Enhancing gestational diabetes mellitus risk assessment and treatment through GDMPredictor: a machine learning approach.

BACKGROUND: Gestational diabetes mellitus (GDM) is a serious health concern that affects pregnant women worldwide and can lead to adverse pregnancy outcomes. Early detection of high-risk individuals and the implementation of appropriate treatment can enhance these outcomes. METHODS: We conducted a study on a cohort of 3467 pregnant women during their pregnancy, with a total of 5649 clinical and biochemical records collected. We utilized this dataset as our training dataset to develop a web server called GDMPredictor. The GDMPredictor utilizes advanced machine learning techniques to predict the risk of GDM in pregnant women. We also personalize treatment recommendations based on essential biochemical indicators, such as A1MG, BMG, CysC, CO2, TBA, FPG, and CREA. Our assessment of GDMPredictor's effectiveness involved training it on the dataset of 3467 pregnant women and measuring its ability to predict GDM risk using an AUC and auPRC. RESULTS: GDMPredictor demonstrated an impressive level of precision by achieving an AUC score of 0.967. To tailor our treatment recommendations, we use the GDM risk level to identify higher risk candidates who require more intensive care. The GDMPredictor can accept biochemical indicators for predicting the risk of GDM at any period from 1 to 24 weeks, providing healthcare professionals with an intuitive interface to identify high-risk patients and give optimal treatment recommendations. CONCLUSIONS: The GDMPredictor presents a valuable asset for clinical practice, with the potential to change the management of GDM in pregnant women. Its high accuracy and efficiency make it a reliable tool for doctors to improve patient outcomes. Early identification of high-risk individuals and tailored treatment can improve maternal and fetal health outcomes http://www.bioinfogenetics.info/GDM/ .

[Arterial spin labeling in assessment of interstitial fibrosis in renal allografts].

Objective: To explore the feasibility and application value of arterial spin labeling (ASL) in evaluating the degree of renal fibrosis after kidney transplantation. Methods: This is a cross-sectional study. Renal transplant recipients who received treatment at the First Affiliated Hospital of Soochow University from December 2021 to December 2022 were enrolled. All participants underwent ASL scan, and the values of renal cortical renal blood flow (RBF) were measured through post-processing software. The participants were divided into different groups according to the Banff interstitial fibrosis score (ci score) of the transplanted kidneys, and then relevant indicators were compared. One-way analysis of variance was conducted to compare the differences in renal cortical RBF among the groups. Spearman correlation analysis was employed to investigate the association between renal cortical RBF and ci score of the transplanted kidney. Receiver operating characteristic curve was used to analyze the diagnostic effectiveness of renal cortical RBF and laboratory indicators for distinguishing varying degrees of fibrosis in transplanted kidneys. The Delong test was utilized to compare the area under the curve (AUC). Results: A total of 60 patients (42 males and 18 females) were included in the study, with a mean age of (44.6±10.8) years. All patients were divided into 4 groups: ci0 group (ci score=0, 11 cases), ci1 group (ci score=1, 21 cases), ci2 group (ci score=2, 20 cases), and ci3 group (ci score=3, 8 cases). With an increase in the degree of fibrosis in the transplanted kidney, there was a corresponding decrease in the renal cortical RBF value. The differences in renal cortical RBF values among the 4 groups were statistically significant[ci0 group: (214.9±28.5) ml·(100 g)-1·min-1; ci1 group: (181.7±29.3) ml·(100 g)-1·min-1; ci2 group: (158.8±39.2) ml·(100 g)-1·min-1; ci3 group: (123.1±27.2) ml·(100 g)-1·min-1; F=14.02, P<0.001]. The renal cortical RBF was moderately negatively correlated with the ci score (r=-0.644, P<0.001). The AUC for discriminating between ci0 and ci1-3 of renal cortical RBF and 24-hour urine protein was 0.881 (95%CI: 0.772-0.950) and 0.680 (95%CI: 0.547-0.795), respectively. The AUC for renal cortical RBF was significantly higher than that for 24-hour urine protein (P=0.047). The renal cortical RBF can distinguish between ci0-1 and ci2-3, as well as ci0-2 and ci3, with the corresponding AUC value of 0.796 (95%CI: 0.673-0.889) and 0.900 (95%CI: 0.795-0.963), respectively. Conclusion: ASL can quantitatively assess renal blood perfusion in transplanted kidneys and demonstrates high operational efficacy in distinguishing varying degrees of fibrosis in the transplanted kidneys.

[Research on the association between the occurrence of spermarche and menarche and psychological distress among Chinese children and adolescents aged 9-18 years].

Objective: To analyze the association between the occurrence of spermarche and menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years. Methods: Data were drawn from the 2019 Chinese National Survey on Students' Constitution and Health, and a total of 54 438 boys aged 11 to 18 years and 76 376 girls aged 9 to 18 years with psychological distress, spermarche/menarche records were included in the final analysis. The occurrence of spermarche/menarche was recorded by physicians, and psychological distress was classified according to the Kessler Psychological Distress Scale scores. The chi-square test was used to compare the difference between groups in the occurrence of spermarche/menarche, and the multinomial logistic regression model and stratification analysis was established to analyze the association between psychological distress and spermarche/menarche. Results: The incidence of spermarche/menarche in 2019 ranged from 6.3% to 96.5% for eight age groups of Chinese boys and 2.8% to 99.0% for ten age groups of girls. The rates of high psychological distress among boys and girls were 32.5% and 32.7%. Among boys aged 11 to 18 years, the rate of high psychological distress increased with age, with a trend test P<0.001, and the difference in the rate of high psychological distress between those who had and had not had their spermarche was not statistically significant in all age groups. Among girls aged 9 to 18 years, the rate of high psychological distress increased with age, with a trend P<0.001; the rate of high psychological distress was higher in the group with menarche at age 10 and 12 than in the group without menarche (all P<0.05). High psychological distress was positively correlated with spermarche among boys aged 13-15 years living in urban areas and hight level economic development areas (OR=1.11, 95%CI: 1.02-1.21;OR=1.18, 95%CI: 1.06-1.32). Overall, high psychological distress was positively correlated with menarche in girls aged 9-12 and 13-15 years (OR=1.33, 95%CI: 1.25-1.42; OR=1.22, 95%CI: 1.07-1.39). High psychological distress was positively correlated with menarche among girls aged 9-12 years living in different regions except for the Northeast region, in areas with different levels of economic development, and in urban and rural areas, in girls aged 13-15 years living in urban, central, and western regions, and in girls aged 16-18 years residing in the central region. Conclusions: This study found an association between the occurrence of spermarche/menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years in 2019, which was particularly significant among girls aged 9 to 12 years and boys aged 13 to 15 years living in areas with higher levels of socioeconomic development.

Sex Specific Global Burden of Osteoporosis in 204 Countries and Territories, from 1990 to 2030: An Age-Period-Cohort Modeling Study.

BACKGROUND: Osteoporosis is a highly prevalent disease with distinct sex pattern. We aimed to estimate the sex specific incidence, prevalence, and disability-adjusted life (DALYs) years of osteoporosis between 1990 and 2019, with additional predictions from 2020 to 2034. METHODS: We collected osteoporosis disease burden data from the Global Burden of Disease study covering the years 1990 through 2019 in 204 countries and territories. The data included information on the number of incident cases of osteoporosis, DALYs, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR) and age-standardized DALYs rates. Additionally, we performed an age-period-cohort analysis to forecast the burden of osteoporosis. RESULTS: The global number of incidence cases of osteoporosis, in 2019, reached 41.5 million cases. From 1990 to 2019, the low-middle socio-demographic index (SDI) region had the highest estimated annual percentage change in the world. Compared to males, female's ASIR and ASPR were all about 1.5 times higher than males for the same years in the same SDI regions. The projected global total number of incidence cases for osteoporosis between 2030 and 2034 is estimated to reach 263.2 million (154.4 million for females and 108.8 for males). Additionally, the burden in terms of DALYs is predicted to be 128.7 million (with 78.4 million for females and 50.3 million for males). CONCLUSION: The global burden of osteoporosis is still increasing, mainly observed in high SDI countries. Females bear a burden 1.5 times higher than males in terms of incidence and DALYs. Steps should be taken to reduce the osteoporosis burden, especially in high SDI countries.

[Assessment of prevalence of malnutrition among Chinese primary and secondary school students and analysis of policy effect during the period of the Program for the Development of Chinese Children 2011-2020].

OBJECTIVE: To evaluate the change of prevalence of malnutrition among Chinese primary and secondary school students and to analyze the policy effect during the period of the Program for the Development of Chinese Children 2011-2020 (PDCC 2011-2020). METHODS: The data of Chinese students aged 7 to 18 years were extracted from 8 successive cross-sectional surveys of the Chinese National Survey on Students ' Constitution and Health (CNSSCH) from 1985 to 2019. Malnutrition of students was evaluated according to the screening standard for malnutrition of school-age children and adolescents. The changes of prevalence of malnutrition among primary and secondary school students were described by gender, urban and rural areas, age group and province, from 2010 to 2019. The Joinpoint regression model was used to analyze the trajectory of the prevalence of malnutrition among students aged 7 to 18 years from 1985 to 2019, so as to evaluate the policy effect of the PDCC 2011-2020. RESULTS: The prevalence of malnutrition among primary and secondary school students in China decreased from 12.7% in 2010 to 8.5% in 2019. The prevalence of malnutrition among boys and girls, urban and rural students, and students of all age groups showed a continuous downward trend (Ptrend < 0.001) from 2010 to 2019. From 2010 to 2019, 27 of the 31 provinces (autonomous regions and municipalities) saw a significant decrease in the prevalence of malnutrition among primary and secondary school students. Joinpoint regression model showed that the prevalence of malnutrition among Chinese primary and secondary school students continued to decline from 1985 to 2019, but 2010 was the turning point in the downward trend. From 1985 to 2010, the prevalence of malnutrition among primary and secondary school students decreased by an average of 2.4% per year (95%CI: 1.9%-2.8%, P < 0.001), and the downward trend accelerated after 2010, with an average annual decline of 4.3% (95%CI: 2.4%-6.2%, P < 0.001). CONCLUSION: The prevalence of malnutrition among primary and secondary school students in China continued to decline from 2010 to 2019, achieving the goal of controlling the prevalence of malnutrition among primary and secondary school students in the PDCC 2011-2020. The PDCC 2011-2020 may have played an important role in improving the malnutrition among primary and secondary school students. However, the problem of malnutrition among primary and secondary school students still exists, and it is still necessary to adhere to the coverage and financial support of the nutrition improvement plan in areas with high incidence of malnutrition.

A 50-year systemic review of bioavailability application in Soil environmental criteria and risk assessment.

Bioavailability has become a critical factor in improving ecological risk assessment and environmental remediation efficiency in contaminated soil research. However, the soil environmental quality standards and risk assessment procedures used in most countries are still based on the total amount of pollutants for lacking sufficient understanding of the exposure pathways and action mechanisms of pollutants. we collected relevant literature from the Web of Science database, spanning the period from 1950 to 2021 by using Citespace to analyze the scientific development of bioavailability. As of January 09, 2022, the database contained 118,813 publications on bioavailability. The review summarizes the progress in bioavailability research and emerging trends, including exploring advanced analytical techniques, advancing modeling approaches, and integrating interdisciplinary approaches to better understand the fate and behavior of pollutants in complex environmental matrices. In particular, the review emphasizes the need for better integration of bioavailability concepts into soil environmental reference, risk assessment procedures, and environmental remediation strategies. Overall, this review emphasized the necessity of incorporating the concept of bioavailability into soil environmental reference, risk assessment procedures, and environmental remediation strategies.

[Multidimensional thinking in the era of gastrointestinal minimally invasive surgery].

Minimally invasive surgery represented by laparoscopic technique has been carried out in China for more than 30 years. Gastrointestinal minimally invasive surgery has been widely recognized and popularized. Today, when the development of minimally invasive technology has reached the ceiling, the authors, who have experienced the innovation of minimally invasive gastrointestinal surgery for more than 30 years, review the gradual, unpredictable but inevitable characteristics of the innovation and development of minimally invasive surgery; figure out that standardized promotion and systematic training are the main reasons for the success of minimally invasive surgery in gastrointestinal surgery; realize that the application and promotion of new medical technology are inseparable from the support of solid clinical and basic evidence; recognize that the re-innovation after the popularization and standardization of gastrointestinal minimally invasive surgery and how to avoid involution are the driving force to seize the development momentum of minimally invasive technology. We make a multidimensional thinking on the development of gastrointestinal minimally invasive surgery, and objectively analyze its development track, in order to calmly rise to the challenges of future technological development.

Suboptimal adherence to prescribed daily growth hormone regimen among medicaid beneficiaries in the United States.

OBJECTIVE: The objective of this retrospective cohort study was to describe the adherence and discontinuation patterns of somatropin over 3 years among children with pGHD insured by Medicaid across the United States. METHODS: Eligible children were aged ≥3 and <16 years with Medicaid coverage, diagnosed with pGHD, and had ≥2 new prescriptions for somatropin between 1 July 2014 and 31 December 2018. Four non-exclusive patient cohorts were constructed (≥3, 12, 24, and 36 months of continuous enrollment after initial prescription). Suboptimal adherence was defined as medication possession ratio <0.80, and discontinuation as a gap of >60 days between somatropin fills. Logistic and proportional hazards regression methods were used to estimate odds of suboptimal adherence and time to discontinuation, respectively. RESULTS: In the 12-month cohort (n = 3623), mean age was 10.5 ± 3.2 years, 70.8% were male, 44.4% White, 29.1% Hispanic, 7.1% Black, and 1.7% Asian. At months 12, 24, and 36, the proportion with suboptimal adherence was 40.9, 50.4, 54.4%, respectively, and 49.2% of patients with ≥3 months of follow-up discontinued therapy. At 12 months, lower age and race/ethnicity (Black vs. White referent) had greater odds of suboptimal adherence. Discontinuation was associated with Black (vs. White referent) race and geographic region. CONCLUSIONS: Sociodemographic characteristics may be risk factors for suboptimal adherence and/or discontinuation of prescribed somatropin therapy. Improving GH regimen adherence among this at-risk population, and specifically among subgroups at highest risk, is warranted to improve clinical outcomes.

[Assessment of imaging performance of digital breast tomosynthesis based on systematic simulation].

OBJECTIVE: To assess the imaging performance of digital breast tomography (DBT) based on systematic simulation. OBJECTIVE: The raw measurements of physical phantoms at a variety of radiation dose levels and clinical patients at the normal radiation dose were acquired from a clinical DBT system for low-dose simulation and reconstruction using 3 reconstruction algorithms, namely Feldkamp-Davis-Kress (FDK), simultaneous algebraic reconstruction technique (SART) and adaptive steepest-descent projection onto convex sets with total-variation constraint (ASDPOCS-TV) algorithms. The image quality was compared across different radiation dose levels and reconstruction algorithms in terms of signal-to-noise ratio (SNR), peak signal-to-noise ratio (PSNR), noise-power spectrum (NPS), artifact spread function (ASF) and full width at half maximum (FWHM) of ASF indexes. OBJECTIVE: The reliability of low-dose DBT simulation strategy was verified by the experiment. Within a suitable range of dose levels, increasing the doses resulted in reduced high-frequency noise component and significantly increased SNR (P < 0.05). But when the value of exposure was below 40 mAs, the images acquired at different dose levels had similar representation. The performance of the 3 reconstruction algorithms varied for different anatomical structures, and the image quality of ASDPOCS-TV algorithm was generally superior to SART and FDK algorithms with less through-plane artifacts and noise. OBJECTIVE: The quality of DBT images is significantly affected by both radiation dose and reconstruction algorithms. A tradeoff of the parameters, the overall image quality and the clinical needs for diagnostic purposes should be considered to achieve the optimal imaging performance on a given clinical task.

[Regional inequality of height among Chinese Han students aged 7 to 18 years from 1985 to 2014].

Objective: To analyze the regional inequality of height among Chinese Han students aged 7 to 18 years from 1985 to 2014. Methods: The Chinese Han students aged 7 to 18 years with complete basic information and height data from 30 mainland provinces (excluding Hong Kong, Macao, Taiwan and Tibet in China) were extracted as participants from 6 successive cross-sectional surveys of the Chinese National Survey on Student's Constitution and Health (CNSSCH). After excluding extreme and illogical cases, a total of 1 495 182 students were included in the analysis. The data of gross domestic product (GDP) per capita of each province at each survey year were collected from the website of National Bureau of statistics of China. Mann-Kendall trend test was used to analyze the trend of mean height across years. Weighted linear regression model was used to analyze the association between mean height of students aged 7 to18 years and GDP per capita at provincial level. Height difference, height ratio, slope index of inequality (SII) and relative index of inequality (RII) were used to measure the height inequality by gender and age groups. Results: The mean height of Chinese Han students aged 7 to 18 years increased from 144.9 cm in 1985 to 151.8 cm in 2014 (P<0.05). The height difference between urban and rural students in all age groups was reducing (P<0.05). The height difference between urban and rural boys aged 13 to 15 years decreased from 5.3 cm in 1985 to 2.5 cm in 2014, and the difference between urban and rural girls aged 7 to 12 years decreased from 4.6 cm in 1985 to 2.4 cm in 2014. The mean height of students aged 7 to 18 years was positively associated with GDP per capita in all survey years for both genders (P<0.001). Taking Shanghai and Guizhou as the representatives of economically developed and underdeveloped provinces, from 1985 to 2014, the height differences between two provinces were 6.8-9.2 cm, 8.0-12.4 cm and 6.3-8.8 cm for boys aged 7 to 12 years, 13 to 15 years and 16 to 18 years, respectively, and the height ratios were stable at 1.05-1.07, 1.05-1.08 and 1.04-1.05 respectively. From 1985 to 2014, the SII of mean height for boys in three age groups were 4.4-6.2, 4.9-6.7 and 2.5-4.7, respectively. The RII of mean height of boys in three age groups were 1.03-1.05, 1.03-1.04 and 1.01-1.03, respectively. In the same period, the SII of mean height for girls in three age groups were 4.2-6.2, 2.8-4.5 and 2.5-3.9, and the RII were 1.03-1.05, 1.02-1.03 and 1.02, respectively. Conclusion: From 1985 to 2014, the urban-rural inequality of height development among Chinese Han students aged 7 to 18 years was narrowing, but the socio-economic inequality of height persisted and remained at a relatively stable level.

[Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents].

OBJECTIVE: To examine the association between family socioeconomic status (SES) and body mass index (BMI) z-score of children and adolescents, and the mediating effect of milk intake in this association. METHODS: In the study, 2 496 students and their parents were selected from 16 schools (4 urban middle schools, 4 rural middle schools, 4 urban primary schools, and 4 rural primary schools) using a stratified cluster sampling method. The frequency and amount of weekly milk intake from the 7-day Food Records reported by the students were extracted. The parents' education and household income were the indicators of family SES. The mediating effect of milk intake between family SES and BMI z-score of children and adolescents were tested using the PROCESS add-on SPSS software. RESULTS: Parents' education level and household income were positively correlated with BMI z-score of children and adolescents (P=0.001 and 0.038, respectively). The overall average daily intake of milk was (0.92±0.84) servings, and the frequency was (4.43±2.70) days per week. The students of primary school, in urban areas, with higher parents' education level, with higher household income, and being non-obese were likely to have higher frequency and amount of milk intake. Milk intake was one of the mediating factors in the relationship between family SES and BMI z-score of children and adolescents. Specifically, the mediating effect of the frequency of milk intake accounted for -6.57% and -10.21% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. The mediating effect of the daily intake of milk accounted for -3.63% and -5.86% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. CONCLUSION: The milk intake of Chinese children and adolescents still needs to be improved. High family SES was found to contribute to high BMI z-score, mediated by the milk intake which was the protective factors of BMI z-score. Further research is needed to study other dietary or physical exercise behaviors that mediate the relationship between family SES and BMI z-score of children and adolescents in order to adopt more targeted interventions.

[CT image quality assessment based on prior information of pre-restored images].

OBJECTIVE: We propose a CT IQA strategy based on the prior information of pre-restored images (PR-IQA) to improve the performance of IQA models. OBJECTIVE: We propose a CNN-based no-reference CT IQA strategy using the prior information of image quality features in the image restoration algorithm, which is combined with the original distorted image information into the two CNNs through the pre-restored image and the residual image. Multi-information fusion was used to improve the feature extraction ability and prediction performance of CNN. We built a CT IQA dataset based on spiral CT data published by Mayo Clinic. The performance of PR- IQA was evaluated by calculating the quantitative metrics and statistical tests. The influence of different hyperparameter settings for PR-IQA was analyzed. We then compared PR-IQA with the BASELINE model based on the single CNN to evaluate the original distorted image without reference image and other eight IQA algorithms. OBJECTIVE: The comparative experiment results showed that the PR-IQA model based on the prior information of 3 different image restoration algorithms (BF, NLM and BM3D) was better than all the tested IQA algorithms. Compared with the BASELINE method, the proposed method showed significantly improved performance, and the mean PLCC was increased by 12.56% and SROCC by 19.95%, and RMSE was decreased by 22.77%. OBJECTIVE: The proposed PR-IQA method can make full use of the prior information of the image restoration algorithm to effectively predict the quality of CT images.

[Comparison of severity classification of Chinese protocol, pneumonia severity index and CURB-65 in risk stratification and prognostic assessment of coronavirus disease 2019].

Objective: To investigate the application of severity classification according to the protocol on the Diagnosis and Treatment of coronavirus disease 2019(COVID-19)by the National Health Commission of China, pneumonia severity index(PSI) and CURB-65　in risk stratification and prognostic assessment of COVID-19. Methods: Clinical data of 234 in-hospital patients with COVID-19 were collected and retrospectively reviewed in Wuhan Tongji Hospital. Patients were divided into 3 groups (common, severe, and critical type) at admission according to the sixth version of the protocol issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19. At the same time, the severity of pneumonia was calculated by PSI and CURB-65, and the patients were stratified into 3 risk groups, namely mild, moderate, and severe groups. The hospital mortality rate was evaluated in each group. Sensitivity, specificity, positive predictive values, negative predictive values, and the area under the receiver operating characteristic(ROC) curve(AUC) for predicting hospital mortality in each rule were assessed. Results: According to the severity classification of Chinese protocol, the proportion of patients with common type, severe type, and the critical type was 15.8%, 75.6%, and 8.5%, respectively. No in-hospital death occurred in the common type. As for PSI and CURB-65, greater proportions of patients were classified as low risk(79.1% and 75.6%, respectively), while smaller proportions of patients were classified as moderate and high risk(16.2%, 15.0%; 4.7%, 9.4%, respectively). In-hospital death occurred in low and moderate risk patients identified by these 2 scoring systems. The mortality of the critical group of the Chinese protocol was 65%, and the sensitivity and specificity of predicting in-hospital mortality were 36.4% and 97.0%, respectively. The mortality in the high risk group of PSI and CURB-65 was 100% and 77.3%. The risk class V of PSI and CURB-65 score 3-5 had high specificity(100% and 97.4%, respectively)but low sensitivity(33.3% and 51.5%, respectively)in predicting in-hospital mortality. The AUC of the Chinese protocol severity classification, PSI, and CURB-65 was 0.735, 0.951, and 0.912. The optimal cut-off point of PSI was risk class Ⅳ, and the sensitivity and specificity for predicting mortality were 90.9% and 90.5%. The optimal cut-off point of CURB-65 was score 2, and the corresponding sensitivity and specificity were 84.8% and 85.6%. Conclusions: PSI and CURB-65 can be used for risk stratification and prognostic assessment in patients with COVID-19.

[Subnational inequalities of early marriage and fertility among Chinese females from 1990 to 2010].

OBJECTIVE: To analyze the inequality of early marriage and adolescent fertility with respect to local economic development among Chinese females aged 15-19 years from 1990 to 2010. METHODS: Aggregated data were extracted from the Chinese National Census from 1990 to 2010. We calculated the ever-married rate and fertility rate of female adolescents aged 15-19 years. Using gross domestic product (GDP) per capita as an indicator for socio-economic status of a province, we calculated the slope index of inequality (SII) and the concentration index (CI) to analyze the subnational inequalities of early marriage and adolescent fertility. Weighted linear regression models were also established to assess the associations between GDP per capita and the ever-married rate/fertility rate. RESULTS: The ever-married rate for Chinese female adolescents aged 15-19 years decreased from 4.7% in 1990 to 1.2% in 2000, and rebounded to 2.1% in 2010. From 1990 to 2000, the fertility rate decreased from 22.0 per 1 000 to 6.0 per 1 000, and further decreased to 5.9 per 1 000 in 2010. In 1990, the socio-economic inequalities of the ever-married rate and fertility rate for female adolescents aged 15-19 years were not statistically significant (P for SII or CI>0.05). The values of SII revealed that, in 2000 and 2010, female adolescents with the lowest GDP per capita had an ever-married rate 2.4% (95%CI: 0.4-4.4) and 2.3% (95%CI: 0.3-4.2) higher than those with the highest GDP per capita, respectively. In the meantime, in 2000 and 2010, female adolescents with the lowest GDP per capita had a fertility rate 12.9 per 1 000 (95%CI: 5.4-20.5) and 9.3 per 1 000 (95%CI: 4.6-14.0) higher than those with the highest, respectively. In 2000 and 2010, the CIs for marriage were -0.32 (P=0.02) and -0.17 (P=0.03), respectively, and the CIs for childbirth were -0.37 (P<0.01) and -0.26 (P<0.01), respectively. In 2000, the ever-married rate and the fertility rate were estimated to increase by 1.4% (95%CI: 0.1-2.7) and 7.9 per 1 000 (95%CI: 2.9-12.8) with 100% increase in GDP per capita, respectively; in 2010, the numbers were 1.5% (95%CI: 0.1-2.9) and 6.7 per 1 000 (95%CI: 3.2-10.1), respectively. CONCLUSION: Subnational socio-economic inequality of early marriage and adolescent fertility existed in 2000 and 2010. Female adolescents residing in less-developed areas were more likely to engage in early marriage and childbirth. Reducing income inequality and increasing education investment for poverty-stricken areas seem to be effective measures to reduce this inequality.

[Scientific and technological innovation and achievement transformation promote the medical development].

With the worldwide adoption of minimally invasive surgery, innovation again becomes the theme. In the past hundred years, molecular biology technology, minimally invasive surgery technology, pharmaceutical research and therapies have been constantly innovated to promote the development of medicine. As the subject of medical innovation, the innovative idea from medical staff is also very important. For surgeons, the invention and improvement of a new operation or surgical instrument directly depends on curiosity and exploration. Whether a novel idea or technology can be transformed and used in clinical practice depends on its commercial prospects and the adjustment of macro health policies. The protection of intellectual property and appropriate distribution of interests are the key to ensure sustainable innovation. We should put scientific and technological innovation and achievement transformation in the important position of the "healthy China" strategy, take scientific and technological innovation as the basis and achievements transformation as the means, promote the development of China's health protection, implement the healthy China strategy, and make our own contribution to provide people with all-round health services.

[National health information and its role in prevention and control of chronic diseases: framework design of person-centered and whole life recycle surveillance system for chronic diseases].

In the perspective of promoting the strategic goal of healthy China, this study reviewed the informatization process of disease prevention and control in China and clarified the important role of national health information in chronic disease information surveillance throughout the life cycle. Guided by goals, needs, and problems, it is proposed that when basic personal electronic health record (EHR) are not well-established, personal electronic disease record (EDR) could be established to support business collaboration. Driven by the construction of national health informatization, this study proposed the relationship between the national health and chronic disease prevention and control coverage and described the architecture design of an integrated and restructured national disease prevention and control information system and its life-cycle monitoring and information management model for chronic disease health events.

[Secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years, between 1953 and 2010].

Objective: To analyze the secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years over the period of 1953-2010. Methods: Data were extracted from the Chinese National Census in 1953-2010. We calculated the all-cause mortality and annualized rates of the changes. Using the provincial gross domestic product (GDP) per capita as an indicator of regional socio-economic development level, we calculated the Wagstaff normal concentration indices for adolescent mortality. Results: Over the period of 1953-2010, the general patterns of Chinese adolescent mortality appeared higher in males than those in females, higher in the 20-24-year-old than those in the 15-19 year-old and in the 10-14 year-old groups, higher in adolescents from the western than those in the eastern regions. The mortality of adolescents decreased from 554.6/100 000 in 1953-1964 to 55.7/100 000 in 2010 in males and decreased from 488.4/100 000 to 26.7/100 000 in females, respectively. The percentage of decrease for females (94.5%) was higher than that for males (90.0%). In 1981-2010, the highest annualized rate of decline for males was seen in Beijing (4.4%), with the lowest seen in Qinghai (0.1%). For girls, Hubei showed the highest annualized rate of decline (6.4%) while Qinghai the lowest (0.8%). Provinces that with higher mortality tended to have lower annualized rate of decline. The concentration indices for boys were -0.07 (95%CI: -0.11- -0.03), -0.13 (95%CI: -0.18- -0.08), and -0.16 (95%CI: -0.22- -0.10) in 1990, 2000, and 2010, respectively, and were -0.07 (95%CI: -0.13- -0.02), -0.18 (95%CI: -0.24- -0.12), and -0.18 (95%CI: -0.26- -0.09) respectively in girls. The indices among 1990, 2000, and 2010 did not show statistically significantly differences, both for boys and girls (P>0.05). Conclusions: Over the half century, the mortality of Chinese adolescents showed dramatic decreasing trend. However, in terms of death rates, gender and geographic disparities were consistently seen in the adolescents.

[Analysis on the urban-rural disparity of childhood stunting and its association with economic growth among Chinese Han students aged 7-18 years old].

Objective: To analyze the urban-rural disparity of childhood stunting and its association with subnational economic growth among Chinese Han students aged 7-18 years. Methods: We used the data from 2014 Chinese National Survey on Students' Constitution and Health. 213 940 Chinese Han students aged 7-18 years with complete height records were included in this study. Stunting was defined according to the Screening Criteria of Malnutrition for School-age Children and Adolescents(2014 version, in Chinese). We divided students into two groups (economically developed and underdeveloped areas) according to the provincial GDP per capita. Spearman correlation coefficient was used to explore the association between the difference of urban-rural stunting prevalence and the provincial GDP per capita. Logistic regression models were established to assess the risk of stunting in rural children compared with urban children. Results: Among 213 940 students, 107 033 (50.0%) were from urban areas. The average height of 7-18 years old and 18 years old [(152.9±15.7) and (166.1±8.7) cm] of urban students were both higher than those of rural students [(150.7±16.0) and (165.1±8.6) cm] (P<0.001). The stunting prevalence of Chinese urban students (0.4%) was statistically significant lower than that of rural students (1.1%) (P<0.001), which was consistent in all age groups (P<0.05). The urban-rural disparity was found in 60% (18/30) of Chinese provinces. The difference of urban-rural stunting prevalence was negatively associated with provincial GDP per capita (r=-0.62, P<0.001). In economically underdeveloped areas, the risk of stunting for rural students aged 7-9 years was 4.69 (95%CI: 2.93-7.52) times that for urban children, while for students aged 10-18 years, the odds ratio was 2.44 (95%CI: 2.02-2.96). In economically developed areas, the risk of stunting for rural students aged 7-9 years was 5.43 (95%CI: 3.67-8.03) times that for urban children, while for students aged 10-18 years, the odds ratio was 2.15 (95%CI: 1.85-2.49). Conclusions: The urban-rural disparity of childhood stunting existed in most places in China. The difference of growth retardation between urban and rural areas was related to regional economic development.

[Factors influencing the incidence of bacterial dysentery in parts of southwest China, using data from the geodetector].

Objective: To analyze the relationship between the incidence of bacterial dysentery and related meteorological, environmental and socio-economic factors in parts of southwest China, under the geodetector. Methods: Incidence data on bacillary dysentery from 2005 to 2014 was collected from the China infectious disease reporting system and meteorological, terrain environment and socio-economic related data were used for statistical analysis with geodetector also used, in Sichuan province, Yunnan province and the Tibet autonomous region (southwest China). Results: Through geodetector model, results showed that the elevation maximum value of power of determinant (PD) (PD=0.308), ethnicity (PD=0.260), followed by summer mean temperature, topography, elevation standard deviation, slope, population density were noticed. The maximum value of PD of summer average relative humidity, summer average precipitation, and regional GDP were all less than 0.200. In the ecological detector model, value of PD appeared significantly different from multiple factors such as summer average precipitation, regional GDP, average altitude, elevation standard deviation, slope, terrain and ethnicity (P<0.05). In the interactive detector model, after the spatial interaction, factors as: value on PD of summer average relative humidity, population density and regional GDP were larger than the value on the sum of PD of two factors with nonlinear superposition enhancing trend. Results from the risk zone detection showed that areas of moderate average summer temperature, low average precipitation, moderate average summer relative humidity, high average altitude, large elevation standard deviation, high slope, mountain topography, Tibeto-Burmese of ethnicity, low population density, low regional GDP were all related to the high incidence rates of bacterial dysentery. Conclusions: Meteorological conditions and topography environments were related to the bacterial dysentery in southwest China, socio-economic behaviors depends on the level of economic development and sanitary conditions etc. were all directing influencing the transmission and incidence of bacterial dysentery. For developing a better intervention programs on bacillary dysentery, socio-economic means should be used for the control of bacillary dysentery, in the region.

[Quality assessment of global guidelines on colorectal cancer screening].

OBJECTIVE: To systematically review and assess the quality of guidelines on colorectal cancer screening worldwide to provide guidance for the development of high-quality colorectal cancer screening guidelines in mainland China. METHODS: CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science were systematically searched to identify guidelines on colorectal cancer screening from inception to Jun. 20th, 2018, and so were some websites and major search engines about the development of the guidelines from the existing literature (search date: Aug. 3rd, 2018). Two experienced reviewers independently examined these abstracts and then extracted information, and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) were used to evaluate the methodological quality of these guidelines by four well trained reviewers. RESULTS: In this study, 46 guidelines published from 1994 to 2018 were finally included in our analysis from 10 countries and 5 regions, among which 5 were from mainland China. The quality of these guidelines was relatively high in domain 1 (scope and purpose) and domain 4 (clarity of presentation), and medium in domain 2 (stakeholder involvement). While in the other three domains (domain 3: rigour of development; domain 5: applicability; domain 6: editorial independence), the results were quite different among these guidelines. The quality of evidence-based guidelines (defined by the criteria based on World Health Organization guideline development handbook) was generally higher than that of the common guidelines. Existing guidelines from mainland China were not evidence-based guidelines, which were of low quality. CONCLUSION: The colorectal cancer screening guidelines all over the world are generally large in number, low in quality, different in statements, and so are the guidelines in China. There are no evidence-based guidelines in mainland China, which cannot provide effective guidance for colorectal cancer screening, so we need to pay more attention to the establishment of guidelines with high quality and high credibility for colorectal cancer screening as well as for cancer screening based on the national condition, in order to provide reasonable guidance for practice in public health and improve the health conditions in our society.