Association of serum folate with prevalence of non-alcoholic fatty liver disease among adults (NHANES 2011-2018).

Background: Folate was involved in oxidative stress, hepatic lipid metabolism and chronic hepatic inflammation. However, evidence about the association between serum folate level and non-alcoholic fatty liver disease (NAFLD) in general population is scarce. This study aimed to explore the relationship between serum folate level and NAFLD among adults. Methods: 7,146 adult participants aged 20 years and over who have complete data of serum folate level and liver function biomarkers in NHANES 2011-2018 were included. Serum folate level was measured by isotope-dilution high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). And suspected NAFLD was defined according to the United States fatty liver index (USFLI). Logistic regression and the restricted cubic spline models were performed. Results: Serum folate level was inversely associated with the presence of NAFLD. When comparing the second, third and fourth quartiles of serum folate level to the lowest quartile, the adjusted ORs of the presence of NAFLD were 0.62 (0.49-0.78), 0.65 (0.51-0.84), and 0.43 (0.32-0.56) respectively (p for trend<0.001). The non-linear and L-shaped relationship was found between serum folate level and the presence of NAFLD in the restricted cubic spline regression (p for non-linearity <0.01). Consistent with serum total folate, serum 5-Methyltetrahydrofolate level was also inversely associated with the presence of NAFLD. Conclusion: Higher serum folate level may be negatively associated with NAFLD.

Association between serum copper, zinc and their ratio and handgrip strength among adults: a study from National Health and Nutrition Examination Survey (NHANES) 2011-2014.

Evidence for the association between serum copper and zinc status and handgrip strength is very limited only in several observational studies with study participants of specific population or a narrower age range. The aim of this study was to evaluate the association between serum copper, zinc and their ratio and handgrip strength in the general population. This study included adult participants aged 20-80 years with complete data of serum copper and zinc status and handgrip strength from NHANES 2011-2014. Handgrip strength was calculated as the average of the maximum measure obtained in each hand with a grip strength dynamometer and corrected using BMI. Serum copper and zinc levels were measured using inductively coupled plasma dynamic reaction cell mass spectrometry, and their ratios were calculated. The multivariable linear regression and restricted cubic spline models were used. Serum copper level was inversely associated with BMI-corrected handgrip strength, and the beta coefficients (95% confidence intervals) comparing the second, third, and fourth to the lowest quartiles of serum copper level were - 0.17 kg (- 0.26; - 0.08), - 0.22 kg (- 0.32; - 0.13), and - 0.36 kg (- 0.44; - 0.28), respectively (P for trend < 0.001). Non-linear association was detected between serum copper level and BMI-corrected handgrip strength (P < 0.01). Consistent with serum copper, serum copper/zinc ratio was inversely associated with BMI-corrected handgrip strength. However, no significant associations were observed between serum zinc level and BMI-corrected handgrip strength (all P > 0.05). Higher serum copper level and copper/zinc ratios were significantly associated with lower handgrip strength. Further research is needed to address related issues.

Environmental tobacco smoke and cancer risk, a prospective cohort study in a Chinese population.

Few prospective cohort studies have investigated associations between environmental tobacco smoke (ETS) and other cancer sites, in addition to lung cancer. We assessed these associations in a population-based prospective cohort study started from 2008 to 2011 with average of 9.1 years of follow-up, in Minhang district, Shanghai, China. The study included a total of 23,415 participants (8388 men, 15,027 women) and 205,515 person-years. Epidemiological data were collected by a standardized questionnaire including ETS exposure. Newly diagnosed patients with primary cancers and deaths were identified by record linkage system with the Shanghai Cancer Registry and Shanghai Vital Statistics. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models, adjusting for potential confounders. During the study period, a total of 1462 patients with diagnoses of primary cancers were identified. Among all participants and non-smokers, ETS was associated with an increased risk of all smoking-related cancers (all: adjusted HR: 1.23, 95% CI: 1.05-1.43 and non-smokers: 1.24, 1.02-1.49), lung cancer (1.29, 0.98-1.71 and 1.27, 0.91-1.77), and stomach cancer (1.86, 1.21-2.85 and 1.75, 1.05-2.91), respectively. Furthermore, associations for lung and stomach cancers were the strongest among non-smoking females. The joint effects of both ETS and active smoking were strongest for all cancers, all smoking-related cancers, lung cancer, and stomach cancer. No clear interactions were observed. These results suggest that ETS exposure may increase the risk of smoking-related cancers in a Chinese population. Further studies on the relationship between ETS exposure and specific cancer sites are warranted to replicate our findings.

Relationship between low-level lead, cadmium and mercury exposures and blood pressure in children and adolescents aged 8-17 years: An exposure-response analysis of NHANES 2007-2016.

This study investigated whether low-level blood and urinary lead, cadmium and mercury exposures were associated with blood pressure (BP) in children and adolescents. Data from National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016 for children and adolescents aged 8-17 years (n = 7076) were analyzed. Outcome variables were systolic BP, diastolic BP and high BP status. High BP was defined as: self-reported antihypertensive medication usage or a diagnosis of hypertension; classified as having elevated BP/hypertension according to 2017 AAP guidelines. Multivariable linear and logistic regressions models were performed and stratified by race/ethnicity and gender. Blood lead was negatively associated with diastolic BP among blacks, and positively associated with diastolic BP among whites. For a two-fold increase of blood lead concentration, the change in diastolic BP was -1.59 mm Hg (95% CI: -3.04 to -0.16 mm Hg) among blacks and 1.38 mm Hg (95% CI: 0.40 to 2.36 mm Hg) among whites. No significant associations between either systolic BP or diastolic BP with urinary lead were observed. The inverse associations between blood lead and high BP were found in females, Mexican Americans and other Hispanics. No associations between blood cadmium and BP were observed, except in other Hispanics. Urinary cadmium levels were inversely correlated with systolic BP, diastolic BP and high BP in all participants and in men. When compared to the lowest quartile of urinary cadmium levels, participants with a urinary cadmium level ≥ 0.12 µg/L had 0.48 (95% CI: 0.29-0.78) times and 0.53 (95% CI: 0.30-0.94) times reduced odds of having high BP in all participants and in men, respectively. No associations between either blood mercury or urinary mercury with systolic BP were observed. Significant inverse associations were found between blood total mercury and methyl mercury with diastolic BP in all participants and in men. Future prospective studies are warranted to confirm these findings.

Associations Between Copper and Zinc and High Blood Pressure in Children and Adolescents Aged 8-17 Years: an Exposure-Response Analysis of NHANES 2007-2016.

Several studies have indicated an association between dietary copper and zinc intake and hypertension, but mainly limited to adult studies. Few studies have examined the associations between copper and zinc and high blood pressure (BP) in children. This study aims to evaluate the associations of zinc and copper with the risk of high BP in children and adolescents aged 8-17 years using the 2007-2016 National Health and Nutritional Examination Surveys (NHANES). A total of 7749 participants (3912 males and 3837 females) were included in the analyses. High BP was defined as (1) the participant (age ≥ 16 years) or the participant's parent/guardian (age < 16 years) reported that the participant had a diagnosis of hypertension irrespective of the BP value; or (2) the participant (age ≥ 16 years) or the participant's parent/guardian (age < 16 years) reported that the participant was currently taking an antihypertensive medication irrespective of the BP value; or (3) a participant classified as having elevated BP /hypertension according to the American Academy of Pediatrics (AAP) new guidelines. Zinc and copper intakes from diet and supplements were assessed with 24-h dietary recall. Positive correlation was found between copper intake and high BP for females, and the ORs (95% CI) across quartiles 2 to 4 compared with quartile 1 were 1.28 (0.81-2.03), 2.06 (1.26-3.36), and 2.69 (1.45-4.98) after adjusting age, gender, race/ethnicity, body mass index (BMI), serum cotinine levels, annual family income, total daily energy intake, and intakes of calcium, sodium, and potassium. Negative correlation was found for males, and the multivariate-adjusted ORs (95% CI) across quartiles 2 to 4 compared with quartile 1 were 0.81 (0.57-1.14), 0.63 (0.42-0.92), and 0.60 (0.37-1.00), respectively. A statistically significantly OR (95% CI) [1.70 (1.08-2.67)] between zinc intake and high BP was observed for participants with normal weight comparing quartiles 3 to quartile 1 of dietary zinc intake. This study suggests that dietary copper and zinc intake may affect BP in children and adolescents. Further longitudinal studies should be warranted to confirm these findings.

Electronic Health Record-Based Screening for Major Cancers: A 9-Year Experience in Minhang District of Shanghai, China.

Background: An electronic health record (e-HR) system has been developed in Minhang District of Shanghai, China, since 2005, making it convenient for local health institutions to provide integrative and comprehensive health care and management for major diseases. Methods: In 2008, an e-HR-based cancer prevention program was initiated to screen multiple cancers, including colorectal, gastric, liver, lung, cervical, and breast cancers, and provide subsequent health education and health management to cancer patients and high-risk individuals. This study was designed in prospective analysis, based on the constructive analysis of key information, observation of cancer screening and healthcare processes and organizations, and stages of cancers detected by the e-HR-based programs. Results: From 2008 to 2016, health education was conducted for over 5 million attendances, and more than 3 million screening tests were performed for eligible residents over 40 years old. A total of 2,948 cancer cases were detected, accounting for 13.3% of all newly diagnosed cancers in the district during the 9-year period. Thirty point seven percent detected cancer cases were at the early stage, significantly higher than the 22.9% in cases identified by e-HR-based follow-up and 13.8% in cases diagnosed due to signs or symptoms. More than 136,000 residents were identified as individuals at high risk of cancer and subject to sustainable clinical follow-up and health management. Conclusions: The successful application of e-HR system in cancer prevention and control in Minhang district of Shanghai, China, implies that the system may act as an extendable and sustainable infrastructure for comprehensive health care and services for a broad spectrum of diseases and health events.

Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial.

BACKGROUND: The diabetes patients in China have low health literacy and low levels of physical activities which may result in the poor glycemic control and other clinical outcomes. This study is designed to evaluate the effectiveness of health literacy and exercise-focused interventions on clinical outcomes among Chinese patients with type 2 diabetes (T2DM). METHODS: In this cluster randomized controlled trial, 799 T2DM patients with the most recent A1c ≥ 7·5% (58 mmol/mol, or fasting glucose level ≥10 mmol/L) were recruited from 35 clinics in 8 communities in Shanghai, China, and randomized into one standard care (control) arm and three intervention arms receiving interventions focused on health literacy, exercise or both. A1c (primary outcome), blood pressure and lipids (secondary outcomes) were measured at baseline, 3-, 6-, 12-months of intervention period and 12-months after completion of the interventions. This trial is registered with the International Standard RCT Number Register, number ISRCTN76130594. FINDINGS: The three intervention groups had more reductions in A1c than the control group, with 0·90% reduction in the health literacy, 0·83% in the exercise and 0·54% in the comprehensive group at 12-months (p<0·001) and these improvements remained even after a 1-year follow-up period post intervention. The risk of suboptimal A1c (≥7·0% or 53 mmol/mol) was also significantly lower in three intervention groups than control group at each follow-up visit, with adjusted risk ratios (RR) ranging from 0.06 to 0.16. However, the control group has greater reductions in low-density lipoprotein (LDL) than the health literacy group from baseline to 12-months (ß=0·55, p<0·0001) and from baseline to 24-months (ß=0·62, p<0·0001). A higher risk of abnormal LDL was also observed for the health literacy group at 12-months [adjusted risk ratio (RR): 2·22, 95%CI: 1·11-4·44] and 24-months [adjusted risk ratio (RR): 2·37, 95%CI: 1·16-4·87] compared to the control group. No significant benefits in systolic blood pressure (SBP), diastolic blood pressure (DBP) and low-density lipoprotein (HDL) were observed from the interventions compared to the usual care. INTERPRETATION: The health literacy and exercise interventions result in significant improvements in A1c. However, no significant benefits in blood pressure and lipids control were observed. These effective interventions may have potential of scaling up in China and other countries to help diabetes patients manage their blood glucose levels. FUNDING: This Study was supported by the China Medical Board (CMB) Open Competition Project (No.13-159) and the Social Science Fund of China National Ministry of Education (No.14YJAZH092).

Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis.

Risk factors for first-ever stroke have been studied extensively, while those for recurrent stroke are not accurately understood. To provide the adequate secondary prevention for the patients, it is necessary to reveal the risk factors that dominate recurrent stroke. Multiple databases were adopted to search for the relevant studies and full-text articles involving in the risk factors for stroke recurrence were reviewed. Meta-analyses were performed with Review Manager 5.0 to estimate the impact of risk factors included, and forest plots, quality analysis and bias analysis for the articles included were also conducted. Finally 11 studies which eventually satisfied the eligibility criteria were included in this study, and patients with initial stroke and recurrent stroke were 14,455 and 1545, respectively. The meta-analyses showed that hypertension (OR = 1.67, 95%CI [1.45, 1.92], P < 0.00001), diabetes mellitus (OR = 1.50, 95%CI [1.30, 1.72], P < 0.00001), atrial fibrillation (OR = 1.88, 95%CI [1.56, 2.25], P < 0.00001) and coronary heart disease (OR = 1.77, 95%CI [1.31, 2.39], P = 0.0002) played a certain role in the process of stroke recurrence, while the influences of dyslipidemia (OR = 0.92, 95%CI [0.67, 1.27], P = 0.62) and smoking (OR = 0.96, 95%CI [0.80, 1.15], P = 0.62) were not significant. Hypertension, diabetes mellitus, atrial fibrillation and coronary heart disease of patients with stroke have statistical associations with recurrent stroke, and secondary prevention and treatment should be provided to curb the recurrence.

Fasting plasma glucose variability and all-cause mortality among type 2 diabetes patients: a dynamic cohort study in Shanghai, China.

The study aims to examine whether the variation of fasting plasma glucose (FPG), represented by coefficient of variation (CV), independently predicts all-cause mortality among Chinese type 2 diabetes patients. This retrospective cohort study was designed based on a standardized electronic management system of diabetes patients in Shanghai, China. 8871 type 2 diabetes patients were enrolled between 1 January 2007 and 31 December 2007 and were followed-up for all-cause mortality until 31 December 2014. All patients were grouped by the quartiles of CV of FPG. 1136 patients deceased during following-up. After adjusting for other risk factors, CV of FPG was not independently associated with all-cause mortality. Stratified analysis by mean FPG levels (<7 mmol/L and ≥7 mmol/L) observed a significant modifying effect of CV of FPG (P for interact test <0.01). CV of FPG was independently associated with all-cause mortality in patients whose glucose control was poor, with the HRs (95% CI) for the second, third, fourth vs first quartiles of CV of FPG being 1.23(0.94-1.61), 1.23(0.94-1.61), and 1.63(1.25-2.13), respectively. Our results suggest that variability of FPG may be an important predictor of mortality among type 2 diabetes in China, particularly for those with their glycemic status uncontrolled.

Cancer incidence in patients with type 2 diabetes mellitus: a population-based cohort study in Shanghai.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has been suggested to increase the risk of cancers. The aim of this study was to investigate the risk of common cancers in Chinese patients with T2DM. METHODS: A population-based retrospective cohort study including 36,379 T2DM patients was conducted in Minhang District of Shanghai, China, during 2004 to 2010. All T2DM patients were enrolled from the standardized management system based on local electronic information system. Newly-diagnosed cancer cases were identified by record-linkage with the Shanghai Cancer Registry. Standardized incidence ratios (SIR) and 95% confidence interval (CI) were used to estimate the risk of cancers among T2DM patients. RESULTS: Overall crude incidence rate (CIR) of cancers was 955.21 per 105 person-years in men and 829.57 per 105 person-years in women. Increased risk of cancer was found in both gender, with an SIR being 1.28 (95% CI = 1.17-1.38) in men and 1.44 (95% CI =1.32-1.55) in women. Increased risk of colon (SIR = 1.97; 95% CI = 1.49 to 2.46), rectum (1.72; 1.23 to 2.21), prostate (2.87; 2.19 to 3.56), and bladder cancers (1.98, 1.28 to 2.68) were observed in men and elevated risk of colon (1.67; 1.25 to 2.08), breast (1.66; 1.38 to 1.95), and corpus uteri cancers (2.87; 2.03 to 3.71) were observed in women. CONCLUSIONS: Our results indicate that Chinese patients with T2DM may have an increased risk of some cancers, and the increase may vary by sub-sites of cancers.

[Birth weight and subsequent risk of type 2 diabetes across two generations in Chinese females].

OBJECTIVE: To evaluate the association between birth weight and subsequent risk of type 2 diabetes (T2DM) across two generations in Chinese females. METHODS: A cross-sectional survey was conducted among 10 324 blood-related females in Shanghai from November 2012 to January 2013. A structured questionnaire was used to collect data about demographic information, birth weight, lifestyle factors and diagnosis of T2DM. Path analysis was performed to estimate the maternal effect of birth weight and diabetes status on their offspring, and mediation analysis was conducted to test whether birth weight mediates the association between maternal and daughters' diabetes status. RESULTS: A positive association was observed between maternal and daughters' birth weight. One kg increase in maternal birth weight was associated with an average of 0.335 (95% CI: 0.307-0.363) kg elevated birth weight in female offspring. Maternal diabetes status was also related with an average of 0.066 (95% CI:0.025-0.107) kg increase in birth weight and tripled risk of subsequent T2DM (OR = 3.173, 95% CI: 1.946-5.174) in female offspring. In all subjects aged ≥ 20 years, no significant relationship was observed between birth weight and risk of T2DM subsequently after adjusting for age. Offspring's birth weight, as a mediator of maternal and daughters' diabetes status, explained 2.8% of their association. CONCLUSION: Maternal birth weight and diabetes status may influence their female offspring's birth weight and subsequent risk of T2DM.

Intake of fruit and vegetables and risk of bladder cancer: a dose-response meta-analysis of observational studies.

BACKGROUND: Observational studies suggest an association between fruit and vegetables intake and risk of bladder cancer, but the results are controversial. METHODS: We therefore summarized the evidence from observational studies in categorical, linear, and nonlinear, dose-response meta-analysis. Pertinent studies were identified by searching EMBASE and PubMed from their inception to August 2013. RESULTS: Thirty-one observational studies involving 12,610 cases and 1,121,649 participants were included. The combined rate ratio (RR, 95 % CI) of bladder cancer for the highest versus lowest intake was 0.83 (0.69-0.99) for total fruit and vegetables, 0.81 (0.70-0.93) for total vegetables, 0.77 (0.69-0.87) for total fruit, 0.84 (0.77-0.91) for cruciferous vegetables, 0.79 (0.68-0.91) for citrus fruits, and 0.74 (0.66-0.84) for yellow-orange vegetables. Subgroup analysis showed study design and gender as possible sources of heterogeneity. A nonlinear relationship was found of citrus fruits intake with risk of bladder cancer (P for nonlinearity = 0.018), and the RRs (95 % CI) of bladder cancer were 0.87 (0.78-0.96), 0.80 (0.67-0.94), 0.79 (0.66-0.94), 0.79 (0.65-0.96), and 0.79 (0.64-0.99) for 30, 60, 90, 120, and 150 g/day. A nonlinear relationship was also found of yellow-orange vegetable intake with risk of bladder cancer risk (P for nonlinearity = 0.033). Some evidence of publication bias was observed for fruit, citrus fruits, and yellow-orange vegetables. CONCLUSION: This meta-analysis supports the hypothesis that intakes of fruit and vegetables may reduce the risk of bladder cancer. Future well-designed studies are required to confirm this finding.

Dietary fiber intake and risk of type 2 diabetes: a dose-response analysis of prospective studies.

Observational studies suggest an association between dietary fiber intake and risk of type 2 diabetes, but the results are inconclusive. We conducted a meta-analysis of prospective studies evaluating the associations of dietary fiber intake and risk of type 2 diabetes. Relevant studies were identified by searching EMBASE (from 1974 to April 2013) and PubMed (from 1966 to April 2013). The fixed or random-effect model was selected based on the homogeneity test among studies. In addition, a 2-stage random-effects dose-response meta-analysis was performed. We identified 17 prospective cohort studies of dietary fiber intake and risk of type 2 diabetes involving 19,033 cases and 488,293 participants. The combined RR (95 % CI) of type 2 diabetes for intake of total dietary fiber, cereal fiber, fruit fiber and insoluble fiber was 0.81 (0.73-0.90), 0.77 (0.69-0.85), 0.94 (0.88-0.99) and 0.75 (0.63-0.89), respectively. A nonlinear relationship was found of total dietary fiber intake with risk of type 2 diabetes (P for nonlinearity < 0.01), and the RRs (95 % CI) of type 2 diabetes were 0.98 (0.90-1.06), 0.97 (0.87-1.07), 0.89 (0.80-0.99), 0.76 (0.65-0.88), and 0.66 (0.53-0.82) for 15, 20, 25, 30, and 35 g/day. The departure from nonlinear relationship was not significant (P for nonlinearity = 0.72), and the risk of type 2 diabetes decreased by 6 % (RR 0.94, 95 % CI 0.93-0.96) for 2 g/day increment in cereal fiber intake. Findings from this meta-analysis indicate that the intakes of dietary fiber may be inversely associated with risk of type 2 diabetes.

[Short-term effect of black film covering on Oncomelania hupensis snail control in marshland and lake regions].

OBJECTIVE: To evaluate the short-term effect of the black film covering combined with niclosamide on Oncomelania hupensis snail control in marshland and lake regions. METHODS: A ditch with snails in Anxiang County was selected as the experimental sites. The ditch was divided into 3 groups: a film group, a niclosamide group, and a niclosamide and film group. The snails were surveyed before the test and 1, 3, 5, 7 days after the experiment. RESULTS: After the film covering, the highest temperature of the surface of soil was 63.7 degrees C on the first day, and the temperature higher than 40 degrees C lasted 4.34 hours. On the second day, the highest temperature was 52.3 degrees C, and the temperature higher than 40 degrees C lasted 4.96 hours. On the fourth day and fifth day, the temperature was lower than 30 degrees C, while the temperature was lower than 34 degrees C on the sixth day. On the seventh day of the experiment, the snail death rates of the film group, the niclosamide group, and the niclosamide and film group on the soil surface were 16.36%, 58.40% and 53.57%, respectively. On the seventh day, the snail death rates of the film group, and the niclosamide and film group under the soil were 20.00% and 40.00%, respectively, while no snails were found under the soil in the niclosamide group 3 days after the experiment. In mesh bags, the snail death rates of the film group, the niclosamide group, and the niclosamide and film group were 84.00%, 95.33% and 95.33%, respectively. CONCLUSION: The short-term effect of the black film covering on snail control is not obvious, and the black film covering does no promote the molluscicidal effect of niclosamide.

[Natural growth and decline of Oncomelania hupensis snails in marshland of Qianliang Lake District in Eastern Dongting Lake area, China].

OBJECTIVE: To understand the change trend of Oncomelania hupensis snails in the bottomland areas of Qian Liang Lake district in Eastern Dongting Lake area so as to provide the evidence for formulating a schistosomiasis control strategy. METHODS: The monitoring data of snails of Qianliang Lake district from 1988 to 2011 were collected retrospectively and analyzed by using the method of the trend Chi-square test. The correlations among the snail density indicators were analyzed. RESULTS: 1988 to 2011, the area of snails surveyed did not change and was 433.2 hm(2). The monitoring data showed that the change trend of the density of living snails and the schistosome infection rates of snails were not obvious (P > 0.05), but the mortality of snails showed a falling trend (P < 0.05); There were positive correlations between the average density of infected snails and the mortality of snails (r = 0.640, P < 0.05) , the infection rate of snails (r = 0.639, P < 0.05) , and the average density of living snails (r = 0.646, P < 0.05) , respectively. There was no correlation among other snail indicators. In 1999, only 7 snails were found, of them, only one snail was alive. The alive snails were not found after 2000. CONCLUSION: In the bottomland areas of Qianliang Lake district, the change trend of the density of alive snails were not obvious from 1988 to 1998, but the number of snails underwent a sharp drop in 1999 and snails have been not found till now.

Diabetes mellitus increases the risk of bladder cancer: an updated meta-analysis of observational studies.

BACKGROUND: Increasing evidence suggests that diabetes mellitus (DM) may be associated with an increased risk of bladder cancer. We performed an updated meta-analysis to examine the association between DM and risk of bladder cancer. MATERIALS AND METHODS: We systematically searched the EMBASE and Medline (PubMed) databases (from inception through February 1, 2013) and reviewed the reference lists of relevant publications to search for additional studies. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with random-effects models. RESULTS: In total, 10 case-control and 14 cohort studies met the inclusion criteria. Analysis of all studies showed that DM was associated with an increased risk of bladder cancer (RR 1.30, 95% CI 1.18-1.43). There was heterogeneity among studies (Pheterogeneity <0.001, I(2)=81.5%). Cohort studies showed a lower risk (RR 1.23, 95% CI 1.09-1.37) than case-control studies (odds ratio 1.46, 95% CI 1.20-1.78). The positive association was significant only in women (RR 1.23, 95% CI 1.02-1.49), but not in men (RR 1.07, 95% CI 0.97-1.18). The combined RRs remained unchanged before and after the studies on type 1 diabetes were excluded from analysis. The association between DM and bladder cancer risk did not differ significantly by methods of DM ascertainment. The combined RRs were 1.17 (95% CI 1.03-1.34), 1.34 (95% CI 1.19-1.51), and 1.57 (95% CI 0.96-2.55), respectively, when restricting the analysis to the studies accounting for body mass index, cigarette smoking, or glucose-lowering drug use. CONCLUSIONS: This meta-analysis indicates a positive association between DM and risk of bladder cancer. Further studies are warranted to determine whether DM prevention and control can reduce risk of bladder cancer.

Identification of parasite-host habitats in Anxiang county, Hunan Province, China based on multi-temporal China-Brazil earth resources satellite (CBERS) images.

Remote sensing is a promising technique for monitoring the distribution and dynamics of various vector-borne diseases. In this study, we used the multi-temporal CBERS images, obtained free of charge, to predict the habitats of the snail Oncomelania hupensis, the sole intermediate host of schistosomiasis japonica, a snail-borne parasitic disease of considerable public health in China. Areas of suitable snail habitats were identified based on the normalized difference vegetation index (NDVI) and the normalized difference water index (NDWI), and the predictive model was tested against sites (snails present or absent) that were surveyed directly for O. hupensis. The model performed well (sensitivity and specificity were 63.64% and 78.09%, respectively), and with further development, we may provide an accurate, inexpensive tool for the broad-scale monitoring and control of schistosomiasis, and other similar vector-borne diseases.

Remote sensing and disease control in China: past, present and future.

Satellite measurements have distinct advantages over conventional ground measurements because they can collect the information repeatedly and automatically. Since 1970 globally and 1985 in China, the availability of remote sensing (RS) techniques has steadily grown and they are becoming increasingly important to improve our understanding of human health. This paper gives the first detailed overview on the developments of RS applications for disease control in China. The problems, challenges and future directions are also discussed with an aim of guiding prospective studies.

[Relationship between snails and recent water level in different marshlands in Xingzi County, Jiangxi Province].

OBJECTIVE: To study the longitudinal change of data on Oncomelania hupensis surveillance in different marshlands and the impact of recent water level in Xingzi County, Jiangxi Province. METHODS: All information including water level of hydrometric station and the data of snails at the marshlands of Xiguanhu, Majiawan and Ximiaoqian was collected to explore the longitudinal change of snails and analyze the relationship between snail distribution and recent water level with Spearman rank correlation analysis. RESULTS: The highest proportion of frames with living snails and living snail densities at Majiawan and Ximiaoqian was 89.66% (442/493) in 2002 and 66.72% (872/1 307) in 2007, 8.33 in 2001 and 7.39 snails per frame in 2006, respectively, and the lowest was 13.26% (126/950) in 2010 and 4.60% (55/1 195) in 2005, 0.42 in 2010 and 0.22 snails per frame in 2002, respectively, and tended to decrease gradually after 2007. At Majiawan, infected snails were found in 2005 and 2009, the density and proportion of infected snails were 0.0033 and 0.0025 snails per frame, 0.09% (3/3 306) and 0.22% (3/1 389). Infected snails were found in Ximiaoqian in 2001, 2003, 2005 and 2009, the highest density and proportion of infected snails were 0.005 0 snails per frame and 0.88% (6/684) in 2005. Infected snails were found in Xiguanhu in 2002 and 2003 with a density and proportion of 0.0029 and 0.0027 snails per frame, 0.10% (1/974) and 0.32% (1/312), respectively. The correlation analysis between proportion of frames with living snails and density at Xiguanhu with the average water level of the first and second month before snail survey showed statistical significance, the correlation coefficient was 0.76, 0.71, 0.82 and 0.78 (P<0.05), respectively. The correlation between proportion of frames with living snails and density at Majiawan showed no statistical significance with the average water level of recent three months before snail survey. The proportion of frames with living snails and density at Xiguanhu were negatively correlated with the average water level of the first and second month before snail survey, the correlation coefficient was -0.67, -0.75, -0.79 and -0.72 (P<0.05), respectively. CONCLUSION: The change trend of snail indicators in different marshlands in the County and impact of water level in recent three months on snail population are both different, and the snail control strategy in marshlands should therefore be adjusted.

[Study on spatial-temporal variation of infected snail in bottomland areas after an integrated control strategy at village level in the marshland and lake regions based on geographic information system].

OBJECTIVE: To evaluate the effect of an integrated control strategy and to quantify the spatial-temporal variation of infected snails in the bottomland areas after the strategy was implemented. METHODS: Based on the geographic database of infected snail distribution at the village level during 2004 - 2010 in Anxiang county, Hunan province, spatial autocorrelation analysis and spatial scan statistics were applied to analyze the spatial-temporal characteristics on the distribution of infected snails. RESULTS: The number of embankments with infected snails in Anxiang county decreased from 23 in 2004 to 10 in 2010, while the rate of frame with infected snail in embankments decreased from 4.32‰ in 2004 to 0.12‰ in 2010. The spatial distribution of infected snails was nonrandom, only in 2004 and 2005 with Moran's I = 0.21 (P < 0.10) and Moran's I = 0.13 (P < 0.10) respectively. Data from the local spatial auto-correlation analysis showed that the number of villages with H-H types of auto-correlation model had been gradually decreasing. The results of SaTScan statistics appeared the same as from the local spatial auto-correlation analysis, showing that the number of areas with increased risk was decreasing. CONCLUSION: The comprehensive measures with emphasis on infectious source control seemed effective for schistosomiasis control program. The current distribution characteristics provided us with evidence that the resource assignment could be more reasonably implemented so as to control schistosomiasis in a more effective way.