Short-term Impact of Cognition-Motivation-Emotional IntelligenceResistance Skills Program on Drug Use Prevention for School Students in Wuhan,China

Drug abuse continues to be a serious public health threat worldwide.Most drug abuse prevention research has been conducted with predominantly American or European adolescent populations.Little is known about approaches that work best to prevent the initiation of Chinese adolescent drug use.For targeting risk factors of drug initiation in Chinese adolescents,a school-based health intervention program named "Cognition-Motivation-Emotional IntelligenceResistance Skills" (CMER) was developed to enhance cognition upon drug use,to decrease motivation of drug use and to improve emotional adjusting and drug resistance skills in this study.A total of 798 students from 3 senior high schools in Wuhan,a city in central China,were assigned randomly to intervention and control groups.The intervention group received the CMER program in which knowledge,development of positive attitude and motivation towards drugs and training of peer resistance skills were basic elements.The immediate impact was compared by measuring the above mentioned elements prior to and three-month after the training session.Students from both groups were asked to complete a self-administered questionnaire.The questionnaire included demographic items,self-reported drug use behavior,cognition,attitude,and motivation associated with the initiation of drug use and resistance skills.Three months after the intervention,significant effects were found on "illegal substance use at least once" (P【0.05) between the intervention and control groups.Immediate effects of the intervention were also found on knowledge,motivation and peer resistance skills (P【0.05),but there was no clear evidence for any effects on attitude towards substance use (P】0.05).It was concluded that the CMER program,which significantly increased the knowledge of drugs and peer resistance skills,was effective in the drug abuse prevention in a sample of school students in Wuhan,China.

Prevalence of fatty liver disease and its risk factors in the population of South China

AIM: To investigate the population-based prevalence of fatty liver disease (FLD) and its risk factors in Guangdong Province,China. METHODS: A cross-sectional survey with multiple-stage stratified cluster and random sampling of inhabitants over 7-year-old was performed in 6 urban and rural areas of Guangdong Province,China. Questionnaires,designed by co-working of epidemiologists and hepatologists,included demographic characteristics,current medication use,medical history and health-relevant behaviors,i.e. alcohol consumption,smoking habits,dietary habits and physical activities. Anthropometric measurements,biochemical tests and abdominal ultrasonography were carried out. RESULTS: Among the 3543 subjects,609 (17.2%) were diagnosed having FLD (18.0% males,16.7% females,P > 0.05). Among them,the prevalence of confirmed alcoholic liver disease (ALD),suspected ALD and nonalcoholic fatty liver disease (NAFLD) were 0.4%,1.8%,and 15.0%,respectively. The prevalence rate (23.0%) was significantly higher in urban areas than (12.9%) in rural areas. After adjustment for age,gender and residency,the standardized prevalence of FLD in adults was 14.5%. Among them,confirmed ALD,suspected ALD and NAFLD were 0.5%,2.3%,and 11.7%,respectively,in adults and 1.3% (all NAFLD) in children at the age of 7-18 years. The overall prevalence of FLD increased with age in both genders to the peak of 27.4% in the group of subjects at the age of 60-70 years. The prevalence rate was significantly higher in men than in women under the age of 50 years (22.4% vs 7.1%,P < 0.001). However,the opposite phenomenon was found over the age of 50 years (20.6% vs 27.6%,P < 0.05). Multivariate and logistic regression analysis indicated that male gender,urban residency,low education,high blood pressure,body mass index,waist circumference,waist to hip ratio,serum triglyceride and glucose levels were the risk factors for FLD. CONCLUSION: FLD,especially NAFLD,is prevalent in South China. There are many risk factors for FLD.

Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults

Background In China,lack of evidence remains a significant challenge for the national initiative to promote physical activity(PA).We aimed to quantify the beneficial effects of meeting or maintaining the recommended PA level[150 minutes per week(min/wk)of moderate PA or 75 min/wk of vigorous PA or an equivalent combination]on incident cardiovascular disease(CVD)among Chinese population.Methods We included 100,560 participants without history of CVD from three cohorts in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.Cox proportional hazards models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for CVD events and its subtypes,including stroke,coronary heart disease,heart failure,and CVD death.Results During a median follow-up of 7.3 years(range:6–15 years),777,163 person-years and 4693 incident CVD events were observed.Compared with participants who were inactive at baseline,the multivariable adjusted HR(95%CI)of developing CVD was 0.74(0.69–0.79)for those who met recommended moderate to vigorous physical activity(MVPA)level at baseline.Furthermore,the risk of CVD incidence was reduced with increment of MVPA(Ptrend<0.001),and the HR(95%CI)of highly-active versus inactive category was 0.62(0.56–0.68).Compared with individuals who were inactive both at the baseline and follow-up,those keeping active over the period of follow-up had a substantial lower risk of incident CVD with the HR(95%CI)of 0.57(0.43–0.77).Conclusions The findings demonstrated that meeting and maintaining the recommended MVPA level could reduce the cardiovascular risk.Wider adoption of the PA recommendations would have considerable health impacts to the Chinese population.

Coalition of DNA polymorphisms of ApoB and ApoAI genes is related with coronary artery disease in Kazaks

Objective To explore the relationship between polymorphisms of XbaI and MspI loci of apolipoprotein B （ApoB） gene and -75 bp,＋83 bp loci of apolipoprotein AI （ApoAI） gene and coronary heart disease （CHD） in Kazaks of Xinjiang Uyghur Autonomous Region,China.Methods These loci were analyzed by PCR-restriction fragment length polymorphism （PCR-PFLP）.Two hundred and five patients with CHD and two hundred and thirty six controls were involved.Results There were significant distinctions among low-density lipoprotein cholesterol （LDL-C）,triglyceride （TG） and the ApoAI/ApoB ratio between the two groups,but no significant distinction among the polymorphism frequencies of the four sites between the two groups.The polymorphism coalition frequency of X-/Ms＋＋/M1＋-/M2＋＋ （named Coalition 11） was significantly higher in CHD compared to the control group （14.6％ vs.7.2％,P ＜ 0.05）.The level of total cholesterol （TC） in Coalition 1 1 was significantly higher and the level of the ApoAI/ApoB ratio in Coalition 11 was significantly lower than Coalition 1～10 in CHD patients.The level of the ApoAI/ApoB ratio of Coalition 11 was significantly lower than the Coalition 1～10 in control group.The levels of ApoAI/ApoB ratio of Coalition 3 were significantly higher compared to Coalition 11 in the two groups,respectively.The level of LDL-C of Coalition 3 was significantly lower than in the Coalition 11 in control group.The level of TC of Coalition 5 was significantly higher than Coalition 3 in the CHD group.The level of the ApoAI/ApoB ratio of Coalition 5 was significantly lower than in Coalition 3 or Coalition 1～10 of the two groups,respectively.The level of LDL-C of Coalition 5 was significantly higher than in Coalition 3 in control group.The ratio of ApoAI/ApoB was negatively related to TC,LDL-C and was positively related to HDL-C,both in CHD and control groups.Conclusion Coalition 11 of the 4 loci polymorphisms of the ApoB and ApoAI genes was correlated with CHD in Kazaks,and perhaps the ratio of ApoAI/ApoB was the most diagnostic parameter related with CHD among all lipid parameters.CHD may also be associated with Coalition 5,and,perhaps,Coalition 3 may have been confirmed as a protection factor against CHD,if more samples were enrolled.

Associations of soybean products intake with blood pressure changes and hypertension incidence: the China-PAR project

Background The relationships between dietary intake of soybean products and incident hypertension were still uncertain.This study aimed to illustrate the associations between intake of soybean products with risks of incident hypertension and longitudinal changes of blood pressure in a prospective cohort study.Methods We included 67,499 general Chinese adults from the Project of Prediction for Atherosclerosis Cardiovascular Disease Risk in China(China-PAR).Information about soybean products consumption was collected by standardized questionnaires,and study participants were categorized into the ideal(≥125 g/day)or non-ideal(<125 g/day)group.Hazard ratios(HRs)and corresponding 95%confidence intervals(95%CIs)for incident hypertension were calculated using Cox proportional hazard models.Among participants with repeated measures of blood pressure,generalized linear models were used to examine the relationships between soybean products consumption and blood pressure changes.Results During a median follow-up of 7.4 years,compared with participants who consumed<125 g of soybean products per day,multivariable adjusted HR for those in the ideal group was 0.73(0.67-0.80).This inverse association remained robust across most subgroups while significant interactions were tested between soybean products intake and age,sex,urbanization and geographic region(P values for interaction<0.05).The mean systolic and diastolic blood pressure levels were 1.05(0.71-1.39)mmHg and 0.44(0.22-0.66)mmHg lower among participants in the ideal group than those in the non-ideal group.Conclusions Our study showed that intake of soybean products might reduce the long-term blood pressure levels and hypertension incidence among Chinese population,which has important public health implications for primary prevention of hypertension.

Case Report: Retirees’ Acceptance and Perceived Contribution of Smartphone in Chronic Disease Management

Objectives: As smartphones become more popular, so do their applications. However, expectations of the elderly regarding the contribution of smartphone in controlling chronic diseases remain unclear. This research aims to understand senior retirees’ smartphone acceptance, perceived contribution of smartphone application in facilitating chronic disease control and their association. Findings from the study provide insights for the development of mobile applications in chronic disease management. Methods: convenience sampling was conducted to recruit 110 senior retirees who worked as volunteers in a regional hospital in Taipei. Data was collected through a structured questionnaire. Descriptive, chi-square and logistic regression statistics were applied to analyze data. Results: A total of 108 completed questionnaires were collected with a return rate of 98.2%. Mean age was 65.34 ± 9.59 years old. Of all respondents, 40.7% reported acceptance of internet-enabled smartphones and 54.6% expected that smartphones would facilitate chronic disease management in the future. However, a statistically significant 37.3% of those expecting smartphone to play a role in disease management did not accept smartphones yet. After controlling for age and education, logistic regression analysis showed that older adults with higher smartphone acceptance were more likely to expect use of smartphone in case management (OR = 7.439, p < 0.001). Conclusions: The research presented a scope for smartphone application to control chronic disease in the future. Despite a relatively lower level of smartphone acceptance, the elderly still expected a positive role for mobile appliances to play in chronic disease management.

Risk stratification of atherosclerotic cardiovascular disease in Chinese adults

Objective: This study aims to determine the distribution of observed atherosclerotic cardiovascular disease (ASCVD) incidence in contemporary cohorts in China, and to identify cut-off points for ASCVD risk classification based on traditional criteria and new equations developed by Prediction for ASCVD Risk in China (China-PAR). Methods: The study populations included cohorts in the China-PAR project, with 34,757 participants eligible for the current analysis. Traditional risk stratification was assessed by using Chinese guidelines on prevention of CVD and hypertension, and 5 risk groups were classified based on these guidelines after slight modification for available risk factors. Kaplan-Meier analysis was conducted to obtain the cumulative incidence of observed ASCVD events for all subjects and sub-groups. The predicted 10-year ASCVD risk was obtained using the China-PAR equations. Results: A total of 1922 ASCVD events were identified during an average follow-up of 14.1 years. According to the group classification based on traditional risk stratification, the observed 10-year risks for ASCVD were 4.61%(95%confidence interval[CI]:4.11-5.10%) in the moderate-risk group and 8.74%(95%CI:7.82-9.66%) in the high-risk group. Based on the China-PAR equations for risk assessment of ASCVD, those with predicted risks of<5%, 5-10%, and≥10%could be classified into categories of low-, moderate-, and high-risk for ASCVD, respectively. Conclusion: The findings enable development of a simple method for classification of individuals into low-, moderate-, and high-risk groups, based on the China-PAR equations. The method will be useful for self-management and prevention of ASCVD in Chinese adults.

Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults:the China-PAR project

Existing evidence on the relationship between cardiovascular health(CVH) metrics and cardiovascular disease(CVD) was primarily derived from western populations. We aimed to evaluate the benefits of ideal CVH metrics on preventing incident atherosclerotic CVD(ASCVD) in Chinese population. This study was conducted among 93,987 adults from the China-PAR project(Prediction for ASCVD Risk in China) who were followed up until 2015. Cox proportional hazard regression models were used to estimate the hazard ratios(HRs) and their corresponding 95% confidence intervals(CIs) of CVH metrics for the risk of ASCVD, including coronary heart disease(CHD), stroke and ASCVD death. We further estimated the population-attributable risk percentage(PAR%) of these metrics in relation to each outcome. We observed gradient inverse associations between the number of ideal CVH metrics and ASCVD incidence. Compared with participants having ≤2 ideal CVH metrics, the multivariable-adjusted HRs(95% CIs) of ASCVD for those with 3, 4, 5, 6 and 7 ideal CVH metrics were 0.83(0.74–0.93), 0.66(0.59–0.74), 0.55(0.48–0.61), 0.44(0.38–0.50) and 0.24(0.18–0.31), respectively(P for trend <0.0001). Approximately 62.1% of total ASCVD, 38.7% of CHD, 66.4% of stroke, and 60.5% of ASCVD death were attributable to not achieving all the seven ideal CVH metrics. After adjusting effects of ideal health factors, having four ideal health behaviors could independently bring adults health benefits in preventing 17.4% of ASCVD, 18.0% of CHD, 16.7% of stroke, and 10.1% of ASCVD death. Among all the seven CVH metrics, to keep with ideal blood pressure(BP) implied the largest public health gains against various ASCVD events(PAR% between 33.0% and 47.2%), while ideal diet was the metric most difficult to be achieved in the long term. Our study indicates that the more ideal CVH metrics adults have, the less ASCVD burden there is in China. Special efforts of health education and behavior modification should be made on keeping ideal BP and dietary habits in general Chinese population to prevent the epidemic of ASCVD.

Comorbidity Burden of Dementia:A Hospital-Based Retrospective Study from 2003 to 2012 in Seven Cities in China

Dementia is increasing dramatically and imposes a huge burden on society. To date, there is a lack of data on the health status of patients with dementia in China. In an attempt to investigate the comorbidity burden of dementia patients in China at the national level, we enrolled 2,938 patients with Alzheimer＇s disease（AD）, vascular dementia（Va D）, or other types of dementia, who were admitted to tertiary hospitals in seven regions of China from January2003 to December 2012. The Charlson Comorbidity Index（CCI） was used to evaluate the comorbidity burden of the patients with dementia. Among these patients, 53.4% had AD, 26.3% had Va D, and 20.3% had other types of dementia. The CCI was 3.0 ± 1.9 for all patients,3.4 ± 1.8 for those with Va D, and 3.0 ± 2.1 for those with AD. The CCI increased with age in all patients, andthe length of hospital stay and daily expenses rose with age and CCI. Males had a higher CCI and a longer stay than females. Moreover, patients admitted in the last 5 years of the study had a higher CCI than those admitted in the first 5 years. We found that the comorbidity burden of patients with dementia is heavy. These findings provide a better understanding of the overall health status of dementia patients, and help to increase the awareness of clinicians and policy-makers to improve medical care for patients.

Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population:the China-PAR project

Evidence on the lifetime risk for atherosclerotic cardiovascular disease （ASCVD） is insufficient; yet, estimating an individual＇s lifetime risk allows for a comprehensive assessment of ASCVD burden. We developed and validated lifetime risk prediction equations for ASCVD using four large and ongoing prospective cohorts of Chinese, the China-PAR project （Prediction for ASCVD Risk in China）. Sexspecific equations were developed using two cohorts （as the derivation cohort） of 21,320 participants. Two other independent cohorts with 14,123 and 70,838 participants were used for their external valida- tion, respectively. We evaluated both calibration and discrimination measures for model performance. Furthermore, we estimated ASCVD-ffee years lost or excess absolute risk attributable to high 10-year risk （≥10.0%） and]or high lifetime risk （≥32.8%）. After 12.3 years＇ follow-up of the derivation cohort, 1048 ASCVD events and 1304 non-ASCVD deaths were identified. Our sex-specific equations had good internal validation, with discriminant C statistics of 0.776 （95% confidence interval [CI]： 0.757-0.794） and 0.801 （95% CI： 0.778-0.825）, and calibration Z2 of 9.2 （P = 0.418） and 5.6 （P = 0.777） for men and women, respectively. Good external validation was also demonstrated with predicted rates closely matched to the observed ones. Compared with men having both low 10-year and low lifetime risk, men would develop ASCVD 3.0, 4.6 and 8.6 years earlier if they had high 10-year risk alone, high lifetime risk alone, or both high 10-year and high lifetime risk at the index age of 35 years, respectively. We developed well- performed lifetime risk prediction equations that will help to identify those with the greatest potential to avert ASCVD burden after implementation of innovative clinical and public health interventions in China.

Integrating polygenic and clinical risks to improve stroke risk stratification in prospective Chinese cohorts

The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportional hazards models were used to estimate the 10-year risk,and Fine and Gray’s models were used for hazard ratios(HRs),their 95%confidence intervals(CIs),and the lifetime risk according to PRS and clinical risk categories.A total of 41,006 individuals aged 30–75 years with a mean follow-up of 9.0 years were included.Comparing the top versus bottom 5%of the PRS,the HR was 3.01(95%CI 2.03–4.45)in the total population,and similar findings were observed within clinical risk strata.Marked gradients in the 10-year and lifetime risk across PRS categories were also found within clinical risk categories.Notably,among individuals with intermediate clinical risk,the 10-year risk for those in the top 5%of the PRS(7.3%,95%CI 7.1%–7.5%)reached the threshold of high clinical risk(≥7.0%)for initiating preventive treatment,and this effect of the PRS on refining risk stratification was evident for ischemic stroke.Even among those in the top 10%and 20%of the PRS,the 10-year risk would also exceed this level when aged≥50 and≥60 years,respectively.Overall,the combination of the PRS with the clinical risk score improved the risk stratification within clinical risk strata and distinguished actual high-risk individuals with intermediate clinical risk.