Design and Development of a Big Data Platform for Disease Burden Based on the Spark Engine.

Objective: This study attempts to build a big data platform for disease burden that can realize the deep coupling of artificial intelligence and public health. This is a highly open and shared intelligent platform, including big data collection, analysis, and result visualization. Methods: Based on data mining theory and technology, the current situation of multisource data on disease burden was analyzed. Putting forward the disease burden big data management model, functional modules, and technical framework, Kafka technology is used to optimize the transmission efficiency of the underlying data. This will be an efficient and highly scalable data analysis platform through embedding embedded Sparkmlib in the Hadoop ecosystem. Results: With the concept of "Internet + medical integration," the overall architecture design of the big data platform for disease burden management was proposed based on the Spark engine and Python language. The main system composition and application scenarios are given at four levels: multisource data collection, data processing, data analysis, and the application layer, according to application scenarios and use requirements. Conclusion: The big data platform of disease burden management helps to promote the multisource convergence of disease burden data and provides a new path for the standardized paradigm of disease burden measurement. Provide methods and ideas for the deep integration of medical big data and the formation of a broader standard paradigm.

Time trends in the burden of stroke and subtypes attributable to PM2.5 in China from 1990 to 2019.

Background: Increasing studies have found that PM2.5 has large adverse effects on stroke mortality. We want to investigate the long-term trends in the mortality of stroke attributable to ambient particulate matter pollution and household air pollution to provide evidence facilitating the design of policy. Methods: The deaths data of stroke and its subtypes attributable to PM2.5 were obtained from the Global Burden of Disease (GBD) 2019, analyzed by Joinpoint regression software and the age-period-cohort (APC) method to assess the magnitude of the trends in mortality and the temporal trends in the mortality rate by age, period, and cohort. Results: From 1990 to 2019, the age-standardized mortality rate (ASMR) attributable to PM2.5 exposure trended downwards, but the trends of ambient particulate matter pollution and household air pollution were opposite. The trends varied among subtypes, the AAPC of intracerebral hemorrhage, ischemic stroke, and subarachnoid hemorrhage attributable to PM2.5 were 0.7, 2.5, and-3.3%, respectively. The longitudinal age curve of the APC model showed that the mortality rates due to PM2.5 exposure increased with age. The period RRs of ischemic stroke due to ambient particulate matter pollution increased significantly. The cohort RRs of ambient particulate matter pollution increased among those born from 1905 to 1990. The net drifts of all subtypes attributable to PM2.5 were below 0, but owing to the increase of ambient particulate matter pollution, the range of the decline was small. Males had higher net drift values, compared with females. Conclusions: Ambient particulate matter pollution has become the main type of PM2.5 leading to stroke in China. PM2.5 exposure is more harmful to ischemic stroke, males, and elderly. Chinese government should pay attention to the long-term impact of ambient air pollution on stroke and take effective public health policies and interventions.

Life satisfaction and its influencing factors of middle-aged and elderly stroke patients in China: a national cross-sectional survey.

OBJECTIVES: This study reports the life satisfaction of middle-aged and elderly patients who had a stroke in China, and explores its association with patients' sociodemographic characteristics, health status, lifestyles and family relationship. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: The samples of this study were selected from the data of China Health and Retirement Longitudinal Study (CHARLS) in 2018, which covered 28 provinces, 150 countries/districts and 450 village/urban communities. 1154 patients who had a stroke aged 45 and over were included in this study as qualified samples. OUTCOME MEASURES: Descriptive analysis was used to report sociodemographic characteristics, health status, lifestyles, family relationship and life satisfaction of middle-aged and elderly patients who had a stroke. χ2 analysis and binary logistic regression were used to analyse the factors influencing the life satisfaction of the patients who had a stroke. RESULTS: Overall, 83.1% of patients who had a stroke were satisfied with their lives, although only 8.7% rated their own health as being good. Patients who had a stroke who were male, elderly, married, living with their spouses and having a pension were more likely to report satisfaction with life (p<0.05). Self-rated health, health satisfaction, chronic lung disease, fall, pain, ability to work and family relationships were also significantly associated with life satisfaction (p<0.05). Patients who drank alcohol (86.8% vs 81.7%, p=0.041), had physical activity (84.4% vs 75.6%, p=0.004) and had social activity (85.3% vs 80.8%, p=0.041) were more satisfied with their lives than those who did not. Multivariable analysis confirmed that age, health satisfaction, physical pain, working ability, relationships with spouse and with children had significant effects on life satisfaction of patients who had a stroke (p<0.05). CONCLUSIONS: Our study indicates the importance of improving the overall health of patients who had a stroke and mediating factors, such as pain management, and work ability, spouse and children relationship in improving the life satisfaction of patients in the poststroke rehabilitation.

Quality of Health Economic Evaluations in Mainland China: A Comparison of Peer-Reviewed Articles in Chinese and in English.

OBJECTIVE: Our objective was to assess the incidence and quality of reporting of published health economic evaluations in mainland China and compare the quality of peer-reviewed articles in Chinese and English. METHODS: A comprehensive search was conducted for economic evaluations pertaining to China published from 2006 to 2015 using the PubMed, CBM, CMCC, CNKI, VIP, and Wanfang databases. All studies in English that met the inclusion criteria were included. For studies in Chinese, 200 sampled studies were included according to the random seeds method, and the same number of the most-cited studies in Chinese as those in English were included according to the number of citations and journal grades. Researchers independently assessed the quality of the studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: After literature search and screening, a total of 310 studies were identified. The majority of these studies were cost-effectiveness studies (82.26%). Scores among different CHEERS items varied greatly. There was a gap between the average quality scores of the studies published in Chinese and those published in English (49.78 ± 9.31 vs. 82.48 ± 17.69) and between the average quality scores of the included most-cited studies in Chinese and English, which was slightly smaller (54.08 ± 10.27 vs. 82.48 ± 17.69). The methods, results, and discussion sections of studies published in Chinese were of low quality. CONCLUSION: The quality of reporting of health economic evaluations in mainland China has developed slowly. Most of the included studies were incomplete in the presentation of content, making the results less reliable. It is important to standardize and improve the quality of Chinese health economic research.

[Prostatitis studies in China from 2000 to 2020: A Knowledge Atlas-based study on the development trend of contemporary disciplines].

OBJECTIVE: To review and analyze the trend of researches on prostatitis in China in the past two decades. METHODS: We searched the core collection of China National Knowledge Infrastructure (CNKI) for studies on prostatitis, and analyzed the data obtained using Excel, Citespace and VOSviewer. RESULTS: Totally, 1 216 original articles were identified, with 3 271 keywords, ≥3-time high-frequency keywords accounting for 12.9%, with "", "", "chronic prostatitis", "prostatitis", and "" as the top 5 ones, each with a centrality higher than 300. Major prostatitis-related studies focused on the 8 keywords, namely, prostatitis, prostatic fluid, rats, prostate, syndromes, efficacy observation, compound (in traditional Chinese medicine, TCM), and therapeutic application. The included literature involved 2 808 authors, with 402 involved more than twice and most of them in a scattered manner. The major topics of prostatitis studies varied in the past two decades, focusing on TCM therapies, promotion of blood circulation and stasis and comprehensive nursing in 2000－2001, on animal models, CD4+ lymphocytes and other experimental molecules in 2007－2010, on urodynamics, risk factors and specific antigens in 2013－2016, and on literature information resources in 2016. CONCLUSIONS: The immune mechanism remains a hot topic in the future researches on prostatitis. In terms of treatment of the disease, TCM has a potential value, and more practice and studies are required for an optimal combination of TCM and Western medicine. Strengthened collaborative efforts are needed to establish an authoritative source channel for the keywords, and incorporate it into the national standard system, and above all, to integrate the prostatitis study into multi-disciplinary researches, eliminate academic barriers, encourage collaborative innovation with multiple parties, and promote the exchanges and development in this field.

Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China.

BACKGROUND: Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. METHODS: Data was collected from China's Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system's respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. RESULTS: Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008-11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582-36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. CONCLUSIONS: Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.

Educational attainment and mortality: results from the Sixth Population Census in China.

BACKGROUND: Health and education are two closely related factors that affect human development. A limited number of studies have been conducted in China, most of which have been based on small sample sizes and with inconsistent results. The study investigates the association between mortality rate and educational level in China based on the sixth national population census in 2010. METHODS: This is large-scale population study based on the nationally administrated data sets of population census in 2010, 2000 and 1990. The 2010 census covered a total population of 1 332 810,869 in China. RESULTS: In general, standardized mortality rate decreased as educational level increased. The standardized mortality rate is higher among males than among females with equivalent educational levels. The standardized mortality rate in all the educational groups declined to varying degrees from 1990. 2000 to 2010. The standardised mortality rate declined with increasing educational levels from no education to university undergraduate groups in 1990, 2000 and 2010. The standardized mortality rate declined as the degree of education increased in cities, towns, and villages, but gradually increased at the same educational level from cities, towns, to villages in general. The difference in each region is considerable and the population quality of the developed area is generally high. The percentage of the uneducated population to the total population aged 15 years and over (%) was positively correlated with the standardized mortality rate. By contrast, the percentage of the population with a high school education to the total population aged 6 years and over (%) was negatively correlated with the standardized mortality rate. CONCLUSIONS: We found that educational level was negatively correlated with the mortality rate. The crude and standardized death rate is lower among individuals with higher educational level. Together with previous research findings, this study indicates that improving total population education attainment remains an important challenge that requires imperative action, while reducing educational inequities remains crucial for the government.

MiR-199a-3p enhances breast cancer cell sensitivity to cisplatin by downregulating TFAM (TFAM).

Chemotherapy resistance is the major obstacle to the effective therapy of cancer. While the mechanism of chemotherapy resistance is still not fully understood. Increasing evidences demonstrated that microRNAs (miRNAs) may have a crucial function in chemotherapy resistance through modulating intracellular pathways. MiR-199a has been shown to be involved in multiple malignancy-related processes, although the precise mechanism is unclear at present. In this study, we found that the expression level of miR-199a-3p was lower in cisplatin (DDP) resistant breast cancer MDA-MB-231/DDP cells compared with parental DDP-sensitive cells. Inhibition of miR-199a-3p in MDA-MB-231 cells significantly attenuated DDP-induced apoptosis and anti-proliferative effects, while overexpression of miR-199a-3p in MDA-MB-231/DDP cells increased the sensitivity to DDP. Moreover, expression levels of mitochondrial transcription factor A (TFAM) were modulated by miR-199a-3p. The luciferase reporter assay indicated that TFAM may be the target gene of miR-199a. Knocking down of TFAM could partially reverse DDP resistance in MDA-MB-231 cells induced by miR-199a-3p inhibition, while TFAM overexpression could partially restore miR-199a-3p-induced chemo-sensitivity of MDA-MB-231/DDP cells to DDP. These results show that miR-199a-3p is able to attenuate cisplatin resistance in breast cancer cells through inhibiting TFAM expression.

How to overcome violence against Healthcare professionals, reduce medical disputes and ensure patient safety.

BACKGROUND & OBJECTIVE: In recent years there have been many cases of violence against healthcare professionals (HCPs) in China leading to the death of some doctors as well as nurses by patient's relatives. Our objective was to identify the causative factors for these violent acts and address these isssues which is vital to ensure patient safety. METHODS: A multidisciplinary research task force was formed to do a root cause analysis of the violent acts against the healthcare professionals. A flowchart was developed to identify the steps in the process and discover the potential links. RESULTS: There are complex reasons behind the violence against HCPs. However, the main reasons were found to be poor quality of medical services and increased awareness of patients' rights and their willingness to knock at the doors of courts to seek justice. The feasible counter measures includes stimulating hospital directors to improve patient safety, aligning incentives with quality of service provided in healthcare facilities, monitoring educational quality of HCPs, making necessary changes in medical education programmes besides setting up a reasonable academic promotion mechanism for health professionals based on merit and competence. CONCLUSION: Poor quality of medical services, increased awareness among patients about their rights has resulted in increase in medical disputes and at times violence against healthcare professionals. A number of effective measures can be undertaken by the government, hospitals, and medical schools ensuring patient safety. However, it is essential to sensitize the hospital directors to elevate their quality of medical services.

Measuring the burden of disease using disability-adjusted life years in Shilin County of Yunnan Province, China.

BACKGROUND: Few studies calculating burden of disease (BOD) have been carried out in China. Disability-adjusted life years (DALY) is one of the useful methods used to estimate BOD. This study aims to use DALY for evaluating BOD and to provide useful information for health planning for residents in Shilin Yi Nationality Autonomous County (Shilin County) of Yunnan Province, China. METHODS: Methods developed for the Global Burden of Disease (GBD) Study by the World Bank and World Health Organization (WHO) were adapted and applied to Shilin County population health data. DALY rate per 1,000 was calculated from medical death certificates in 2003 in Shilin County. The geographic coordinates of towns or townships were determined using the geocode function of R2.3.1 geographical information system (GIS) software. RESULTS: Respiratory diseases were by far the leading cause of years of life lost (YLL) in both males and females. The four other leading causes of YLL in descending order were: unintentional injuries, cardiovascular diseases, intentional injuries, and malignant neoplasms. However, the five leading causes of years lived with disability (YLD) were, in descending order: neuropsychiatric conditions, intentional injuries, respiratory diseases, unintentional injuries, and cardiovascular diseases. The leading cause of total disease burden (DALY) was neuropsychiatric conditions. Townships of Muzhuqing, Xijiekou, and Weize were the areas with most serious disease burden in Shilin County. CONCLUSIONS: Prevention and treatment of neuropsychiatric conditions and respiratory diseases for both females and males should be enhanced in Shilin County, so as to decrease injury. More preventive interventions for noninfectious chronic diseases should be emphasized in remote townships.

Assessing the disease burden of Yi people by years of life lost in Shilin county of Yunnan province, China.

BACKGROUND: Years of Life Lost (YLL) is one of the methods used to estimate the duration of time lost due to premature death. While previous studies of disease burden have been reported using YLL, there have been no studies investigating YLL of Yi people in rural China. Yunnan Province ranks first in terms of Yi people in China. This paper uses YLL to estimate the disease burden of Yi people in Shilin county of Yunnan Province. This study aims to address the differentials about YLL between Yi people and Han people for providing useful information for health planning. METHODS: We applied the Global Burden of Disease (GBD) method created by WHO. YLL rate per 1,000 were calculated from medical death certificates in 2003 in Shilin Yi Nationality Autonomous County (Shilin county). RESULTS: The male had greater YLL rate per 1,000 than did the female almost in each age group. It demonstrated a higher premature mortality burden due to injuries in Shilin county. Among the top non-communicable diseases, respiratory diseases are the most common mortality burden. Yi people are still suffering from maternal conditions, with two times the burden rates of Han people. For Yi people, while malignant neoplasm was one of the least burden of disease for male, it was the greatest for female, which is the opposite to Han people. CONCLUSION: Strategies of economic development should be reviewed to enhance the prevention and treatment of injuries, maternal conditions and respiratory diseases for Yi people.