Urinary Creatinine Concentrations and Its Explanatory Variables in General Chinese Population: Implications for Creatinine Limits and Creatinine Adjustment.

Objective: The study aimed to analyze the applicability of the World Health Organization's exclusionary guidelines for Urinary creatinine (Ucr) in the general Chinese population, and to identify Ucr related factors. Methods: We conduct a cross-sectional study using baseline data from 21,167 participants in the China National Human Biomonitoring Program. Mixed linear models and restricted cubic splines (RCS) were used to analyze the associations between explanatory variables and Ucr concentration. Results: The geometric mean and median concentrations of Ucr in the general Chinese population were 0.90 g/L and 1.01 g/L, respectively. And 9.36% samples were outside 0.3-3.0 g/L, including 7.83% below the lower limit and 1.53% above the upper limit. Middle age, male, obesity, smoking, higher frequency of red meat consumption and chronic kidney disease were associated significantly with higher concentrations of Ucr. Results of the RCS showed Ucr was positively and linearly associated with body mass index, inversely and linearly associated with systolic blood pressure, diastolic blood pressure, triglycerides level, and glomerular filtration rate, and were non-linearly associated with triiodothyronine. Conclusion: The age- and gender-specific cut-off values of Ucr that determine the validity of urine samples in the general Chinese population were recommended. To avoid introducing bias into epidemiologic associations, the potential predictors of Ucr observed in the current study should be considered when using Ucr to adjust for variations in urine dilution.

[Use the Markov-decision tree model to optimize vaccination strategies of hepatitis E among women aged 15 to 49].

Objective: To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49. Methods: The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies. Parameters of the models were estimated on the basis of published studies and experience of experts. Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model. Results: Compared with non-vaccination group, strategy on post-screening vaccination with rate as 100%, could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives. After implementation of screening program and with the vaccination rate reaching 100%, the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 Yuan/QALY, respectively. Vaccination post to the implementation of a screening program, the result showed better benefit than the vaccination rate of 100%. Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects. If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23, the vaccination rate of 100% strategy was better than the post-screening vaccination strategy, otherwise the post-screening vaccination strategy appeared the optimal strategy. Conclusion: Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance.

[Impact of extended-spectrum ß-lactamase on clinical outcome and medical cost in patients with bloodstream infection due to Klebsiella pneumoniae].

OBJECTIVE: To evaluate the impact of extended-spectrum ß-lactamase (ESBL) on clinical outcome and medical cost in patients with bloodstream infection (BSI) due to Klebsiella pneumoniae. METHODS: A retrospective study was conducted in patients admitted into Changhai Hospital between January 2013 and December 2014, who suffered from BSI due to Klebsiella pneumoniae during hospitalization. Patients were divided into two groups according to whether Klebsiella pneumoniae produced ESBL (ESBL positive group and ESBL negative group). They were matched with propensity score matching method in a 1∶1 ratio and then multiple regression model was used to analyze the impact of ESBL on clinical outcome and medical cost. Clinical outcome was evaluated by 30-day mortality post BSI; medical cost was evaluated by total length of stay (LOS), post-BSI LOS, total hospital cost and antimicrobial cost. RESULTS: Before matching, the two groups were significantly different in age, nosocomial infection rate, LOS before BSI and surgical rate during hospitalization (all P<0.05). The ESBL-positive group had higher 30-day mortality post BSI (21.3% vs 8.7%, P=0.054), and higher total LOS [25.0(12.0, 33.0) vs 16.0(10.0, 23.0) d, P=0.015], post-BSI LOS [16.0(9.0, 26.0) vs 10.0(5.0, 16.0) d, P=0.006], total hospital cost [69 409(40 605, 198 021) vs 45 683(28 448, 67 000) ï¿¥, P<0.001] and antimicrobial cost [10 279(4 815, 25 500) vs 3 783(1 596, 11 879) ï¿¥, P<0.001]. After matching, the two groups had no significant differences in clinical characteristics such as sex, age, nosocomial infection rate, LOS before BSI, APACHEⅡ score, Charlson Comorbidity Index, underlying diseases and surgical rate during hospitalization (all P>0.05). Multiple regression analysis indicated that ESBL could significantly increase the total LOS, post-BSI LOS, total hospital cost and antimicrobial cost (all P<0.001), but did not increase the 30-day mortality post BSI (P=0.910). CONCLUSIONS: ESBL can significantly increase the medical cost in patients with BSI due to Klebsiella pneumoniae but does not increase the 30-day mortality post BSI.

Sampling survey on intellectual disability in 0 approximately 6-year-old children in China.

OBJECTIVES: To understand the current status of intellectually disabled children and the prevalence of intellectual disability (ID) in children aged 0 approximately 6 years and its risk factors, and to provide scientific evidence to formulate relevant policies for helping intellectually disabled children. METHODS: Multiphase, stratified, unequal proportional and cluster sampling was adopted to investigate 60 124 children aged 0 approximately 6 years. All the children investigated were screened for ID using the Denver Developmental Screening Test, and those with positive screening test would be further diagnosed by varied specialists using the Gesell Developmental Inventory. RESULTS: In total, 560 of 60 124 children were diagnosed as intellectually disabled with an overall prevalence of 0.93%. Prevalence of ID was highest in children living in medium-developed areas with a prevalence of 1.20%, higher than in those living in developed areas (0.75%) and in underdeveloped areas (0.84%). It was higher in rural areas (1.03%) than in urban areas (0.83%), and higher in boys (1.01%) than in girls (0.84%). Prevalence of ID increased with the age of children and decreased with the educational level of their parents. CONCLUSIONS: The study suggested that ID is still prevalent in the children of China, and rehabilitation for them is lagging behind current needs. Early prevention of ID in children and pre-school education for them should be strengthened.

Data mining approach to policy analysis in a health insurance domain.

This study examined the characteristics of the knowledge discovery and data mining algorithms to demonstrate how they can be used to predict health outcomes and provide policy information for hypertension management using the Korea Medical Insurance Corporation database. Specifically, this study validated the predictive power of data mining algorithms by comparing the performance of logistic regression and two decision tree algorithms, CHIAD (Chi-squared Automatic Interaction Detection) and C5.0 (a variant of C4.5) using the test set of 4588 beneficiaries and the training set of 13,689 beneficiaries. Contrary to the previous study, the CHIAD algorithm performed better than the logistic regression in predicting hypertension, and C5.0 had the lowest predictive power. In addition, the CHIAD algorithm and the association rule also provided the segment-specific information for the risk factors and target group that may be used in a policy analysis for hypertension management.

[Graf's ultrasound examination method in assessment of dysplasia and congenital dislocation of infant hip].

OBJECTIVE: To discuss the application of Graf's sonographic method in assessment of developmental dysplasia and dislocation of infant hip. METHODS: 2258 infants (4516 hips) were examined and evaluated by Graf's method. RESULTS: The analysis of data showed that type I hip accounted too 78.99%, type II 20.56%, and type III and type IV 0.45%. CONCLUSION: Graf's method can provide qualitative and quantitative evaluation for hips of infants in 3 months after birth. It is an effective in developmental dysplasia of the hip (DDH) and is also useful for early treatment and follow-up of DDH.

Racial residential segregation and the concentration of low- and high-income households in the 45 largest U.S. metropolitan areas.

"The objectives of this paper are to determine the relationship between racial residential segregation and (1) the spatial concentration of low- and high-income households, and (2) the socioeconomic characteristics of racial minority households. The three largest racial minority groups are compared (blacks, Hispanics, and Asians) in the largest 45 metropolitan areas in the United States. Data were obtained from the U.S. bureau of the Census' Population and Housing Summary Tape files. The results revealed that residential segregation of blacks was distinctly different from Asians and Hispanics. Moreover, for Asians and Hispanics, their socioeconomic characteristics matter in their level of residential segregation. For black households, however, their socioeconomic characteristics matter little."