Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing.

INTRODUCTION: Beijing initiated the nation's most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy. METHODS: This study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall's coefficient of concordance was calculated. RESULTS: Twenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall's concordance coefficient was 0.218 for all indicators. For all model composition, Kendall's concordance coefficients were statistically significant. CONCLUSION: This study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

Multiple streams approach to tobacco control policymaking in the capital city of the world's largest tobacco consuming country.

The aim of this study was to analyse the policymaking process of Beijing tobacco control regulations based on a multiple streams framework to provide a reference for other cities, at the national level and for the international community to promote the development of tobacco control policy. Twenty-one documents related to tobacco control in Beijing were collected, nine informants were interviewed and the interview data were analysed by a thematic framework method. It was found that indicators, feedback and a focus event in the problem stream drew the attention of policymakers and the society for tobacco control. In 2011, Ying Songnian, a representative of the Beijing Municipal People's Congress, put forward tobacco control legislation, which was just in time for the legislative reform of the Congress. The proposal was studied by the Congress, and a strategy of 'social co-governance' was founded. In the political stream, the government actively promoted tobacco control and social organizations extensively participated in it. In 2013, the General Office of the Central Committee of the Chinese Communist Party and the General Office of the State Council issued a notice on matters related to leading cadres taking the lead in banning smoking in public places, which opened a policy window for decision-makers who were hesitatant. The issue of tobacco control was successfully put on the policy agenda and contributed to the introduction of the Beijing Municipal Regulations on Smoking Control. Development of the factors in problem stream, policy stream and political stream promoted the setting up of the tobacco control policy agenda in Beijing. It is suggested that more cities should learn from the experience of Beijing, seize the opportunity of the ideological change of the ruling party, actively identify the problems, mobilize and advocate for representatives and introduce the concept of 'social co-governance' to promote tobacco control legislation.

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants.

OBJECTIVES: To identify clues for women's tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals' social integration. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15-59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES: Social environmental changes were measured by differences in smoking prevalence and women's empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness. RESULTS: Differences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women's empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women's smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women's empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified. CONCLUSIONS: Tobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.

Assessment of the Clinical Diagnosis of Onychomycosis by Dermoscopy.

Background: As a common clinical superficial fungal infection, the diagnosis of onychomycosis relies on clinical features, traditional KOH direct microscopy and fungal culture. In recent years, dermoscopy has been widely used in the diagnosis and treatment of infectious diseases and has provided new options for the diagnosis of onychomycosis. Objective: To evaluate the value of dermoscopy in the clinical diagnosis of onychomycosis and to explore the relationship between each clinical subtype and the dermoscopic pattern. Methods: A retrospective study of 114 cases of clinically suspected onychomycosis was conducted to compare the differences between dermoscopy and fungal pathogenic examination (microscopy and culture) in the diagnostic sensitivity of onychomycosis and to analyze the relationship between nine common dermoscopic modalities and clinical subtypes of onychomycosis. Results: Among the 114 proposed patients, 87 nails with positive fluorescent staining microscopy and/or positive fungal cultures were diagnosed as onychomycosis. The sensitivity and specificity of dermatoscopy, using the mycological findings as a reference, were 86.21 and 33.33%, respectively. The incidence of common dermatoscopic patterns in the 87 nails with confirmed onychomycosis was as follows: white flocculation in 76 cases (87.35%), longitudinal nail pattern in 72 cases (82.76%), jagged changes in the distal nail plate in 69 cases (79.31%) and yellow staining in 46 cases (52.87%), these four patterns were more commonly seen in the distal lateral subungual onychomycosis and total dystrophic onychomycosis, but there was no statistical difference in the positive dermatoscopic pattern between these two types (P > 0.05). Conclusion: Dermoscopy can be an important aid in the diagnosis of onychomycosis, especially when fungal microscopy or culture is not appropriate, but this method is still not a substitute for fungal microscopy and culture.

Prognosis assessment model based on low serum calcium in patients with acute pulmonary thromboembolism.

BACKGROUND AND OBJECTIVE: The pulmonary embolism severity index (PESI) and simplified PESI (sPESI) are recommended to recognize patients with acute pulmonary thromboembolism (PTE) with low prognosis risk, which is of great significance for treatment. This study aims to verify the influence of hypocalcaemia on the prognosis of patients with PTE and to establish a new prognosis assessment model. METHODS: This is an observational, multicentre study enrolling patients with PTE from February 2010 to June 2020 across 12 Chinese hospitals. Variables in PESI, serum calcium levels and patient survival status as of 5 July 2020 were collected. The area under the curve of the receiver operating characteristic curve, sensitivity, specificity and Youden index were used to evaluate model performance. RESULTS: In the cohort of 4196 patients with PTE, independent associations existed between hypocalcaemia and mid- and long-term mortalities (p <0.05). By including hypocalcaemia, the new 30-day death risk prediction rule, Peking Union Medical College Hospital rule (PUMCH rule), showed significantly higher specificity (0.622 [0.582, 0.661]; p <0.001) than the PESI (0.514 [0.473, 0.554]) and sPESI (0.484 [0.444, 0.525]) and similar sensitivity (0.963 [0.810, 0.999]; p = 0.161) with PESI (0.889 [0.708, 0.976]) and sPESI (0.963 [0.810, 0.999]) in the internal validation cohort. Well-performing predictive validity was also verified on a constructed external validation cohort. CONCLUSION: Hypocalcaemia is independently associated with mid- and long-term PTE mortalities. The PUMCH rule showed significantly higher specificity than the PESI and sPESI and similar sensitivity, which may be used as a prognostic assessment tool for patients with acute PTE.

Risk-Averse Two-Stage Stochastic Minimum Cost Consensus Models with Asymmetric Adjustment Cost.

In the process of reaching consensus, it is necessary to coordinate different views to form a general group opinion. However, there are many uncertain factors in this process, which has brought different degrees of influence in group decision-making. Besides, these uncertain elements bring the risk of loss to the whole process of consensus building. Currently available models not account for these two aspects. To deal with these issues, three different modeling methods for constructing the two-stage mean-risk stochastic minimum cost consensus models (MCCMs) with asymmetric adjustment cost are investigated. Due to the complexity of the resulting models, the L-shaped algorithm is applied to achieve an optimal solution. In addition, a numerical example of a peer-to-peer online lending platform demonstrated the utility of the proposed modeling approach. To verify the result obtained by the L-shaped algorithm, it is compared with the CPLEX solver. Moreover, the comparison results show the accuracy and efficiency of the given method. Sensitivity analyses are undertaken to assess the impact of risk on results. And in the presence of asymmetric cost, the comparisons between the new proposed risk-averse MCCMs and the two-stage stochastic MCCMs and robust consensus models are also given.

Inequalities in changing mortality and life expectancy in Jiading District, Shanghai, 2002-2018.

BACKGROUND: Improvements of population health in China have been unevenly distributed among different sexes and regions. Mortality Registration System provides an opportunity for timely assessments of mortality trend and inequalities. METHODS: Causes of death were reclassified following the method of Global Burden of Disease Study (GBD). Age-standardized mortality rate (ASMR) and ring-map of the rate by town were used to describe inequalities in changing mortality. Life expectancy (LE) and cause-deleted LE were calculated on the basis of life table technique. RESULTS: The burden of death from 2002 to 2018 was dominated by cardiovascular diseases (CVD), neoplasms, chronic respiratory diseases and injuries in Jiading district, accounting for almost 80% of total deaths. The overall ASMR dropped from 407.6/100000 to 227.1/100000, and LE increased from 77.86 years to 82.31 years. Women lived about 3.0-3.5 years longer than men. Besides, a cluster of lower LE was found for CVD in the southeast corner and one cluster for neoplasms in the southern corner of the district. The largest individual contributor to increment in LE was neoplasms, ranged from 2.41 to 3.63 years for males, and from 1.60 to 2.36 years for females. CONCLUSIONS: Improvement in health was mainly attributed to the decline of deaths caused by CVD and neoplasms, but was distributed with sex and town. This study served as a reflection of health inequality, is conducive to formulate localized health policies and measures.

A study of environmental regulation, technological innovation, and energy consumption in China based on spatial econometric models and panel threshold models.

Under different technological innovation modes, regional energy consumption may have spatial heterogeneity. Spatial heterogeneity complicates the nexus between environmental regulation and energy consumption. Traditional spatial homogeneity analysis is hard to describe the nonlinear nexus between them. Based on the data of 30 provinces in China from 2007 to 2017, this paper employs the spatial econometric method and the nonlinear econometric method to investigate the spatial effects and nonlinearity of energy consumption, respectively. The results display that under the current level of economic development, per capita energy consumption has a significant spatial spillover effect. Environmental regulation promotes regional per capita energy consumption in the short term. On the contrary, the technological effect of environmental regulation has significantly reduced Chinese per capita energy consumption. Therefore, energy policy should be tailored to local conditions, and policymakers can strengthen the environmental regulatory system and encourage enterprises to implement green technology innovation.

De novo pattern discovery enables robust assessment of functional consequences of non-coding variants.

MOTIVATION: Given the complexity of genome regions, prioritize the functional effects of non-coding variants remains a challenge. Although several frameworks have been proposed for the evaluation of the functionality of non-coding variants, most of them used 'black boxes' methods that simplify the task as the pathogenicity/benign classification problem, which ignores the distinct regulatory mechanisms of variants and leads to less desirable performance. In this study, we developed DVAR, an unsupervised framework that leverage various biochemical and evolutionary evidence to distinguish the gene regulatory categories of variants and assess their comprehensive functional impact simultaneously. RESULTS: DVAR performed de novo pattern discovery in high-dimensional data and identified five regulatory clusters of non-coding variants. Leveraging the new insights into the multiple functional patterns, it measures both the between-class and the within-class functional implication of the variants to achieve accurate prioritization. Compared to other two-class learning methods, it showed improved performance in identification of clinically significant variants, fine-mapped GWAS variants, eQTLs and expression-modulating variants. Moreover, it has superior performance on disease causal variants verified by genome-editing (like CRISPR-Cas9), which could provide a pre-selection strategy for genome-editing technologies across the whole genome. Finally, evaluated in BioVU and UK Biobank, two large-scale DNA biobanks linked to complete electronic health records, DVAR demonstrated its effectiveness in prioritizing non-coding variants associated with medical phenotypes. AVAILABILITY AND IMPLEMENTATION: The C++ and Python source codes, the pre-computed DVAR-cluster labels and DVAR-scores across the whole genome are available at https://www.vumc.org/cgg/dvar. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

A Modified Strategy Using Barbed Sutures for Wound Closure in Total Joint Arthroplasty: A Prospective, Randomized, Double-Blind, Self-Controlled Clinical Trial.

BACKGROUND Barbed suture has reported time-saving and safety benefits for wound closure in total joint arthroplasty (TJA). However, this technique requires further investigation. The aim of this study was to use a prospective, randomized, self-controlled study to further determine the efficiency and safety of this technology and to introduce our modified suturing method through a randomized, self-controlled trial. MATERIAL AND METHODS From August 2015 to December 2016, 84 patients (hip 46, knee 38) who had undergone primary simultaneous bilateral total knee or hip arthroplasties were enrolled in this study. Barbed sutures were randomized and used on one side, and traditional sutures (Vicryl) were used on the other side. RESULTS Closure time was shorter with the barbed sutures: 6.25 min (12.00 min vs. 18.25 min, p=0.000) for hip and 5.54 min (13.18 min vs. 18.71 min, p=0.000) for knee. There was no difference in the complication rate for the 2 groups. The total cost of our suturing strategy (Quill) was 872.3 RMB, which is 375.1 RMB higher than the total cost of the standard suture method (Vicryl). However, the traditional barbed suturing method (Quill) cost 2195.6 RMB. CONCLUSIONS Barbed suturing was a fast and safe method for wound closure in TJA. We also recommend our modified suturing strategy, especially in countries where operation cost was not associated with operation time.

The prevalence of smoking, second-hand smoke exposure, and knowledge of the health hazards of smoking among internal migrants in 12 provinces in China: a cross-sectional analysis.

BACKGROUND: Previous studies have provided inconsistent findings on smoking among migrants, and very limited data exist on their second-hand smoke exposure. This study aims to investigate internal migrants' smoking prevalence, second-hand smoke exposure among non-smokers, and knowledge of the health hazards of smoking in 12 major migrant provinces in China in 2013. METHODS: Data from the 2013 Migrant Dynamics Monitoring Survey in China published by the National Commission of Health and Family Planning was used in this study. Descriptive analysis, Chi-square analysis, and sex-stratified multivariate logistic regression analysis were used to explore the determinants of current smoking and second-hand smoke exposure. RESULTS: Among 7200 migrants, 34.1% (55% male, 4% female) were current smokers. For males, factors associated with current smoking were education year (aOR = 0.95, 95% CI: 0.93-0.98), duration of stay (aOR = 1.01, 95% CI: 1.00-1.03) and occupation (aOR = 1.25, 95% CI: 1.03-1.53). For females, household registration status (aOR = 1.70, 95% CI: 1.04-2.80) was the most important factor associated with current smoking. Sixty five percent of non-smokers were exposed to second-hand smoke. Factors associated with exposure to second-hand smoke were duration of stay (aOR = 1.01, 95% CI: 1.00-1.02), divorced/widowed marital status (aOR = 0.48, 95% CI: 0.25-0.91), occupation (aOR = 1.29, 95% CI: 1.05-1.58) and the nature of employer (aOR = 0.77, 95% CI: 0.60-0.97). About 95% of participants were aware that lung cancer is one of the hazards of smoking. Non-current smokers had a better knowledge of fertility reduction and accelerated aging as hazards of smoking than current smokers (p < 0.01). Knowledge of the impact of smoking on cardiovascular diseases was relatively low compared with knowledge of other smoking-related hazards (26.1-44.3%). CONCLUSIONS: Current smoking and exposure to second-hand smoke among internal migrants in China is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors, such as focusing on divorced/widowed women.

Mobility patterns and associated factors among pregnant internal migrant women in China: a cross-sectional study from a National Monitoring Survey.

BACKGROUND: Residential instability during pregnancy has been linked to poor health outcomes. As a first step toward providing better health care to pregnant migrant women, the size and characteristics of this population and factors associated with mobility during pregnancy should be studied. METHODS: Using the "Monitoring Data of Chinese Migrants" for 2012, from the Chinese National Population and Family Planning Commission, this study explored mobility patterns during pregnancy and associated factors among migrants within China. From a library of 158,556 participants, two subsamples were selected. Percentages, with chi-squared tests, and means and standard deviations, with ANOVAs, were adopted to describe mobility patterns during pregnancy (always staying in sending area, mainly staying in sending area, mainly staying in receiving area, and always staying in receiving area) and delivery location choice. Logistic regression analysis was used to explore the associated factors. RESULTS: We found that the percentage of migrants always or mainly staying in receiving areas during pregnancy rose from nearly 40% in 1985 to more than 80% in 2012, while the percentage of migrants who were mobile between receiving and sending areas during pregnancy fluctuated between 30 and 40% before 1995, and between 40 and 45% after 1995, decreasing to around 40% after 2008. The percentage of respondents who chose to deliver in receiving areas fluctuated but increased from 10% in 1985 to more than 50% in 2011. Among respondents who had delivered during the last year of the survey period, families with older pregnant women (OR = 1.09, 95% CI 1.05-1.13), their own housing (OR = 5.66, 95% CI 2.45-13.05), longer time in the receiving area (OR = 1.14, 95% CI 1.09-1.20), and strong will to integrate (OR = 1.32, 95% CI 1.15-1.51) always stayed in the receiving area during pregnancy, rather than the sending area, and families with broadly similar characteristics were inclined to choose the receiving area for their delivery. CONCLUSIONS: The mobility patterns of pregnant migrant women in China have been changing in recent years, with the percentage of them staying in receiving areas during pregnancy and delivering there increasing. Individual and family characteristics were also associated with mobility patterns and delivery location choice.

Type 1 diabetes mellitus care and education in China: The 3C study of coverage, cost, and care in Beijing and Shantou.

AIMS: The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines. METHODS: The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association. RESULTS: The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions. CONCLUSIONS: The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.

The Migrant Paradox in Children and the Role of Schools in Reducing Health Disparities: A Cross-Sectional Study of Migrant and Native Children in Beijing, China.

Migrants usually exhibit similar or better health outcomes than native-born populations despite facing socioeconomic disadvantages and barriers to healthcare use; this is known as the "migrant paradox." The migrant paradox among children is highly complex. This study explores whether the migrant paradox exists in the health of internal migrant children in China and the role of schools in reducing children's health disparities, using a multi-stage stratified cluster sampling method. Participants were 1,641 student and parent pairs from Grades 4, 5, and 6 of eight primary schools in Beijing. The following school types were included: state schools with migrant children comprising over 70% of total children (SMS), private schools with migrant children comprising over 70% (PMS), and state schools with permanent resident children comprising over 70% (SRS). Children were divided into Groups A, B, C or D by the type of school they attended (A and B were drawn from SRSs, C was from SMSs, and D was from PMSs) and whether they were in the migrant population (B, C, and D were, but A was not). Related information was collected through medical examination and questionnaires completed by parents and children. Prevalence of caries, overweight and obesity, poor vision, and self-reported incidence of colds and diarrhea in the previous month were explored as health outcomes. The results partially demonstrated the existence of the migrant paradox and verified the role of schools in lowering health disparities among children; there are theoretical and practical implications for improving the health of migrant children.

Social determinants of health behaviors in primary school children: A cross-sectional study of both migrant and resident children in Beijing, China.

Childhood risky behaviors always result in adverse health outcomes. These behaviors are greatly affected by social environment and individual factors. However, few studies explored the social determinants of schoolchildren's health behaviors. In this cross-sectional study, the social determinants of health behaviors were examined among both migrant and resident students in Beijing, China. Data of 967 children from six urban and suburban primary schools were analyzed using multiple linear regression analysis. The results showed that less than 60% of children performed some healthy behaviors, although their health knowledge was generally good. Children's health behavior scores were greatly determined by school characteristics, health knowledge, demographic characteristics, and family context. Therefore, improving health education and conditions in primary schools is the priority to promote children's healthy behaviors, especially for disadvantaged children.

Smoking and Its Determinants in Chinese Internal Migrants: Nationally Representative Cross-Sectional Data Analyses.

INTRODUCTION: Migrants often face multiple risk factors for smoking initiation. Former studies that have explored the smoking habits of Chinese migrants have provided inconsistent findings and lacked nationally representative samples. METHODS: Using data from the 2012 Migrant Dynamics Monitoring Survey in China published by the National Population and Family Planning Commission, this study explored current smoking rates and its determinants among migrants in China. RESULTS: The smoking rates of men (46.9%, 46.3%-47.3%) and women (1.8%, 1.7%-1.9%) differed significantly. Although the overall smoking rates in migrants was slightly lower than in the general population, the rates in certain subgroups were much higher. Among men, the three leading associated factors were the following: higher smoking rates among the divorced or widowed (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.34-1.74); lower smoking rates among those with an educational level of senior high school or above (OR = 0.73, 95% CI: 0.71-0.76), and higher smoking rates in the migrant-receiving area (OR = 1.29, 95% CI: 1.18-1.42). Among women, smoking rates were also higher in the migrant-receiving area (OR = 1.78, 95% CI: 1.34-2.34), when monthly income was more than 3000 Renminbi (OR = 1.65, 95% CI: 1.43-1.90), and among those with an educational level of senior high school or above (OR = 0.65, 95% CI: 0.56-0.75). The social integration of migrants, the duration of stay, and working hours had weaker associations with smoking risk. CONCLUSIONS: The sociodemographic features, work pressure, and migration-related features were sex-dependent determinants of smoking rates. These factors need to be considered when planning tobacco control interventions among migrants. IMPLICATIONS: Our study was the first to analyze a nationally representative Chinese migrant sample with respect to smoking, its differential rates across various subgroups, and its determinants. Our results provided overall levels of migrant smoking rates. The findings also demonstrated the influences of sex, other sociodemographic variables, migration-related factors, work pressure, and social integration on the smoking habits of migrants. These results provide a database of information for developing and improving tobacco control interventions in migrants.

Comparative efficacy and cost effectiveness of splenectomy and thrombopoietin prior to peginterferon and ribavirin therapy with compensatory cirrhosis associated with hepatitis C and thrombocytopenia.

The aim of the present study was to evaluate and compare the treatment efficacy and cost of two therapies, splenectomy and thrombopoietin, in order to optimize the treatment plans for patients with HCV-associated cirrhosis. A prospective randomized controlled trial was conducted on 69 patients with a platelet count <60,000/mm3 that were enrolled between 2009 and 2013, including 38 cases as the research group and 31 cases as the observed group. The study included two stages: A 4-week initial treatment and a 48-week antiviral treatment, during which a number of parameters were evaluated, including platelet count, liver stiffness measure, albumin, total bilirubin, alanine aminotranferase and treatment cost-effectiveness. Of the 38 patients, 21 underwent a splenectomy and their platelet counts increased to 60,000/mm3 after the 4-week initial treatment. The patients then started a 48-week P-R antiviral treatment, and 18 cases completed the treatment. In addition, 17/38 patients received thrombopoietin as a drug therapy. The platelet counts in 15 cases increased to >60,000/mm3 and the patients received antiviral treatment, among which 9 cases completed the second treatment stage. The expense of the splenectomy group treatment was higher compared with that received by the thrombopoietin group. The results of the present study indicated that splenectomy was more effective at increasing platelet count. More splenectomy patients completed the full course of antiviral treatment and presented a sustained virologic response, compared with the thrombopoietin group. Therefore, splenectomy may be more expensive compared with thrombopoietin; however, the improved efficacy suggests that on balance it is the preferable treatment option.

Comprehensive assessment of patellar morphology using computed tomography-based three-dimensional computer models.

BACKGROUND: The objectives of this study were to assess patellar morphology using computed tomography-based three-dimensional computer models and to determine the utility of the subchondral method for patellar resection in total knee arthroplasty (TKA). METHODS: Overall, 120 subjects (60 males, 60 females) from 20 to 50 years old were included. Computer tomography images were used to construct 3D computer models of 240 knees. An anthropometric analysis of variance was used with the models to detect differences between the sides, age groups, and genders. RESULTS: Based on the available numbers, there were significant gender differences in the patellar length, width, and thickness even with strict control for the height and weight of the patients. The average patellar width/thickness ratio was 1.95, regardless of gender, and there was a good correlation between the patellar width and thickness (male: r=0.68, p<0.01; female: r=0.75, p<0.01). After using the subchondral method to virtually resect the patellae, the mean thickness for males and female was 14.0mm and 12.3mm, respectively. The proportion of the residual bony thickness that was less than 12 mm was 5.83% (seven cases) in the male group and up to 42.5% (51 cases) in the female group. There was excellent intra-observer reliability and inter-observer reliability regarding the dimensional measurements in this study. CONCLUSIONS: A robust method of measuring and virtually resecting the patella was established. The anthropometric dimensions of this study could provide basic data for guiding surgical management of the patella in TKA and are useful in designing patellar implants. CLINICAL RELEVANCE: The anthropometric patellar information is essential for surgeons to perform patellar resurfacing in TKA.

Clustering of Risk Behaviors and their Social Determinants among Primary School Learners in Beijing, China: A Cross-sectional Study.

BACKGROUND: Studies in developed countries reveal that poor lifestyle choices triggering diseases typically cluster among children. However, there is insufficient evidence on the clustering of risk behaviors among children in developing countries. This study aimed to determine the clustering of risk behaviors and their social determinants among 4 th -and 5 th -grade learners in Beijing, China. METHODS: The sample comprised of 967 learners from six primary schools enrolled migrant and resident learners by two-stage stratified cluster sampling. Prevalence denoted the risk behaviors and their clustering. A log-linear model was used to explore the clustering patterns. Ordinal logistic regression determined the influence of demographic characteristics, school environment, and family context on behavioral clustering. RESULTS: The prevalence of none, one, two, and three or more risk factors was 61.2%, 20.0%, 10.8%, and 8.1% for infectious diseases and 46.0%, 30.6%, 15.4%, and 8.0% for chronic diseases, respectively. Some behaviors appeared dependent and were more likely to be observed together. The three most influential factors for infectious diseases were school type (odds ratio [OR] =4.47, 95% confidence interval [CI] 3.00-6.66), school located in an inner suburb (OR = 0.27, 95% CI 0.18-0.38), and gender (OR = 0.56, 95% CI 0.42-0.74). Regarding risk behaviors for chronic diseases, clustering was not associated with household registration status and number of appliances, but was significantly associated with school type (OR = 5.36, 95% CI 3.72-7.73), school located in an inner suburb (OR = 0.59, 95% CI 0.43-0.81), and gender (OR = 0.61, 95% CI 0.47-0.78). School environment variables were the most significant contributor to the number of risk behaviors. CONCLUSIONS: The characteristics of schools enrolling migrants and residents influenced the number of risk behaviors. Therefore, improved school conditions and integrated behavioral interventions are particularly recommended for health promotion.

[Cost-effectiveness of schistosomiasis comprehensive control in Lushan County from 2007 to 2012].

OBJECTIVE: To evaluate the cost-effectiveness of comprehensive control strategy which mainly controls the schistosomiasis infection source in Lushan County from 2007 to 2012. METHODS: The data of the schistosomiasis endemic, Oncomelania hupensis snail status, control technology, and funding were collected and analyzed statistically in the endemic villages of Lushan County from 2007 to 2012. RESULTS: The schistosome infection rate of the residents decreased from 0.04% in 2007 to 0 in 2012. The numbers of advanced schistosomiasis patients decreased from 128 in 2007 to 121 in 2012. No acute schistosomiasis patients were found. The average density of living snails decreased from 0.06 snial/0.1 m2 to 0.05 snail/0.1 m2, with the decreased rate of 16.67%, and no schistosome infected snails were found. However, the snail area increased from 15.84 hm2 in 2007 to 52.12 hm2 in 2012, with the rise rate of 229.04%. The year per capita was 200.48 yuan, the cost of the infection rate decreasing by 1% was 949,900 yuan, and the cost of living snail density decreasing by 1% was 5,698,200 yuan. CONCLUSION: The cost-effectiveness of comprehensive control strategy which mainly controls the schistosomiasis infection source is relatively good in Lushan County from 2007 to 2012.