Co-occurrence of DSM-IV mental disorders and alcohol use disorder among adult Chinese males.

BACKGROUND: Studies from high-income countries report moderate-to-strong positive associations between alcohol use disorder (AUD) and other mental disorders, but there is little evidence about the comorbidity of AUD from low-and-middle-income countries. METHODS: A sample of 74 752 adults from five provinces that account for >12% of China's adult population was screened using the General Health Questionnaire, and the Structured Clinical Interview for DSM-IV was administered by psychiatrists to a subsample of 9619 males. The associations between AUD and other mental disorders at each site and the characteristics of men with AUD with and without comorbid mental disorders were estimated using logistic regression and summarized across sites using meta-analysis. Generalized estimation equations estimated the associations between the clinical features of alcohol dependence and comorbidity. RESULTS: Robust inverse associations were found between current AUD and any mood disorder (adjusted OR = 0.6, 95% CI = 0.4-0.8) and any anxiety disorder (OR = 0.5, 95% CI = 0.3-1.0). Compared with men without AUD, men with AUD without comorbid disorders were more likely to be middle-aged, to be currently married, and to have higher family incomes. Men with comorbid AUD and other disorders were more likely to have the clinical features of alcohol dependence than men with AUD without comorbid disorders. CONCLUSIONS: Inverse associations between AUD and other mental disorders and the higher social status of men with AUD than men without AUD found in this large, representative sample of community-dwelling Chinese males highlight the importance of considering the local substance-use culture when designing clinical or preventive interventions for addictive conditions.

Closing the knowledge gap in secondhand smoke exposure among children: employment of a five-minute household survey in China.

OBJECTIVE: The 2010 Global Burden of Disease study unexpectedly reports no health burden associated with secondhand smoke (SHS) exposure in children 5-17 years of age. One possible reason for this error is that children under 13 years of age are not considered in standard community surveys of SHS exposure. This study aims to use a 5-min household survey to estimate the prevalence of SHS exposure among children in urban and rural China. STUDY DESIGN: Cross-sectional survey. METHODS: A multi-stage stratified sample of 1120 urban and rural households with 3073 residents from the Ningbo, China, was identified and one adult member from each household was administered a brief survey about the demographic characteristics and smoking status of all household residents. RESULTS: Adjusting for the sampling design and clustering within households, 63% of children less than 7 years of age, 53% of the children 7-12 years of age, and 54% of the children 13-17 years of age were living in households with daily smokers. Controlling for the number of male residents, significantly more households with daily smokers were located in rural areas (p < 0.001) and the average education level of adults in households with daily smokers was significantly lower than that among adults in households without daily smokers (p = 0.007). CONCLUSION: The heavy household exposure of children in China to SHS is an unrecognized public health problem that demands urgent policy and programmatic responses. The brief household survey developed for this study is an easy method for monitoring the prevalence of SHS exposure of children over time that could be useful in community-based tobacco control initiatives.

Notch-induced transcription factors are predictive of survival and 5-fluorouracil response in colorectal cancer patients.

BACKGROUND: The purpose of this study was to evaluate the expression of Notch-induced transcription factors (NTFs) HEY1, HES1 and SOX9 in colorectal cancer (CRC) patients to determine their clinicopathologic and prognostic significance. METHODS: Levels of HEY1, HES1 and SOX9 protein were measured by immunohistochemistry in a nonmalignant and malignant tissue microarray of 441 CRC patients, and the findings correlated with pathologic, molecular and clinical variables. RESULTS: The NTFs HEY1, HES1 and SOX9 were overexpressed in tumours relative to colonic mucosa (OR=3.44, P<0.0001; OR=7.40, P<0.0001; OR=4.08 P<0.0001, respectively). HEY1 overexpression was a negative prognostic factor for all CRC patients (HR=1.29, P=0.023) and strongly correlated with perineural and vascular invasion and lymph node (LN) metastasis. In 5-fluorouracil (5-FU)-treated patients, the tumour overexpression of SOX9 correlated with markedly poorer survival (HR=8.72, P=0.034), but had no predictive effect in untreated patients (HR=0.70, P=0.29). When HEY1, HES1 and SOX9 expression were combined to predict survival with chemotherapy, in treated patients there was an additive increase in the risk of death with each NTF overexpressed (HR=2.09, P=0.01), but no prognostic import in the untreated patient group (HR=0.74, P=0.19). CONCLUSION: The present study is the first to discover that HEY1 overexpression correlates with poorer outcome in CRC, and NTF expression is predictive of CRC patient survival with 5-FU chemotherapy. If confirmed in future studies, testing of NTF expression has the potential to enter routine pathological practice for the selection of patients to undergo chemotherapy alone or in combination with Notch inhibitors.

Titanium-assisted growth of silica nanowires: from surface-matched to free-standing morphologies.

We report on an oxide-assisted growth technique for silica nanowires which allows tuning the growth from surface-matched nanowires to free-standing morphologies based on growth control by Ti in the role of a catalyst and surfactant. Using an adjustable Ti concentration, we grew silica nanowires with lengths ranging from 100 nm up to several millimetres whose defect chemistry was analysed by electron microscopy tools, monochromatic cathodoluminescence imaging and time resolved photoluminescence spectroscopy. The knowledge of the luminescence properties and the related defect occurrence along with their spatial distribution is pivotal for advancing silica nanowire growth in order to realize successful device designs based on self-assembled Si/SiO(x) nanostructures. We demonstrate a core-shell structure of the grown nanowires with a highly luminescent 150 nm thick shell and outstandingly fast decaying dynamics (≈1 ns) for glass-like materials. The conjunction of the observed efficient and stable luminescences with their attributed decaying behaviours suggests applications for silica nanowires such as active and passive optical interconnectors and white light phosphors. The identification of a time domain difference for the spectral regime from 2.3 to 3.3 eV, within the confined spatial dimensions of a single nanowire, is very promising for future, e.g. data transmission applications, employing silica nanowires which exhibit achievable compatibility with commonly applied silicon-based electronics. A qualitative growth model based on silica particle diffusion and Ti-assisted seed formation is developed for the various types of segregated silica nanowires which extends commonly assumed oxide-assisted growth mechanisms.

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology.

OBJECTIVES: Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs). DESIGN: An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency. SETTING: International. PARTICIPANTS: Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations. OUTCOME MEASURES: Definitions of English-language terms for suicidal behaviours. RESULTS: The recommended definition of 'suicide' describes a fatal act initiated and carried out by the actors themselves. The definition of 'suicide attempt' was restricted to non-fatal acts with intent to die, whereas definition of 'self-harm' more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of 'suicidal ideation', 'death wishes' and 'suicide plan'. 'Aborted suicide attempt' and 'interrupted suicide attempt' were not considered components of 'preparatory suicidal behaviour'. There were several differences between representatives from HICs and LMICs. CONCLUSION: This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

Injury-related fatalities in China: an under-recognised public-health problem.

The May 2008 earthquake in Wenchuan drew attention to the important but largely unrecognised public-health problem of injury-related mortality and morbidity in China. Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost due to premature mortality in China. Traffic-related injuries (mainly among cyclists and pedestrians), suicide, drowning, and falls account for 79% of all injury deaths. Rural injury death rates are double those of urban rates and male rates are double those of female rates. Despite an 81% increase in the traffic-related mortality from 1987 to 2006-associated with rapid motorisation-the overall injury mortality decreased by 17%, largely due to a surprising (and unexplained) 57% reduction in the suicide rate. Low-cost prevention measures that are most likely to produce large reductions in injury deaths include enforcement of laws for drinking and driving and for seat belt and helmet use, restriction of access to the most potent pesticides, and teaching children to swim. China needs to improve monitoring of fatal and non-fatal injuries, promote intersectoral collaboration, build institutional capacities, and, most importantly, mobilise community support and political will for investment in prevention.

Wireless Sensor Networks for monitoring underwater sediment transport.

Monitoring of the coastline and coastal processes, in particular sediment movement, is vital to ensure that erosion response is appropriate given the dynamic nature of coastal systems. This should take place regularly over long periods and it is important that data are collected from submerged portions of the littoral zone, as well as the visible beach. This highlights two limitations in existing coastal monitoring techniques: 1. they require largely manual operation and 2. are limited to the visible beach, which results in an incomplete picture of what is happening in the coastal zone. Due to the current difficulties in gathering data beneath the sea surface, this paper reviews wireless sensor network (WSN) technology as a means to overcome these limitations. Analysis showed that WSNs are a promising technology for coastal monitoring, not only in terms of overcoming limitations, but also in terms of cost, safety, and the size of areas they are able to monitor. Previous work using WSNs in this environment is somewhat limited, especially as most current methods are largely limited to the visible beach, and do not consider submerged areas of the coastal zone. From consideration of the physical environment, geological and geographical processes, and informed by advances in technology, research gaps are identified, discussed and evaluated to provide strategies for implementation of WSNs to monitor sediment transport.

Comparison of chlorpropamide and glibenclamide treatment of maturity-onset diabetes: control assessed by fasting plasma glucose concentrations.

Twelve maturity-onset diabetic subjects were treated with chlorpropamide once daily, glibenclamide once daily, or glibenclamide twice daily in a crossover design study. Doses were increased until the fasting blood glucose concentrations became less than 6 mmol/L (108 mg/dl), at which time the patients were admitted for a 24-h study period. There was little difference between the plasma glucose and insulin responses to chlorpropamide or glibenclamide given twice daily (mean doses 489 and 11 mg/day, respectively). When glibenclamide was given once daily (mean dose 9 mg/day), similar plasma glucose concentrations during the day were obtained with slightly higher plasma glucose concentrations during the night. Four patients had chlorpropamide-induced flushing with alcohol, and six patients had postprandial hypoglycemia on glibenclamide. Chlorpropamide once daily or glibenclamide twice daily are suitable for control based on fasting blood glucose measurements.

Witch doctors and mental illness in mainland China: a preliminary study.

This study, the first report on witch doctors in the People's Republic of China, found that most witch doctors are poorly educated peasants who perform healing rituals as a part-time occupation. Despite being officially illegal, folk healing practices are flourishing in the countryside: 73.9% (N = 286 of 387) of psychiatric outpatients from rural areas and 70.5% (N = 43 of 61) of mentally ill persons identified in a rural community admitted to consulting witch doctors. These findings indicate an urgent need to systematically assess the beneficial and detrimental effects of these practices on China's health care system.

Psychiatry and the criminal justice system: testing the myths.

Several states are changing legislation and treatment programs for mentally ill offenders without knowing how current laws and programs operate. To address this problem the authors linked data from police records, court reports, and clinical files for 2,735 psychiatric referrals from the criminal justice system of Alaska from 1977 through 1981. They found that only 0.2%-2.0% of all schizophrenic persons in the community were arrested for violent crimes each year, accounting for 1.1%-2.3% of all arrests for violent crimes; that psychiatrists agreed about competency and responsibility in 79% of the cases evaluated by more than one clinician; and that a successful insanity defense occurred in 0.1% or less of all criminal cases.

Neuroleptic malignant syndrome in 12 of 9,792 Chinese inpatients exposed to neuroleptics: a prospective study.

In a prospective study of an estimated 9,792 inpatients treated with neuroleptic medication at a large Chinese psychiatric hospital, 12 patients developed neuroleptic malignant syndrome. The estimated prevalence of neuroleptic malignant syndrome in these psychiatric inpatients was 1.23/1,000 (95% confidence interval = 0.63/1,000 to 2.14/1,000). Unlike other investigators, the authors found that young adulthood, nonschizophrenic illness, oral high-potency neuroleptics, and concurrent use of lithium were not important risk factors for neuroleptic malignant syndrome. However, depot fluphenazine decanoate, particularly if used without an antiparkinsonian agent, was a risk factor.

Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience.

OBJECTIVE: This study compared insured and uninsured schizophrenic inpatients in China and examined changes in the acute inpatient care of schizophrenic patients during China's economic reform era. METHOD: Detailed chart reviews of 50 randomly selected inpatients discharged from a hospital in central China each year from 1984 through 1993 identified 321 patients with schizophrenia. Demographic, insurance, treatment, and cost data of these patients were collected from the charts. RESULTS: With logistic regression models to control for confounding variables, the analyses showed that the 129 insured patients were significantly more likely than the 192 uninsured patients to be urban residents, to be older, to have had 7 or more years of schooling, and to have had more psychiatric hospitalizations; moreover, their index admissions were longer and were more likely to include use of traditional Chinese medications. The estimated 19% of schizophrenic individuals in the community with health insurance receive inpatient treatment 2.8 times more frequently than the 81% without insurance. Compared to admissions in 1984-1988, admissions in 1989-1993 were significantly shorter and involved longer periods of polypharmacy with multiple antipsychotic medications but included lower mean chlorpromazine-equivalent doses of medication. The relative cost of inpatient care for an acute episode of schizophrenia increased 3.5-fold over the 10-year period, from 11% of mean annual household income in 1984 to 37% in 1993. CONCLUSIONS: Changes in the incentive system for care providers and rapid increases in the cost of care during the economic reform era have resulted in increasingly restricted availability of services for the many schizophrenic patients without health insurance.

Factitious mourning: painless patienthood.

Of 20 patients who falsely reported the deaths of loved ones in order to assume the patient role, most presented with depression and suicidal ideation secondary to reported multiple dramatic deaths for which there was no available verification, and many had histories of factitious physical symptoms, manipulative suicide attempts, substance abuse, and sociopathy. Diagnostic categories were of limited usefulness for these patients. Factitious symptoms can better be understood as one form of dysfunctional care-eliciting behavior. The authors recommend early and repeated confrontations in a firm but nonjudgmental manner combined with referral to outpatient psychotherapy focused on the underlying characterological problems.

Development and validation of a calcium intake questionnaire for postmenopausal women in China.

PURPOSE: Develop and evaluate a food frequency questionnaire (FFQ) for assessing calcium intake in Chinese postmenopausal women. METHODS: An interviewer-conducted FFQ that asks respondents about their consumption of 110 calcium-containing foods over the previous week was developed and administered to 21 randomly selected postmenopausal women from Chengdu. This FFQ uses both the traditional weight-estimation method of assessing portion size in China and a new volume-estimation method. Test-retest reliability was assessed by re-administering the questionnaire two weeks later and validity was assessed by comparing the computed daily calcium intake to that obtained by a researcher-conducted 4-day food record. RESULTS: Estimates of calcium intake derived from the volume-estimation method were significantly lower than estimates derived from the traditional weight-estimation method (median calcium intakes = 270 mg/day versus 570 mg/day), but were quite similar to those obtained from the 4-day food record (median calcium intake = 275 mg/day). The test-retest reliability and validity of the volume-estimation method (intraclass correlation coefficient (ICC) = 0.73 and 0.86, respectively) were better than those of the weight-estimation method (ICC = 0.58 and 0.39, respectively). CONCLUSIONS: The reliability and validity of the traditional weight-estimation FFQ method of assessing dietary intake of nutrients in China is poor; this method may significantly overestimate dietary intakes. The proposed volume-estimation FFQ method for assessing calcium intake is a simple, interviewer-conducted method that is both reliable and valid. The calcium intake of postmenopausal women in urban China is much lower than the recommended daily allowance of 800 mg.

Gastric trichobezoar: case report and literature review.

Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. In adults, bezoars are most frequently encountered after a gastric operation, but in children, bezoars are associated with pica, mental retardation, and coexistent psychiatric pathologic disorders. We describe a 4-year-old girl with trichotillomania in whom a gastric trichobezoar resulted in failure to gain weight, iron deficiency anemia, and a painless epigastric mass. The causes of gastric bezoars are discussed, with emphasis on diagnostic considerations, treatment options, and preventive measures.

Perforation of the inferior vena cava by the Kim-Ray Greenfield filter.

Perforation of the inferior vena cava has been reported following insertion of the Kim-Ray Greenfield filter. This report describes this complication as a consequence of a preventable technical error. However, the clinical implications of such a malpositioned filter may extend beyond the possible obvious complications of retroperitoneal hemorrhage or paracaval organ injury. Inadequate protection against pulmonary embolism may result. A three-dimensional concept is presented to illustrate the loss of equal "compartmentalization" of the cava.

Acutely sodded expanded polytetrafluoroethylene grafts produce only prostacyclin: a qualitative difference from saphenous veins.

Select subsets of patients require prosthetic graft material for revascularization. Although arterial prosthetic grafts of large caliber perform acceptably, grafts of <6 mm exhibit a high attrition rate. Microvessel endothelial sodding, a method resulting in the lining of prosthetic grafts with autologous endothelium, improves graft patency; however, aggressive antiplatelet therapy is still required, because terminating an antiplatelet regimen accelerates graft attrition. The present investigation was designed to address the acute production of vasoactive substances in microvessel endothelial cell sodded expanded polytetrafluoroethylene (ePTFE) grafts in an attempt to delineate a possible mechanism behind the continued requirement for antiplatelet therapy. Equal lengths of acutely sodded ePTFE grafts (canine falciform ligament source) and saphenous veins (SV) (canine source) were evaluated by superfusion bioassay. Basal secretion from ePTFE grafts relaxed the biodetector ring 1 +/- 3%, whereas SV relaxed the ring 10 +/- 3% (p < 0.05, ePTFE vs. SV). Relaxation with acetylcholine stimulation was 49 +/- 7% in grafts and 50 +/- 10% in veins (p = NS). Calcium ionophore stimulation produced relaxation of 37 +/- 9% from ePTFE grafts and 100 +/- 23% from SV (p < 0.05). Indomethacin added to perfusate reduced relaxations from sodded ePTFE grafts to 20.2 +/- 9.2% with acetylcholine stimulation and 12.5 +/- 4.3% with calcium ionophore (p < 0.05 vs. control); addition of N(G)-monomethyl-L-arginine (L-NMMA) had no effect on the release of vasoactive substances from ePTFE grafts. In contrast, relaxations of effluent from SV stimulated by acetylcholine and calcium ionophore were significantly attenuated with indomethacin and L-NMMA (p < 0.05 vs. control). Scanning electron microscopy demonstrated confluent endothelium in SV and a nonconfluent endothelial cell layer in grafts. Acutely sodded ePTFE grafts produce vasoactive substances that quantitatively and qualitatively differ from those produced by canine SV. The ePTFE grafts produce mainly prostanoids, whereas SV produce both nitric oxide and prostanoids. The endothelial cell isolation procedure and absence of immediate graft luminal confluence may contribute to the observed differences.

Effects of transdermal nicotine treatment on structure and function of coronary artery bypass grafts.

Smoking is a major risk factor for failure of coronary artery bypass grafts (CABG). Experiments were designed to determine effects of transdermal nicotine, independent of smoking, on structure and function of CABG. Saphenous veins were placed as CABG in untreated dogs (control) or in dogs treated with transdermal nicotine (one 11-mg or two 22-mg patches/day) for 5 wk. Serum nicotine and plasma nitric oxide were measured. Grafts were removed and prepared for organ chamber studies and histology. Serum nicotine averaged 12.1 and 118.7 ng/ml in the 11 mg/day and 44 mg/day groups, respectively. Plasma nitric oxide was higher in dogs treated with 11 mg/day doses compared with controls. In organ chamber studies, endothelium-dependent relaxations to thrombin and A-23187 and endothelium-independent relaxations to nitric oxide were greatest in grafts from dogs treated with 11 mg/day doses. Intimal thickness of the grafts were similar among groups. However, staining for bone sialoprotein was increased in the media of grafts from the 11 mg/day treatment group. These data suggest that transdermal nicotine in doses comparable and double to those used for conventional smoking cessation treatment in humans does not adversely affect early patency of canine CABG up to 4 wk postoperatively. Transdermal nicotine, however, may increase production of and response to nitric oxide in bypass grafts.

Intrapleural regional analgesia for pain management in cholecystectomy.

Fifty patients undergoing cholecystectomy either electively or urgently were treated in the postoperative period with the intrapleural injection of 30 mL of 0.75% bupivacaine hydrochloride with epinephrine (1:200,000). The frequency of narcotic administration and the postoperative stay were compared with those of 50 historical controls. The group receiving intrapleural regional analgesia had significant, prolonged pain relief requiring minimal narcotic analgesics in the first 24 hours postoperatively and had a significantly shortened hospital stay. There were no complications related to catheter insertion or bupivacaine toxic effects. This technique is safe and effective in controlling perioperative pain.

Carotid endarterectomy in the presence of contralateral carotid occlusion: the role of EEG and intraluminal shunting.

Patients undergoing carotid endarterectomy in the presence of occlusion of the contralateral carotid artery appear at greater risk for operative-related stroke or death. We had experience with 37 such patients in a five-year period. Routine intraluminal shunting without EEG monitoring was used in nine patients. Twenty-eight patients had continuous EEG monitoring during surgery. Of this group, 12 patients required intraluminal shunting based on intraoperative EEG criteria. In the early postoperative period, there was one death, and there were no instances of new, fixed neurological deficits. Life table analysis shows that 80% of the patients are neurologically stable in the five-year follow-up period. Electroencephalographic monitoring proved valuable in the detection of patients requiring intraluminal shunting, in the occasional recognition of poorly functioning shunts, and in the determination of the importance of alterations in blood pressure or cardiac rhythm on cerebral blood flow.