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.

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 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.

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.

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.

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.

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).

[Analysis of epidemic features of scrub typhus between year 2006 and 2010 in Shandong province, China].

OBJECTIVE: To explore the epidemic features of scrub typhus between year 2006 and 2010 in Shandong Province. METHODS: Based on the data collected through Diseases Reporting Information System between year 2006 and 2010 in Shandong province, 1291 cases of scrub typhus were selected. The study described the population distribution features of the scrub typhus patients, and explored the temporal and spatial distribution features of the disease by applying the methods of spatial thematic mapping, inverse distance weighted, spatial autocorrelation analysis, spatial clustering analysis, temporal clustering analysis and spatial variation analysis in temporal trends based on Geographic Information software (ArcGIS 9.3) and Spatial Clustering Software (SatScan 7.0). RESULTS: The onset age of the 1291 patients ranged between 1 and 92 years old.639 out of 1291 patients were over 55 years old, accounting for 49.5%.640 patients were male and the other 651 patients were female, occupying 49.6% and 50.4% respectively. The gender ratio was 1:1.02. Patients were found in farmers, workers, students and preschool children. However, most of the cases were farmers, up to 84.8% (1095/1291). Global Moran's I index was 0.324 (P < 0.01). The local Moran's I index in 8 locations were proved to have statistical significance (P < 0.01); all of which were H-H clustering areas. Gangcheng (38 cases), Laicheng (154 cases), Xintai (160 cases) and Donggang (105 cases) were important locations, whose local Moran's I index were 2.111, 1.642, 1.277 and 0.775 respectively. The clustering period of scrub typhus in respective year were as follows: 2006.09.23 - 2006.11.20 (202 cases), 2007.10.02 - 2007.11.11 (197 cases), 2008.09.30 - 2008.11.07 (302 cases), 2009.09.25 - 2009.11.10 (204 cases), and 2010.10.05 - 2010.11.13 (226 cases), whose RR values were separately 45.55, 34.60, 50.64, 53.09 and 79.84 (P < 0.01). Two spatial clustering area were found in the study, one was the area centered Taian and Xintai with radiation radius at 58.28 km (542 cases) and the other one was the area centered Rizhao and Donggang with radiation radius at 22.68 km (134 cases), whose RR values were 4.52 and 3.96 (P < 0.01). The spatial features of the two clustering areas were inland low hills area and coastal hills area. The highest annual growth rate of the disease was 45.04%, found in the area centered Linyi and Mengyin counties, with the radiation radius at 45.82 km. The RR value was 3.68 (P < 0.01). CONCLUSION: The majority of the scrub typhus patients were middle-aged and elderly farmers. The epidemic peak was between the last 10 days of September and the first 10 days of November. A positive spatial correlation of the disease was found; and most cases clustered in inland low hills area and costal hills area; especially the area around Linyi and Mengyin, with the highest annual growth rates of the disease.

Previous abortion and the risk of neural tube defects: a case-control study.

OBJECTIVE: To further explore the association between abortion history and neural tube defect (NTD) risk and the association of different interpregnancy intervals from prior abortion to current conception on NTD risk. STUDY DESIGN: A matched case-control study was conducted. Cases were 459 women who delivered and gestated babies/fetuses with NTDs in two provinces of China and 459 women with live-born infants, without an apparent congenital malformation, matched with cases by the same region, the same hospital, and childbirth in the same year as controls. All of the subjects were investigated by trained interviewers with the same criteria. Conditional logistic regression models were used to calculate odds ratios (ORs) and their 95% CI of abortion history and interpregnancy intervals on NTD risk. RESULTS: Women with abortion history did not have an increased risk for spina bifida and encephalocele. The interpregnancy interval of < 6 months from prior abortion to current conception was significantly associated with anencephaly risk. CONCLUSION: Abortion with an interpregnancy interval of < 6 months from prior abortion to current conception may have an increased risk for anencephaly and should be considered in maternal reproductive health care.

A case-control study of the effects of pregnancy planning on neural tube defects and its primary preventive measures.

BACKGROUND: Measures for prevention of neural tube defects (NTDs) have been recommended for many years in China, but the compliance with these measures is unsatisfactory. This study aims to compare the effect differences between planned pregnancy and unplanned pregnancy in the compliance with these measures and analyze the interactions between pregnancy planning and these measures for NTD prevention. METHODS: A 1:1 matched case-control study was conducted. We randomly selected 349 women who delivered or gestated babies/fetuses with NTDs in the last two years in two provinces and matched them with 349 women who delivered babies without obvious birth defects as controls. RESULTS: In the case group, 99 women reported that they had planned their pregnancies, accounting for 28.4%, and the proportion who received preconception examinations and took folic acid prior to conception was 13.8 and 8.6%, respectively. According to the multivariate analysis, health education (odds ratio [OR], 0.350), preconception examinations (OR, 0.497) and folic acid consumption prior to conception (OR, 0.257) all had preventative effects on NTDs (for all, p < 0.05). In both groups, the proportions of women who received preconception examinations and reported folic acid intake were much higher for those who reported planning their pregnancies compared to women with an unplanned pregnancy (for all, p < 0.01); and for NTD prevention, synergistic interactions existed between pregnancy planning and the other preventive measures. CONCLUSION: Folic acid consumption prior to conception, preconception examinations, and health education have preventive effects on NTDs. Pregnancy planning can significantly promote compliance with these preventive behaviors. In addition, there are synergistic interactions between pregnancy planning and these measures.

Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China.

BACKGROUND: Before 1986, scrub typhus was only found endemic in southern China. Because human infections typically occur in the summer, it is called "summer type". During the autumn-winter period of 1986, a new type of scrub typhus was identified in Shandong and northern Jiangsu province of northern China. This newly recognized scrub typhus was subsequently reported in many areas of northern China and was then called "autumn-winter type". However, clinical characteristics of associated cases have not been reported. METHODS: From 1995 to 2006, all suspected scrub typhus cases in five township hospitals of Feixian county, Shandong province were enrolled. Indirect immunofluorescent assay (IFA) was used as confirmatory serodiagnosis test. Polymerase chain reaction (PCR) connected with restriction fragment length polymorphism (RFLP) and sequence analyses were used for genotyping of O. tsutsugamushi DNAs. Clinical symptoms and demography of confirmed cases were analyzed. RESULTS: A total of 480 scrub typhus cases were confirmed. The cases occurred every year exclusively between September and December with a peak occurrence in October. The case numbers were relatively higher in 1995, 1996, 1997, and 2000 than in other years. 57.9% of cases were in the group aged 21-50. More cases occurred in male (56%) than in female (44%). The predominant occupational group of the cases was farmers (85.0%). Farm work was reported the primary exposure to infection in 67.7% of cases. Fever, rash, and eschar were observed in 100.0%, 90.4%, and 88.5% of cases, respectively. Eschars formed frequently on or around umbilicus, abdomen areas, and front and back of waist (34.1%) in both genders. Normal results were observed in 88.7% (WBC counts), 84.5% (PLT counts), and 89.7% (RBC counts) of cases, respectively. Observations from the five hospitals were compared and no significant differences were found. CONCLUSION: The autumn-winter type scrub typhus in northern China occurred exclusively from September to December with a peak occurrence in October, which was different from the summer type in southern China. In comparison with the summer type, complications associated with autumn-winter type scrub typhus were less severe, and abnormalities of routine hematological parameters were less obvious.

The effectiveness of prenatal serum biomarker screening for neural tube defects in second trimester pregnant women: a meta-analysis.

BACKGROUND: Neural tube defects (NTDs) are common and serious birth defects all over the world. Prenatal screening for NTDs using maternal serum alpha-fetoprotein (MSAFP) during the second trimester of pregnancy has been widely used, but its effectiveness remains unclear. METHODS: We evaluated the studies published in the English and Chinese on MSAFP screening for NTDs. The homogeneity of the studies was evaluated by the forest graph. Meta-analysis was applied to calculate the combined effect values and their 95% confidence intervals. RESULTS: As many as 22 articles were selected according to the criteria and were included in the meta-analysis, for a total of 684,140 pregnant women screened during the second trimester. All the studies selected were homogenous according to the forest graph (chi(2) = 25.17, P > 0.10). The combined relative risk estimate was 0.25 and its 95% confidence interval was 0.21 to 0.29. The combined protective rate was 75%. The sensitivity and specificity of MSAFP screening were 75.1 and 97.7%, respectively. CONCLUSION: Use of MSAFP during the second trimester in pregnant women is an effective measure for the screening of NTDs.

Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China.

Both scrub typhus and hemorrhagic fever with renal syndrome (HFRS) are severely epidemic in northern China and often present with acute undifferentiated fever. To correctly distinguish the two diseases at an early stage, we collected and compared clinical and routine laboratory data of 46 patients with confirmed scrub typhus and 49 patients with confirmed HFRS presenting to the outpatient departments of three town hospitals in northern China. Most patients with HFRS but none of the patients with scrub typhus had hemorrhagic manifestations. Retro-orbital pain, lumbar back pain, flank tenderness, proteinuria, and occult blood in urine often occurred in patients with HFRS. However, skin eschar, regional lymphadenopathy, and maculopapular rash were more commonly found in patients with scrub typhus. In addition, platelet counts in patients with HFRS were significantly lower than in patients with scrub typhus. These findings will be useful for physicians to distinguish scrub typhus from HFRS.

Nucleotide sequence characterization and phylogenetic analysis of hantaviruses isolated in Shandong Province, China.

BACKGROUND: China is the most severe endemic area of hemorrhagic fever with renal syndrome (HFRS) in the world with 30,000-50,000 cases reported annually, which accounts for more than 90% of total number of cases worldwide. The incidence rate of the syndrome in Shandong Province is one of the highest in China, which has ever reached 50 per 100,000 persons per year. However, the molecular characteristics of hantaviruses (HV) epidemic in Shandong Province remain unclear. Therefore it is useful to clarify nucleotide sequence and phylogenetic characteristics of HV isolated in Shandong Province in order to provide better advices to control and prevent HFRS. METHODS: RNAs were extracted from sera of clinically diagnosed patients and positive rodent lungs that were detected by indirect immunofluorescent assay (IFA). Partial M segments of HV were amplified from the RNAs with reverse transcription nested polymerase chain reactions (nested PCR) using hantavirus genotype specific primers. The nested PCR products were sequenced and compared with those from previously epidemic isolates in Shandong and with other representative HV sequences from GenBank. Phylogenetic tree analyses were performed based on the sequences of the M genes. RESULTS: Thirty-four HV isolates in Shandong showed 67.1%-100% nucleotide identities. The nucleotide homologies among 6 Hantaan viruses (HTNV) isolates in Shandong were 78.1%-98.7%, while the homologies among 28 Seoul virus (SEOV) isolates in Shandong were 93.7%-100%. There were at least 3 subtypes HTNV (H2, H5, H9) and 2 subtypes SEOV (S2, S3) in Shandong Province. CONCLUSIONS: In Shandong Province, the homologies of HTNV were lower and there were no predominant subtypes, while the homologies of SEOV were higher and S3 was the predominant subtype. The homologies of SEOV from rodents were higher than those from patients. The distribution of subtypes in Shandong was similar to that of the adjoining provinces. Phylogenetic analyses of the sequences showed geographic clustering of HV in Shandong.

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.

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 burden caused by injury in countryside residents in Dongying, Shandong Province].

OBJECTIVE: To make clear the burden of injury in residents living in countryside of Dongying, Shandong Province. METHODS: A retrospective questionnaire survey was conducted among 15,276 residents in 20 villages of Dongying Municipality of Shandong Province with a multiphase cluster randomly sampling on cases of injury from March 1, 2002 to February 28, 2003. The injury was decided with three principles which had been carried out through the nation. The standardized incidence and mortality rates were calculated on base of the population data of Shandong Province in 2000. The burden of injury was evaluated by incidence rate, mortality rate, years of potential life lost (YPLL) system, disability adjusted life year (DALY), direct and indirect economic costs, et al. RESULTS: Totally 902 were injured cases in which the crude incidence rate was 5.90%, and the standardized incidence rate was 5.93%. It was shown higher in men (7.79%) than in women (4.03%). The crude death rate was 12.438 per million. And the standardized death rate was 11.257 per million. 27 cases were crippled. The years, the working years and the valued years of the potential life lost were 24, 19.6 and 8.7 years respectively for each death case. Disability adjusted life years was 566.61 years. Direct economic cost for medical expenses of all cases was 816.3 thousand RMB Yuan and 200.1 thousand RMB Yuan for else costs. Indirect economic cost was 5,492.9 thousand RMB Yuan according to DALY. CONCLUSION: Injury was common incidence in rural residents in Dongying which caused a heavy burden on them. Prevention and control of injuries would be enhanced.

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.