Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension.

BACKGROUND: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. METHODS: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. RESULTS: Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers' advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. CONCLUSION: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension (SMASH) Project.

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion>9 g/d, but reported low or moderate sodium intake. The agreement between self-reported sodium intake level and 24-h urine sodium excretion level was low in both normotensive subjects and hypertensive subjects. These findings suggested that many subjects who reported low sodium intake had actual urine sodium excretion>9 g/d. Sodium intake is often underestimated in both hypertensive and normotensive participants in China.

Dietary sodium intake and its impact factors in adults of Shandong province.

Dietary sodium intake and its impact factors in 2 140 adults aged 18-69 years were analyzed. The mean daily sodium intake was 5745.0 (5427.6-6062.5) mg per day, which was higher in males than in females (P<0.01). After having been adjusted for gender, age and urban/city areas, the mean daily sodium intake was significantly higher in participants with a lower education level, drinkers and smokers than in those with a higher education level, nondrinkers and nonsmokers (P<0.01). The dietary sodium intake in adults of Shandong Province is higher than the recommended standards.

[Evaluation on the effectiveness of community intervention on hypertension related knowledge in mid-western rural area of Shandong province].

OBJECTIVE: To evaluate the intervention effect of health education on hypertension knowledge in mid-western rural area of Shandong province. METHODS: A project was launched on chronic disease control in mid-western rural area of Shandong province from 2007 to 2010. The baseline survey was performed using multi-stage random sampling method in 8 counties of mid-western rural area of Shandong province in April, 2007. A total of 20 087 participants aged 25 and above were recruited in the survey to study the relationship between awareness of hypertension and diet, smoking, obesity. Health education focusing on balance diet, physical activity promotion and tobacco control was performed among intervention population. The final evaluation survey using same questionnaire was performed in 2010, classified in intervention (4071 participants) and control (2145 participants) group. Control group was selected from non-intervention town in same county. Intervention and control group shared the same baseline data in 2007 for evaluation. By comparing the changes of hypertension knowledge before and after intervention, the intervention effect was evaluated. RESULTS: Awareness of the relationship between hypertension and diet rose from 34.0% (6830/20 087) at baseline in 2007 to 69.3% (2821/4071) (χ(2) = 1757.30, P < 0.01) of intervention group and 44.8% (961/2145) (χ(2) = 99.30, P < 0.01) of control group in 2010. Awareness of hypertension associated to smoking rose from 25.6% (5142/20 087) at baseline in 2007 to 55.2% (2247/4071) (χ(2) = 1396.59, P < 0.01) in intervention group, 30.9% (662/2145) (χ(2) = 27.83, P < 0.01) in control group in 2010. Awareness of hypertension related to obesity rose from 37.2% (7472/20 087) of the baseline in 2007 to 68.3% (2780/4071) (χ(2) = 1339.27, P < 0.01) in intervention group, 45.1% (967/2145) (χ(2) = 51.14, P < 0.01) in control group in 2010. CONCLUSION: Community comprehensive intervention showed significant effects on hypertension related knowledge improvement in mid-western rural area of Shandong province.

Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China.

OBJECTIVE: Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment. METHODS: This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment. RESULTS: Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted HR, 0.79 (95% CI: 0.66-0.96)] and more than nine years [adjusted HR, 0.82 (95% CI: 0.69-0.98)] were associated with lower risk of cognitive impairment. CONCLUSION: A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.

The impact of routine follow-up with health care teams on blood pressure control among patients with hypertension.

A series of guidelines concerning hypertension emphasize the importance of follow-up in patients' management. The aim of this study was to assess the impact of routine follow-up on blood pressure (BP) control. A total of 1511 patients with hypertension aged ≥ 35 years were selected randomly from 17 communities in two cities and four townships located in Shandong and Jiangsu provinces in China. About half of the patients visited the community clinic four or more times yearly; follow-up was conducted by telephone for 43.3%. Forty-four point two percent of patients who did not visit a community clinic received telephonic follow-up; a higher percentage of telephonic follow-up was found in patients who visited community clinics frequently. Positive changes in BP level and BP control were associated with the number of clinical visits, while no significant correlations were found with telephonic follow-up. After adjustment for covariates, a higher number of clinic visits was associated with better BP control, with odds ratios of 1.628 (95% confidence interval (CI): 1.141-2.322), 1.472 (95% CI: 1.008-2.271), and 1.790 (95% CI: 1.154-2.778) for 4-6, 7-12, and >12 visits/year, respectively. Taking an antihypertensive drug showed a strong, positive association with the number of clinic visits (OR 1.747, 95% CI: 1.484-2.056). These data suggest that health care systems may achieve greater success by increasing the frequency of clinical visits and that the positive changes may be related to improvement in medication adherence. Routine follow-up by telephone was not significantly associated with BP level and BP control.

Estimating daily salt intake based on 24†h urinary sodium excretion in adults aged 18-69†years in Shandong, China.

OBJECTIVE: 24 h urinary sodium extretion was used to estimate the daily salt intake of shandong residents aged from 18 to 69 years in China. SETTING: 20 selected counties/districts in Shandong stratified by geographic region (Eastern, Central Southern and North Western) and residence type (urban vs rural). PARTICIPANTS: Among 2184 randomly selected adults, 2061 provided usable 24 h urine samples. Urine volume <500 mL or male creatinine <3.81 (female creatinine <4.57) are not included in the analysis. RESULTS: The mean sodium level excreted over 24 h was 237.61 mmol (95% CI 224.77 to 250.44) mmol. Overall, the estimated mean salt intake was 13.90 g/day (95% CI 13.15 to 14.65). The mean salt intake among rural residents was higher than that among urban residents (14.00 vs 13.68 g; p<0.01). Salt intake in men was higher than that in women (14.40 vs 13.37 g; p<0.01). Approximately 96% of the survey participants had a dietary salt intake of ≥6 g/day. CONCLUSIONS: The salt intake in Shandong is alarmingly higher than the current recommended amount (6 g/day). Thus, effective interventions to reduce salt intake levels to combat the increasing burden of non-communicable diseases need to be developed and implemented.

[Study on waist circumference and hip circumference of 7 - 18 year-old children and adolescents in Shandong province].

OBJECTIVE: To study the development of waist circumference (WC) and hip circumference (HC) in children and adolescents in Shandong province, and to provide scientific data for developing related reference values for screening central obesity in Chinese children and adolescents. METHODS: Using data from 'Student physical fitness and health surveillance 2010 project' in Shandong province, a total of 42 275 students aged 7 - 18 years were selected to participate in this study. WC, HC, waist-to-hip ratio (WHR) and wrist-to-stature ratio (WSR) of subjects were measured. Comparison of data from the current study and other similar studies was made. RESULTS: The mean values of WC increased with age, and boys all significantly higher than girls in all age categories (P < 0.01). There were two crosses on gender regarding the HC curves: before the age of 11 years, with mean HC higher in boys than in girls, but girls were higher than boys between the age of 12 to 14 while boys were also higher than girls after the age of 15 years. The 50(th) percentiles (P(50)) of WC of children and adolescents aged 7 to 18 years in Shandong appeared above the figures by 1.3 - 3.1 cm (boys) and 1.2 - 2.0 cm (girls) from 15 provinces in China as well as above the data from Hong Kong by 1.9 - 5.4 cm (boys) and 2.0 - 6.5 cm (girls), respectively. Overall, 20.20% of the boys and 16.57% of the girls had a WC of ≥ 90(th) percentile and 15.73% and 7.38% of the boys and girls had a WHtR of ≥ 0.5 which both showed significant differences between genders (P < 0.01). CONCLUSION: Children and adolescents from Shandong province had a high level of WC.

Dietary sodium intake: knowledge, attitudes and practices in Shandong Province, China, 2011.

OBJECTIVE: To investigate the knowledge, attitudes and practices (KAP) for dietary sodium intake among adult residents of Shandong Province, China. METHODS: In 2011, we conducted a cross sectional survey among a representative sample of 15,350 adults aged 18 to 69 years using a standardized questionnaire to assess their KAP for sodium. Variation in the KAPs by gender, and residence location were compared using the Chi-square tests. Predictors for the 'intention to' and 'currently taking action to' reduce sodium intake were determined by multivariate logistic regression with adjustment for confounding factors. RESULTS: KAPs for dietary sodium intake among urban residents was generally more favorable than among rural residents. Women were likely to have more favorable KAPs than men. About four fifth of subjects reported that they favored a low sodium diets. However, 31% reported that consumption of less sodium results in less physical strength. Overall, 70% indicated their intention to reduce sodium intake, although only 39 % reported that they had taken action to reduce sodium. Multiple logistic regression analyses indicated that favorable actions to dietary sodium reduction were more likely to occur among those who were aware of the link between sodium and hypertension, and less likely among those who had unfavorable attitudes towards dietary sodium reduction. CONCLUSION: Increasing knowledge levels about the benefits of sodium reduction will be a key success factor for effective sodium reduction initiatives and is linked to favorable behavioral change. Emphasis should be placed on the rural area.

[Burden of disease on road traffic injuries in Penglai city, Shandong province, in 2006 - 2007].

OBJECTIVE: To evaluate the burden of road traffic injury (RTI) from perspectives both on the health of population and on social economic status so as to provide scientific evidence for policy making. METHODS: The status of mortality and disability caused by traffic accident in Penglai county was estimated, based on data from death registration and a sampling survey from 2006 to 2007. Together with the disability weights gained from global burden of disease (GBD), health burden (DALY) was measured with GBD formula. The economic burden of RTI was evaluated. RESULTS: Average loss of the health life years (HLY) related to RTI was 31 373.04 per year. 70.59 HLY were lost per 1000 persons. Loss among the males was higher than females. The loss of DALY among the age group 15 - 44 years ranked the first place (39 209.71 HLY) which accounted for 62.42% of the total DALY. 79.45% of the total DALY were caused by disability. In 2006 and 2007, the economic loss caused by RTI was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP while the indirect economic costs (2.15 billion RMB) accounted for 98.45% of the total costs in Penglai city. The economic loss of the males was obviously higher than the females and the loss by the group aged 15 - 59 years old accounted for 97.65% of the total. CONCLUSION: RTI had severely influenced the health of the residents in Penglai city and brought heavy burden to the individuals, families as well as the society.

[Field observation on the effect of low-sodium and high-potassium salt substitute on blood pressure in the rural community-based population in China].

OBJECTIVE: To investigate the effect of commercial low-sodium and high-potassium salt substitutes on blood pressure in the rural community-based population in China. METHODS: We conducted a quasi-experiment on 411 adults, who were 30 to 60 years of age, in 2 rural communities from Laiwu city in Shandong province of China on data from blood pressure screening. The subjects were divided into 2 groups: high blood pressure (HBP) and non-HBP (NHBP). Both groups and their family members took a low-sodium and high-potassium salt substitute for 3 months to replace the normal salt in their bodies. Blood pressure (BP) and 24-hour urinary sodium and potassium were measured regularly in the 2 groups. RESULTS: There was a continuously decreasing trend for BP at the end of the first month. Three months later, the mean BP decreased by 7.4 mm Hg (1 mm Hg = 0.133 kPa, t = 10.096, P = 0.000) for SBP and 3.8 mm Hg (t = 8.017, P = 0.000) for DBP in the HBP group, when compared to a 1.2 mm Hg (t = 2.507, P = 0.007) decrease on SBP and 1.0 mm Hg (t = 2.987, P = 0.002) on DBP in the NHBP group. The mean urinary sodium had a decrease of 15.5 mmol/24 h (t = 1.803, P = 0.037), but the urinary potassium increased by 4.2 mmol/24 h (t' = 2.132, P = 0.018). The result of urinary sodium appeared to be as follows: potassium ratio (Na(+)/K(+)) decreased by 1.2 (t = 2.786, P = 0.003) in the HBP group. However, in NHBP group, the mean urinary sodium decreased by 1.7 mmol/24 h (t = 0.211, P = 0.417) and urinary potassium increased by 3.7 mmol/24 h (t' = 2.207, P = 0.015), together with the decrease of Na(+)/K(+) by 0.7 (t = 1.818, P = 0.036). CONCLUSION: Results from our study clearly demonstrated that the intake of low-sodium and high-potassium salt substitute could effectively reduce the BP with good compliance among adults in the rural community-based population in China. This was an effective but non-medical method to prevent and control the high blood pressure.

[Estimation on disease burden related to hepatitis B virus infection in Shandong province of China].

OBJECTIVE: To comprehensively measure the burden of hepatitis B, liver cirrhosis and liver cancer in Shandong province, using disability-adjusted life years (DALYs) to estimate the disease burden attribute to hepatitis B virus (HBV) infection. METHODS: Based on the mortality data of hepatitis B, liver cirrhosis and liver cancer derived from the third National Sampling Retrospective Survey for Causes of Death during 2004 and 2005, the incidence data of hepatitis B and the prevalence and the disability weights of liver cancer gained from the Shandong Cancer Prevalence Sampling Survey in 2007, we calculated the years of life lost (YLLs), years lived with disability (YLDs) and DALYs of three diseases following the procedures developed for the global burden of disease (GBD) study to ensure the comparability. RESULTS: The total burden for hepatitis B, liver cirrhosis and liver cancer were 211,616 (39,377 YLLs and 172,239 YLDs), 16,783 (13,497 YLLs and 3286 YLDs) and 247,795 (240,236 YLLs and 7559 YLDs) DALYs in 2005 respectively, and men were 2.19, 2.36 and 3.16 times as that for women, respectively in Shandong province. The burden for hepatitis B was mainly because of disability (81.39%). However, most burden on liver cirrhosis and liver cancer were due to premature death (80.42% and 96.95%). The burden of each patient related to hepatitis B, liver cirrhosis and liver cancer were 4.8, 13.73 and 11.11 respectively. CONCLUSION: Hepatitis B, liver cirrhosis and liver cancer caused considerable burden to the people living in Shandong province, indicating that the control of hepatitis B virus infection would bring huge potential benefits.

[Time trends on the prevalence of cancer during 1970-2005 in Shandong province].

OBJECTIVE: To analyze time trend of cancer during 1970-2005 in Shandong province so as to develop strategies for control and prevention of cancer at the community level. METHODS: Data was from 4 retrospective surveys regarding all causes of death during 1970-1974, 1985-1989, 1990-1992 and 2004-2005, in Shandong province. Other than one set of data collected in 1985-1989 by Shandong province itself, the other 3 set of data were from the national surveys, in which the survey-point sampling of choice was based on data of 1970-1974 for assessing its representativeness. The observing indices would include standardized mortality and mortality. A join-point regression model was used to analyze the changing rate of tumor. RESULTS: The mortality rate of the entire tumor increased 143.15 percent in 2005 than in 1970. The changing slope of standardized rate of all tumors in the regression model showed that the inter-annual growth rate were 0.54 and 1.24 percent from 1970 to 1984 and from 1985 to 1992. The rate of increase since 1992 had been 0.18 percent. During 2004-2005, the main malignant cancers were lung, stomach, liver, esophageal, colorectal, leukemia, breast and cervical cancer, in order. Lung cancer rose from the 4th ranking to the first while cervical cancer dropped from the fifth ranking to the 8th place. Esophageal cancer and cervical cancer were decreased annually while gastric cancer was increased in the early days but decreased later on. The rest of the cancers were on the rise year by year. Rates of lung and breast cancers were higher while gastric and esophageal cancers were lower seen in the urban than in rural areas. CONCLUSION: In Shandong province, a marked increase was seen in the mortality rate of tumors in the past 35 years. Evidence showed that the spectrum of death among main malignant tumors had changed which might provide a scientific basis for the development of a community-based prevention and control program on cancer.

[Estimation on the mortality and disease burden attributed to selected risk factors in Shandong province].

OBJECTIVE: To determine the major health related risk factors and provide evidence for policy-making, using health burden analysis on selected factors among general population from Shandong province. METHODS: Based on data derived from the Third Death of Cause Sampling Survey in Shandong, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) were calculated according to the GBD methodology. Deaths and DALYs attributed to the selected risk factors were than estimated together with the PAF data from GBD 2001 study. The indirect method was employed to estimate the YLDs. RESULTS: 51.09% of the total deaths and 31.83% of the total DALYs from the Shandong population were resulted from the 19 selected risk factors. High blood pressure, smoking, low fruit and vegetable intake, alcohol consumption, indoor smoke from solid fuels, high cholesterol, urban air pollution, physical inactivity, overweight and obesity and unsafe injections in health care settings were identified as the top 10 risk factors for mortality which together caused 50.21% of the total deaths. Alcohol use, smoking, high blood pressure, low fruit and vegetable intake, indoor smoke from solid fuels, overweight and obesity, high cholesterol, physical inactivity, urban air pollution and iron-deficiency anemia were proved as the top 10 risk factors related to disease burden and were responsible for 29.04% of the total DALYs. CONCLUSION: Alcohol use, smoking and high blood pressure were determined as the major risk factors which influencing the health of residents in Shandong. The mortality and burden of disease could be reduced significantly if these major factors were effectively under control.

[Estimation of disability weights on malignant neoplasms in Shandong province].

OBJECTIVE: To determine stage-specific and average disability weights (DWs) of malignant neoplasm and provide support and evidence for study on burden of cancer and policy development in Shandong province. METHODS: Health status of each cancer patient identified during the cancer prevalence survey in Shandong, 2007 was investigated. In line with the GBD methodology in estimating DWs, the disability extent of every case was classified and evaluated according to the Six-class Disability Classification version and then the stage-specific weights and average DWs with their 95% confidence intervals were calculated, using SAS software. RESULTS: A total of 11 757 cancer cases were investigated and evaluated. DWs of specific stage of therapy, remission, metastasis and terminal of all cancers were 0.310, 0.218, 0.450 and 0.653 respectively. The average DW of all cancers was 0.317 (95%CI: 0.312 - 0.321). Weights of different stage and different cancer varied significantly, while no significant differences were found between males and females. DWs were found higher (> 0.4) for liver cancer, bone cancer, lymphoma and pancreas cancer. Lower DWs (< 0.3) were found for breast cancer, cervix uteri, corpus uteri, ovarian cancer, larynx cancer, mouth and oropharynx cancer. CONCLUSION: Stage-specific and average DWs for various cancers were estimated based on a large sample size survey. The average DWs of 0.317 for all cancers indicated that 1/3 healthy year lost for each survived life year of them. The difference of DWs between different cancer and stage provide scientific evidence for cancer prevention strategy development.

[Changes of mortality and causes of death from 1970 to 2005 and decomposition analysis in Shandong province].

OBJECTIVE: To describe the trend of overall mortality and major causes of death in Shandong population from 1970 to 2005, and to quantitatively estimate the influential factors. METHODS: Trends of overall mortality and major causes of death were described using indicators such as mortality rates and age-adjusted death rates by comparing three large-scale mortality surveys in Shandong province. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality. RESULTS: The total mortality had had a slight change since 1970s, but had increased since 1990s. However, both the mortality rates of age-adjusted and age-specific decreased significantly. The mortality of Group I diseases including infectious diseases as well maternal and perinatal diseases decreased drastically. By contrast, the mortality of non-communicable chronic diseases (NCDs) including cardiovascular diseases (CVDs), cancer and injuries increased. The sustentation of recent overall mortality was caused by the interaction of demographic and non-demographic factors which worked oppositely. Non-demographic factors were responsible for the decrease of Group I disease and the increase of injuries. With respect to the increase of NCDs as a whole, demographic factors might take the full responsibility and the non-demographic factors were the opposite force to reduce the mortality. Nevertheless, for the increase of some leading NCD diseases as CVDs and cancer, the increase was mainly due to non-demographic rather than demographic factors. CONCLUSION: Through the interaction of the aggravation of ageing population and the enhancement of non-demographic effect, the overall mortality in Shandong would maintain a balance or slightly rise in the coming years. Group I diseases in Shandong had been effectively under control. Strategies focusing on disease control and prevention should be transferred to chronic diseases, especially leading NCDs, such as CVDs and cancer.

[Application of 'waist circumference cutoff point' in screening diabetes mellitus among rural residents in mid-western area of Shandong Province, China].

OBJECTIVE: To determine the value and the optimal cutoff point of waist circumference (WC) in screening diabetes mellitus (DM) and to provide evidence for DM prevention and identifying population at risk in mid-western rural areas of Shandong province. METHODS: A sample consisting 16 341 rural residents was selected and studied. All participants were physically examined on height, weight, WC and fasting plasma glucose (FPG). Oral glucose tolerance test (OGTT) was performed for subjects with FPG valued from 6.1 to 7.0 mmol/L. DM was defined according to the criteria set by WHO in 1999. Area under the curve (AUC), sensitivity, specificity and Youden index were computed based on the receiver operating characteristic (ROC) curve analysis. Optimal cutoff point was determined by the maximum of Youden index. RESULTS: The prevalence rates of DM for males and females increased along with the rise of WC (trend test chi2 = 72.01, 122.65, P < 0.01). It appeared significantly higher in those with WC > or = 85 cm in females and > or = 80 cm in males, with those WC < 85 cm for females and < 80 cm for males, in particular. AUCs were 0.639 and 0.655 for males and females respectively and both had significant differences (t = 7.22, 11.07, P < 0.01). However, the AUCs did not show significant difference (t = 0.70, P > 0.05) between males and females. The Youden index reached maximum when WC approached 85 cm for females (24.90%) and 80 cm for males (24.39%). The sensitivity and specificity were 58.04% and 66.86% for males, and 67.08% and 57.31% for females. CONCLUSION: WC seemed to be an effective indicator for screening the DM. The optimal cutoff point of WC would be 85 cm for females and 80 cm for males in screening DM and defining the population at risk in this area.

[Study on the risk factors of hypertension among rural residents in mid-west areas of Shandong province, using the classification tree analysis methodology].

OBJECTIVE: To explore the risk factors of hypertension and risk population for adults aged > or = 25 in the mid-western rural areas of Shandong province and to provide evidence for development of intervention measure. METHODS: Subjects aged > or = 25 were selected by multi-stage stratified random sampling method. All participants were interviewed with a standard questionnaire and physically examined on height, weight, waist circumference, blood pressure and fasting plasma glucose (FPG). Classification tree analysis was employed to determine the risk factors of hypertension and high risk populations related to it. RESULTS: The major risk factors of hypertension would include age, abdominal obesity, overweight or obesity, family history and high blood sugar. The major populations at high risk would include populations as: a) being elderly, b) at middle-age but with: high blood sugar or with abdominal obesity/overweight, or with family history, c) people at middle-age but with family history and abdominal obesity. Through classification tree analysis, sensitivity, specificity and overall correct rates were 71.87%, 66.38% and 68.79%, respectively on 'learning sample' while 70.70%, 65.84% and 67.97% respectively on 'testing sample'. CONCLUSION: Efforts on both weight and blood sugar reduction were common prevention measures for general population. Different kinds of prevention and control measures should be taken according to different risk factors existed in the targeted high-risk population of hypertension. Community-based prevention and control for hypertension measures should be integrated when targeting the population at high risk.

[Study on the molecular mechanism of apoptosis in esophageal cancer cells induced by soybean isoflavone].

OBJECTIVE: To investigate the function of apoptosis in esophageal cancer cells induced by soybean isoflavone, and the relation between this apoptosis and expression of bcl-2 and bax. METHODS: In vitro experiments, MTT assay was used to determine the cell growth inhibitory rate. Transmission electron microscope and TUNEL staining method were used to quantitatively and qualitatively detect the apoptosis status of esophageal cancer cell line EC-9706 before and after the soybean isoflavone treatment. Immunohistochemical staining and reverse transcription-polymerase chain reaction were used to detect the expression of apoptosis-regulated gene bcl-2 and bax. RESULTS: Soybean isoflavone inhibited the growth of esophageal cancer cell line EC-9706 in a dose- and time-dependent manner. Soybean isoflavone induced EC-9706 cells to undergo apoptosis with typically apoptotic characteristics, including morphological changes of chromatin condensation, chromatin crescent formation, nucleus fragmentation and apoptotic body formation by transmission electron microscope and staining positive cells, using TUNEL assay. Soybean isoflavone reduced the expression of apoptosis-regulated gene bcl-2, and improving the expression of apoptosis-regulated gene bax. CONCLUSION: Soybean isoflavone seemed to be able to induce the apoptosis in esophageal cancer. This type of apoptosis might be mediated by down-expression of apoptosis-regulated gene bcl-2 and up-expression of apoptosis-regulated gene bax.