Multi-state Markov model in outcome of mild cognitive impairments among community elderly residents in Mainland China.

BACKGROUND: Although knowledge of established risk factors for Alzheimer's disease (AD) can logically contribute to the search for predictors of the progression of cognitive impairment, it has not yet been firmly established where in the cognitive impairment process these risk factors exert their effects and how to predict quantitatively for the progression of mild cognitive impairments (MCI) to AD. This study aimed to determine whether known risk factors increased the risk of progression from MCI to AD and to make prediction based on transition probabilities. METHODS: Based on ten examinations of 600 community-dwelling MCI residents and cognitive assessments to classify individuals into MCI, global impairment, and AD, a multi-state Markov Cox's regression model was used and the hazard ratios with their confidence intervals and transition probabilities were estimated. RESULTS: Multivariate analysis showed that gender, age, and hypertension were statistically significant predictors of transition from MCI to global impairment; age, education, and reading statistically influenced transition from global impairment to MCI; gender, age, hypertension, diabetes, and apolipoprotein E geneε4 status were statistically associated with transition from global impairment to AD. Subjects at MCI were more likely (67%) to remain in that cognitive state at the next cognitive assessment than to transition to cognitive deterioration. For global impairment, probability of remaining in the same state was only 18% and that of forward transition was three times more likely than that of backward transition. CONCLUSIONS: Known risk factors influenced differently for different transitions. Transition from global impairment was more likely to worsen to severe cognitive deterioration than transition from MCI.

[Relations between alcoholism and osteoporosis or femoral head necrosis].

OBJECTIVE: To explore the relationship of alcoholism between osteoporosis or femoral head necrosis. METHODS: In this case-control study, we selected 95 eligible patients with femoral head necrosis and another 67 cases of osteoporosis as case group, together with 342 patients of fractures from the Second Hospital affiliated to Shanxi Medical College, from February to December 2010, as the control group. Questionnaire was used to collect general information of the patients. Through comparative analysis, related factors of femoral head, osteoporosis were defined. 18 patients with alcoholic femoral head necrosis, 11 patients with alcoholic osteoporosis and 20 patients with fractures were selected from the above said three groups and going through the Alcohol Use Disorders Identification Test (AUDIT) as well as the Alcohol Use Disorders Scale(ADS). Using SPSS 13.0 conducted one-way ANOVA(analysis of variance), chi-square test, categorical logistic regression analysis were used for statistical analysis. RESULTS: Results from logistic regression analysis showed that the adjusted odds ratio of those subjects who liked drinking alcohol had an incidence of femoral head necrosis or osteoporosis as 7.70 (95% CI:1.84, 32.30) and 8.44 (95% CI:1.70, 41.90), respectively. The risks of using hormone for treating femoral head necrosis or osteoporosis were 78.43 (95%CI:11.20, 149.05) and 22.75 (95%CI:2.59, 100.27) times than those without. Data from the AUDIT showed that:over-dose of alcohol drinking habit existed 100% in the femoral head necrosis group while 54.45% in the osteoporosis group, while 75 percent patients in the fractures group had normal alcohol drinking habit. Statistically significant differences appeared in the three groups (P < 0.01). RESULTS: from the ADS showed that there were statistically significant differences between the ADS scores of the three groups(F = 3.68, P = 0.03). CONCLUSION: Alcohol intake did seem to be highly correlated with the incidence rates of femoral head necrosis or osteoporosis. Alcohol-related necrosis could be viewed as alcohol-dependent diseases while alcohol-related and osteoporosis could partially be recognized as alcohol-dependent disease.

[Multi-state Markov model in expressing the outcome of mild cognitive impairment among community-based elderly residents].

OBJECTIVE: To introduce the Multi-state Markov model in studying the outcome prediction of mild cognitive impairment (MCI). METHODS: Based on the intelligence quotient (IQ) changes that reflecting the trends in cognitive function in the patients under follow-up program, we constructed a four states model and used Multi-state Markov model to analyze the patients. RESULTS: Among 600 MCI patients, there were 174 (29.0%) males and 426 (71.0%) females, with age range of 65-90 years-old (average 69.7 ± 6.6). For univariate analysis, gender, age, education level, marital status, smoking, household income, cerebral hemorrhage, hypertension, high cholesterol, diabetes, LDL-C, SBP and DBP were found to be associated with cognitive function. For multivariate analysis, female, older age, cerebral hemorrhage and higher SBP were shown to be the risk factors for transition from the state of cognitive stability to the state of severe deterioration, and their coefficients were 0.762, 0.366, 0.885, and 0.069, respectively. Age (0.038) could influence the transition from the state of cognitive stability to slight deterioration. Higher education level was shown to be the protective factor for these transitions (-0.219 and -0.297). Transition intensity from the state of cognitive stability to the state of slight and severe deterioration was 1.2 times that of transition to the state of improving. Transition intensity from state of slight deterioration to cognitive stability was 11.4 times that of transition to severe deterioration. CONCLUSION: Multi-state Markov model was an effective tool in dealing with longitudinal data.

[A three-year follow-up study on the transfer of mild cognitive impairment to Alzheimer's disease among the elderly in Taiyuan city].

OBJECTIVE: To explore the incidence rate of people with mild cognitive impairment (MCI) which transferred to Alzheimer's disease (AD) and to study the related influencing factors. METHODS: 600 MCI aged people were experienced screening test which was conducted by WHO-BCA, MMSE and DCR. A three-year follow-up study was conducted to get the information on the aged people with MCI. Data related to demography, behavior, chronic diseases and perception of the elderly with MCI were collected through face to face interview. Characteristics of the elderly with MCI aged people were tested by 16PF. The content of Apoe was tested by PCR. People with NC were investigated by telephone to get the progression and the time to AD. Methodologies on statistics were log-rank test and Cox proportional hazards regression model. RESULTS: The incidence rate of MCI to AD was 6.53% person-years. The incidence rate of the normal people to AD was 1.24% person-years. The hazard of MCI to AD was 5.27 times (95%CI: 3.01 - 9.82) of the normal people to AD. The result of Cox proportional hazards regression model displayed that:older age (RR = 3.14, 95%CI: 2.98 - 7.46), hypertension (RR = 3.28, 95%CI: 3.02 - 8.48), hyperlipemia (RR = 2.22, 95%CI: 1.29 - 3.82), diabetes (RR = 4.87, 95%CI: 2.56 - 9.25), lack of sports (RR = 2.02, 95%CI: 1.29-3.14), anxiety (RR = 4.46, 95%CI: 3.07 - 8.14), dread fullness (RR = 4.08, 95%CI: 3.52 - 5.25), loneliness (RR = 1.89, 95%CI: 1.13 - 3.16), characteristics of anxiety (RR = 5.07, 95%CI: 2.56 - 10.04, introvert characteristics (RR = 2.05, 95%CI: 1.33 - 3.15) and ApoE4 (RR = 1.73, 95%CI: 1.15 - 2.63) were the risk factors of MCI to AD. Higher education (RR = 0.29, 95%CI: 0.07 - 0.43), intellectual work (RR = 0.14, 95%CI: 0.05 - 0.32), often reading books (RR = 0.30, 95%CI: 0.15 - 0.58), often taking part in recreational activities (RR = 0.41, 95%CI: 0.23 - 0.75) seemed to be the protective of MCI to AD. CONCLUSION: The rate of the elderly with MCI that developing to AD was high, suggesting further study on the cognitive situation among the MCI aged people should be carried out.

[An epidemiological study of visual disability and visual rehabilitation in Beijing].

OBJECTIVE: To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing. METHODS: Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated. RESULTS: About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability. CONCLUSION: Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.

[Study on hearing impairment among elderly population in the community of Taiyuan city, Shanxi province].

OBJECTIVE: To study the characteristics and influencing factors on hearing impairment among elderly population in the community of Taiyuan city. METHODS: 384 ageing people above 60 years old were selected from Chaoyang and Guandi community in Taiyuan city by multi-stage sampling. Data on influencing factors of hearing impairment were collected by questionnaire. 5 ml fasting blood samples were drawn to detect the level of glucose, triglyceride and cholesterin in the blood samples. All the objects were tested with binaural hearing. The level of binaural hearing threshold at 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, 4 kHz, 8 kHz were measured by GVSLN-TC-GK2000 hearing-assistant evaluative apparatus. The level of 3 kHz, 4 kHz, average hearing threshold from ear with better audition was chosen as dependent variable. Socio-demographic data, environmental factors and biochemical indicator were chosen as independent variables, t test, ANOVA and accumulative logistic regression were performed to analyze the influencing factors on hearing impairment by software SPSS 13.0. RESULTS: The prevalence of hearing impairment among elderly population was 90.9%. The hearing disorder was 78.6% with 1.3% of them using hearing-assistant apparatus. Results from single factor analysis showed that the average levels of 3 kHz, 4 kHz, 8 kHz hearing thresholds were significantly different among elderly with different age, sex, education background and the levels of glucose and cholesterin (P < 0.01). Results of accumulative logistics regression showed that except glucose in which was the only one included in regression model of lower median frequency group, all the others were included in regression model of frequency group. Being male, older age and with higher level of glucose and cholesterin in blood were risk factors causing hearing impairment. Higher education level seemed to be a preventive factor. CONCLUSION: Hearing impairment appeared in higher prevalence among the elderly population, suggesting that proper measures should be taken. It is beneficial for abating hearing impairment to decrease the level of glucose and cholesterin in blood.

[A case-control study on the influencing factors to mild cognitive impairment among the community-based elderly population].

OBJECTIVE: To explore the influencing factors on mild cognitive impairment among the community-based elderly population. METHODS: A 'n : m' matched case-control study was conducted to analyze the risk factors. Cox regression model of survival analysis was selected to deal with non-geometric proportional matched data which was difficult to analyze by logistic regression model. RESULTS: Four hundred and twenty-three cases together with nine hundred and twenty-five controls were interviewed with an uniformed questionnaire. Through univariate and multivariate cox regression analysis, the odds ratio and 95% CI of these risk factors appeared to be: physical labor as 1.396 (1.092-1.785); smoking as 1.551 (1.021-2.359); higher level of blood glucose as 1.354 (1.102-1.664); HDL-C in the serum as 1.543 (1.232-1.932); LDL-C in the serum as 1.299 (1.060-1.592); lower level of estrogen in the serum as 1.263 (1.031-1.547); hypertension as 1.967 (1.438-2.689); diabete: 1.381 (1.139-1.675); depressive disorder: 1.406 (1.110-1.780); cerebral thrombosis as 1.593 (1.307-1.943); higher SBP as 1.331 (1.129-1.569) and ApoEepsilon 4 carrier as 1.462 (1.140-1.873) respectively. Odds ratio and 95% CI on protection factors appeared to be: reading newspaper frequently as 0.610 (0.503-0.740); frequently doing housework as 0.804 (0.665-0.973); frequently engaging in social activities as 0.617 (0.502-0.757); reemployment after formal retirement as 0.759 (0.636-0.906); having acumen olfaction as 0.900 (0.845-0.958); having extrovert personality as 0.829 (0.699-0.984); being decisive as 0.811 (0.662-0.993). CONCLUSION: The major measures to prevent MCI seemed to be including the following factors as: being intellectuals, engaging in healthy life style and decreasing the risk in developing hypertension, diabetes, depressive disorder and cerebrovascular disease. However, olfactory hypoesthesia, cowardice and having introvert character, ApoEepsilon 4 carrier etc could be treated as early indications to signify MCI.

[A cross-sectional study on prevalance and risk factors of disabilities in aged 0-6 years children in Beijing, China].

OBJECTIVE: To explore the epidemiological status of disabilities on vision impairment (VI), hearing loss (HL), mental retardation (MR), autism spectrum disorder (ASD) and motor disorder (MD) in aged 0-6 years old children in Beijing. METHODS: A total of 28 738 children under 7 years old were recruited from permanent residents of Beijing City by 2-phase cluster sampling. The screening procedure was 2-phase, and the diagnosis criteria were developed by the experts group. RESULTS: The overall disability rate was 11.45 per thousand (95 % CI:10.22-12.68). The false negative rates in HL and ASD were 0.14 per thousand, 0.80 per thousand, respectively, with a adjusted overall rate of 12.19per thousand. The prevalence rates of different kind disabilities from high to low were MR 9.31per thousand, MD 2.12per thousand, ASD 1.53per thousand (0.73per thousand before adjusted), HL 1.04per thousand (0.91per thousand before adjusted) VI 0.73per thousand. The results of logistic regression analysis showed that the possible non-biological risk factors for those disabilities were being male, living in city area, advancing age, mother with low education, mother engaged in labor work, and family with low income. It was primarily (49.62%) those prenatal factors other them the known suspected factors that causing disabilities. CONCLUSIONS: Compared with data from a countrywide study in 1987, the overall disability rate had a mild decrease (16.36%) with the most (56.85%) appeared in HL. It is indispensable to establish a disabilities surveillance program for the early recognition and intervention of children with disabilities. It is also crucial to clarify a disability definition for children combined with their characteristics of growth and development. We strongly recommended in developing a new definition on children' disabilities and establishing new criteria according to the contents of developmental disabilities of Center for Disease Control, USA.

[Study on the RNA of severe acute respiratory syndrome (SARS) associated coronavirus in the blood and excretion of convalescent patients with SARS].

OBJECTIVE: To examine the RNA of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) in the blood and excretion of convalescent patient with SARS for prevention and treatment of the disease. METHODS: A total of 276 samples, including plasma, urine, feces and sputum, obtained from 23 convalescent patients with SARS were studied at 3 time-points at least 21 days after the onset of symptoms. RNA was extracted and nested reverse transcription-polymerase chain reaction (RT-PCR) was carried out using SARS-CoV specific primers. RESULTS: Among the 276 samples, SARS-CoV RNA was detected in 6 cases (38.8%) by nested RT-PCR. The positive rates of SARS-CoV RNA was 5.8% in feces and 2.9% in sputum samples but SARS-CoV RNA was not detectable in plasma and urine of all the cases. CONCLUSION: The existence of SARS-CoV RNA in the excretion of some convalescent patients with SARS showed that the excretion from these patients should be carefully treated whilthe re-transmission of SARS by which, should be further studied.

[Study on the related factors of suicidal ideation in college undergraduates].

OBJECTIVE: To evaluate psychosocial factors and patterns on suicidal ideation of the undergraduates in Shanxi province. METHODS: Four thousand eight hundred and eighty-two undergraduates in Shanxi province were investigated with multistage stratified random clustered samples. Factors associated with suicidal ideation were analyzed with logistic regression and Path analysis by scores of Beck Scale for Suicide Ideation (BSSI), Suicide Attitude Questionnaire (QSA), Adolescent Self-Rate Life Events Check List (ASLEC), DSQ, Social Support Rating Scale, SCL-90, Simple Coping Modes Questionnaire and EPQ. RESULTS: Tendency of psychological disorder was the major factor. Negative life events did not directly affect suicidal ideation, but personality did directly or indirectly affect suicidal ideation through coping and defensive response. CONCLUSIONS: Personality played a stabilized fundamental role while life events were minor but "triggering" agents. Mental disturbance disposition seemed to be the principal factor related to suicidal ideation. Above three factors were intergraded and resulted in suicidal ideation in chorus.

[Similarity weight method and its application based on the attribute synthetic evaluation system].

OBJECTIVE: To explore a way of determining the weights of variables in synthetic evaluation. METHODS: Based on the attribute synthetic evaluation system, similarity weight was used to cluster and rank the atmospheric quality on 11 large cities. RESULTS: Realized the classification and ranking for the atmospheric quality of the cities given, the results were almost comparable to that achieved by Topsis evaluation. CONCLUSION: The method of comprehensive assessment using similarity weight in the attribute synthetic evaluation system seemed to be objective and rational. Not only it embodied the weights of variables involved, but also exploiting the information presented by the sample.

[Factors influencing intelligence in elderly population in a community-based study in Taiyuan city].

OBJECTIVE: To explore the factors which influencing the intelligence in elderly in a community, so as to provide reference on primary prevention of dementia. METHODS: A door to door survey was conducted. A total number of 830 elderly were assessed using WAIS-RC, H-NTLA and data collected through questionnaires on lifestyles, family and social activity were analysed, using the factor analysis, stepwise regression and canonical correlation analysis. RESULTS: The main variables related to the verbal were eggs diet, blood pressure, fruit, visit their children, alcohol intake (standard coefficients of regression are -0.118, -0.079, -0.060, -0.036, -0.117, respectively). The main variables related to cognition were recreation, sports and hereditary history of mental disorders (standard coefficients of regression were 0.035, -0.127, respectively). The main variables related to memory were contact to chemical materials, age of their parents during delivery, alcohol intake and the relationship between husband and wife (standard coefficients of regression were -0.063, 0.055, -0.030, -0.037, respectively). The variables related to canonical variable V(1) would include education and occupation (canonical correlation = 0.5993, P = 0.0001) while V(2) would include cerebrovascular accident (canonical correlation = 0.3925, P = 0.0005). CONCLUSION: Intelligent work, family harmony, prevention of cerebrovascular diseases were the main areas to prevent intellectual disability in the elderly.

[Preparation and characterization of monoclonal antibodies against SARS-associated coronavirus nucleocapsid protein].

OBJECTIVE: To obtain monoclonal antibodies (McAbs) against severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) nucleocapsid (N) protein to develop diagnostic test for SARS and study the pathogenesis of the disease. METHODS: BALB/c mice were immunized with purified N protein of SARS-CoV. Hybridoma cell lines secreting monoclonal antibodies against SARS-associated coronavirus nucleocapsid were established after cell fusion with mouse splenic cells and SP2/0 cells. The specificity of the McAbs obtained was examined by Western blot and indirect fluorescence assay. Epitopes reacted with the McAbs were preliminarily located through Western blot by expressing truncated N proteins. RESULTS: After cell fusion and three rounds of cell cloning, six hybridoma cell lines secreting monoclonal antibodies specifically against SARS-CoV nucleocapsid were obtained. Western blot and indirect fluorescence assay showed that the McAbs reacted specifically with nucleocapsid protein and SARS-CoV. Among the six McAbs, three recognize the epitopes located in the N-terminus of the protein, whereas the others reacted with those located in the C-terminus. CONCLUSION: The anti-SARS-CoV nucleocapsid McAbs were developed and these McAbs may be useful in the development of diagnosis assays and basic research of SARS.

[Study on the epidemiological characteristics of severe acute respiratory syndrome in Shanxi province].

OBJECTIVE: To describe the epidemiological characteristics and related factors of SARS in Shanxi in order to provide scientific basis for prevention and control of severe acute respiratory syndrome (SARS). METHODS: Data on clinically-diagnosed SARS cases reported to Shanxi Center for Disease Control and Prevention through SARS reporting system of Shanxi province and epidemiological reports were collected from early March to 20 May, 2003. The characteristics of SARS distribution in time, place and population in Shanxi were described. The epidemiological characteristics and related influential factors were analyzed with EPI info 6.0 software. RESULTS: Since the first imported SARS case was diagnosed clinically on 7 March and till 20 May in Shanxi province, the number of cumulative clinically-diagnosed SARS cases were 445 with an attack rate of 1.34/10,000. 20 deaths occurred in that period with the mortality rate 4.49%. The number of cases increased from 28 March and formed the first peak. However, the number continued to increase until 18 April to have formed the second peak. Since then, the number of cases has gradually decreased gradually. Since 19 May, there has been no clinically-diagnosed cases being reported. SARS cases were mostly seen in urban areas of the city (83.82% of the total SARS cases) with sporadic cases found in rural areas. Students and medical staff and people from 20 - 59 years of age occupied the large part of the cases. Age specific mortality rate increased with age and the male/female ratio was 1:0.87. CONCLUSION: In Shanxi province, the SARS epidemic seemed to have had the following stages: importation of the first case, gradual increase of the number of cases to reach the peak and decreasing. Case identification at early stage as well as taking measures to decrease the chance of transmission were strategically crucial for controlling the spread of SARS virus in the community.

[Study on the disabilities in aged 0-7 years children in Shenzhen, China].

OBJECTIVE: To explore the prevalence of vision, mental, audibility, language, psychiatry, extremity, and influence factors in the 0 - 7 year olds. METHODS: A total number of 77,727 0 - 7 year old children living in Shenzhen city were tested with tree phase screening under the Chinese standard of evaluation in disabilities. RESULTS: The prevalence of all disabilities was 5.59 per thousand (adjusted rate was 8.49 per thousand with a false negative of 3.1 per thousand ). The prevalence of mental disease was the highest (1.88 per thousand, with adjusted rate 3.43 per thousand ), the prevalence of language disability was 1.88 per thousand (including retarded language development, with adjusted rate 3.43 per thousand ). The prevalence rates of psychiatry, extremity and audibility disability were 1.59 per thousand, 1.56 per thousand, 1.11 per thousand respectively with of vision the lowest (0.37 per thousand ). The prevalence of all disabilities, audibility, language and mental was on the increase with age. The difference was statistically significant. Among all different age groups regarding psychiatric disease, the highest fell in the 2 - 4 year olds. The prevalence of extremity was not statistically different among age groups. The suspected agents of disease which occurred before or during pregnancy took up 45.7%. CONCLUSION: The prevalence of six kinds disabilities in Shenzhen was about 10 per thousand lower than that of the samples of the nation in 1989, but two times higher than that of similar studies in Japan. The prevalence rates of language and psychiatric disease were higher than that of the nation in 1989. The causation should be further studied.