Spatial and Temporal Patterns of Disease Burden attributable to High Body Mass Index in Belt and Road Initiative Countries, 1990-2019.

OBJECTIVE: This study aimed to analyze the spatial and temporal patterns of disease burden attributed to high body mass index (DB-hBMI) from 1990 to 2019 in Belt and Road Initiative (BRI) countries, in light of increasing hBMI prevalence worldwide. DESIGN: The study was a secondary analysis of global burden of disease 2019 (GBD 2019) that analyzed (using Joinpoint regression analysis) numbers and the age-standardized rate of mortality and disability-adjusted life years (DALYs) of hBMI-induced diseases and their trends from 1990 to 2019 and in the final decade. SETTING: GBD 2019 study data for BRI countries were categorized by country, age, gender, and disease. PARTICIPANTS: GBD 2019 data were used to analyze DB-hBMI in BRI countries. RESULTS: In 2019, China, India, and Russia reported the highest mortality and DALYs among BRI countries. From 1990 to 2019, the age-standardized DALYs increased in Southeast Asia and South Asia, whereas many European countries saw declines. Notably, Bangladesh, Nepal, and Vietnam showed the steepest increases, with AAPC values of 4.42%, 4.19%, and 4.28%, respectively (all P<0.05). In contrast, Israel, Slovenia, and Poland experienced significant reductions, with APCC values of -1.70%, -1.63%, and -1.58%, respectively (all P<0.05). The most rapid increases among males were seen in Vietnam, Nepal, and Bangladesh, while Jordan, Poland, and Slovenia recorded the fastest declines among females. Across most BRI countries, the burden of diabetes and kidney diseases related to hBMI showed a significant uptrend. CONCLUSION: DB-hBMI varies significantly by region, age, gender, and disease type across BRI countries. It can pose a substantial threat to public health.

CHD-related/specific mortality of 3.17 million people in a transitioning region: trends, risk factors, and prevention.

BACKGROUND: Demographic shifts cause uncertain changes in the burden of coronary heart disease (CHD) in transitioning regions. We aimed to analyze the trends of CHD burden and its risk factors in Pudong, Shanghai, and explore prevention strategies for transitioning regions. METHODS: We analyzed CHD-related and CHD-specific deaths in Pudong from 2005 to 2020, including the crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), years of life lost (YLL), and age-specific proportions. We also examined the impact of population aging on the burden of CHD. The Joinpoint Regression Program was used to analyze trends, and the decomposition method was used to evaluate the impact of demographics on the mortality rate. RESULTS: Of the 86,171 CHD-related deaths, 52,152 (60.52%) were CHD-specific deaths. For both CHD-related and CHD-specific deaths, there was a significant increase in the CMR, ASMRW, and YLL rate, except in the 70-79-year age group, which exhibited a distinctive and statistically significant decline in these rates (all P < 0.05). There were steadily increasing trends in the rates caused by aging from 2005 to 2020, with average annual percent changes (AAPCs) of 42.59% and 41.43%, respectively (all P < 0.05). CONCLUSIONS: Our results indicate that the CHD burden in Pudong has been persistently increasing, but in the age group of 70-79 years, substantial declines were observed. The quality of primary healthcare services may be a critical point in addressing the overwhelming CHD burden.

A novel nomogram based on cardia invasion and chemotherapy to predict postoperative overall survival of gastric cancer patients.

BACKGROUND: We aimed to establish and externally validate a nomogram to predict the 3- and 5-year overall survival (OS) of gastric cancer (GC) patients after surgical resection. METHODS: A total of 6543 patients diagnosed with primary GC during 2004-2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We grouped patients diagnosed during 2004-2012 into a training set (n = 4528) and those diagnosed during 2013-2016 into an external validation set (n = 2015). A nomogram was constructed after univariate and multivariate analysis. Performance was evaluated by Harrell's C-index, area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and calibration plot. RESULTS: The multivariate analysis identified age, race, location, tumor size, T stage, N stage, M stage, and chemotherapy as independent prognostic factors. In multivariate analysis, the hazard ratio (HR) of non-cardia invasion was 0.762 (P < 0.001) and that of chemotherapy was 0.556 (P < 0.001). Our nomogram was found to exhibit excellent discrimination: in the training set, Harrell's C-index was superior to that of the 8th American Joint Committee on Cancer (AJCC) TNM classification (0.736 vs 0.699, P < 0.001); the C-index was also better in the validation set (0.748 vs 0.707, P < 0.001). The AUCs for 3- and 5-year OS were 0.806 and 0.815 in the training set and 0.775 and 0.783 in the validation set, respectively. The DCA and calibration plot of the model also shows good performance. CONCLUSIONS: We established a well-designed nomogram to accurately predict the OS of primary GC patients after surgical resection. We also further confirmed the prognostic value of cardia invasion and chemotherapy in predicting the survival rate of GC patients.

Improving the hepatitis cascade: assessing hepatitis testing and its management in primary health care in China.

Objective: The study aimed to decentralize hepatitis testing and management services to primary care in China. Methods: A nationwide representative provider survey amongst community health centres (CHCs) using randomized stratified sampling methods was conducted between September and December 2015. One hundred and eighty CHCs and frontline primary care practitioners from 20 cities across three administrative regions of Western, Central and Eastern China were invited to participate. Results: One hundred and forty-nine clinicians-in-charge (79%), 1734 doctors and 1846 nurses participated (86%). Majority of CHCs (80%, 95% CI: 74-87) offered hepatitis B testing, but just over half (55%, 95% CI: 46-65) offered hepatitis C testing. The majority of doctors (87%) and nurses (85%) felt that there were benefits for providing hepatitis testing at CHCs. The major barriers for not offering hepatitis testing were lack of training (54%) and financial support (23%). Multivariate analysis showed that the major determinants for CHCs to offer hepatitis B and C testing were the number of nurses (AOR 1.1) and written policies for hepatitis B diagnosis (AOR 12.7-27.1), and for hepatitis B the availability of reproductive health service. Conclusions: Primary care providers in China could play a pivotal role in screening, diagnosing and treating millions of people with chronic hepatitis B and C in China.

Opportunities and barriers to STI testing in community health centres in China: a nationwide survey.

BACKGROUND: China has strengthened its primary care workforce and implemented a wide network of community health centres (CHCs). However, STI testing and management are not currently included in the 'Essential Package of Primary Health Care in China'. Legislation change to encourage STI service delivery would be important, but it is also critical to determine if there are also provider-related opportunities and barriers for implementing effective STI programmes through CHCs if future legislation were to change. METHODS: A national representative survey was conducted between September and December 2015 in a stratified random sample of 180 CHCs based in 20 cities in China. Primary care practitioners (PCPs) provided information on current experiences of STI testing as well as the barriers and facilitators for STI testing in CHCs. Multivariate logistic regression was conducted to determine factors associated with PCPs performing STI testing. RESULTS: 3580 out of 4146 (86%) invited PCPs from 158 CHCs completed the survey. The majority (85%, 95% CI 84% to 87%) of doctors stated that STI testing was an important part of healthcare. However, less than a third (29%, 95% CI 27% to 31%) would perform an STI test if the patients asked. Barriers for performing STI testing included lack of training, concerns about reimbursement, concerns about damage to clinics' reputations and the stigma against key populations. Respondents who reported that they would perform an STI test were likely to be younger, received a bachelor degree or higher, received specific training in STIs, believed that STI test was an important part of healthcare or had resources to perform STI testing. CONCLUSIONS: There is potential for improving STI management in China through upskilling the primary care workforce in CHCs. Specific training in STIs is needed, and other structural, logistical and attitudinal barriers are needed to be addressed.

Bridging the Gaps Between Patients and Primary Care in China: A Nationwide Representative Survey.

PURPOSE: China introduced a national policy of developing primary care in 2009, establishing 8,669 community health centers (CHCs) by 2014 that employed more than 300,000 staff. These facilities have been underused, however, because of public mistrust of physicians and overreliance on specialist care. METHODS: We selected a stratified random sample of CHCs throughout China based on geographic distribution and urban-suburban ratios between September and December 2015. Two questionnaires, 1 for lead clinicians and 1 for primary care practitioners (PCPs), asked about the demographics of the clinic and its clinical and educational activities. Responses were obtained from 158 lead clinicians in CHCs and 3,580 PCPs (response rates of 84% and 86%, respectively). RESULTS: CHCs employed a median of 8 physicians and 13 nurses, but only one-half of physicians were registered as PCPs, and few nurses had training specifically for primary care. Although virtually all clinics were equipped with stethoscopes (98%) and sphygmomanometers (97%), only 43% had ophthalmoscopes and 64% had facilities for gynecologic examination. Clinical care was selectively skewed toward certain chronic diseases. Physicians saw a median of 12.5 patients per day. Multivariate analysis showed that more patients were seen daily by physicians in CHCs organized by private hospitals and those having pharmacists and nurses. CONCLUSIONS: Our survey confirms China's success in establishing a large, mostly young primary care workforce and providing ongoing professional training. Facilities are basic, however, with few clinics providing the comprehensive primary care required for a wide range of common physical and mental conditions. Use of CHCs by patients remains low.

Patterns and trends of mortality from metastatic colorectal cancer in Shanghai, China from 2005 to 2021: a population-based retrospective analysis.

PURPOSE: Metastatic colorectal cancer (mCRC) is the leading cause of CRC deaths, however, the relative epidemiological research was insufficient. We aimed to analyze the patterns and trends of mortality of mCRC in Shanghai with a more complete system for monitoring the cause of death of the population and find potential methods to reduce the burden of CRC in China. METHODS: Mortality data from 2005 to 2021 of mCRC deaths were obtained from the mortality registration system in Shanghai. We analyzed the crude mortality rates, age-standardized mortality rates, and rates of years of life lost (YLL rates) of mCRC. In addition, the trends were quantified using Joinpoint Regression software. RESULTS: A total of 4,386 mCRC deaths were included, with 1,937 (44.16%) liver metastases and 1,061 (24.19%) lung metastases. The crude mortality rate and age-standardized mortality rate of mCRC were 9.09 per 105 person-years and 3.78 per 105 person-years, respectively. The YLL was 50,533.13 years, and the YLL rate was 104.67 per 105 person-years. The overall annual crude mortality rate of mCRC increased by 1.47% (95% CI 0.28-2.68%, P < 0.001) from 2005 to 2021. The crude mortality rate of mCRC increased by 3.20% per year (95% CI 1.80-4.70%, P < 0.001) from 2005 to 2013, but the trend of mortality growth remained stable from 2013 to 2021. The YLL rates remained stable between 2005 and 2021. CONCLUSIONS: Population aging was the most likely factor responsible for the increase in CRC mortality in Pudong. Physical examinations and screenings for the elderly were possible reasons for reducing the burden of CRC in fast-growing regions.

Changes of the acute myocardial infarction-related resident deaths in a transitioning region: a real-world study involving 3.17 million people.

Background: The impact of acute myocardial infarction (AMI) on the life span of residents in a transitioning region has not been studied in depth. Therefore, we aimed to evaluate the changes in AMI-related resident deaths in a transitioning region in China. Methods: A longitudinal, population-based study was performed to analyze the deaths with/of AMI in Pudong New Area (PNA), Shanghai from 2005 to 2021. The average annual percentage change (AAPC) of AMI in crude mortality rates (CMR), age-standardized mortality rates worldwide (ASMRW), and rates of years of life lost (YLLr) were calculated by the joinpoint regression. The impact of demographic and non-demographic factors on the mortality of residents who died with/of AMI was quantitatively analyzed by the decomposition method. Results: In 7,353 residents who died with AMI, 91.74% (6,746) of them were died of AMI from 2005 to 2021. In this period, the CMR and ASMRW of residents died with/of AMI were 15.23/105 and 5.17/105 person-years, the AAPC of CMR was 0.01% (95% CI: -0.71,0.72, p = 0.989) and 0.06% (95% CI: -0.71,0.84, p = 0.868), and the ASMRW decreased by 2.83% (95% CI: -3.66,-2.00, p < 0.001) and 2.76% (95% CI: -3.56,-1.95, p < 0.001), respectively. The CMR of people died of AMI showed a downward trend (all p < 0.05) in people ≥60 years but an upward trend [AAPC = 2.47% (95% CI: 0.07,4.94, p = 0.045)] in people of 45-59 years. The change in CMR of people died with/of AMI caused by demographic factors was 28.70% (95% CI: 12.99,46.60, p = 0.001) and 28.07% (95% CI: 12.71,45.52, p = 0.001) per year, respectively. Conclusion: Preventative strategies for AMI should be applied to enhance the health management of residents aged 45-59 years or with comorbidities in the transitioning region.

Patterns and Trends in Mortality Associated With and Due to Diabetes Mellitus in a Transitioning Region With 3.17 Million People: Observational Study.

BACKGROUND: Diabetes mellitus (DM) imposes a significant disease burden in economically transitioning regions. Most transitioning regions share similar experience in urbanization processes. Shanghai's Pudong district serves as a representative area of such regions. OBJECTIVE: We aimed to assess the burden of and trends in DM mortality in Shanghai's Pudong district and analyze the impact of aging and multimorbidity. METHODS: A longitudinal, population-based study was conducted to analyze DM mortality in Pudong from 2005 to 2020. We used joinpoint regression to analyze epidemiological features and long-term trends in crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), and years of life lost (YLL). Furthermore, the decomposition method was used to evaluate the contribution of demographic and nondemographic factors associated with mortality. RESULTS: There were 49,414 deaths among individuals with DM, including 15,512 deaths due to DM. The CMR and ASMRW were 109.55/105 and 38.01/105 person-years, respectively. Among the mortality associated with and due to DM, the total annual ASMRW increased by 3.65% (95% CI 3.25%-4.06%) and 1.38% (95% CI 0.74%-2.02%), respectively. Additionally, the total annual YLL rate increased by 4.98% (95% CI 3.92%-6.05%) and 2.68% (95% CI 1.34%-4.04%). The rates of YLL increase in persons aged 30 to 44 years (3.98%, 95% CI 0.32%-7.78%) and 45 to 59 years (4.31%, 95% CI 2.95%-5.69%) were followed by the increase in persons aged 80 years and older (10.53%, 95% CI 9.45%-11.62%) for deaths associated with DM. The annual CMR attributable to demographic factors increased by 41.9% (95% CI 17.73%-71.04%) and 36.72% (95% CI 16.69%-60.2%) for deaths associated with and due to DM, respectively. Hypertension, cerebrovascular disease, and ischemic heart disease were the top 3 comorbidities. CONCLUSIONS: Aging and multimorbidity played essential roles in changing the burden of DM in an urbanizing and transitioning region. There is an increasing disease burden among young and middle-aged people, emphasizing the need for greater attention to these groups. Health management is an emerging method that holds important implications for alleviating the future burden of DM.

The burden and trend of liver metastases in Shanghai, China: a population-based study.

BACKGROUND: Studies on the epidemiology of liver metastases (LM)-related mortality are rare. we aimed to describe the burden and trend of liver metastases in Pudong of Shanghai, which could be beneficial to cancer prevention. METHODS: We performed a retrospective population-based analysis of cancer mortality data with liver metastases in Shanghai Pudong from 2005 to 2021. Long-term trends in crude mortality rates (CMRs), age-standardized mortality rates worldwide, and rate of years of life lost (YLL) were analyzed by the Join-point regression model. In addition, we evaluate the impact of the demographic and nondemographic factors on the mortality of disease by the decomposition method. RESULTS: Cancer with liver metastases accounted for 26.68% of all metastases. The CMR and age-standardized mortality rates by Segi's world population (ASMRW) of cancer with liver metastases were 15.12/105 person-years and 6.33/105 person-years, respectively. The YLL from cancer with liver metastases was 84 959.87 years, with the age group of 60-69 years having the highest YLL of 26 956.40 years. The top three cancer types in liver metastases are colorectal, gastric, and pancreatic cancer. The long-term trend of ASMRW significantly decreased by 2.31% per year ( P <0.05). The ASMRW and YLL rates of those over 45 decreased year by year. Particularly striking was the 70-79 age group. Although the overall mortality of cancer with liver metastases decreased, there was still a significant upward trend toward an increased mortality rate caused by cancer with liver metastases in aging patients. CONCLUSION: Liver metastases were a common site of metastases in patients with cancers originating from the digestive system. The disease burden caused by cancer with liver metastases provides valuable evidence for cancer management.

The burden of congenital birth defects between 1990 and 2019 in China: an observational study.

Background: Congenital birth defects (CBDs) are a major public health issue. This study aims to assess trends in the burden of CBDs between 1990 and 2019 across China based on the Global Burden of Disease Study 2019 (GBD 2019). Methods: Indicators of the burden of CBDs included incidence, mortality, and disability-adjusted life years (DALYs). Metrics included number, rate, and age-standardized rate with 95% uncertainty intervals (UIs). Data were stratified by region [China, global, high-, middle-, low-socio-demographic index (SDI)], age, sex, and type of CBD. Average annual percentage changes (AAPC) and trends were evaluated. Results: In China, between 1990 and 2019, the age-standardized incidence rate for CBDs showed an increasing trend, with an AAPC of 0.26% (0.11% to 0.41%), reaching 148.12 per 105 person-years (124.03 to 176.33) in 2019. Most CBDs were congenital heart anomalies, with an AAPC of 0.12% (-0.08% to 0.32%). The age-standardized mortality rate for CBDs showed a decreasing trend, with an AAPC of -4.57% (-4.97% to -4.17%), reaching 4.62 per 105 person-years (3.88 to 5.57) in 2019. Most mortality was associated with congenital heart anomalies, with an AAPC of -3.77% (-4.35% to -3.19%). The age-standardized DALYs rate for CBDs showed a decreasing trend, with an AAPC of -3.74% (-3.95% to -3.52%), reaching 480.95 per 105 person-years (407.69 to 570.04) in 2019. Conclusions: Morbidity associated with CBDs increased in China between 1990 and 2019, accelerated by the adoption of the two-child policy, and ranked high globally. These findings emphasize the need for prenatal screening and primary and secondary prevention strategies.

Determination of diabetic retinopathy prevalence and associated risk factors in Chinese diabetic and pre-diabetic subjects: Shanghai diabetic complications study.

BACKGROUND: The prevalence of diabetic retinopathy is not well studied in the Chinese pre-diabetic population, also known as impaired glucose regulation. Hence, we investigated the prevalence of and risk factors associated with retinopathy in diabetic and pre-diabetic subjects from Chinese communities. METHODS: A total of 3736 Chinese subjects were recruited from urban communities in Shanghai. The participants were classified as normal glucose tolerance, impaired glucose regulation (IGR) and diabetes based on the 75 g oral glucose tolerance test. The levels of diabetic retinopathy (DR) were assessed with non-mydriatic retinal photographs according to the Diabetic Retinopathy Disease Severity Scale. RESULTS: The prevalence of diabetic retinopathy in patients with diabetes and impaired glucose regulation subjects was 9.4% and 2.5%, respectively. In subjects with IGR, hypertension (odds ratio: 3.54, p = 0.028), including elevated systolic and diastolic blood pressure and obesity (odds ratio: 3.53, p = 0.028) were significantly associated with diabetic retinopathy after age and sex adjustments. The factors associated with retinopathy in diabetes included diabetes duration, blood glucose levels, glycated hemoglobin levels, and the presence of albuminuria. Diabetic retinopathy was significantly associated with fasting plasma glucose in known diabetes, whereas in newly-diagnosed subjects, diabetic neuropathy was closely correlated to postprandial plasma glucose. CONCLUSIONS: Hyperglycemia was a strong risk factor for diabetic retinopathy. In pre-diabetic subjects, diabetic retinopathy was also associated with hypertension and obesity.

Hyperuricemia accompanied with changes in the retinal microcirculation in a Chinese high-risk population for diabetes.

OBJECTIVE: To investigate the association of retinal vascular calibers with hyperuricemia in a middle-aged and elderly population. METHODS: A cross-sectional design was applied in this study and 869 participants aged =40 years from a high-risk group for diabetes were recruited. All participants received the anthropometrical measurements and laboratory tests. Retinal arteriolar and venular caliber of the participants were measured with a semi-automated system. Hyperuricemia was defined as a serum uric acid level >420 µmol/L in men and >360 µmol/L in women. Linear regression models were used to assess the association of hyperuricemia with retinal vascular calibers. These models were additionally adjusted for age, central obesity, hypertension, dyslipidemia, weekly activity, smoking status, and education. RESULTS: Among the 869 participants, 133 (15.3%) suffered from hyperuricemia. The crude mean serum uric acid level was 312.3 µmol/L (Standard Deviation 79.5); mean concentration was 355.0 µmol/L (SD 75.5) in male participants, and 288.0 µmol/L (SD 71.1) in female participants (age-adjusted difference 58.1 µmol/L, 95% Confidence Internal 48.5, 67.6). After adjusting for additional covariates, male participants with hyperuricemia had 3.77 µm (95% CI -0.46, 8.00) smaller arteriolar caliber and 6.20 µm (95% CI 0.36, 12.04) larger venule than those without hyperuricemia; the corresponding numbers among female participants were 1.57 µm (95% CI -1.07, 4.21) for retinal arteriolar caliber and 2.28 µm (95% CI -1.72, 6.27) for retinal venular caliber. CONCLUSION: Hyperuricemia was associated with smaller retinal arteriolar caliber and larger venular caliber mainly in male participants in this study.

A Predictive Model Based on a New CI-AKI Definition to Predict Contrast Induced Nephropathy in Patients With Coronary Artery Disease With Relatively Normal Renal Function.

Background: Contrast induced nephropathy (CIN) is a common complication in patients receiving intravascular contrast media. In 2020, the American College of Radiology and the National Kidney Foundation issued a new contrast induced acute kidney injury (CI-AKI) criteria. Therefore, we aimed to explore the potential risk factors for CIN under the new criteria, and develop a predictive model for patients with coronary artery disease (CAD) with relatively normal renal function (NRF). Methods: Patients undergoing coronary angiography or percutaneous coronary intervention at Zhongshan Hospital, Fudan University between May 2019 and April 2020 were consecutively enrolled. Eligible candidates were selected for statistical analysis. Univariate and multivariate logistic regression analyses were used to identify the predictive factors. A stepwise method and a machine learning (ML) method were used to construct a model based on the Akaike information criterion. The performance of our model was evaluated using the area under the receiver operating characteristic curves (AUC) and calibration curves. The model was further simplified into a risk score. Results: A total of 2,009 patients with complete information were included in the final statistical analysis. The results showed that the incidence of CIN was 3.2 and 1.2% under the old and new criteria, respectively. Three independent predictors were identified: baseline uric acid level, creatine kinase-MB level, and log (N-terminal pro-brain natriuretic peptide) level. Our stepwise model had an AUC of 0.816, which was higher than that of the ML model (AUC = 0.668, P = 0.09). The model also achieved accurate predictions regarding calibration. A risk score was then developed, and patients were divided into two risk groups: low risk (total score < 10) and high risk (total score ≥ 10). Conclusions: In this study, we first identified important predictors of CIN in patients with CAD with NRF. We then developed the first CI-AKI model on the basis of the new criteria, which exhibited accurate predictive performance. The simplified risk score may be useful in clinical practice to identify high-risk patients.

Factors associated with the depression among people with disabilities: A cross-sectional study in Chinese communities of Shanghai.

Depression has become a growing health issue in the world and is projected to become a leading cause of global burden. However, there is little scientific research on the factors associated with depression in people with disabilities in China. In this cross-sectional study, we aimed to explore the prevalence and related factors of depression among people with disabilities in communities in mainland China.Participants with disability certificates were recruited via face-to-face interviews to complete questionnaires. Contents include participants' demographic characteristics, the Modified Barthel Index (MBI), chronic medical history, and the Patient Health Questionnaire-9 (PHQ-9).A total of 1815 participants (M age = 60.35 ±â€Š13.66) whose questionnaires are eligible were finally included. Among them the incidence rate of depressive symptoms was up to 39.9%. Multifactor regression analysis showed that grade I disability (odds ratio (OR) = 1.37, P < .05), impairment activities of daily living (OR = 3.23, P < .001), diabetes (OR = 1.43, P < .05), and hyperlipidemia (OR = 1.59, P < .001) were associated with depression in the disabled. However, intelligence disability is a protective factor of depression (OR = 0.69, P < .05).The data demonstrates that the depression of the disabled should arouse the attention of our society. Furthermore, the interventions to disability degree, impairment activities of daily living, diabetes, and hyperlipidemia may help to improve the mental health of the disabled people.

Primary care workforce and continuous medical education in China: lessons to learn from a nationwide cross-sectional survey.

OBJECTIVES: This study aimed to examine the education and training background of Chinese community health centres (CHCs) staff, continuous medical education (CME) and factors affecting participation in CME. DESIGN: Cross-sectional survey. SETTING: Community health centres (CHCs). PARTICIPANTS: All doctors and nurses working in selected CHCs (excluding those solely practising traditional Chinese Medicine). MAIN OUTCOME MEASURES: CME recorded by CHCs and self-reported CME participation. METHODS: A stratified random sample of CHCs based on geographical distribution and 2:1 urban-suburban ratio was selected covering three major regions of China. Two questionnaires, one for lead clinicians and another for frontline health professionals, were administered between September-December 2015, covering the demographics of clinic staff, staff training and CME activities. RESULTS: 149 lead clinicians (response rate 79%) and 1734 doctors and 1846 nurses completed the survey (response rate 86%). Of the doctors, 54.5% had a bachelor degree and only 47% were registered as general practitioners (GPs). Among the doctors, 10.5% carried senior titles. Few nurses (4.6%) had training in primary care. Those who have reported participating in CME were 91.6% doctors and 89.2% nurses. CME participation in doctors was more commonly reported by older doctors, females, those who were registered as a GP and those with intermediate or senior job titles. CME participation in nurses was more common among those with a bachelor degree or intermediate/senior job titles or those with longer working experience in the CHC. CONCLUSION: Only half of doctors have bachelor degrees or are registered as GPs as their prime registration in the primary care workforce in China. The vast majority of CHC staff participated in CME but there is room for improvement in how CME is organised.

A survey of anxiety and depression symptoms among primary-care physicians in China.

OBJECTIVE: Anxiety and depression disorder are the most prevalent mental health problems. However, few studies are available pertaining to these problems among Chinese doctors, especially the assessment of the anxiety and depression symptoms among primary-care providers. The aim of this study was to assess the anxiety and depression symptoms among Chinese primary-care physicians and their associated factors. METHODS: A cross-sectional study was conducted among 451 primary-care physicians in Shanghai China (effective response rate was 79.8%). There were 177 male physicians and 274 female physicians with average age of 37.8 (SD +/- 11.1) years. Questionnaire pertaining to depression disorder was indicated by the Zung Self-Rating Depression Scale (SDS) and anxiety disorder was indicated by the Zung Self-Rating Anxiety Scale (SAS). RESULTS: The average SAS and SDS standard scores of the primary-care physicians were 41.1 +/- 11.5 and 46.5 +/- 11.8 respectively. Both of the scale scores were higher than those of Chinese national norms (P both < 0.001). SDS standard score > or = 53 and SAS standard score > or = 50 were regarded as screening-positive criteria. SAS and SDS screening positive rates of primary-care physicians were 18.0% and 31.7% respectively. In addition, married/cohabited and divorced/widowed physicians aged over 30 years with educational background of junior college had higher risks of anxiety and depression disorders. CONCLUSIONS: Chinese primary-care physicians were at considerably high risk of anxiety and depression disorders, which was worthy of attention during healthcare system reform in China.

Association of the adiponectin gene rs1501299 G>T variant, serum adiponectin levels, and the risk of coronary artery disease in a Chinese population.

BACKGROUND: The present study aimed to investigate whether the single nucleotide polymorphism (SNP) 276G>T (rs1501299) of the adiponectin (ADIPOQ) gene was associated with the risk of coronary artery disease (CAD) and serum adiponectin levels in a Chinese population. METHODS: The rs1501299 polymorphism of the ADIPOQ gene was genotyped in 438 subjects with angiographically diagnosed CAD and 443 controls. Levels of serum adiponectin were determined in 152 CAD subjects and 155 controls. RESULTS: The CAD subjects had GT and TT genotypes more frequently, and had GG genotype less frequently than the controls. The OR increased and was significant after adjustment for known CAD risk factors. Significant difference was also observed with T allele being more frequent among the CAD subjects. The T allele at the rs1501299 polymorphism was associated with a higher risk of CAD. The mean adiponectin levels of CAD patients were lower than control subjects. No significant correlation was seen of different genotypes with serum adiponectin levels. CONCLUSIONS: The adiponectin rs1501299 G>T variant was positively related with an increased risk of CAD, and the CAD patients had lower adiponectin levels which were not affected by the different genotypes of rs1501299 in the present study.

Frequency of generalized anxiety disorder in Chinese primary care.

OBJECTIVE: This study aimed to assess the frequency of generalized anxiety disorder (GAD) among primary care patients in China. We also determined the rate of comorbid major depression (MD) in patients with GAD and explored the differences in sociodemographic and health-related characteristics between patients with and without GAD. METHOD: We invited consecutive outpatients who presented to 4 primary care facilities in Shanghai, China to fill out a survey composed of a screening questionnaire based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) for GAD (GAD-7), the Zung Self-Rating Depression Scale (SDS), and various sociodemographic and health-related variables. The 4 primary care facilities covered urban and suburban areas of the city. Patients completed the survey in the reception area as they waited for their medical appointment. RESULTS: The frequency of GAD in Chinese primary care was 4.1% (3.9% for males and 4.3% for females). This estimate was based on 127 positive results among a total of 3073 surveys collected. Of the patients who screened positive for GAD, 72.4% also screened positive for MD. Patients with GAD were more likely to report chronic medical conditions and to attend a university-affiliated primary care clinic. CONCLUSION: Our results showed that the frequency of GAD was significantly high in Chinese primary care patients. Compared with the GAD prevalence in Chinese general population from previously published studies, our findings suggest a link between GAD and health-seeking behaviors. Generalized anxiety disorder was also strongly correlated with MD. Integration of a routine GAD screening regime merits serious consideration to screen, diagnose, and treat patients with GAD in the primary care setting.