Assessment and model guided cancer screening promotion by village doctors in China: a randomized controlled trial protocol.

BACKGROUND: Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service. METHODS/DESIGN: The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS. DISCUSSION: Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion. TRIAL REGISTRATION: ISRCTN33269053.

Life events and chronic physical conditions among left-behind farmers in rural China a cross-sectional study.

BACKGROUND: This study investigates the relationships between life events and chronic physical conditions among left behind farmers, a newly emerged weak group in vast rural China. METHODS: The study collected information about life events, chronic physical conditions, blood pressure and fasting blood glucose from 4681 famers living in 18 randomly selected villages (Lu'an, Anhui, China) from early November 2013 to the end of December 2013. It compared the risk and odds ratios (RRs/ORs) among different subgroups divided according two life event indices derived by adding up un-weighted-ratings and weighted-ratings based on multivariate logistic regression coefficients respectively. RESULTS: A total of 4040 (86.3 % eligible) farmers completed the survey. RRs between farmers with lower than the first 1/15-percentile of life event index and with higher life event index scores ranged 1.43-5.79 for chronic gastritis and 0.42-9.07 for prostatitis, 1.01-4.97 for cervicitis/vaginitis, 1.45-3.28 for cardio-cerebrovascular diseases, 1.12-1.58 for hypertension, 1.00-1.66 for diabetes, 1.07-3.35 for pre-diabetes and 5.00-55.00 for "other chronic physical conditions". CONCLUSIONS: Life events were independently linked with most of the chronic physical conditions in a dose-effectiveness way. RRs between subgroups divided by given percentile cutoff points of life event index compiled using logistic regression models turned out to be substantially higher than that between subgroups divided by same cutoff points of life event index produced via summing up the un-weighted Likert ratings of all the events studied.

A smart web aid for preventing diabetes in rural China: preliminary findings and lessons.

BACKGROUND: Increasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation's vast population lives. OBJECTIVE: This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care. METHODS: Development of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients' knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2-assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data. RESULTS: The 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m(2), SD 3.21 vs mean 23.36 kg/m(2), SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective. CONCLUSIONS: SWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711.

Development and application of a Chinese webpage suicide information mining system (sims).

OBJECTIVES: This study aims at designing and piloting a convenient Chinese webpage suicide information mining system (SIMS) to help search and filter required data from the internet and discover potential features and trends of suicide. METHODS: SIMS utilizes Microsoft Visual Studio2008, SQL2008 and C# as development tools. It collects webpage data via popular search engines; cleans the data using trained models plus minimum manual help; translates the cleaned texts into quantitative data through models and supervised fuzzy recognition; analyzes and visualizes related variables by self-programmed algorithms. RESULTS: The SIMS developed comprises such functions as suicide news and blogs collection, data filtering, cleaning, extraction and translation, data analysis and presentation. SIMS-mediated mining of one-year webpage revealed that: peak months and hours of web-reported suicide events were June-July and 10-11 am respectively, and the lowest months and hours, September-October and 1-7 am; suicide reports came mostly from Soho, Tecent, Sina etc.; male suicide victims over counted female victims in most sub-regions but southwest China; homes, public places and rented houses were the top three places to commit suicide; poisoning, cutting vein and jumping from building were the most commonly used methods to commit suicide; love disputes, family disputes and mental diseases were the leading causes. CONCLUSIONS: SIMS provides a preliminary and supplementary means for monitoring and understanding suicide. It proposes useful aspects as well as tools for analyzing the features and trends of suicide using data derived from Chinese webpages. Yet given the intrinsic "dual nature" of internet-based suicide information and the tremendous difficulties experienced by ourselves and other researchers, there is still a long way to go for us to expand, refine and evaluate the system.

Relationships between stressful life events and impaired fasting glucose among left-behind farmers in rural China.

OBJECTIVE: This study aims at examining the effects of stressful life events on risk of impaired fasting glucose among left-behind farmers in rural China. METHODS: The study collected data about stressful life events, family history of diabetes, lifestyle, demographics and minimum anthropometrics from left-behind famers aged 40-70 years. Calculated life event index was applied to assess the combined effects of stressful life events experienced by the left-behind farmers and its association with impaired fasting glucose was estimated using binary logistic regression models. RESULTS: The prevalence of abnormal fasting glucose was 61.4% by American Diabetes Association (ADA) standard and 32.4% by World Health Organization (WHO) standard. Binary logistic regression analysis revealed a coefficient of 0.033 (P<.001) by ADA standard or 0.028 (P<.001) by WHO standard between impaired fasting glucose and life event index. The overall odds ratios of impaired glucose for the second, third and fourth (highest) versus the first (lowest) quartile of life event index were 1.419 [95% CI=(1.173, 1.717)], 1.711 [95% CI=(1.413, 2.071)] and 1.957 [95% CI=(1.606, 2.385)] respectively by ADA standard. When more and more confounding factors were controlled for, these odds ratios remained statistically significant though decreased to a small extent. CONCLUSIONS: The left-behind farmers showed over two-fold prevalence rate of pre-diabetes than that of the nation's average and their risk of impaired fasting glucose was positively associated with stressful life events in a dose-dependent way. Both the population studied and their life events merit special attention.

Associations of blood pressure with common factors among left-behind farmers in rural China: a cross-sectional study using quantile regression analysis.

The whole range of blood pressure (BP) has important implications. Yet, published studies focus primarily on hypertension and hypotension, the two extremes of BP continuum. This study aims at exploring quantile-specific associations of BP with common factors. The study used cross-sectional survey, collected information about gender, age, education, body mass index (BMI), alcohol intake, diet risk behavior, life event index, physical activity, fasting capillary glucose (FCG), and systolic/diastolic blood pressure (SBP/DBP) and pulse pressure (PP) from farmers living in 18 villages from rural Anhui, China, and performed descriptive and multivariate and quantile regression (QR) analysis of associations of SBP, DBP, or PP with the 9 factors surveyed. A total of 4040 (86.3%) eligible farmers completed the survey. Average hypertension prevalence rate and SBP, DBP, and PP values estimated 43.20 ± 0.50% and 141.37 ± 21.98, 87.76 ± 12.23, and 53.63 ± 15.72 mm Hg, respectively. Multivariate regression analysis revealed that all the 9 factors were significantly (P < 0.05) associated with one or more of SBP, DBP, and PP. QR coefficients of SBP, DBP, or PP with different factors demonstrated divergent patterns and age, BMI, FCG, and life event index showed substantial trends along the quantile axis. Hypertension prevalence rate was high among the farmers. QR modeling provided more detailed view on associations of SBP, DBP, or PP with different factors and uncovered apparent quantile-related patterns for part of the factors. Both the population group studied and the trends in QR coefficients identified merit specific attention.

Patterns and trends with cancer incidence and mortality rates reported by the China National Cancer Registry.

National cancer registration reports provide a huge potential for identifying patterns and trends of important policy, research, prevention and treatment significance. As summary reports written on an annual basis, the China Cancer Registry Annual Reports (CCRARs) fall short from fully addressing their potential. This paper attempts to explore part of the patterns and trends hidden behind published CCRARs. It extracted data for cancer incidence rates (IRs) and mortality rates (MRs) for 2004, 2006 and 2009 from relevant CCRARs and portrayed 4 kinds of indicators in line graphs. The study showed that: a) all of the line graphs of age-specific IRs and MRs characterized typical "growth curves or histogram"; b) graphs of IRs and MRs for males and urban areas had higher peaks than that for females and rural regions; c) most of the line graphs of IR/MR ratios comprised a starting peak, a secondary peak and a decreasing tail and the secondary peaks for females and urban areas were higher than those for males and rural areas; d) most of the urban versus rural IR ratios valued above one, but most the urban versus rural MR ratios, below one; e) the accumulative IRs and MRs showed a stable increasing trend from 2004 to 2009 for urban areas, but mixed for rural regions.

Association of risk of gastric cancer and consumption of tobacco, alcohol and tea in the Chinese population.

This study aimed at summarizing epidemiological research findings on associations between tobacco, alcohol and tea consumption and risk of gastric cancer (GC) in the Chinese population. The review searched PubMed, Embase, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases and reference lists of review papers for all studies published in English or Chinese languages. Information extracted, via two independent researchers, from retrieved articles included first author, year of publication, study design, sample size, source of controls and adjusted odds ratio (OR) or relative risk (RR) with the corresponding 95% confidence intervals (CIs) for each category. Statistical analyses used software STATA version 12.0. The systematic search found 89 articles containing 25,821 GC cases and 135,298 non-cases. The overall random effects in terms of pooled OR and 95%CI for tobacco, alcohol and tea consumption were 1.62 (95%CI: 1.50-1.74), 1.57 (95%CI: 1.41-1.76) and 0.67 (95%CI: 0.59-0.76) respectively; while the heterogeneity among included studies ranged from 80.1% to 87.5%. The majority of subgroup analyses revealed consistent results with the overall analyses. All three behavioral factors showed statistically significant dose-dependent effects on GC (P<0.05). The study revealed that tobacco smoking and alcohol drinking were associated with over 1/2 added risk of GC, while tea drinking conferred about 1/3 lower risk of GC in the Chinese population. However, these results should be interpreted with caution given the fact that most of the included studies were based on a retrospective design and heterogeneity among studies was relatively high.

Association between pancreatitis and subsequent risk of pancreatic cancer: a systematic review of epidemiological studies.

This study aimed to summarize published epidemiological evidence for the relationship between pancreatitis and subsequent risk of pancreatic cancer (PC). We searched Medline and Embase for epidemiological studies published by February 5th, 2014 examining the risk of PC in pancreatitis patients using highly inclusive algorithms. Information about first author, year of publication, country of study, recruitment period, type of pancreatitis, study design, sample size, source of controls and attained age of subjects were extracted by two researchers and Stata 11.0 was used to perform the statistical analyses and examine publication bias. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with the random effects model. A total of 17 articles documenting 3 cohort and 14 case-control studies containing 14,667 PC cases and 17,587 pancreatitis cases were included in this study. The pooled OR between pancreatitis and PC risk was 7.05 (95%CI: 6.42-7.75). However, the pooled ORs of case-control and cohort studies were 4.62 (95%CI: 4.08-5.22) and 16.3 (95%CI: 14.3-18.6) respectively. The risk of PC was the highest in patients with chronic pancreatitis (pooled OR=10.35; 95%CI: 9.13-11.75), followed by unspecified type of pancreatitis (pooled OR=6.41; 95%CI: 4.93-8.34), both acute and chronic pancreatitis (pooled OR=6.13; 95%CI: 5.00-7.52), and acute pancreatitis (pooled OR=2.12; 95%CI: 1.59-2.83). The pooled OR of PC in pancreatitis cases diagnosed within 1 year was the highest (pooled OR=23.3; 95%CI: 14.0-38.9); and the risk in subjects diagnosed with pancreatitis for no less than 2, 5 and 10 years were 3.03 (95%CI: 2.41-3.81), 2.82 (95%CI: 2.12-3.76) and 2.25 (95%CI: 1.59-3.19) respectively. Pancreatitis, especially chronic pancreatitis, was associated with a significantly increased risk of PC; and the risk decreased with increasing duration since diagnosis of pancreatitis.

Association between gestational diabetes mellitus and subsequent risk of cancer: a systematic review of epidemiological studies.

PURPOSE: This study aimed at summarizing epidemiological evidence of the association between gestational diabetes mellitus (GDM) and subsequent risk of cancer. MATERIALS AND METHODS: We searched Medline, Embase, Cancer Lit and CINAHL for epidemiological studies published by February 1, 2014 examining the risk of cancer in patients with history of GDM using highly inclusive algorithms. Information about first author, year of publication, country of study, study design, cancer sites, sample sizes, attained age of subjects and methods used for determining GDM status were extracted by two researchers and Stata version 11.0 was used to perform the meta-analysis and estimate the pooled effects. RESULTS: A total of 9 articles documented 5 cohort and 4 case- control studies containing 10,630 cancer cases and 14,608 women with a history of GDM were included in this review. Taken together, the pooled odds ratio (OR) between GDM and breast cancer risk was 1.01 (0.87-1.17); yet the same pooled ORs of case-control and cohort studies were 0.87 (0.71-1.06) and 1.25 (1.00-1.56) respectively. There are indications that GDM is strongly associated with higher risk of pancreatic cancer (HR=8.68) and hematologic malignancies (HR=4.53), but no relationships were detected between GDM and other types of cancer. CONCLUSIONS: Although GDM increases the risk of certain types of cancer, these results should be interpreted with caution becuase of some methodological flaws. The issue merits added investigation and coordinated efforts between researchers, antenatal clinics and cancer treatment and registration agencies to help attain better understanding.