Access to colorectal cancer screening in populations in China, 2020: A coverage-focused synthesis analysis.

In populations in China, colorectal cancer (CRC) screening can be mainly accessed through organized screening, opportunistic screening, and physical examination. This screening intervention is found to be effective but the exact coverage rate is difficult to measure. Based on data from published articles, official websites, and available program reports, the screening coverage rate and related indicators were quantified. A rapid review was then conducted to estimate the overall and the breakdown coverage rates of the sub-type screening services, by leveraging the numbers of articles and the by-type median sample sizes. Up to 2020, two central government-funded and four provincial/municipal-level organized CRC screening programs have been initiated and included in this analysis. For populations aged 40-74, the estimated coverage rate of organized programs in China was 2.7% in 2020, and the 2-year cumulative coverage rate in 2019-2020 was 5.3% and the 3-year cumulative coverage rate in 2018-2020 was 7.7%. The corresponding coverage rates of 50-74-year-olds were estimated to be 3.4%, 7.1%, and 10.3%, respectively. Based on the rapid review approach, the overall screening coverage rate for 40-74 years, considering organized screening programs, opportunistic screening, and physical examinations, was then estimated to be 3.0% in China in 2020. However, comparing the findings of this study with the number of health check-ups reported in the local national health statistics yearbooks suggests that the number of CRC physical examinations may be underestimated in this study. The findings suggest that further efforts are needed to improve population access to CRC screening in China. Furthermore, evidence for access to opportunistic CRC screening and physical examination is limited, and more quantitative investigation is needed.

Correction: The role of the Basic Public Health Service program in the control of hypertension in China: Results from a cross-sectional health service interview survey.

[This corrects the article DOI: 10.1371/journal.pone.0217185.].

Systematic Review and Meta-Analysis of Factors Influencing Self-Medication in Children.

To evaluate the prevalence, influencing factors, and behavior rules of self-medication in children. Articles on self-medication in children from various electronic databases (PubMed, Cochrane Library, Web of Science, the WHO website (https://www.who.int/), ABI, CNKI, and Wanfang), were searched to August 2022. The single-group meta-analyses of the prevalence, influencing factors, and behavior rules of self-medication in children were performed using Revman 5.3 and Stata 16.0. The overall pooled prevalence of self-medication in children was 57% (95% CI: 0.39-0.75, I² = 100%, P < .00001 Z = 6.22). The pooled prevalence for main influencing factors, in terms of caregivers, was: 73% (95% CI: 0.72-0.75, I² = 100%, P < .00001, Z = 111.18) for those in rural areas; 55% (95% CI: 0.51-0.59, P = .04, Z = 26.92, I² = 68%, P < .00001) for females; 75% (95% CI: 0.74-0.76, I² = 68%, P < .00001, Z = 106.66) for those whose income was less than 716 dollars; 77% (95% CI: 0.75-0.79, I² = 99%, P < .000001, Z = 92.59) for the middle-aged and elderly; and 72% (95% CI: 0.58-87, I² = 99%, P < .00001, Z = 9.82) for those with a degree below bachelor. In the process of self-medication for children, 19% (95% CI: 0.06-0.32, I² = 99%, P < .00001, Z = 2.82) of the caregivers did not read the instructions, 28% (95% CI: -0.03-0.60, I² = 100%, P < .000001, Z = 1.77) neglected adverse effects, 49% (95% CI: 0.11-0.87, I² = 100%, P = .01, Z = 2.51) spontaneously increased or decreased the dosages, 49% (95% CI: 0.48-0.55, I² = 65%, P < .00001, Z = 16.51) had an awareness of over-the-counter (OTC) drugs, and 41% (95% CI: 0.18-0.64, I² = 99%, P < .00001, Z = 3.49) misrecognized the antibiotics. Self-medication for children was common, although the overall prevalence was not very high. The prevalence of self-medication in children was relatively higher among those caregivers who were female, rural, had low-income, were elder, or had a degree below bachelor. Common behaviors during self-medication in children included spontaneous dose increase or decrease, a lack of awareness of OTC drugs, and misconception of antibiotics. Government departments should formulate corresponding policies to provide quality health education resources for the caregivers of children.

Building quality primary health care development in the new era towards universal health coverage: a Beijing initiative.

Primary health care (PHC) is the most effective way to improve people's health and well-being, and primary care services should act as the cornerstone of a resilient health system and the foundation of universal health coverage. To promote high quality development of PHC, an International Symposium on Quality Primary Health Care Development was held on December 4-5, 2023 in Beijing, China, and the participants have proposed and advocated the Beijing Initiative on Quality Primary Health Care Development. The Beijing Initiative calls on all countries to carry out and strengthen 11 actions: fulfill political commitment and accountability; achieve "health in all policies" through multisectoral coordination; establish sustainable financing; empower communities and individuals; provide community-based integrated care; promote the connection and integration of health services and social services through good governance; enhance training, allocation and motivation of health workforce, and medical education; expand application of traditional and alternative medicine for disease prevention and illness healing; empower PHC with digital technology; ensure access to medicinal products and appropriate technologies; and last, strengthen global partnership and international health cooperation. The Initiative will enrich the content of quality development of PHC, build consensus, and put forward policies for quality development of PHC in China in the new era, which are expected to make contributions in accelerating global actions.

The role of the Basic Public Health Service program in the control of hypertension in China: Results from a cross-sectional health service interview survey.

OBJECTIVES: Non-communicable diseases (NCDs) have become the main cause of mortality in China. In 2009, the Chinese government introduced the Basic Public Health Service (BPHS) program to relieve the rising burden of NCDs through public health measures and delivery of essential medical care. The primary aim of this study was to evaluate the impact of the BPHS program on hypertension control. METHODS: The China National Health Development Research Center (CNHDRC) undertook a Cross-sectional Health Service Interview Survey (CHSIS) of 62,097 people from primary healthcare reform pilot areas across 17 provinces from eastern, central, and western parts of China in 2014. The current study is based on responses to the CHSIS survey from 7,867 participants, who had been diagnosed with hypertension. Multi-variable mixed logit regression analysis was used to estimate the association between BPHS management and uncontrolled hypertension. In a follow-up analysis, generalized structural equation modelling (GSEM) was used to test for mediation of the BPHS program effect through patient compliance with medication. FINDINGS: The estimated proportion of patients with uncontrolled hypertension was 30% lower (23.2% vs 31.5%) in those participants who were adequately managed under the BPHS program. Other predictors of hypertension control included compliance with medication, self-reported wellbeing, income, educational attainment and exercise; smoking was associated with reduced hypertension control. The significant inverse association between uncontrolled hypertension and age indicates poor outcomes for younger patients. Additional testing suggested that nearly 40% of the effect of BPHS management (95% CI: 28.2 to 51.7) could be mediated by improved compliance with medication; there was also an indication that the effect of management was 30% stronger in districts/counties with established digital information management systems (IMS). CONCLUSION: Hypertension control improved markedly following active management through the BPHS program. Some of that improvement could be explained by greater compliance with medication among program participants. This study also identified the need to tailor the BPHS program to the needs of younger patients to achieve higher levels of control in this population. Future investigations should explore ways in which existing healthcare management influences the success of the BPHS program.

Comparing knowledge and use of health services of migrants from rural and urban areas in Kunming City, China.

This paper compares the knowledge and utilization of health services among rural residents, urban residents, rural migrants and urban migrants in a large Chinese city. Data were obtained from a questionnaire survey of 2765 individuals (1951 heads of households and 814 spouses) in Guandu district, Kunming, in 2005. The determinants of their knowledge and utilization of health services were analysed using multivariate logistic regression. First, the migrant population was less likely to know of, or utilize, high-level hospitals and township hospitals than residents. Migrants were more likely to utilize private rather than public services for general health care and delivery care. Second, there was a difference between rural migrants and urban migrants in terms of knowledge and utilization of health services. Rural migrants utilized more low-cost private clinics, but had less knowledge about sources of condoms than urban migrants. Finally, rural residents had more knowledge and utilization of township hospitals than urban residents. This latter group were more likely to utilize high-level hospitals. Migrants' access to health care in urban China is understood better using a dual rural-urban and migrant-resident analytical framework. Rural migrants are the most disadvantaged in their access to urban health care. Further reform of the registered residence system and urban public financing system is recommended. Better information on services and their utilization should be provided to migrants and residents.

Interaction of methylenetetrahydrofolate reductase C677T, cytochrome P4502E1 polymorphism and environment factors in esophageal cancer in Kazakh population.

AIM: To evaluate the association and interaction of genetic polymorphisms in methylenetetrahydrofolate reductase (MTHER) and cytochrome P4502E1 (CYP4502E1), environment risk factors with esophageal cancer (EC) in Kazakh, a high EC incidence area of Xinjiang Uygur Autonomous Region, China. METHODS: A 1:2 matched case-control study was conducted with 120 cases of EC and 240 population- or hospital-based controls. The controls were matched for sex, nationality, area of residence and age within a 5-year difference. MTHER and CYP4502E1 genotypes were identified by PCR-based restriction fragment length polymorphism (RFLP). A conditional logistic regression model was established to identify risk factors. The strata method was adopted in interaction analysis. RESULTS: Low consumption of green vegetables and fresh fruits, alcohol drinking, and unsafe water (shallow well, or river) were found to be the risk factors for EC. Individuals with the MTHFR677 (C/T+T/T) genotype had a 2.62-fold (95% CI: 1.61-4.28) risk of developing EC compared with those who carried the C/C genotype. Individuals with the CYP4502E1C1/C1 genotype had a 3.00-fold (95% CI: 1.82-4.96) risk compared with those who carried the CYP4502E1 (C1/C2+C2/C2) genotype. Gene-environment interaction analysis showed that MTHFR677 gene polymorphism was correlated with consumption of green vegetables and fresh fruit, while CYP4502E1 C1/C1 was correlated with alcohol drinking and unsafe drinking water. MTHFR and CYP4502E1 analysis of gene-gene interaction showed that individuals with the MTHFR677 (C/T+T/T) and CYP4502E1C1/C1 genotypes had a 7.41-fold (95% CI: 3.60-15.25) risk of developing EC compared with those who carried the MTHFR677C/C and CYP4502E1 RsaI C1/C2+C2/C2 genes, and the interaction rate was higher than that of the two factors alone. CONCLUSION: Low consumption of green vegetables and fresh fruits, alcohol drinking, and unsafe water (shallow well, or river) and polymorphisms in MTHFR and CYP4502E1 genes are important risk factors for EC. There is a synergistic interaction among polymorphisms in MTHFR and CYP4502E1 genes and environment factors. MTHFR and CYP4502E1 genes can be used as biomarkers for prevention of EC in Kazakh, Xinjiang Uygur Autonomous Region, China.

[Analysis on the changing trends of non-communicable diseases in Xinjiang Production and Construction Corps, from 1998 to 2008].

OBJECTIVE: To understand the changing trends of non-communicable diseases (NCDs) in Xinjiang Production and Construction Corps from 1998 to 2008. METHODS: A stratified-cluster random sampling based cross-sectional NCDs survey was carried out in 2008, and using the data of NCDs from the health service surveys in 1998 and 2004, in Xinjiang Production and Construction Corps. The prevalence rate of NCDs was standardization according to age proportion of the population being surveyed in 1998. RESULTS: In 1998, 2004 and 2008, the prevalence rates of NCDs in Xinjiang Production and Construction Corps were 17.26%, 25.61%, 24.85% while the Standardized rates of NCDs were 17.26%, 23.54% and 20.49% respectively. The prevalence rates of NCDs were statistically significant different in 35-, 45-, 55- and over 65 age groups in 1998, 2004 and 2008 which showed an consecutive upward trend. The prevalence rates of hypertension, diabetes, cerebrovascular disease, coronary heart disease and chronic obstructive pulmonary disease increased significantly from 1998 to 2008. The prevalence rate of hypertensive disease among 25- age group, diabetes among 35- age group, cerebrovascular disease and coronary heart disease among 45- age groups showed an increasing trend. CONCLUSION: Cardiovascular and cerebrovascular diseases, together with diabetes were the fastest increasing ones over the past 10 years and becoming the major diseases, making the Xinjiang Production and Construction Corps an aging population. NCDs should be prioritized in the health development plan. Targeted health education should be carried out in the whole population, together with other interventions as well as management programs on chronic diseases to reduce the prevalence of NCDs.

[A 1:2 matched case-control study on the interaction of HPV16E6 and HLA-DR9 allele to esophageal cancer in Kazakh ethnicity, Xinjiang].

OBJECTIVE: To evaluate the role and the association between HPV16E6 infection and HLA-DR9 immune-associated gene to esophageal cancer (EC) in Kazakh of Xinjiang, China. METHODS: A 1:2 matched case-control study was conducted with 63 cases of EC and 126 controls involved. The controls were matched by sex, nationality, area of residence and age within 5-year difference. HPV16E6 and HLA-DR9 allele were identified by PCR-SSP. Interaction was performed to identify risk factors. RESULTS: HPV16E6 infection and HLA-DR9 allele positive status were the risk factors for EC, with OR values as 2.67 (95%CI: 1.38 - 5.17) and 3.83 (95%CI: 1.48 - 9.96) respectively. The rate of HPV16E6 infection in individuals with HLA-DR9 allele was different from the ones who were HLA-DR9 allele free (chi(2) = 7.57, P = 0.006), with OR value as 5.79 (95%CI: 1.53 - 21.87). In the controls, the rates of HPV16E6 infection were 22.2% and 16.2% among individuals with HLA-DR9 allele atatus as positive or negative, and without statistically significant difference. Interaction analysis showed there was an interaction of HPV16E6 with HLA-DR9 and were higher than the sum of the two factors presented individually. CONCLUSION: In our study, we found that the HLA-DR9 allele and HPV16E6 infection had a function of synergy in the process of malignant transformation of esophageal epithelial cells, and jointly promoting the occurrence and development of EC.

[Study on the ingestion of folate and polymorphism of MTHFR C677T with esophageal cancer in Xinjiang Kazakh].

OBJECTIVE: To study the relationship between esophageal cancer (EC) and the ingestion of folate, methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphisms in Kazakh area, Xinjiang. METHODS: A 1:2 matched case-control study was adopted. 120 cases diagnosed as esophageal cancer were collected with 240 population-based and hospital-based controls were selected by the same sex, same nationality and each pair's ages were permitted to differ within 5 years. MTHFR genotypes were detected by polymeerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the conditional logistic regression model was performed in this study. RESULTS: Data showed that the ingestion of folate was related to EC in Kazakh (chi2 = 7.868, nu = 1, P < 0.01) with OR: 0.519 (95% CI:0.329-0.821) while more folate intake appeared to be the protective factor of EC in Kazakh. The MTHFR C677T genotype frequencies of EC group was different from the control group (chi2 = 15.823, nu = 1, P < 0.01). The individuals with 677CT, TT genotype had a 2.613-fold (95% CI: 1.628-4.194) increased risk of developing EC, compared to those who had 677CC genotype. Data from Interaction Analysis showed that more folate intake could reduce the incidence of esophageal cancer to the individuals who carried the MTHFR 677CT or TT genotypes. RESULTS: from multivariate conditional logistic regression analysis showed that: unsanitary drinking water, irregular eating, prefer eating peppery food, engorgement, crusted rice or wheat, having history of stomach or esophagus illness, carrying MTHFR 677CT or TT genotypes were risk factors of esophageal cancer while taking in more folate was the protective factor of EC. CONCLUSION: Lacking of folate intake were mainly risk factor and the polymorphisms of MTHFRC677T gene were susceptibility factor of esophageal cancer in Kazakh in Xinjiang.

[A case-control study on risk factor of Kaposi's sarcoma in Xinjiang].

OBJECTIVE: To analyse related risk factors of classic Kaposi' s sarcoma in Xinjiang. METHODS: A 1:4 case-control study was used and the conditional logistic regression model was performed in this study. Cases were followed up in Xinjiang while controls were selected by the same sex, nation and age within 5 years with cases. RESULTS: Interleukin-6,vascular endothelial growth factor, beta-MG, neopterin, human herpevirus 8, were found to be associated with Kaposi's sarcoma risk in one-way variance model while beta2 -MG and human herpevirus 8 entered the multiple conditional logistic regression model, and their ORs were 1.002(95%CI: 1.000-1.003), 81.041 (95%CI: 1.790-3669.620). CONCLUSION: There was a correlate relationship between beta2 -MG and classic Kaposi's sarcoma being found that human herpevirus 8 exposure related factors seemed to have played important roles on classic Kaposi's sarcoma in Xinjiang.