) and NAFLD (vs non-NAFLD) were independently associated with increased risks of diabetes as well as prediabetes plus diabetes, with the adjusted ORs (95% CIs) of 9.40 (3.38 to 26.14) and 2.02 (1.47 to 2.77), respectively. Compared with MHAO and non-NAFLD, MHAO and NAFLD showed significantly increased risks of prediabetes plus diabetes with the adjusted ORs (95% CIs) of 2.87 (1.32 to 6.27, p=0.008). And there were significantly positive trends between increasing categories jointly by MHAO and NAFLD (from MHAO and non-NAFLD, MHAO and NAFLD, MUAO and non-NAFLD to MUAO and NAFLD) with risks of diabetes and prediabetes plus diabetes (both trend tests: p<0.001). CONCLUSIONS: About 35% of subjects with MHAO accompanied by NAFLD showed excessive risk of prediabetes plus diabetes compared with MHAO and non-NAFLD. Thus, NAFLD should be screened and intervened even for those subjects with metabolically healthy obesity (MHO) and should be considered as one additional criterion when defining and diagnosing MHO.

Sensitive pH-responsive point-of-care electrochemical immunoassay for influenza A (H1N1) virus using glucose oxidase-functionalized Ti3C2-MXene nanosheets.

Influenza A (H1N1) virus is a serious health threat and potential leading cause of death around the world during the processes of immunity and inflammation. Herein a sensitive pH-responsive point-of-care (POC) electrochemical immunoassay was designed for the quantitative monitoring of H1N1 influenza virus using glucose oxidase (GOx) and secondary antibody-functionalized Ti3C2-MXene nanosheets. The assay was carried out on the basis of the sandwich-type immunoreaction in the capture antibody-coated microplate. Two-dimensional (2D) Ti3C2-MXene nanosheets with a large surface area could efficiently enhance the loading amount of GOx molecules, thereby resulting in the signal amplification. Accompanying the formed immunocomplexes, labeled GOx molecules catalyzed glucose into gluconic acid and hydrogen peroxide. The generated gluconic acid caused a pH change of the detection solution, which was quantitatively determined on a handheld pH meter. Two labeling strategies with and without Ti3C2-MXene nanosheets were investigated to determine the target H1N1 influenza virus, and improved properties were acquired with the Ti3C2-MXene-labeled system. Under optimum conditions, the Ti3C2-MXene-based immunoassay gave good dynamic responses toward the target H1N1 influenza virus from 0.01 µg mL-1 to 100 µg mL-1 with a detection limit of 1.3 ng mL-1. Good reproducibility, high specificity, and acceptable stability were also achieved in the analysis of the target H1N1 influenza virus. Significantly, measurements of the H1N1 influenza virus from clinical human samples were demonstrated to further confirm the method reliability and accuracy of the Ti3C2-MXene-based electrochemical immunoassay. Importantly, such a pH-meter-based immunoassay can be suitable for use in point-of-care applications and opens new opportunities for diagnostics.

Time Distributions of Common Respiratory Pathogens Under the Spread of SARS-CoV-2 Among Children in Xiamen, China.

Objectives: The aim of this study was to observe the effect of COVID-19 prevention and control measures on the transmission of common respiratory viruses in a pediatric population. Methods: This was a retrospective observational study. The study population was selected from children with respiratory diseases who attended Xiamen Children's Hospital from January 1, 2018 to January 31, 2021. All children were screened for influenza virus, parainfluenza virus, respiratory syncytial virus (RSV), adenovirus, and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The changes in respiratory virus detection rates before and after the SARS-CoV-2 intervention were analyzed using an interrupted time-series model. Polynomial curve fitting was also used to predict future short-term trends in respiratory virus detection. Results: A total of 56,859 children were seen at Xiamen Children's Hospital from January 1, 2018 to Jan 31, 2021, of which 32,120 were tested for respiratory viruses via pharyngeal swabs. The overall positive detection rates of the four respiratory viral infections decreased significantly (P = 0.0017) after the implementation of the quarantine and school suspension measures in January 2020. Among them, the detection rate of RSV decreased most significantly (P = 0.008), and although there was no statistically significant difference in the detection rates of the influenza virus, parainfluenza virus, and adenovirus, a downward trend in the graph was observed. The positive detection rates of RSV in the 0-1-, 1-3-, and 3-7-year-old groups all decreased significantly (P = 0.035, 0.016, and 0.038, respectively). The change in the positive detection rate of RSV was relatively stable in the 7-18-year-old group. A total of 10,496 samples were tested for SARS-CoV-2, and no positive cases were reported. Conclusions: The combination of preventive and control measures for COVID-19 reduced the detection rate of four common respiratory viruses, with the greatest impact on RSV. If prevention and control measures continue to be maintained, the overall detection rate or absolute number of detections for the four respiratory viruses will remain low in the short term. However, this trend is likely to vary with the changes in measures.

Infant Breastfeeding and Behavioral Disorders in School-Age Children.

OBJECTIVE: To explore the effects of breastfeeding on behavioral disorders of school-age children. MATERIALS AND METHODS: Totally 1,979 children of 6-11 years old from three primary schools in Xiamen, China, were assessed and included for further analysis. The Pearson chi-square test and multivariable logistic regression model were used to analyze the effects of breastfeeding on internalizing behaviors such as depression, withdrawn, and somatic complaints, and externalizing behaviors such as aggression and rule-breaking behavior. RESULTS: The Pearson chi-square test revealed that the percentages in internalizing behavioral problems (χ2 = 21.693, p < 0.001), depression (χ2 = 12.713, p = 0.002), and somatic complains (χ2 = 12.850, p = 0.002) were significantly lower with the decrease of the duration of breastfeeding. However, there were no statistically significant differences in externalizing behavioral problems. After adjusting the potential covariates, children who were breastfed for >6 months were significantly associated with the reduced risk of internalizing behavioral problems (Odds ratio = 0.446, 95%CI: 0.228-0.873) and depression (Odds ratio = 0.452, 95% CI: 0.225-0.906) compared with those who were never breastfed, whereas differences were not found in externalizing behavioral problems. CONCLUSION: Increased duration of breastfeeding (≥6 months) could help lower internalizing behavioral problems, particularly depression, in school-age children. Breastfeeding with longer duration will play an important role to prevent and reduce children's internalizing behavioral disorders.

Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis.

The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis

Abstract: The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

Association of traffic-related air pollution with children's neurobehavioral functions in Quanzhou, China.

BACKGROUND: With the increase of motor vehicles, ambient air pollution related to traffic exhaust has become an important environmental issue in China. Because of their fast growth and development, children are more susceptible to ambient air pollution exposure. Many chemicals from traffic exhaust, such as carbon monoxide, nitrogen dioxide, and lead, have been reported to show adverse effects on neurobehavioral functions. Several studies in China have suggested that traffic exhaust might affect neurobehavioral functions of adults who have occupational traffic exhaust exposure. However, few data have been reported on the effects on neurobehavioral function in children. OBJECTIVES: The objective of this study was to explore the association between traffic-related air pollution exposure and its effects on neurobehavioral function in children. METHODS: This field study was conducted in Quanzhou, China, where two primary schools were chosen based on traffic density and monitoring data of ambient air pollutants. School A was located in a clear area and school B in a polluted area. We monitored NO(2) and particulate matter with aerodynamic diameter < or = 10 mum as indicators for traffic-related air pollution on the campuses and in classrooms for 2 consecutive days in May 2005. The children from second grade (8-9 years of age) and third grade (9-10 years of age) of the two schools (n = 928) participated in a questionnaire survey and manual-assisted neurobehavioral testing. We selected 282 third-grade children (school A, 136; school B, 146) to participate in computer-assisted neurobehavioral testing. We conducted the fieldwork between May and June 2005. We used data from 861 participants (school A, 431; school B, 430) with manual neurobehavioral testing and from all participants with computerized testing for data analyses. RESULTS: Media concentrations of NO(2) in school A and school B campus were 7 microg/m(3) and 36 microg/m(3), respectively (p < 0.05). The ordinal logistic regression analyses showed that, after controlling the potential confounding factors, participants living in the polluted area showed poor performance on all testing; differences in results for six of nine tests (66.7%) achieved statistical significance: Visual Simple Reaction Time with preferred hand and with nonpreferred hand, Continuous Performance, Digit Symbol, Pursuit Aiming, and Sign Register. CONCLUSION: We found a significant relationship between chronic low-level traffic-related air pollution exposure and neurobehavioral function in exposed children. More studies are needed to explore the effects of traffic exhaust on neurobehavioral function and development.

Blood lead levels of children and its trend in China.

To evaluate Chinese children's blood lead levels (BLLs) and identify its distribution features, we collected articles on children's BLLs published from Jan, 2004 to Aug, 2007 with sampling time since 2001, by searching Chinese Biomedical Disk (CBMDisk), Chinese Journal Full-test Database (CJFD) and other ways. After a rigorous investigation, 35 articles eligible for inclusion criteria were reviewed. Meanwhile, to reveal the trend of Chinese children's BLLs, the data was compared with the results from our former study carried out in 2004, which reviewed the articles published since 1995 to 2003. The results showed that the mean BLLs of Chinese children from 2001 to 2007 was 80.7 microg/L (45.5-165.3 microg/L), and 23.9% (3.2%-80.7%) of children's BLLs was higher than 100 microg/L. Both BLLs and prevalence of BLLs higher than 100 microg/L were lower than that of 1995 to 2003. Of 24 provinces or cities, only 4 showed higher BLLs and higher prevalence rates of lead poisoning (BLLs > or =100 microg/L) than that of 1995 to 2003. The mean BLLs of children living in industrial areas were higher than those in urban and suburban areas, and suburban higher than urban areas. Boys' BLLs were 79.3 microg/L, significantly higher than girls 76.9 microg/L (P<0.001). The results also showed that children's BLLs increased with their ages, and the decreased BLLs for all age were observed comparing with the results of our former study in 2004. Overall, our study revealed that the BLLs of children in China showed a decreasing trend after gasoline with lead was banned in China in 1st July 2000. Our study also showed that the BLLs of children in China were still higher than that in developed countries, which suggested that children's lead poisoning prevention and controlling would be a long-term mission in China.

[Study on rhGM-CSF as adjuvant in revaccination among adults of non-and hyporesponders to hepatitis B vaccine].

OBJECTIVE: To investigate the effect of recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) as adjuvant on immune response in adults of non-and hyporesponders to hepatitis B vaccine. METHODS: Those who were once immunized with recombined yeast gene hepatitis B vaccine more than one standard scheme in two years and negative for hepatitis B markers were randomly sorted as group A and group B. 33 adults of group A were given hepatitis B vaccine 10 microg each time. The immune procedure was 0, 1 and 6 month. 34 adults of group B were given rhGM-CSF 300 microg for the first day, then 10 microg each time for routine immune. The blood samples were collected before the first injection and in 1, 2 and 8 months (T1, T2, T8) following the first injection to test Anti-HBs. RESULTS: Anti-HBs positive conversion rates of group A and B at T8 was 39.39% and 64.71% respectively (P = 0.038). Anti-HBs levels of group B at T1, T2, T8 were (113.85 +/- 198.56) mIU/ml, (312.40 +/- 349.44) mIU/ml, (427.74 +/- 411.58) mIU/ml (P = 0.001). There was significant difference between group A and B in T8 Anti-HBs levels (P = 0.010). CONCLUSION: Better immune response was found in the group of rhGM-CSF with hepatitis B vaccine. So rhGM-CSF can induce the immune respond to hepatitis B vaccine.

[Effects of traffic exhausts on children' s neurobehavioral functions scored by neurobehavioral evaluation methods in Quanzhou, Fujian province].

OBJECTIVE: To explore the effects of traffic exhausts on children's neurobehavioral functions. METHODS: A field study was conducted in Quanzhou, Fujian province where two primary schools were chosen based on the numbers of automobiles passing by,and the data of ambient air pollutants from the monitoring system. School B and School A located at the high traffic exhausts pollution area and the clear area, respectively. Neurobehavioral functions of pupils in grade 2 and 3 were scored. RESULTS: School B had very similar score of Ruiwen Test with School A, while the score of Digit Eras Test was lower than that in School A with marginal significance. The scores of Digit Symbol,Aim Tracing, Sign Register and Cormect Number test were 38.5 +/- 9.96, 84.3 +/- 27.83, 37.4 +/- 11.62 and 17.1 +/- 5.88 in School B,respectively, which were significantly lower than those in School A (41.6 +/- 12.97, 95.5 +/- 35.80, 42.3 +/- 15.58 and 18.7 +/- 5.78) respectively. Scores in Digit Symbol,Aim Tracing,Sign Register and Cormect Number of pupils in School B were 2.9, 11.5, 5.6 and 1.6 lower than those in School A after adjusting on other confounding factors. CONCLUSION: It was suggested that traffic exhausts might cause damage to children's neurobehavioral functions.

Blood lead levels in children, China.

To evaluate Chinese children's blood lead levels (BLLs) and identify its distribution features, we collected articles on children's BLLs published from 1994 to March 2004 using the Chinese Biomedical Disc and reviewed 32 articles eligible for the following criteria: (1) BLLs measured by Graphite Furnace Atomic Absorption Spectroscopy or Inductively Coupled Plasma-Mass Spectrometry; (2) strict quality control; (3) no lead pollution sources in the areas where the screened subjects live; and (4) sample size bigger than 100. We found that mean BLLs of Chinese children was 92.9 microg/L (37.2-254.2 microg/L), and 33.8% (9.6-80.5%) of the subjects had BLLs higher than 100 microg/L. Nine of the 27 provinces or cities reported had average BLLs 100 microg/L. Boys' BLL was 96.4 microg/L, significantly higher than girls' 89.4 microg/L (P<0.001). BLLs of children 6 years increased with age. The mean BLLs of children living in industrial and urban areas were significantly higher than those of children in suburbs and rural areas. Our results suggested that children's BLLs in China are higher than those of their counterparts in other countries due to its heavy lead pollution. Therefore, this is of great public health importance.