Effectiveness of Lifestyle and Drug Intervention on Hypertensive Patients: a Randomized Community Intervention Trial in Rural China.

BACKGROUND: Strict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow. OBJECTIVE: To evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients. DESIGN: Randomized community intervention trial. PARTICIPANTS: The control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China. MAIN MEASURES: Data on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention. KEY RESULTS: BP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001). CONCLUSION: The addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.

Associations of metabolic disorder factors with the risk of uncontrolled hypertension: a follow-up cohort in rural China.

We evaluated how metabolic disorders affected antihypertension therapy. 2,912 rural Chinese patients with hypertension who provided blood samples, demographic and clinical data at baseline and after 1 year of antihypertension therapy were evaluated. At baseline, 1,515 patients (52.0%) were already receiving drug therapy and 11.4% of them had controlled blood pressure (BP). After 1 year, all 2,912 patients were receiving antihypertension therapy that was administered by community physicians, and 59.42% of them had controlled BP. Central obesity and abnormal triglyceride, high-density lipoprotein cholesterol, and glucose were associated with 15-70% higher risks of uncontrolled hypertension. Metabolic syndrome using the JIS criteria was associated with poor BP control (odds ratio: 1.71 and 1.54 for the baseline and follow-up datasets, respectively). The risk of uncontrolled hypertension increased with the number of metabolic disorders (p for trend <0.01). The presence of ≥3 metabolic disorder factors was associated with higher risks of poor BP control. The associations of metabolic factors and uncontrolled hypertension were stronger for the standard and modified ATP III criteria, compared to the IDF and JIS criteria. Metabolic factors were associated with less effective antihypertension therapy, and all definitions of metabolic syndrome helped identify patients with elevated risks of uncontrolled hypertension.

Prevalence of metabolic syndrome and its risk factors among rural adults in Nantong, China.

The prevalence of metabolic syndrome (MS) varies worldwide due to genetic and environmental factors. A population-based cross-sectional study, with 37,582 participants recruited in Nantong, China in 2007-2008 (stage I) and 2013 (stage II). Socio-demographic, lifestyle factors, disease history and fasting blood sample were collected. The prevalence of MS was much higher in 2013 (42.6%) than that in 2007-2008 (21.6%), which was significantly higher in older people in both stages. Participants with two or more familial history of diseases were associated with a higher MS prevalence compared to those who didn't have familial history of diseases. Total physical activity (PA) was associated with 24 and 19% decreased risk of MS in men and women. Occupational PA in moderate and vigorous intensity was associated with a 25%-45% decreased risk of MS. Female smokers who smoked more than 10 cigarettes per day or over 25 years were associated with 96 and 74% increased MS risk, respectively. The highest quartile of rice wine consumption was associated with a lower risk of MS with OR of 0.63 in women, compared with female non-drinkers. These findings indicated that PA and rice wine are two protective factors in MS prevention in rural areas of East China.

Biocompatible composite nanoparticles with large longitudinal relaxivity for targeted imaging and early diagnosis of cancer.

Early diagnosis of cancer greatly increases the chances of successful treatment by radical resection. The sensitivity of magnetic resonance imaging (MRI) techniques for detecting early stage tumors can be increased with the assistance of a positive MRI contrast agent. However, the traditional positive MRI contrast agents, such as Gd-chelates and Gd-based inorganic nanoparticles, are often limited by their cytotoxicity and low specificity. Here, we propose a new design of MRI contrast agent based on gadolinium oxide nanocrystals (GON) for targeted imaging and cancer early diagnosis with good biocompatibility. The GON were prepared using a polyol method and then encapsulated into albumin nanoparticles (AN), which were cross-linked with glutaraldehyde and found to exhibit bright and stable autofluorescence without conjugation to any fluorescent agent. After that, a target molecule, folic acid (FA), was conjugated onto the surface of the GON-loaded AN (GON-AN) to construct a GON-AN-FA composite. The as-prepared nanoparticles are biocompatible and stable in serum. The results of MRI relaxation studies show that the longitudinal relaxivities (r1) of GON-AN (11.6 mM-1 s-1) and GON-AN-FA (10.8 mM-1 s-1) are much larger than those of traditional positive MRI contrast agents, such as Magnevist (3.8 mM-1 s-1). The results of cell viability assays indicate that GON-AN and GON-AN-FA are almost non-cytotoxic. Furthermore, the specificities of GON-AN and GON-AN-FA were evaluated with two kinds of cancer cells which overexpress folate receptor alpha (FRα). The results reinforce that the autofluorescent GON-AN-FA is able to target cancer cells via recognition of the ligand FA and the receptor FRα. Therefore, our autofluorescent GON-AN-FA possessing a large longitudinal relaxivity and good biocompatibility represents a significant advance for the targeted imaging and early diagnosis of cancer.

[Survey of patients with chronic hepatitis B to identify factors that influence quality of life].

OBJECTIVE: To survey patients with chronic hepatitis B (CHB) to determine their perceptions of CHB-related quality of life (QOF) and to determine the factors influencing this measure. METHODS: A total of 268 patients with CHB (disease group) and 205 healthy individuals (control group) completed the World Health Organization (WHO)QOL-BREF life assessment survey and a self-designed questionnaire of health and QOL. The groups' responses were comparatively analyzed by the cluster sampling method and the independent samples t-test. The strength of influence of each factor on the patients' perceptions of QOL was determined by multiple stepwise regression and one-way ANOVA. RESULTS: The disease group had significantly lower scores than the control group for overall QOL (62.88 ± 8.22 vs. 67.31 ± 5.82), the physiological area (PHYS: 64.71 ± 15.05 vs. 73.21 ± 11.26), the psychological area (PSYCH: 64.35 ± 14.71 vs. 68.94 ± 10.13), the social relations area (SOCIL: 67.20 ± 12.98 vs. 69.83 ± 8.65), the environmental area (ENVIR: 59.58 ± 13.23 vs. 63.97 ± 10.24), the QOL self-assessment (60.75 ± 21.54 vs. 66.90 ± 17.57) and the health self-assessment (58.13 ± 19.15 vs. 76.26+/-14.27) (all, P less than 0.05). Multiple stepwise regression analysis identified the following parameters as risk factors of PHYS: depression (P less than 0.001), perception of being seriously ill (P less than 0.001), self-payment for treatment (P = 0.003), CHB significant impact on income (P = 0.002), poor appetite (P = 0.002), langur (P less than 0.001), and fear of infecting others (P = 0.022). Confidence of treatment was a protective factor of PHYS (P = 0.001). The risk factors of PSYCH were depression (P less than 0.001) and recurrence (P less than 0.001), and the protective factors were confidence of treatment (P = 0.003) and male sex (P = 0.014). The risk factors of SOCIL were depression (P less than 0.001, dissatisfaction with the attitude of the people around (P = 0.001), recurrence (P = 0.008), and advanced age (P = 0.009), and the protective factors were social support (P less than 0.001) and confidence of treatment (P = 0.015); however, the scores were significantly different for different occupations (P = 0.008). The risk factors of ENVIR were depression (P less than 0.001), dissatisfaction with the attitude of the people around (P less than 0.001), living in rural area (P = 0.007), and recurrence (P = 0.016). CONCLUSION: Patients should be monitored for depressive symptoms during the course of clinical medical care for CHB so that psychological care may be initiated in a timely manner. It is important to strengthen communication between healthcare professionals and patients in order to improve the patient's perception of social support and quality of life.