Cognitive functioning transitions, health expectancies, and inequalities among elderly people in China: A nationwide longitudinal study.

OBJECTIVE: In China, cognitive impairment has become a huge challenge owing to the rapid aging process. We investigate cognitive health expectancy and potential factors leading to inequalities of cognitive health for Chinese older people. METHODS: The study included 19 943 participants aged 65 to 95 at the first observation in Chinese Longitudinal Healthy Longevity Survey collected during 2002-2014. Cognitive impairment was categorized into none, mild, and severe by the score of cMMSE. Multistate models based on continuous-time Markov process were applied to calculate cognitive health expectancies and estimate hazard ratio from no impairment to impairment for potential factors. RESULTS: Urban women and men aged 65 were expected to spend 31.18% and 19.82% of their remaining 17.46 and 15.45 years with cognitive impairment; meanwhile, rural women and men aged 65 were expected to spend 35.31% and 21.39% of their remaining 16.73 and 14.87 years with cognitive impairment. Women achieving lower educational attainment (HR1-6 years  = 0.78, 95% CI, 0.71-0.87; HR7+ years  = 0.59, 95% CI, 0.49-0.70) than men and rural residents having less access to medical service (HR = 0.79, 95% CI, 0.68-0.92) and doing less regular exercise (HR = 0.87, 95% CI, 0.80-0.96) than urban people caused the differences of cognitive health for genders and regions. CONCLUSIONS: Women and rural people experience less cognitive health expectancies compared with their counterparts, respectively. Chinese government should pay more attention to rural women and make efforts to reduce the inequalities of cognitive health by increasing opportunities of education for women and improving access to medical service and healthy lifestyle for rural people.

Assessment of Complementary Treatment with Yiqi Fumai Lyophilized Injection on Acute Decompensated Ischemic Heart Failure (ACT-ADIHF): Rationale and Design of a Multicenter, Randomized, Controlled Trial.

BACKGROUND: Heart failure (HF) is the end stage of many heart diseases, and ischemic heart disease (IHD) is the primary cause. Yiqi Fumai lyophilized injection, a contemporary Chinese medicine preparation, widely used in the treatment of IHF patients, shows clinical efficacy on improving symptoms and cardiac function, but the quality of the current literature does not address multiple important issues. This article describes a protocol for assessment of complementary treatment with Yiqi Fumai lyophilized injection in acute decompensated IHD. METHODS: The protocol is designed as a multicenter randomized controlled trial to assess the efficacy and safety of complementary treatment with Yiqi Fumai lyophilized injection on acute decompensated IHD. This trial will be carried out in 37 hospitals in China and expected to enroll 666 inpatients with acute decompensated IHF due to coronary heart disease. On the basis of standardized western medications, patients are randomized to either the treatment group (250 ml 5% glucose / sodium injection + 5.2 g Yiqi Fumai lyophilized injection) or the control group for 7 days and follow-up for 30 ± 3 and 60 ± 3 days. The primary outcome is change in brain natriuretic peptide (BNP) concentrations. The secondary outcomes are composite endpoint, left ventricular ejection fraction, blood troponin T/I, cardiothoracic ratio, life quality scale, scores of the four traditional Chinese medicine (TCM) diagnostic methods. DISCUSSION: Standardized western medications together with TCM have been extensively used in China and have developed into a comprehensive treatment model. The trial will provide clinical research evidence for application of complementary treatment with intravenous Yiqi Fumai lyophilized injection on decompensated IHF. TRIAL REGISTRATION: This study protocol has been listed in the Chinese Clinical Trial Registry (registration number: ChiCTR-IPR-15007396, http://www.chictr.org.cn/showproj.aspx?proj=12370 ) on November 6, 2015.

Spatial trends and pollution assessment for mercury in the surface soils of the Nansi Lake catchment, China.

Surface soil samples collected from Nansi Lake catchment were analyzed for mercury (Hg) to determine its spatial trends and environmental impacts. Results showed that the average soil Hg contents were 0.043 mg kg-1. A positive correlation was shown between TOC and soil Hg contents. The main type of soil with higher TOC contents and lower pH values showed higher soil Hg contents. Soil TOC contents and CV values were both higher in the eastern catchment. The eastern part of the catchment, where the industry is developed, had relatively high soil Hg contents and a banding distribution of high Hg contents was corresponded with the southwest-northeast economic belt. Urban soils had higher Hg contents than rural soils. The urbanization pattern that soil Hg contents presented a decreasing trend from city center to suburb was shown clearly especially in the three cities. Soil Hg contents in Jining City showed a good consistency with the urban land expansion. The spatial trends of soil Hg contents in the catchment indicated that the type and the intensity of human activities have a strong influence on the distribution of Hg in soils. Calculated risk indices showed that the western part of the catchment presented moderately polluted condition and the eastern part of the catchment showed moderate to strong pollution level. The area with high ecological risk appeared mainly along the economic belt.

Antipsychotic Drug-Induced Somnolence: Incidence, Mechanisms, and Management.

Somnolence is a common side effect of antipsychotics. To assess the incidence of this side effect, we performed a MEDLINE search for randomized, double-blinded, placebo- or active-controlled studies of adult patients treated with antipsychotics for schizophrenia, mania, bipolar depression, or bipolar disorder. We extracted rates of somnolence from original publications and pooled them based on the dose of each antipsychotic in the same psychiatric condition, then estimated the absolute risk increase (ARI) and the number needed to harm (NNH) of an antipsychotic relative to placebo or an active comparator in the same psychiatric condition. According to the ARI in acute schizophrenia, bipolar mania, and bipolar depression, antipsychotics can be classified as high somnolence (clozapine), moderate somnolence (olanzapine, perphenazine, quetiapine, risperidone, ziprasidone), and low somnolence (aripiprazole, asenapine, haloperidol, lurasidone, paliperidone, cariprazine). The risk of somnolence with blonanserin, brexpiprazole, chlorpromazine, iloperidone, sertindole, and zotepine needs further investigation. The rates of somnolence were positively correlated to dose and duration for some antipsychotics, but not for others. Many factors, including antipsychotic per se, the method used to measure somnolence, patient population, study design, and dosing schedule, might affect the incidence of antipsychotic-induced somnolence. The mechanisms of antipsychotic-induced somnolence are likely multifactorial, although the blockade of histamine 1 receptors and α1 receptors may play a major role. The management of antipsychotic-induced somnolence should include sleep hygiene education, choosing an antipsychotic with a lower risk for somnolence, starting at a lower dose with a slower titration based on psychiatric diagnoses, adjusting doses when necessary, and minimizing concurrent somnolence-prone agents. Since most cases of somnolence were mild to moderate, allowing tolerance to develop over at least 4 weeks is reasonable before discontinuing an antipsychotic.

The cost-effectiveness analysis of JinQi Jiangtang tablets for the treatment on prediabetes: a randomized, double-blind, placebo-controlled, multicenter design.

BACKGROUND: At present, diabetes is a chronic disease of great cost and heavy burdens. The International Diabetes Federation has repeatedly warned that by 2025, the global number of diabetics would rise to 333 million from 194 million in 2003. Although the occurrence of diabetes in developing countries is lower, China has a large population, so that the number of cases is increased. At the same time, more people have prediabetes, a growing health concern where a large percentage of the patients develop full type 2 diabetes. In addition, the patients of diabetes easily incur complications such as blindness, kidney failure, and cardiovascular diseases that can seriously affect the patients' quality of life and cause great economic burdens to family and society. Therefore, effective interventions for prediabetes are needed to prevent or delay the occurrence and development of diabetes. METHODS: A randomized controlled trial that was assessed with pharmacoeconomic methods was undertaken in this study. The study term was 24 months (12 months for the intervention and 12 months for follow up). Four hundred participants, recruited from four cities in China: Beijing, Tianjin, Xian, and Naning, were randomized to the treatment group (JQJT tablets) and the control group (placebo). Participants included in this study had been diagnosed with prediabetes according to the criteria for western medicine and Traditional Chinese Medicine (TCM). The end-point effectiveness indexes included the incidence of diabetes and the reversion rate. The drug costs and lifestyle intervention costs were included in the total costs. The study used the cost-effectiveness analysis to discuss the economic advantage of the JQJT tablets. RESULTS: The outcomes of the study contained 2 sections,namely clinical outcomes and cost-effectiveness analysis outcomes. The clinical outcomes: the treatment group and control group had no significant statistical difference P> 0.05) on the baseline of situation; Jinqi Jiangtang tablet effectively reduced the incidence of diabetes mellitus and enhanced reversion rate. compared with the control group (p< 0.05); the scores of SF-36 of two groups had no significant difference P> 0.05); finally the compliance of participants between the two groups had no significant difference. The cost-effectiveness analysis outcomes:in the intervention period of 12 months,on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio;on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio; in the follow-up period of 24 months, on the aspect of reversion rate, the treatment group had better economic advantage by using cost-effectiveness ratio and the incremental cost-effectiveness ratio, on the aspect of the incidence of diabetes, the control group had better economic advantage by using cost-effectivenes ratio and the incremental cost-effectiveness ratio.At the same time, these outcomes remained the same by sensitivity analysis. Assuming that prices and resident incomes rose 5%, the sensitiveness analysis shows that the two group affected by the paremeters changed little. CONCLUSION: The importance and effectiveness of lifestyle education and JinQi Jiangtang tablets was proven. In both the intervention period and follow-up, JinQi Jiangtang tablets combined with lifestyle education had a greater cost advantage effect than the lifestyle education alone on the reversion rate; the lifestyle education had a greater cost advantage effect than the JinQi Jiangtang tablets combined with lifestyle education on the incidence of diabetes. TRIAL REGISTRATION: Chinese Clinical Trials ChiCTR-TRC-09000401 ) , registered on 25 May 2009.

[Systematic economic assessment and quality evaluation for traditional Chinese medicines].

To learn about the economic studies on traditional Chinese medicines in domestic literatures, in order to analyze the current economic assessment of traditional Chinese medicines and explore the existing problems. Efforts were made to search CNKI, VIP, Wanfang database and CBM by computer and include all literatures about economic assessment of traditional Chinese medicines published on professional domestic journals in the systematic assessment and quality evaluation. Finally, 50 articles were included in the study, and the systematic assessment and quality evaluation were made for them in terms of titles, year, authors' identity, expense source, disease type, study perspective, study design type, study target, study target source, time limit, cost calculation, effect indicator, analytical technique and sensitivity analysis. The finally quality score was 0.74, which is very low. The results of the study showed insufficient studies on economics of traditional Chinese medicines, short study duration and simple evaluation methods, which will be solved through unremitting efforts in the future.

[Uncertainty analysis of ecological risk assessment caused by heavy-metals deposition from MSWI emission].

The CALPUFF model was applied to simulate the ground-level atmospheric concentrations of Pb and Cd from municipal solid waste incineration (MSWI) plants, and the soil concentration model was used to estimate soil concentration increments after atmospheric deposition based on Monte Carlo simulation, then ecological risk assessment was conducted by the potential ecological risk index method. The results showed that the largest atmospheric concentrations of Pb and Cd were 5.59 x 109-3) microg x m(-3) and 5.57 x 10(-4) microg x m(-3), respectively, while the maxima of soil concentration incremental medium of Pb and Cd were 2.26 mg x kg(-1) and 0.21 mg x kg(-1), respectively; High risk areas were located next to the incinerators, Cd contributed the most to the ecological risk, and Pb was basically free of pollution risk; Higher ecological hazard level was predicted at the most polluted point in urban areas with a 55.30% probability, while in rural areas, the most polluted point was assessed to moderate ecological hazard level with a 72.92% probability. In addition, sensitivity analysis of calculation parameters in the soil concentration model was conducted, which showed the simulated results of urban and rural area were most sensitive to soil mix depth and dry deposition rate, respectively.

[Content analysis and assessment of polycyclic aromatic hydrocarbons in surface sediments from Beijiang River, China].

In the present study, 16 polycyclic aromatic hydrocarbons (PAHs) in the surface sediment from Beijiang River in China were quantitatively determined by GC/MS. The concentration of PAHs varied from 38.2 to 6470 ng x g(-1) dry weight, with average 1071 ng x g(-1), which was in moderate level compared with other rivers in Pear River Basin. The PAHs distribution in Bejiang River was obviously affected by point source emissions. The high PAHs concentrations of 6470 ng x g(-1) and 4 470 ng x g(-1) were found at the outfalls of Shaoye and the Shakou town, respectively, where PAHs probably derived from local mining/smelting and related industrial actives. The ecological risk of surface sediment in Beijiang River was assessed with the methods of sediment quality guidelines (SQGs), sediment quality standards (SQSs) and contamination factors (CFs) . The result shows that the adverse biological toxicity effect might occasionally happen in more than half of sampling stations. By comparison with the background area, the contamination degrees of PAHs in 20 sampling stations were at very high level, which should arrest the local governments' attentions. The highest ecological risk areas occurred at the outfalls of Shaoye and the Shakou town in which the ecological risks derived from PAHs were within between probable effect level (PEL) and frequent effect level (FEL). The future research was suggested mainly focusing on the status of benthos, sources of pollutants and ways to control pollution in high-risk areas.