Status quo and influencing factors of multiprofessional and multidisciplinary teamwork for early mobilization in mechanically ventilated patients in ICUs: A multi-centre survey study.

AIM: To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice. DESIGN: A multi-centre cross-sectional survey. METHODS: From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author-developed questionnaire on the status of collaboration and the Assessment of Inter-professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration. RESULTS: Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities. CONCLUSION: The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China's human resources and each region's economic development level. IMPACT: This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities. PATIENT OR PUBLIC CONTRIBUTION: The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients.

Cardiovascular health in urban Chinese children and adolescents.

INTRODUCTION: Cardiovascular diseases remain the leading cause of death and disease burden in China and worldwide. We aimed to evaluate the status of cardiovascular health among urban Chinese children and adolescents. METHODS: We conducted a cross-sectional study comprising 12,618 children and adolescents aged 6-18 years, who were recruited from Chinese urban areas during 2013-2015. The poor, intermediate, and ideal levels of 7 cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, blood glucose, and total cholesterol were defined according to revised American Heart Association criteria. RESULTS: Ideal smoking status was the most prevalent health component (overall, 90.7%; males, 86.3% and females, 95.4%), whereas ideal health diet score (overall, 8.7%; males, 9.1% and females, 8.3%) was the least prevalent among urban Chinese children and adolescents. The majority (overall, 84.9%; males, 82.6% and females, 87.4%) of participants had 3-5 ideal metrics. The overall prevalence of ideal cardiovascular health (i.e. meeting all 7 ideal components) was extremely low (overall, 0.5%; males, 0.5% and females, 0.4%). CONCLUSIONS: The prevalence of ideal cardiovascular health in urban Chinese children and adolescents is extremely low, particularly for physical activity and healthy dietary intake. Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk. Key messages Ideal health diet score was the least prevalent health component among urban Chinese children and adolescents The prevalence of ideal cardiovascular health in urban Chinese children and adolescents was extremely low Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk.

Black-White Difference in the Impact of Long-Term Blood Pressure From Childhood on Adult Renal Function: The Bogalusa Heart Study.

BACKGROUND: To examine racial difference in the impact of long-term burden of blood pressure (BP) from childhood on adult renal function between middle-aged blacks and whites. METHODS: The study cohort consisted of 1,646 whites and 866 blacks aged 20-51 years at follow-up who had BP measured at least 4 times since childhood, with a mean follow-up period of 25.3 years. The area under the curve (AUC) was calculated as a measure of long-term burden of BP from childhood to adulthood. Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine to assess renal function in adulthood. RESULTS: Black vs. white adults had significantly higher values of eGFR and long-term burden of systolic BP for both males and females. In multivariable linear regression analyses, adjusting for sex, adult age, body mass index, smoking, and alcohol use, adult eGFR was significantly and negatively associated with adult systolic BP (standardized regression coefficient [ß] = -0.10, P = 0.005) and diastolic BP (ß = -0.11, P = 0.003) in blacks, but not in whites. The total BP AUC values were also significantly and negatively associated with adult eGFR (ß = -0.10, P = 0.005 for systolic BP and ß = -0.09, P = 0.013 for diastolic BP) in blacks only. Childhood BP was not significantly associated with adult eGFR in blacks and whites. CONCLUSIONS: These findings suggest that black-white disparities in the influence of elevated BP on the development of renal dysfunction occur in middle adulthood, which underscores the importance of BP control in the black population.

[Dietary habits of school-age children and its associations with blood pressure level in Beijing, China].

OBJECTIVE: To study the dietary habits of school-age children in urban and rural districts and their association with blood pressure levels in Beijing, China. METHODS: A stratified, randomly clustered sampling design was used, 29 primary and secondary schools from four urban districts and three rural districts in Beijing were randomly selected in 2004. 20 638 children aged 6-18 years old were surveyed, and 19 072 of them provided completed usable data. The weight, height and blood pressure of the subjects were measured according to standard method.10 food-groups' information was collected by a semi-quantitative food frequency questionnaire. The relationship between different dietary habits and the blood pressure levels in school children was analyzed by multiple linear regression model. RESULTS: The prevalence of obesity among children in urban area (12.2%, 1 218/9 984) was higher than that in rural area (6.7%, 609/9 088) (χ(2) = 4.62, P < 0.05) , whereas the prevalence of hypertension among children in urban area (8.0%, 799/9 984) was lower than that in rural area (8.9%, 809/9 088) (χ(2) = 167.32, P < 0.05) . The diastolic blood pressure (DBP) among children was (65.7 ± 8.6) mmHg (1 mmHg = 0.133 kPa) in urban area and (67.0 ± 8.7) mmHg in rural area, respectively (F = 86.44, P < 0.05) , and the systolic blood pressure (SBP) among children was (103.4 ± 12.2) mmHg in urban area and (104.3 ± 11.6) mmHg in rural area, respectively (F = 11.33, P < 0.05) . Factor analysis revealed 4 dietary habits labeled prudent habit, protein habit, high-fat and high-calorie habit and vegetables and fruits habit. The 4 dietary habits' variance contribution rate respectively was 24.7%, 14.6%, 14.0%, 8.9%, and the 4 dietary habits totally reflect 62.2% characteristics of the 10 food-groups.In urban area, prudent habit was inversely associated with DBP (ß' = -0.026, P < 0.05) , Protein habit was inversely associated with both children's SBP (ß' = -0.018, P < 0.05) and DBP (ß' = -0.030, P < 0.05) .In rural area, prudent habit was associated with children's SBP (ß' = -0.050, P < 0.05) and DBP (ß' = -0.039, P < 0.05) . CONCLUSIONS: The dietary habits of school age children varied by sociodemographic characters in Beijing. The prudent habit and protein habit may decrease the children's blood pressure levels.

Insulin resistance determined by Homeostasis Model Assessment (HOMA) and associations with metabolic syndrome among Chinese children and teenagers.

OBJECTIVE: The aim of this study is to assess the association between the degree of insulin resistance and the different components of the metabolic syndrome among Chinese children and adolescents. Moreover, to determine the cut-off values for homeostasis model assessment of insulin resistance (HOMA-IR) at MS risk. METHODS: 3203 Chinese children aged 6 to 18 years were recruited. Anthropometric and biochemical parameters were measured. Metabolic syndrome (MS) was identified by a modified Adult Treatment Panel III (ATP III) definition. HOMA-IR index was calculated and the normal reference ranges were defined from the healthy participants. Receiver operating characteristic (ROC) analysis was used to find the optimal cutoff of HOMA-IR for diagnosis of MS. RESULTS: With the increase of insulin resistance (quintile of HOMA-IR value), the ORs of suffering MS or its related components were significantly increased. Participants in the highest quintile of HOMA-IR were about 60 times more likely to be classified with metabolic syndrome than those in the lowest quintile group. Similarly, the mean values of insulin and HOMA-IR increased with the number of MS components. The present HOMA-IR cutoff point corresponding to the 95th percentile of our healthy reference children was 3.0 for whole participants, 2.6 for children in prepubertal stage and 3.2 in pubertal period, respectively. The optimal point for diagnosis of MS was 2.3 in total participants, 1.7 in prepubertal children and 2.6 in pubertal adolescents, respectively, by ROC curve, which yielded high sensitivity and moderate specificity for a screening test. According to HOMA-IR > 3.0, the prevalence of insulin resistance in obese or MS children were 44.3% and 61.6% respectively. CONCLUSIONS: Our data indicates insulin resistance is common among Chinese obese children and adolescents, and is strongly related to MS risk, therefore requiring consideration early in life. As a reliable measure of insulin resistance and assessment of MS risk, the optimal HOMA-IR cut-off points in this cohort were developed with variation regarding puberty. HOMA-IR may be useful for early evaluating insulin resistance in children and teenagers and could have a long-term benefit of preventive and diagnostic therapeutic intervention.

Prevalence of metabolic syndrome in a cohort of Chinese schoolchildren: comparison of two definitions and assessment of adipokines as components by factor analysis.

BACKGROUND: Although attention to metabolic syndrome (MetS) in children has increased, there is still no universally accepted definition and its pathogenesis remains unclear. Our aim was to compare the current definitions of childhood MetS in a Chinese cohort and to examine the clustering pattern of MetS risk factors, particularly inclusion of leptin and adiponectin as additional components. METHODS: 3373 schoolchildren aged 6 to 18 years were recruited. Anthropometric and biochemical parameters and adipokines were measured. MetS was identified using both the International Diabetes Federation (IDF) and a modified Adult Treatment Panel III (ATP III) definitions. Exploratory factor analysis was performed to establish grouping of metabolic characteristics. RESULTS: For children ≥ 10 years, the prevalence of MetS was 14.3% in the obese group and 3.7% in the overweight group according to the new IDF definition, and 32.3% in the obese group and 8.4% in the overweight group according to the modified ATPIII definition. Frequency of hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), impaired fasting glucose, elevated blood pressure, and central obesity according to the new IDF definition was 16.7%, 20.7%, 15.8%, 25.5% and 75.5% in obese boys and 14.7%, 24.0%, 12.0%, 11.0% and 89.0% in obese girls, respectively. Metabolic abnormalities in children under 10 years of age were also noted. Using factor analysis on eight conventional variables led to the extraction of 3 factors. Waist circumference (WC) provided a connection between two factors in boys and all three factors in girls, suggesting its central role in the clustering of metabolic risk factors. Addition of leptin and adiponectin also led to the extraction of 3 factors, with leptin providing a connection between two factors in girls. When using WC, mean arterial pressure, triglyceride/HDL-C ratio, HOMA-IR and leptin/adiponectin ratio as variables, a single-factor model was extracted. WC had the biggest factor loading, followed by leptin/adiponectin ratio. CONCLUSIONS: MetS was highly prevalent amongst obese children and adolescents in this cohort, regardless of the definition used. Central obesity is the key player in the clustering of metabolic risk factors in children, supporting the new IDF definition. Moreover, our findings suggest that a common factor may underlie MetS. Leptin/adiponectin ratio as a possible component of MetS deserves further consideration.

A national sampling survey on birth weight in 1998 in China: mean value and standard deviation.

OBJECTIVE: To understand the distribution of live birth weight in China. METHODS: A national survey on live birth weight was performed during July-October, 1998 in China, with stratified sampling. Totally, 22 350 live newborns (11 584 males and 10 766 females) with 28 weeks or more of gestation were measured for their birth weight in the sampling sites during 1998. RESULTS: The ratio of male to female newborns measured was 1.08. The rates of multiple birth and preterm birth (< 37 weeks of gestation) were 1.8% and 3.5%, respectively. Live birth weight was higher in the urban areas (3 301 g) than that in the rural area (3 225 g) (t = 9.4. P < 0.001), the highest in the coastal areas (3 262 g), middle in the inland areas (3 254 g) and the lowest in the remote areas (3 115 g) (F = 177.9, P < 0.001), with a decreasing trend. Live birth weight in the first-class rural areas approximated to that in the urban areas, and that in the second-class, third-class and fourth-class rural areas decreased significantly. The average live birth weight in the fourth-class rural areas was 200 g lower than that in the urban areas. CONCLUSIONS: Generally, the average live birth weight in China was closed to that in the developed countries. But, a big difference in the average live birth weight between regions with varied economic development and health care condition was observed. An intervention measure should be implemented in the poverty-stricken rural areas to increase their average live birth weight.