Study of Zero-Inflated Regression Models in a Large-Scale Population Survey of Sub-Health Status and Its Influencing Factors

Objective Sub-health status has progressively gained more attention from both medical professionals and the publics. Treating the number of sub-health symptoms as count data rather than dichotomous data helps to completely and accurately analyze findings in sub-healthy population. This study aims to compare the goodness of fit for count outcome models to identify the optimum model for sub-health study.Methods The sample of the study derived from a large-scale population survey on physiological and psychological constants from 2007 to 2011 in 4 provinces and 2 autonomous regions in China. We constructed four count outcome models using SAS: Poisson model, negative binomial (NB) model, zero-inflated Poisson (ZIP) model and zero-inflated negative binomial (ZINB) model. The number of sub-health symptoms was used as the main outcome measure. The alpha dispersion parameter and O test were used to identify over-dispersed data, and Vuong test was used to evaluate the excessive zero count. The goodness of fit of regression models were determined by predictive probability curves and statistics of likelihood ratio test.Results Of all 78 307 respondents, 38.53% reported no sub-health symptoms. The mean number of sub-health symptoms was 2.98, and the standard deviation was 3.72. The statistic O in over-dispersion test was 720.995 (P<0.001); the estimated alpha was 0.618 (95% CI: 0.600-0.636) comparing ZINB model and ZIP model; Vuong test statistic Z was 45.487. These results indicated over-dispersion of the data and excessive zero counts in this sub-health study. ZINB model had the largest log likelihood (-167 519), the smallest Akaike’s Information Criterion coefficient (335 112) and the smallest Bayesian information criterion coefficient (335455),indicating its best goodness of fit. The predictive probabilities for most counts in ZINB model fitted the observed counts best. The logit section of ZINB model analysis showed that age, sex, occupation, smoking, alcohol drinking, ethnicity and obesity were determinants for presence of sub-health symptoms; the binomial negative section of ZINB model analysis showed that sex, occupation, smoking, alcohol drinking, ethnicity, marital status and obesity had significant effect on the severity of sub-health.Conclusions All tests for goodness of fit and the predictive probability curve produced the same finding that ZINB model was the optimum model for exploring the influencing factors of sub-health symptoms.

Concepts of body constitution, health and sub-health from traditional Chinese medicine perspective

This paper described and discussed the important literature and ideas about the concepts, types and measurement of body constitution, in terms of healthy,sub-healthy and disease status. In view of traditional Chinese medicine, ‘‘healthy" state is a status of relative balance of Yin and Yang to keep our bodily homeostasis. If there are significant physical and/or psychological stressors, such as loss of a beloved one and failure in study or work, the body can no longer keep its own bodily condition balanced and subsequently enter a state of ‘‘sub-health"(sub-optimal health).‘‘unhealthy" body constitution such as ‘‘Dampnessheat", ‘‘Cold-dampness" and ‘‘Heat- or Cold- dryness"with a subnormal body temperature and humidity and clinical manifestations such as insomnia, malaise and overweight will be presented. Immediate, appropriate strategies such as modification of life-style and seeking medical treatment can prevent evolution of an illness.Otherwise, the body will enter a disease status with a‘‘pathological" body constitution of ‘‘Yin or Yang deficiency'', ‘‘Blood-stasis" and/or ‘‘Phlegm-dampness". To be complimentary with health promotion and disease prevention in Western medicine, understanding about an individual's body constitution, together with itsdeterminants(e.g., healthy eating and lifestyle behaviors), can contribute to a more proactive, holistic and individualized healthcare.

Structural and functional characteristics of microbiota in oropharynx of sub-healthy children with gastrointestinal heat retention syndrome differentiated by traditional Chinese medicine

Objective:To explore the structural and functional characteristics of microbiota in oropharynx of subhealthy children with gastrointestinal heat retention syndrome(GHRS)differentiated by traditional Chinese medicine,and screen the biometric operational taxonomic units(OTUs)to assist the clinical diagnosis.Methods:We recruited children according to the“GHRS diagnostic scale”,collected their oropharyngeal swabs,and sequenced the 16 SrDNA V4 region.We described the bacterial structure with alpha-indexes,beta-distances,and relative abundances;moreover,we screened the differential genera/OTUs with Wilcoxon rank-sum test,Metagenome Seq analysis,and linear discriminant analysis effect size(LEf Se)analysis,in which biometric OTUs were selected to construct the receiver operating characteristic curve to verify the diagnostic value.The bacterial function was predicted with Kyoto Encyclopedia of Genes and Genomes pathways according to 16S rDNA gene by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.Results:The study population was composed of 10 children with GHRS and 10 healthy control children.GHRS children were more likely to overeat(gluttony,P=.033).Alpha-indexes,such as Sobs,abundancebased coverage estimator,Bootstrap,and Qstat,were significantly higher in the GHRS group,while betadistances did not exhibit any significant intergroup differences.There were 9 differently distributed nonpredominant genera between the groups in Wilcoxon rank-sum test,as well as 13 non-predominant genera in Metagenome Seq analysis and 3 non-predominant OTUs in LEfSe analysis.OTU44 and OTU196 were used to construct the receiver operating characteristic curve,and the area under curve was 0.92.Predicted functions showed that pathways related to oxidative phosphorylation and carbon metabolism were enriched in healthy control samples,while the pathway related to renin secretion was remarkably enriched in GHRS samples.Conclusion:Unique oropharyngeal microbial structure and function were identified in GHRS children.OTU44 and OTU196 were specific OTUs,which could be used as biomarkers of GHRS to assist clinical diagnosis.

Clinical Efficacy of Sedative Cataplasm for Insomnia Patients with Sub-health

[Objectives]This study aimed to observe the clinical efficacy of sedative cataplasm in the treatment of insomnia patients with sub-health.[Methods]A total of 90 insomnia patients with sub-health were randomly and evenly divided into treatment group and control group.The patients in the control group were given Bozi Yangxin pills orally,and those in the treatment group were treated with sedative cataplasm on Shenjue acupoint.The treatment duration was 4 weeks.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate clinical efficacy.[Results]The overall efficacy of the treatment group and control group was 91.1%and 77.1%,respectively,and the difference between the two was significant(P<0.05).After treatment,the PSQI scores of each group changed significantly(P<0.05).[Conclusions]Sedative cataplasm has a good clinical efficacy on sub-healthy insomnia patients.

Progress of research on massage therapy for sub-health conditions

Sub-health state is a kind of low-quality state between health and disease, and will lead to disease if not intervened in time. As one of the external treatment options in traditional Chinese medicine (TCM), massage therapy has achieved an ideal curative effect in the treatment of the sub-health state. This paper summarizes the articles on massage treatment for the treatment of patients in the sub-health state from the past decade. It mainly includes the current understanding of sub-health, treatment ideas and specific methods, as well as clinical classification of treatment modalities. From the perspective of treatment ideas and specific methods, most massage therapies are performed under the guidance of the holistic concept of TCM, and the concept of treatment based on syndrome differentiation (four diagnostic methods of TCM: inspection, auscultation, inquiry, and palpation). In this treatment, not only are the therapeutic functions of meridians and acupoints emphasized, but the selection of the therapeutic time is also performed according to the "Ziwuliuzhu" and the "Lingguibafa"(the acupuncture method based on time in ancient China). According to the different clinical symptoms of sub-health, it can be divided into three types: physical sub-health, psychological sub-health, and social adaptive sub-health. Massage therapy eliminates pain, relieves physical fatigue, and has a good therapeutic effect on physical sub-health. It can alleviate anxiety and depression, promote psychosomatic pleasure of patients, and has a satisfactory regulatory effect on the psychological sub-health symptoms. However, basic research on using modern medical theories and the means to explain its mechanism of action is relatively weak. Therefore, only constantly improving the quality of clinical observation and strengthening basic research can provide more and better evidence for the clinical application of massage therapy in treating the symptoms of the sub-health status.

Relationship Research between the Chinese Medicine Constitution and Sub-Health

With further development of the bio-psycho-social medical model, people began to re-examine the knowledge of disease and health. The concept of sub-health has also been proposed in western medicine. Because of the lack of a specific standard, it is difficult to make clinical diagnosis and treatments for sub-health. Chinese medicine constitution theory has been widely accepted in China, and has a set of executable standards. This paper puts forward a new research method that connects the sub-health in western medicine and Chinese medicine constitution theory together. The potential relationships and influences between Chinese medicine constitution theory and sub-health were analyzed and key content and research progress were discussed. The research method in this paper will provide new ideas for sub-health research.

A research on the composing of sub-health people’s hygienic gymnastics

according to statistics, 70 percent of Chinese people are in sub-health, so the health care for them should be payed more attention. In recent years, researches on sub-health people has increased and the classifi cation, diagnose for sub-health people’s current situation has entered an area of researching. Among them, the research of sub-health people’s infl uence on society stands out, because the occupational group is tightly related to the promotion of social economic development and stability. Hygienic gymnastics will help to improve sub-health situation and it still need to conduct relatively composing and completing. In this paper, questionnaire method and literature method are used to carry out investigation and analysis on sub-health people and therefore, the hygienic gymnastics for sub-health improving is composed and summarized.

亚健康评定量表评价广州市城镇居民的亚健康状况的信效度

目的：检验第一版亚健康评定量表（SHMS V1.0）测量广州市城镇居民亚健康状况的信效度。方法：应用 SHMS V1.0对917名城镇居民进行现场测试。结果：总量表的 Cronbach’s α系数为0.927,分半信度为0.871。量表各因子之间与其子量表分的相关系数为0.576~0.916（P 〈0.01）,39个条目与其所属因子得分的相关性均较大（0.643~0.879）,与 SF-36总分的相关系数为0.739（P 〈0.01）。经探索性因子分析,KMO 统计量为0.919, Bartlett 球型检验结果为χ2=15512.758,υ=595,共提取出7个公因子,与理论构想基本吻合。经验证性因子分析,χ2=2330.101（P =0.000）,CMIN/DF=4.524,GFI =0.855,NFI =0.846,CFI =0.875,AGFI =0.832,RMSEA =0.061,说明该模型的拟合效果理想。结论：SHMS V1.0可以反映出广州市城镇居民亚健康状况,具有较好的信度和效度。

Symptom characteristics and prevalence of qi deficiency syndrome in people of varied health status and ages: A multicenter cross-sectional study

Objective:Aging caused by a deficiency syndrome can be found in ancient and modern traditional Chinese medicine literature.Qi deficiency syndrome(QDS)is a vital factor in the aging process.This study aimed to establish a full-scale trial to evaluate the prevalence,symptom severity,frequency,and distribution of QDS in different age groups and varying health status to elucidate the role of qi deficiency in the aging process and deterioration of health.Methods:This cross-sectional study was conducted in four hospitals in China,and data from 1220 participants were included.The participants,aged between 20 and 79 years,completed questionnaires that recorded prevalence of QDS and severity or frequency of relevant symptoms,then were interviewed by investigators.We used frequency analysis and chi-squared tests to perform comparative analysis of prevalence in different age and health groups;we used a ranksum tests for quantitative analysis of symptoms severity and frequency scores;we performed a regression analysis of correlation between syndrome occurrence and potential factors using nonconditional binary logistic stepwise regression of numerical variables.P<0.05 was considered statistically significant.Results:Prevalence,symptom severity and frequency scores of QDS showed a rising trend when physical condition worsened,rather than when age increased.Health status,fatigue,shortness of breath or no desire to talk,spontaneous sweating,swollen tongue with teeth marks on side,and deficient and weak pulse,rather than increasing age were contributing factors to this syndrome.Distribution of QDS in certain health and age stages showed remarkable irregularities.Conclusions:Qi deficiency may be a contributing factor for sub-health(sub-optimal health)and chronic diseases rather than aging.It may play a crucial role in chronic disease pathogenesis of young and middle-aged people,and in sub-health pathogenesis of older adults.Recognition of the warning signs and symptoms of QDS may lead to early intervention and prevention of subhealth,and chronic diseases.

The Public Nutrition Improvement Oligo + Project

The OLIGO+ Project has been launched by PNDC last year further to the observation that the micro-ecology imbalance status in China is responsible for sub-health.Taking the challenge to improve the public health and nutrition,OLIGO+ Project is aiming to raise the issue of micro ecology imbalance to a public level and advocate the addition of Oligo prebiotics in food by food industry.Consumption of prebiotics ingredient will then promote micro-ecological balance and public health.After this first year of successful implementation,OLIGO+ Project will keep the same ambitious objectives for 2009.The soluble fibers,mostly resistant to digestion in the small intestine and largely fermented in the colon demonstrating prebiotic effects have also been included in the OLIGO+ Project.

Evaluation on Effectiveness and Safety of Chinese Herbs inTreatment of Sub-health: A Systematic Review andMeta-Analysis of Randomized Controlled Trials

Objective: To evaluate the effectiveness and safety of Chinese herbs in the treatment of sub-health systematical y. Methods: Nine databases were systematicaly and extensively searched to col ect randomized control ed trials(RCTs) about Chinese herbs in the treatment of sub-health. The outcomes included overal effective rate, main symptoms, quality of life, etc. Literature screening, data extraction and quality assessment were conducted according to Cochrane Handbook 5.1. Meta-analysis was conducted to the included literature with Review Manager Software.Results: Seventy-two studies involving 9,296 patients with sub-health were included with 4,908 patients in experimental groups and 4,387 patients in control groups. The overal quality of included clinical research was not high. In the aspect of improving overall effective rate, relieving main symptoms, Pittsburgh sleep quality index(PSQI) score, Athens Insomnia Scale(AIS) score, Fatigue Scale-14(FS-14), Cornel Medical Index(CMI) score and discontinuation rate, the effects of experimental groups were better than that of control groups. According to available research reports, adverse reactions in Chinese herb groups were mainly mild gastrointestinal symptoms, which did not affect the treatment.Conclusion: Chinese herbs have a curative effect in the treatment of sub-health. However, there are no clear criteria for diagnosis and curative effectiveness judgment global y, which would affect the accuracy of curative effect evaluation.

Evaluation of the Health Status of Six Volunteers from the Mars 500 Project Using Pulse Analysis

Objective：To comprehensively evaluate the health status of 6 volunteers from the Mars 500Project through analyzing their pulse graphs and determining the changes in cardiovascular function,degree of fatigue and autonomic nervous function.Methods：Six volunteers were recruited;all were male aged 26–38years（average 31.83±4.96 years）.Characteristic parameters reflecting the status of cardiovascular functions were extracted,which included left ventricular contraction,vascular elasticity and peripheral resistance.The degree of fatigue was determined depending on the difference between the calendar age and biological age,which was calculated through the analysis of blood pressure value and characteristic parameters.Based on the values of pulse height variation and pulse time variation on a 30-s pulse graph,autonomic nervous function was evaluated.All parameters examined were marked on an equilateral polygon to form an irregular polygon of the actual figure,then health status was evaluated based on the coverage area of the actual figure.Results：The results demonstrated：（1）volunteers developed weakened pulse power,increased vascular tension and peripheral resistance,and slight decreased ventricular systolic function;（2）the degree of fatigue was basically mild or moderate;and（3）autonomic nervous function was excited but generally balanced.Conclusions：These volunteers were in the state of sub-health.According to Chinese medicine theories,such symptoms are mainly caused by the weakening of healthy qi,Gan（Liver）failing in free coursing,and disharmony between Gan and Wei（Stomach）,which manifests as a weak and string-like pulse.