Evaluating the effectiveness and feasibility of a digital health intervention to community-based rehabilitation in older adults: A cluster randomized controlled trial study protocol.

Objective: The escalating global aging population underscores the need to effectively manage geriatric diseases, constituting a significant public health concern. Community-based rehabilitation has emerged as a crucial and accessible paradigm for the rehabilitation of older adults. In China, however, the practical implementation of community-based rehabilitation faces formidable challenges, including a dearth of specialized rehabilitation therapists, substantial disparities between demand and supply, and suboptimal satisfaction rates. We aimed to develop a community-based rehabilitation management platform for older adults centered around digital health technology, with the plan to conduct a cluster randomized controlled trial to gather more evidence to explore the best practices and service models of community-based rehabilitation based on digital health technology. Methods: This cluster randomized controlled trial will be conducted in Zunyi City, China. We will recruit 286 adults aged ≥60 years and randomly allocate 20 subdistricts in a 1:1 ratio into either the intervention group, which will use the Rehabilitation Journey application, or the control group, which will be given a Rehabilitation Information Booklet for Older Adults. Both groups will undergo a 12-month rehabilitation management program, encompassing six months of guidance and an additional six months of follow-up through online and offline methods. The evaluation indicators will be assessed at enrollment and at 3rd, 6th, and 12th month. Discussion: This study endeavors to furnish novel insights to develop a tailored community-based rehabilitation management program for older adults, delivering customized, intelligent, and precise rehabilitation services.

The Effects of Tai Chi on Lung Function, Exercise Capacity and Health Related Quality of Life for Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study.

BACKGROUND: Although several studies have assessed the effect of Tai Chi in management of chronic obstructive pulmonary disease (COPD), these studies have a wide sample variation and convey inconclusive results. This study aims to determine if a 3-month Tai Chi program improves lung function, exercise capacity, and health related quality of life (HRQoL) in people with COPD. METHODS: A randomised controlled, single blind trial was undertaken. Patients were randomly allocated to either Tai Chi group (n=26) or control group (n=24). Participants in the Tai Chi group received a Tai Chi exercise program three times weekly for 3-months while participants in the control group were advised to maintain their routine activities. Outcome measures included lung function, 6-minute walk distance (6WMD) and COPD Assessment Test (CAT). The measurements took place at baseline and immediately after the 3-month intervention period. RESULTS: Of 50 participants, 46 completed the intervention. Compared to control, Tai Chi significantly increased 6WMD (mean difference 60.5m, 95% CI 30.27-78.69), and reduced score of CAT (mean difference 14 points, 95% CI 11-24). An 86% compliance to the Tai Chi training was noted and no adverse events were observed in Tai Chi group. CONCLUSIONS: The Tai Chi program is a safe, effective and feasible method to improve exercise capacity and health-related quality of life in people with COPD.

Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China.

BACKGROUND: Hepatitis B virus (HBV) infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China. METHODS: Totally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg) and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children. RESULTS: Of 298 children born to HBV carrier mothers, 11 (3.7%) were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P < 0.01). The rates of anti-HBs ≥ 10 mIU/ml in children of carrier and non-carrier mothers were 69.5% and 69.2% respectively (P = 0.95). The hepatitis B vaccine coverage in two groups was 100% and 99.4% respectively (P = 0.50), but 15.1% of HBV-exposed infants did not receive the timely birth dose. Prenatal HBsAg screening was performed only in 156 (52.3%) of the carrier mothers. Consequently, only 112 (37.6%) of HBV-exposed infants received HBIG after birth. Furthermore, of the 11 HBV-infected children, only one received both HBIG and hepatitis B vaccine timely, seven missed HBIG, two received delayed vaccination, and one missed HBIG and received delayed vaccination. CONCLUSIONS: There are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.

Risk factors and long-term health consequences of macrosomia: a prospective study in Jiangsu Province, China.

We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years. A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia. A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia. The mean maternal age of the macrosomia group was 24.74±3.32 years, which is slightly older than that in the control group (24.35±3.14 years, P = 0.000). The mean maternal body mass index (BMI) at early pregnancy was 22.75±2.81 kg/m(2), which was also higher than that in the control group (21.76±2.59 kg/m(2), P = 0.000). About 64.6% of macrosomic neonates were males, compared with 51.0% in the control group (P = 0.000). Compared with women with normal weight (BMI: 18.5-23.9 kg/m(2)), women who were overweight (BMI: 24-27.9 kg/m(2)) or obese (BMI≥28 kg/m(2)), respectively, had a 1.69-fold (P = 0.000) and a 1.49-fold (P = 0.000) increased risks of having a neonate with macrosomia, while light weight (BMI<18.5 kg/m(2)) women had an approximately 50% reduction of the risk. Furthermore, macrosomia infant had a 1.52-fold and 1.50-fold risk, respectively, of developing overweight or obesity at the age of 7 years (P = 0.001 and P = 0.000). Older maternal age, higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia. Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.

Transplacentally acquired maternal antibody against hepatitis B surface antigen in infants and its influence on the response to hepatitis B vaccine.

BACKGROUND: Passively acquired maternal antibodies in infants may inhibit active immune responses to vaccines. Whether maternal antibody against hepatitis B surface antigen (anti-HBs) in infants may influence the long-term immunogenicity of hepatitis B vaccine remains unknown. METHODOLOGY/PRINCIPAL FINDINGS: Totally 338 pairs of mothers and children were enrolled. All infants were routinely vaccinated against hepatitis B based on 0-, 1- and 6-month schedule. We characterized the transplacental transfer of maternal anti-HBs, and compared anti-HBs response in children of mothers with or without anti-HBs. In a prospective observation, all 63 anti-HBs positive mothers transferred anti-HBs to their infants; 84.1% of the infants had higher anti-HBs concentrations than their mothers. One and half years after vaccination with three doses of hepatitis B vaccine, the positive rate and geometric mean concentration (GMC) of anti-HBs in 32 infants with maternal anti-HBs were comparable with those in 32 infants without maternal antibody (90.6% vs 87.5%, P = 0.688, and 74.5 vs 73.5 mIU/ml, P = 0.742, respectively). In a retrospective analysis, five and half years after vaccination with three doses vaccine, the positive rates of anti-HBs in 88 children of mothers with anti-HBs ≥1000 mIU/ml, 94 children of mothers with anti-HBs 10-999 mIU/ml, and 61 children of mothers with anti-HBs <10 mIU/ml were 72.7%, 69.2%, and 63.9% (P = 0.521), respectively; anti-HBs GMC in these three groups were 38.9, 43.9, and 31.7 mIU/ml (P = 0.726), respectively. CONCLUSIONS/SIGNIFICANCE: The data demonstrate that maternal anti-HBs in infants, even at high concentrations, does not inhibit the long-term immunogenicity of hepatitis B vaccine. Thus, current hepatitis B vaccination schedule for infants will be still effective in the future when most infants are positive for maternal anti-HBs due to the massive vaccination against hepatitis B.

[A study on population-based prenatal screening and diagnosis of Down's syndrome in Jiangsu province].

OBJECTIVE: To screen and diagnose Down's syndrome during mid-term pregnancy to reduce the number of babies with Down's syndrome. METHODS: With the multi-level of stratified cluster sampling, twenty thousand and eight hundred and three women at 15-20 weeks gestation were screened by maternal serum AFP and beta-hCG using the time resolved fluoroimmunoassay (TRFIA). Then the screened high-risk women were diagnosed by amniocentesis, cell culture and chromosome analyses. The born children were diagnosed by follow-up and peripheral blood chromosome analyses. RESULTS: Six fetuses were diagnosed by serum screening and amniotic fluid chromosome analyses, and 3 born children were diagnosed by follow-up and peripheral blood chromosome analyses. Nine cases of Down's syndrome were detected in total, with the positive prenatal screen rate being 67% (6/9). CONCLUSION: The prenatal screening and diagnosis can reduce the birth of Down's syndrome patients and improve the population quality. However, the diagnosis accuracy still needs to be improved to further reduce the false negative rate and prevent misdiagnosis.

Comparison of second-trimester maternal serum free-beta-human chorionic gonadotropin and alpha-fetoprotein between normal singleton and twin pregnancies: a population-based study.

BACKGROUND: The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free beta-human chorionic gonadotropin (free beta-HCG) and alpha-fetoprotein (AFP) in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy. METHODS: On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free beta-HCG of 195 normal twin pregnancy and 26,512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. RESULTS: According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women (98%), from the target population accepted prenatal screening for maternal serum AFP, beta-HCG detection, and all babies were followed up for at least six months. There were 197 (0.73%) twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect (NTD), trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free beta-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free beta-hCG during the 16th gestational week (P = 0.012). CONCLUSION: The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free beta-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17-19 gestational weeks.

Seroprevalence of hepatitis B surface antigen among pregnant women in Jiangsu, China, 17 years after introduction of hepatitis B vaccine.

OBJECTIVE: To estimate the prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in Jiangsu Province, eastern China, 17years after vaccination against hepatitis B virus (HBV) was introduced. METHODS: From August 2002 to July 2004, serum samples from 6398 women between 15 and 20weeks of pregnancy and from 6 urban and 8 rural areas across Jiangsu Province were tested for markers of HBV. The results were then compared with the rates before 1980. RESULTS: The overall rates of 6.71% for HBsAg and 36.84% for anti-HBs were significantly lower and higher, respectively, than the prevaccination rates. The rate for HBsAg was lower in urban areas than in rural areas (5.75% vs 7.14%, P=0.04). Although the rate used to be much higher in the northern part of Jiangsu Province, which is less prosperous than the southern part, the rates are now similar in both parts (6.60% vs 6.97%). CONCLUSION: These findings demonstrate a drop in the prevalence of HBsAg among pregnant women in Jiangsu Province since the introduction of vaccination programs in 1980, and indicate that HBV infection can also be controlled in less prosperous areas.

[Evaluating the applicability of MoM in second trimester maternal serum to screening for Down's syndrome in Jiangsu province].

OBJECTIVE: To study the applicability of MultiCalc software to prenatal screening of Down's syndrome in Jiangsu province, China. METHODS: The gestational age-specific median of maternal serum marker was calculated by means of regression method. Regression functions for adjustment of Multiple of the Median (MoM) by weight were established for our own population. RESULTS: Before the adjustment by weight, the average level of alpha fetal protein(AFP) was 16% higher and the free beta-human chorionic gonadotrophin (beta-hCG) was 14% higher than those of the Caucasian in MultiCalc software respectively. But when the AFP and free beta-hCG results were converted to weight-adjusted MoM levels, the values were 0.99 and 1.02 respectively. The median of MoM of AFP and the free beta-hCG were 1.00 through the regression model of gestational age and weight adjustment. CONCLUSION: There was no difference of average weight-adjusted MoM levels between the Jiangsu population and the Caucasian, and the MultiCalc software was applicable to maternal serum screening for Down's syndrome of Jiangsu.

[Effects of chlorotriptolide and triptonide on chromosome aberration and micronuclei of bone marrow cell in male rats].

OBJECTIVES: To observe the effects of chlorotriptolide (T4) and triptonide (T7) on the chromosome aberration and micronuclei rates of bone marrow cell in male SD rats. METHODS: Antifertility doses of T4[80 micrograms/(kg.d)] or T7[317 micrograms/(kg.d)] were given to male rats per OS for 10 weeks. Bone marrow slides were then prepared and compared with the controls. RESULTS: The chromosome aberration and micronuclei rates were not significantly different from those of the controls (P > 0.05). CONCLUSIONS: The results were in accordance with our previous reports about the effects of T4 and T7 on the chromosome aberration and micronuclei rates of rat spermatogenic cells. At the antifertility doses, T4 and T7 did not show a mutagenic effect.