Effects of folic acid supplementation during different pregnancy periods and relationship with the other primary prevention measures to neural tube defects.

OBJECTIVE: To find out the prevention effects of folic acid supplements during different pregnancy periods on neural tube defects (NTDs) and the relationship of folic acid supplements with the other NTDs' primary preventive measures. METHODS: A 1:1 case-control study was conducted. Four hundred and fifty-nine women who delivered or gestate infants/fetuses with NTDs in the last two years were randomly selected as cases and were matched with women who delivered babies without obvious birth defects as controls. RESULTS: For anencephaly, folic acid supplementation during the periconceptional period and preconceptional period has a 57-83% reduction in risk of NTDs(ORs ranged from 0.17 to 0.43). For spina bifida, folic acid supplementation during the periconceptional period has a 79% reduction in risk of NTDs (OR = 0.21). For encephalocele, folic acid supplementation during the periconceptional period has a 67% reduction in risk of NTDs (OR = 0.33). The prevention effects on NTDs were significant when these preventive measures combined with folic acid supplements during the periconceptional period, with OR 0.04, 0.07, 0.10 and 0.11. CONCLUSION: The specific effects of folic acid supplementation during different periods show the reduction in the risk of NTDs, anencephaly, spina bifida, encephalocele. During periconceptional period, folic acid supplements have preventive effects on all NTDs' subtypes.

The effects of preconception examinations on neural tube defects and the primary preventive measures: case-control study.

BACKGROUND: Preventive measures for neural tube defects (NTDs) have been recommended for many years in China, but the compliance with these measures is unsatisfactory. This study aims to analyze the effects of preconception examinations on NTDs and its primary preventive measures. METHODS: A 1:1 hospital-based case-control study was conducted. Four hundred and fifty-nine women who delivered or gestate infants/fetuses with NTDs from January 2006 to December 2008 were randomly selected and matched with women who delivered babies without obvious birth defects as controls in Shandong and Shanxi province. Multivariate conditional logistic regression was adopted. RESULTS: Significant associations were shown between preconception examinations (OR = 0.461), health education (OR = 0.336), periconceptional folic acid supplement (OR = 0.295), periconceptional rational diet adjustment (OR = 0.278) and NTDs. In the case group, the rates of periconceptional folic acid supplement and health education conduction by women who had preconception examinations were significantly higher than that of those who had not, OR being 3.04 and 4.55, respectively (p < 0.05). Among the preventive effects on NTDs, preconception examinations and other NTDs primary preventive measures had significant combined effects and the combined effects with periconceptional folic acid supplement were the greatest, with OR of 0.04. CONCLUSION: Preconception examinations have preventive effects on NTDs and can significantly improve the compliance of other NTDs primary preventive measures. In addition, preconception examinations and these measures have synergetic prevention effects, indicating the critical role played by preconception examinations on NTDs prevention.

Maternal consumption of non-staple food in the first trimester and risk of neural tube defects in offspring.

To study the associations between maternal consumption of non-staple food in the first trimester and risk of neural tube defects (NTDs) in offspring. Data collected from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTDs-affected births and 459 mothers without NTDs-affected births. Logistic regression models were used to examine the associations between maternal consumption of non-staple food in the first trimester and risk of NTDs in offspring. The effects were evaluated by odds ratio (OR) and 95% confidence intervals (95% CIs) with SAS9.1.3.software. Maternal consumption of milk, fresh fruits and nuts in the first trimester were protective factors for total NTDs. Compared with consumption frequency of ˂1 meal/week, the ORs for milk consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.50 (95% CI: 0.28-0.88), 0.56 (0.32-0.99), and 0.59 (0.38-0.90), respectively; the ORs for fresh fruits consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.29 (95% CI: 0.12-0.72), 0.22 (0.09-0.53), and 0.32 (0.14-0.71), respectively; the ORs for nuts consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.60 (95% CI: 0.38-0.94), 0.49 (0.31-0.79), and 0.63 (0.36-1.08), respectively. Different effects of above factors on NTDs were found for subtypes of anencephaly and spina bifida. Maternal non-staple food consumption of milk, fresh fruits and nuts in the first trimester was associated with reducing NTDs risk in offspring.

Genetic and environmental effects on the bone development of the hand and wrist in Chinese young twins.

We assessed genetic and environmental effects on bone development of the hand and wrist, and on key anthropometric measures in Chinese young twins. In total, 139 monozygotic and 95 dizygotic twin pairs aged from 5 to 18 years were recruited. The twin correlations of total hand and wrist scores for monozygotic (MZ) and dizygotic (DZ) twins were 0.71 and 0.36, respectively. Bivariate model analysis showed moderate genetic correlations only for total skeletal maturity vs. weight and total skeletal maturity vs. waist circumference (r, 0.51 and 0.46, respectively). Our findings demonstrated that genetic factors played important roles in bone development of the hand and wrist in Chinese young twins, and that these genetic effects might be distinct from those influencing anthropometric measures.

Nausea and vomiting in early pregnancy and the risk of neural tube defects: a case-control study.

There has been considerable professional debate on the association between nausea and vomiting in early pregnancy (NVP) and neural tube defects (NTDs) risk. This study explored the association between NVP and NTDs risk, and the effect of folic acid supplements on the association. A 1:1 matched case-control study was conducted and conditional logistic regression model was used to analyze the associations. The result showed the odds ratio (OR) of severe NVP for NTDs was 2.403 (95%CI 1.437,4.017; P<0.001) and that of moderate NVP was 1.469 (95%CI 1.063,2.031; P = 0.020) compared with light NVP when adjusted by the potential confounders. Stratified by intake of folic acid supplements, the ORs for severe and moderate NVP turned to 2.147 (95%CI 1.140, 4.043; P = 0.018) and 2.055 (95%CI 1.320, 3.199; P = 0.001) in the stratum of non-intake of folic acid supplements while ORs reduced to 1.851 (95%CI 0.729, 4.699; P = 0.195) and 1.003 (95%CI 0.594, 1.694; P = 0.992) in the stratum of intake of folic acid supplements, respectively. We conclude that severe/moderate NVP has an association with the risk of NTDs, which was not found in the group with intake of folic acid supplements. Folic acid supplements should be recommended to use for the prevention of NTDs.

Breast cancer awareness among women in Eastern China: a cross-sectional study.

BACKGROUND: High breast cancer mortality has been attributed to lack of public awareness, which leads to late diagnoses. As little is known about the level of knowledge and awareness of breast cancer in China, this study was designed to explore it among women in Eastern China. METHODS: We conducted a cross-sectional survey covering 122,058 females around Shandong, Hebei, Jiangsu and Tianjin, in Eastern China, using in-person interviews based on a self-designed structured questionnaire. Student's t-test, Pearson's χ2 test, reliability analysis, exploratory factor analysis, univariate and multivariate logistic regression analyses were performed in the statistical analysis. RESULTS: The results showed poor awareness of breast cancer among women aged 25-70 years in Eastern China. Only 18.6% of women were highly aware in the study, whereas 81.4% were poorly aware. Among all participants, family history of breast cancer was the best accepted risk factor for breast cancer (awareness rate 31.5%), followed by menarche at age before 12 (11.2%), no parity or late childbirth (13.9%), menopause at a late age (13.7%), high-fat diets (19.1%), long time drinking (19.5%) and long-term use of estrogen drugs (20.7%). Multivariate logistic regression analysis (α = 0.05) identified nine variables that predicted awareness of breast cancer: age (OR = 0.975, 95% CI: 0.960-0.990), location (OR = 1.675, 95% CI: 1.602-1.752), occupation (OR = 4.774, 95% CI: 4.316-5.281), family history of breast cancer (OR = 1.234, 95% CI: 1.073-1.420), household annual income (OR = 0.418, 95% CI: 0.400-0.436), behavioral prevention score (OR = 4.137, 95% CI: 3.991-4.290), no smoking (OR = 2.113, 95% CI: 1.488-2.999), no drinking (OR = 1.427, 95% CI: 1.018-2.000), overall life satisfaction (OR = 0.707, 95% CI: 0.683-0.731). CONCLUSIONS: Our study indicates insufficient awareness of breast cancer among women in Eastern China, and an urgent need for health education programs on this subject.

Maternal flu or fever, medications use in the first trimester and the risk for neural tube defects: a hospital-based case-control study in China.

PURPOSE: This study aims to evaluate the effects of maternal flu or fever, and medications (antibiotics and antipyretics) use in the first trimester on neural tube defects (NTDs) risk in offspring. METHODS: Data came from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTD-affected births and 459 mothers without NTD-affected births. Logistic regression models were used to evaluate the effects of maternal flu, fever, and medications use on NTD risk. The effects were evaluated by adjusted odds ratio (OR) and 95 % confidence intervals (CIs) with SAS9.1.3.software. RESULTS: NTDs risks were significantly associated with maternal flu or fever (OR = 2.63, 95 % CI = 1.64-4.23) and antipyretics use (OR = 3.38, 95 % CI = 1.68-6.79), but not with antibiotics use (OR = 1.82, 95 % CI = 0.85-3.93). The risk effect of antipyretics use on anencephaly (OR = 7.81, 95 % CI = 1.96-31.13) was markedly higher than on spina bifida (OR = 3.02, 95 % CI = 1.08-8.42). Maternal flu or fever together with antipyretics use showed a higher OR for total NTDs (3.27 vs.1.87), anencephaly (7.38 vs.2.08), and spina bifida (2.97 vs.2.07) than maternal flu or fever with no antipyretics use. CONCLUSIONS: Maternal flu or fever and antipyretics use in the first trimester were risk for NTDs. Maternal flu or fever together with antipyretics use increased NTD risk than only maternal flu or fever.

Maternal passive smoking during pregnancy and neural tube defects in offspring: a meta-analysis.

PURPOSE: This study aims to examine the association between maternal passive smoking during pregnancy and the occurrence of neural tube defects (NTDs) in offspring. METHODS: We retrieved studies published on the association between maternal passive smoking during pregnancy and the occurrence of NTDs in offspring. Meta-analysis was applied to calculate the pooled effect estimates and their 95% confidence intervals (CIs) using data from 10 case-control studies. The publication bias was assessed by the Egger's regression asymmetry test and Begg's rank correlation test with Begg's funnel plot. RESULTS: The pooled effect estimate of maternal passive smoking was 1.82 (95% CI 1.46-2.27) for total NTDs; the effect estimates were 1.72 (95% CI 1.44-2.06), 1.52 (95% CI 1.29-1.79), and 2.32 (95% CI 1.34-4.01) for NTDs subtypes of anencephaly, spina bifida and encephalocele, respectively. Stratified by geographic region of the studies, the pooled effect estimates were 2.11 (95% CI 1.46-3.06), 1.65 (95% CI 1.16-2.34), 1.25 (95% CI 0.41-3.80) in China, USA and Iran, respectively. CONCLUSIONS: This meta-analysis suggested that maternal passive smoking during pregnancy was associated with an increased risk of total NTDs and three NTDs subtypes in offspring. Specifically, the associations were also found to be significantly positive both in China and USA.

Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China.

Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world. Among 1565 samples tested from children, 41 (2.6%) were positive for HEV and 223 (14.3%) for human rhinovirus (HRV). Seven (17.1%) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack. The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China. In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.

Maternal smoking during pregnancy and neural tube defects in offspring: a meta-analysis.

PURPOSE: This study aims to examine the association between maternal smoking during pregnancy and neural tube defects (NTDs) in offspring. METHODS: We retrieved published studies on the association between maternal smoking during pregnancy and NTDs risk in offspring. Meta-analysis was applied to calculate the overall odds ratios (ORs) and their 95 % confidence intervals (CIs). The publication bias was assessed by the Egger's regression asymmetry test and Begg's rank correlation test. RESULTS: The overall effect of maternal smoking during pregnancy on NTDs was 1.03 (OR = 1.03, 95 % CI = 0.80-1.33). When subgroup analysis was conducted by geographic regions, the overall effects were 1.39 (OR = 1.39, 95 % CI = 1.18-1.64), 0.88 (OR = 0.88, 95 % CI = 0.66-1.17) in Europe and USA; when subgroup analysis was conducted by NTDs types, the overall effect was 1.55 (OR = 1.55, 95 % CI = 1.06-2.26) for spina bifida. CONCLUSIONS: Women who smoked during pregnancy had mildly elevated risk of having infants with NTDs.

Uncoupling protein 2 gene polymorphisms in association with overweight and obesity susceptibility: A meta-analysis.

A meta-analysis was performed to evaluate the associations of uncoupling protein 2 (UCP2) gene polymorphisms (Ala55Val, 45-bp insertion/deletion, and -866G/A) with overweight and obesity. A total of 42 studies were included in our analysis. Pooled effect estimates and 95% confidential intervals of each polymorphism were calculated under different inherited models. Fixed or random effect model was selected based on the between-study heterogeneity evaluated with I(2) . Source of heterogeneity was explored by subgroup analysis and meta-regression analysis. Potential publication bias was assessed using funnel plot and Peters test. After excluding studies that deviated from the Hardy-Weinberg equilibrium, T allele of Ala55Val polymorphism was associated with an increased risk of overweight and obesity under recessive model in the overall (OR = 1.24, 95%CI = 1.06-1.45) and Asian (OR = 1.28, 95%CI = 1.06-1.55) populations; and A allele of -866G/A polymorphism had a protective effect on overweight and obesity, especially for European populations (dominant model: OR = 0.88, 95%CI = 0.81-0.96, co-dominant 1 model: OR = 0.89, 95%CI = 0.81-0.98, co-dominant 2 model: OR = 0.85, 95%CI = 0.74-0.94, additive model: OR = 0.88, 95%CI = 0.80-0.95, and allelic model: OR = 0.91, 95%CI = 0.86-0.97). No evidence was observed in the association of 45-bp insertion/deletion polymorphism with overweight and obesity susceptibility. We failed to fully explore the between-study heterogeneity regarding the association of Ala55Val polymorphism with overweight and obesity. Further studies are required to provide more convincing evidence.

Psychometric properties of the suicidal ideation questionnaire among Chinese high school students.

OBJECTIVES: To test the psychometric properties of the Suicidal Ideation Questionnaire (SIQ) among Chinese high school students. METHODS: The reliability and validity of SIQ were analyzed with data of 505 high school students in Jinan, China. RESULTS: The Cronbach's coefficient alpha of SIQ was above 0.95 and the Cronbach's coefficients alphas of SIQ when each item was deleted were relatively stable. The convergent validity analyses showed that there were statistically significant correlations between SIQ total scores and DSD total scores by gender. Exploratory factor analysis produced four factors of SIQ. CONCLUSION: The SIQ has a high level of reliability and validity and should be a reliable measure for suicide ideation in Chinese high school students.

WITHDRAWN: Uncoupling protein 2 gene polymorphisms in association with overweight and obesity susceptibility: A meta-analysis.

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Genetic variants of Orientia tsutsugamushi in domestic rodents, northern China.

We screened Orientia tsutsugamushi from 385 domestic rodents and 19 humans with scrub typhus in rural Tai'an District, Shandong Province, a new scrub typhus epidemic area in northern China. Sequence analysis identified 7 genotypes in the rodents, of which 2 were also identified in the humans.

[Study on the molecular epidemiological characteristics of norovirus in acute gastroenteritis of Beijing].

OBJECTIVE: To study the prevalence, genotypes and molecular characteristics of norovirus (NoV) in acute gastroenteritis. METHODS: RT-PCR was used to determine the molecular epidemiology of NoV. RESULTS: Out of 685 samples, 66 positive specimens were identified and the prevalence was 9.6% (66/685), 9.9% in males and 9.4% in females, respectively, with no significant difference. The prevalence rates showed no differences between age groups or between inpatients and outpatients. NoV gastroenteritis did not present any seasonal distribution. 43 out of the 66 specimens were classified, with 10 (22.7%) belonged to GI including 2 GI.3, 1 GI.4, 4 GI.5 and 3 GI.7. Other 33 (77.3%) belonged to GII genogroup, including GII.4 accounted for 60.6% (20/33) and followed by 7 GII.12, 2 GII.6, 1 GII.2, 1 GII.3, 1 GII.5. Six specimens mixed with GI and GII and 3 specimens were classified as GI.3/GII.7, GI.5/GII.5 and GI.4/GII.4. CONCLUSION: The main symptoms of acute gastroenteritis were abdominal pain, nausea, vomit and fever. There were many genotypes identified in our study and the main genotypes were GII.4/2006a and 2006b. GI and GII could be coinfected with each other.

Maternal body mass index and the association between folic acid supplements and neural tube defects.

AIM: To study the influence of maternal body mass index (BMI) on the association between folic acid supplementation and neural tube defects (NTDs) risk in offspring. METHODS: A hospital-based, case-control study was conducted between 2006 and 2008 on 459 mothers with NTDs-affected births and 459 mothers without NTDs-affected births. Logistic regression models examined the associations between folic acid supplementation and the NTDs risk in offspring for all mothers, underweight/normal weight mothers (BMI<24.0) and overweight/obese mothers (BMI ≥24.0). The effects were evaluated by adjusted odds ratio (AOR) and 95% confidence intervals (CIs) with SAS 9.1.3 software. RESULTS: The overall AOR for periconceptional folic acid supplementation was 0.315 (95% CI = 0.172-0.577) when compared with no supplements. Stratified by maternal BMI, the AOR for periconceptional folic acid supplementation in overweight/obese mothers was greater than in underweight/normal weight mothers (0.646 vs. 0.208). The AOR for folic acid supplementation within 3 months before conception was 0.711 (95% CI = 0.323-1.563) in all mothers. Stratified by maternal BMI, the AOR for folic acid supplementation within 3 months before conception in overweight/obese mothers was greater than in underweight/normal weight mothers (0.658 vs. 0.527). CONCLUSION: The association between folic acid supplementation and the reduced NTDs risk was weaker in overweight/obese mothers (BMI ≥24.0) than in underweight/normal weight mothers (BMI <24.0).

Clinical application of RT-nested PCR integrated with RFLP in Hantavirus detection and genotyping: a prospective study in Shandong Province, PR China.

The aim of the present study was to evaluate the clinical usefulness of applying RT-nested PCR along with RFLP as a method for diagnosis and genotypic differentiation of Hantavirus in the acute-stage sera of HFRS patients as compared to the ELISA technique. A prospective study of patients with suspected HFRS patients was carried out. Sera were collected for serological evaluation by ELISA and RT-nested PCR testing. Primers were selected from the published sequence of the S segment of HTNV strain 76-118 and SEOV strain SR-11, which made it possible to obtain an amplicon of 403 bp by RT-nested PCR. The genotypic differentiations of the RT-nested PCR amplicons were carried out by RFLP. Sequence analyses of the amplicons were used to confirm the accuracy of the results obtained by RFLP. Of the 48 acute-stage sera from suspected HFRS patients, 35 were ELISA-positive while 41 were positive by RT-nested PCR. With Hind III and Hinf I, RFLP profiles of the RT-nested PCR amplicons of the 41 positive sera exhibited two patterns. 33 had RFLP profiles similar to the reference strain R22, and thus belonged to the SEOV type. The other 8 samples which were collected during October-December had RFLP profiles similar to the reference strain 76-118, and thus belonged to the HTNV type. Sequence phylogenetic analysis of RT-nested PCR amplicons revealed sdp1, sdp2 YXL-2008, and sdp3 as close relatives of HTNV strain 76-118, while sdp22 and sdp37 as close relatives of SEOV strain Z37 and strain R22 located in two separate clusters in the phylogenetic tree. These results were identical to those acquired by RFLP. RT-nested PCR integrated with RFLP was a rapid, simple, accurate method for detecting and differentiating the genotypes of Hantavirus in the acute-stage sera of suspected HFRS patients. In Shandong province, the main genotypes of Hantavirus belonged to the SEOV types, while the HTNV types were observed during the autumn-winter season.

Maternal overweight and obesity and the risk of neural tube defects: a case-control study in China.

BACKGROUND: Studies have suggested that being obese before pregnancy is a risk factor for neural tube defects (NTDs), while results of many studies are controversial. This study aims to explore the association between maternal overweight and obesity before pregnancy and risk of NTDs. METHODS: A 1:1 matched case-control study was conducted. Cases were 459 women who delivered infants or conceived fetuses with NTDs in two provinces of China and controls were 459 women with live-born infants, without an apparent congenital malformation, matched with cases by region, delivery hospital, and year of childbirth. RESULTS: Compared with normal body weight, maternal obesity (body mass index, BMI ≥ 28 kg/m(2)) before pregnancy had a significant increased risk for NTDs as a group after adjusting for age, occupation, educational level, family income, parity, and use of folic acid (odds ratio, OR = 2.45; p < 0.05). No significant increase in NTD risk was found for maternal underweight (BMI < 18.5 kg/m(2)) and overweight (BMI from 24 to 28 kg/m(2)). For three subtypes of NTDs, anencephaly, spina bifida, and encephalocele, no significant increase in risk was found with maternal underweight, overweight, or obesity (all, p > 0.05). CONCLUSION: Maternal obesity before pregnancy is associated with risk of NTDs and should be considered in maternal reproductive health care.

Periconceptional factors affect the risk of neural tube defects in offspring: a hospital-based case-control study in China.

OBJECTIVE: To explore the periconceptional factors affecting the risk of neural tube defects (NTDs), we carried out a hospital-based case-control study in China. METHODS: A 1:1 matched case-control study was conducted. With self-designed questionnaires, we solicited relevant information from 459 case mothers and 459 control mothers selected in two provinces of China through face-to-face interviews. Univariate and multivariate conditional logistic regression analyses were conducted to evaluate the effect values by odds ratios (ORs) and 95% confidence intervals (95%CIs) with SAS9.1.3.software. RESULTS: Daily passive tobacco smoke exposure was a risk factor for total NTDs (OR = 8.688, 95%CI = 2.329-32.404). Diet adjustment in the first trimester (OR = 0.061, 95%CI = 0.014-0.274), periconceptional folic acid intake (OR = 0.059, 95%CI = 0.011-0.321) and health education (OR = 0.251, 95%CI = 0.081-0.781) were protective factors for total NTDs. Differences in factors and their effects on NTDs were found for the three subtypes of NTDs: anencephaly, spina bifida and encephalocele. CONCLUSIONS: Daily passive tobacco smoke exposure, diet adjustment in the first trimester, periconceptional folic acid intake and health education were associated with NTDs.