Variations, effectiveness and its associated factors of a nationwide web-based hypertension management training project in China: insights from a government-led campaign for 1.2 million lay health workers

OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the factors contributing to the variations of effectiveness.METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to participate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension management knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness.RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs increased significantly from 62.87 ± 21.14 out of 100 in the pre-test to 88.30 ± 11.31 in the post-test by 25.43(95% confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36) in the pre-test and soared the most after training,up to 84.22 by 54.94%.Individual factors associated with disparities in the knowledge of hypertension management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being explained by factors at the regional level.CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the training,could be generalized to other low-and middle-income countries in facilitating the hypertension management capacity of LHWs.Localization and evaluation is warranted on the way to its further application.

Nationwide questionnaire survey on pediatric pancreatic tumors in Japan

BACKGROUND Pediatric pancreatic tumors are rare and account for<0.1%of all childhood cancers.The primary treatment for pancreatic tumors is surgical resection.However,because of the lack of knowledge regarding pediatric pancreatic tumors,no comprehensive treatment plans for pediatric pancreatic tumors have been developed.AIM To compared the clinical features,treatment methods,and prognosis of pediatric pancreatic tumors in Japan with those in other countries.METHODS Questionnaires were sent to 213 pediatric surgical units in Japan.Pancreatic tumors that were not surgically treated were excluded from the survey.The primary survey investigated the number of patients aged 0-18 years who underwent pancreatic tumor surgery and the type of tumors managed during the 22-year study period(from January 1,2000 to December 31,2021)by post card.The secondary survey assessed the clinical images,treatment methods,and tumor outcomes via email.RESULTS The primary survey enrolled 228 patients.In the secondary survey,213 patients were eventually enrolled.The most common type of pancreatic tumor was solid pseudopapillary neoplasm(SPN)[n=164(77.0%)],followed by pancreatoblastoma[n=16(7.5%)],pancreatic endocrine tumor[n=14(6.6%)],non-epithelial tumor[n=9(4.2%)],pancreatic tumor[n=7(3.3%)],and metastatic pancreatic tumor[n=3(1.4%)].Overall,123(57.7%)patients underwent distal pancreatectomy,of whom 49 underwent laparoscopic surgery.Forty-four(20.7%)patients underwent enucleation,of whom eight underwent laparoscopic surgery.Thirty-two(15.0%)patients underwent pancreaticoduodenectomy,of whom one underwent laparoscopic surgery.All patients with SPN,including those with distant metastases and recurrent disease,survived.CONCLUSION SPN was more common in Japan than in other countries.Regardless of the histological type,resection is the most effective treatment for pediatric pancreatic tumors.

Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission:A nationwide analysis

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

A Nationwide Evaluation of the State of Practice of Performance Measurements for Intelligent Transportation Systems

State departments of transportation’s (DOTs) decisions to invest resources to expand or implement intelligent transportation systems (ITS) programs or even retire existing infrastructure need to be based on performance evaluations. Nonetheless, an apparent gap exists between the need for ITS performance measurements and the actual implementation. The evidence available points to challenges in the ITS performance measurement processes. This paper evaluated the state of practice of performance measurement for ITS across the US and provided insights. A comprehensive literature review assessed the use of performance measures by DOTs for monitoring implemented ITS programs. Based on the gaps identified through the literature review, a nationwide qualitative survey was used to gather insights from key stakeholders on the subject matter and presented in this paper. From the data gathered, performance measurement of ITS is fairly integrated into ITS programs by DOTs, with most agencies considering the process beneficial. There, however, exist reasons that prevent agencies from measuring ITS performance to greater detail and quality. These include lack of data, fragmented or incomparable data formats, the complexity of the endeavor, lack of data scientists, and difficulty assigning responsibilities when inter-agency collaboration is required. Additionally, DOTs do not benchmark or compare their ITS performance with others for reasons that include lack of data, lack of guidance or best practices, and incomparable data formats. This paper is relevant as it provides insights expected to guide DOTs and other agencies in developing or reevaluating their ITS performance measurement processes.

A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic:implications and policy recommendations

The Coronavirus Disease 2019(COVID-19)epidemic emerged in Wuhan,China,spread nationwide and then onto half a dozen other countries between December 2019 and early 2020.The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people's lives.It has also triggered a wide variety of psychological problems,such as panic disorder,anxiety and depression.This study is the first nationwide largescale survey of psychological distress in the general population of China during the COVID-19 epidemic.

A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations

The Coronavirus Disease 2019(COVID-19)epidemic emerged in Wuhan,China,spread nationwide and then onto half a dozen other countries between December 2019 and early 2020.The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives.It has also triggered a wide variety of psychological problems,such as panic disorder,anxiety and depression.This study is the first nationwide largescale survey of psychological distress in the general population of China during the COVID-19 epidemic.

Analysis of the Results of Two Nationwide Surveys on Clonorchis sinensis Infection in China

Objective To examine Clonorchis sinensis infection in China and evaluate the effectiveness of efforts to prevent and control it,two nationwide surveys were undertaken in 31 provinces,autonomous regions,and municipalities（PAMs） during 1988-92（the 1990 survey） and during 2001-04（the 2003 survey）.Methods During the period 2001-04,two sampling methods were applied.The first method repeated the stratified cluster random sampling used in the 1990 survey;the second method applied two-characteristic stratified cluster random sampling in 27 PAMs—the 2003 endemic area（EA） survey.The Kato-Katz thick smear method was used for the nationwide survey.Results The infection rates of Clonorchis sinensis in the 1990 and 2003 surveys were 0.311% and 0.579%,respectively.The infection rate was 2.40% in the 2003 EA survey,and it was estimated that 12.49 million people in China were infected with Clonorchis sinensis.Conclusion The 2003 survey showed that the standardized infection rate of Clonorchis sinensis increased by 74.85% compared with the 1990 survey.The infection rate in males was higher than in females;the infection rate among people eating raw fish or eating out frequently was higher than among those who did not.

Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

AIM To assess the effect of early vs late endoscopic retrograde cholangiopancreatography(ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample.METHODS We used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day(days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure,acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with inhospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex,severe disease and comorbidities.RESULTS Four thousand five hundred and seventy patients satisfied the inclusion criteria;with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs2.4%, adjusted odds ratio(aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality(1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions(9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group(6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group($21459 vs $16939, P < 0.0001).CONCLUSION Early ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP.

Trends and risk factors of elderly-onset Crohn’s disease: A nationwide cohort study

BACKGROUND The incidence of inflammatory bowel disease(IBD)is increasing in Asia.Numerous risk factors associated with IBD development have been investigated.AIM To investigate trends and environmental risk factors of Crohn’s disease(CD)diagnosed in persons aged≥40 years in South Korea.METHODS Using the National Health Insurance Service database,a total of 14060821 persons aged>40 years who underwent national health screening in 2009 were followed up until December 2017.Patients with newly diagnosed CD were enrolled and compared with non-CD cohort.CD was identified according to the International Classification of Diseases 10th revision and the rare/intractable disease registration program codes from the National Health Insurance Service database.The mean follow-up periods was 7.39 years.Age,sex,diabetes,hypertension,smoking,alcohol consumption,regular exercise,body mass index,anemia,chronic kidney disease(CKD)and dyslipidemia were adjusted for in the multivariate analysis model.RESULTS During the follow-up,1337(1.33/100000)patients developed CD.Men in the middle-aged group(40-64 years)had a higher risk than women[adjusted hazard ratio(aHR)1.46,95%confidence interval(CI):1.29-1.66];however,this difference tended to disappear as the age of onset increases.In the middle-aged group,patients with a history of smoking[(aHR 1.46,95%CI:1.19-1.79)and anemia(aHR 1.85,95%CI:1.55-2.20)]had a significantly higher CD risk.In the elderly group(age,≥65 years),ex-smoking and anemia also increased the CD risk(aHR 1.68,95%CI:1.22-2.30)and 1.84(95%CI:1.47-2.30,respectively).Especially in the middle-aged group,those with CKD had a statistically elevated CD risk(aHR 1.37,95%CI:1.05-1.79).Alcohol consumption and higher body mass index showed negative association trend with CD incidence in both of the age groups.[Middle-aged:aHR 0.77(95%CI:0.66-0.89)and aHR 0.73(95% CI:0.63-0.84),respectively][Elderly-group:aHR 0.57(95% CI:0.42-0.78)and aHR 0.84(95%CI 0.67-1.04),respectively].For regular physical activity and dyslipidemia,negative correlation between CD incidences was proved only in the middle-aged group[aHR 0.88(95%CI:0.77-0.89)and aHR 0.81(95%CI:0.68-0.96),respectively].CONCLUSION History of cigarette smoking,anemia,underweight and CKD are possible risk factors for CD in Asians aged>40 years.

Predictors of thirty-day readmission in nonagenarians presenting with acute heart failure with preserved ejection fraction: a nationwide analysis

BACKGROUD Acute heart failure with preserved ejection fraction(HFpEF)is a common but poorly studied cause of hospital admissions among nonagenarians.This study aimed to evaluate predictors of thirty-day readmission,in-hospital mortality,length of stay,and hospital charges in nonagenarians hospitalized with acute HFpEF.METHODS Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database.We excluded patients who died in index admission,and discharged in December each year to allow thirty-day follow-up.Univariate regression was performed on each variable.Vari-ables with P-value<0.2 were included in the multivariate regression model.RESULTS From a total of 45,393 index admissions,43,646 patients(96.2%)survived to discharge.A total of 7,437 patients(15.6%)had a thirty-day readmission.Mean cost of readmission was 43,265 United States dollars(USD)per patient.Significant predictors of thirty-day readmission were chronic kidney disease stage III or higher[adjusted odds ratio(aOR)=1.20,95%CI:1.07−1.34,P=0.002]and diabetes mellitus(aOR=1.18,95%CI:1.07−1.29,P=0.001).Meanwhile,female(aOR=0.90,95%CI:0.82−0.99,P=0.028)and palliative care encounter(aOR=0.27,95%CI:0.21−0.34,P<0.001)were associated with lower odds of readmission.Cardiac arrhythmia(aOR=1.46,95%CI:1.11−1.93,P=0.007)and aortic stenosis(aOR=1.36,95%CI:1.05−1.76,P=0.020)were amongst predictors of in-hospital mortality.CONCLUSIONS In nonagenarians hospitalized with acute HFpEF,thirty-day readmission is common and costly.Chronic co-morbidities predict poor outcomes.Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.

Equity Study in Health Workforce on Tuberculosis Control in China: a Nationwide Evaluation

We aimed to describe the distribution of tuberculosis （TB） health workers in China and provide evidences of potential inequity for policy development. We used Lorenz curves and Gini index to characterize the distribution of TB health workers by population size, geographical area and number of annual registered TB cases. An additional stratified analysis was done by three economic regions. The Gini index were 0.33 for population size, 0.62 for geographical area and 0.30 for number of registered tuberculosis cases that indicated an acceptable average, significant inequity and a relative average distribution nationwide respectively.

The Nationwide Impact of Injury-related Deaths on Average Life Expectancy in China

To expand the evidence base to inform future public policy aimed at accident prevention, we investigated the impact of different categories of injury on average life expectancy in China. We used data from the National Death Cause Registration Information System and National Maternity and Children Health Surveillance databases, as well as 2010 population data from the National Bureau of Statistics. We then calculated the average life expectancy of the Chinese population, in addition to life expectancy after eliminating injury-related mortality. The average life expectancy of the Chinese population in 2010 was 74.93 years. After eliminating deaths due to injuries, the fourth leading cause of mortality in China, average life expectancy increased by 1.36 years. When this was broken down by population sub-groups, these gains were 1.76 and 0.79 years in men and women, 0.94 and 1.56 years in urban and rural residents, and 1.11, 1.30, and 1.67 years for residents in the Eastern, Central and Western regions respectively. After eliminating all categories of injury, the average life expectancy of the Chinese population was found to increase by 1.36 years. This figure was higher for males and residents of rural areas and Western China.

In-hospital mortality of hepatorenal syndrome in the United States:Nationwide inpatient sample

BACKGROUND Hepatorenal syndrome(HRS)is a life-threatening condition among patients with advanced liver disease.Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited.AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States.METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014(weighted sample of 23973 admissions).The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality.We estimated odds ratios from multilevel mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.RESULTS Overall hospital mortality was 32%.Hospital mortality decreased from 44%in 2005 to 24%in 2014(P<0.001),while there was an increase in the rate of liver transplantation(P=0.02),renal replacement therapy(P<0.001),length of hospital stay(P<0.001),and hospitalization cost(P<0.001).On multivariable analysis,older age,alcohol use,coagulopathy,neurological disorder,and need for mechanical ventilation predicted higher hospital mortality,whereas liver transplantation,transjugular intrahepatic portosystemic shunt,and abdominal paracentesis were associated with lower hospital mortality.CONCLUSION Although there was an increase in resource utilizations,hospital mortality among patients admitted for HRS significantly improved.Several predictors for hospital mortality were identified.

2019 Nationwide Conference on Raw Materials for Refractories Successfully Held in Tianjin

2019 Nationwide Conference on Raw Materials for Refractories,organized by Refractories Committee of The Chinese Society for Metals,Sinosteel Luoyang Institute of Refractories Research Co.,Ltd.(LIRR),State Key Laboratory of Advanced Refractories,Sinosteel Technology Incubator(Tianjin)Co.,Ltd.,and Refractories Press,sponsored by Imerys Aluminates Technology Co., Ltd.

Smoking rate trends of male 7th and 11th graders in Japan based on repeated, nationwide, cross-sectional surveys every 4 years from 1996 to 2008

Backgrounds: Smoking in childhood has become an important public health concern. Previous studies have reported on secular trends in childhood smoking rates and compared with smoking rates at fixed ages. They also described secular trends regarding the prevalence of smoking at fixed ages. The variations in smoking rate of young children and adolescents by follow-up groups have not been studied by follow-up groups at a national level. Objective: We looked at trends and generational impacts on smoking rate by using follow-up groups of male Japanese high school students to quantitatively assess differences in trends, based on multiple nationwide data from the Japanese Youth Tobacco and Drinking Surveys gathered every 4 years between 1996 and 2008. Methods: The surveys were nationwide, cross-sectional random sampling surveys given every 4 years from 1996 to 2008, using the single-stage cluster sampling methodology. The cluster unit of the sampling was school. The survey targeted junior and senior high school students from schools selected through Japan using the National School Directory. Students enrolled in the sampled schools were subjects of the study. Participants were 53,925 high school students from 7th grade to 11th grade in 1996, 2000, 2004 and 2008. We divided the three follow-up groups every 4 years from 1996 to 2004 for male junior high school students in 7th grades, age 13. The end periods were 4 years later when they had become 11th graders, age 17, from 2000 to 2008. Main outcome measures in this study were life time smoking, current smoking within 30 days and daily smoking at 7th or 11th grade and the trend of the smoking rates between 7th to 11th grades. Results: Life time smoking rate, current smoking rate and daily smoking rate in Japanese high school students decreased at 7th grade from 1996 to 2004. They also decreased at 11th grade from 2000 to 2008. However, the slopes differed among their follow-up groups. The increments in their smoking rates from 7th grade to 11th grade in male high school students were smaller in recent follow-up groups both in 2000 and in 2004 than in follow-up groups in 1996. Then, those increments in follow-up groups between in 2000 and in 2004 were similar in lifetime smoking rate and current smoking rate. Conclusions: We have shown that monitoring trends by follow-up group are important in studying smoking for public health. Values of smoking rates from a young age to adolescence by follow-up group should be examined. Values of smoking rate and regular changes in smoking rate are important because smoking rate changes dynamically during adolescence. Not only trends in smoking rates at fixed ages, but also generational impacts should be considered by using follow-up groups to study smoking behaviors among students. We need to continue careful monitoring of follow-up group smoking prevalence. When long-term health promotions are planned or assessed, policy makers need to look at changes in follow-up groups.

Do peripartum and postmenopausal women with primary liver cancer have a worse prognosis? A nationwide cohort in Taiwan

BACKGROUND While primary liver cancer(PLC)is one of the most common cancers around the world,few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum and postmenopausal women with PLC.AIM To investigate whether peripartum and postmenopausal women with PLC have lower overall survival rates compared with women who were not peripartum and postmenopausal.METHODS The Taiwan National Health Insurance claims data from 2000 to 2012 was used for this propensity-score-matched study.A cohort of 40 peripartum women with PLC and a reference cohort of 160 women without peripartum were enrolled.In the women with PLC with/without menopause study,a study cohort of 10752 menopausal females with PLC and a comparison cohort of 2688 women without menopause were enrolled.RESULTS Patients with peripartum PLC had a non-significant risk of death compared with the non-peripartum cohort[adjusted hazard ratios(aHR)=1.40,95%confidence intervals(CI):0.89-2.20,P=0.149].The survival rate at different follow-up durations between peripartum PLC patients and those in the non-peripartum cohort showed a non-significant difference.Patients who were diagnosed with PLC younger than 50 years old(without menopause)had a significant lower risk of death compared with patients diagnosed with PLC at or older than 50 years(postmenopausal)(aHR=0.64,95%CI:0.61-0.68,P<0.001).The survival rate of women<50 years with PLC was significantly higher than older women with PLC when followed for 0.5(72.44%vs 64.16%),1(60.57%vs 51.66%),3(42.92%vs 31.28%),and 5 year(s)(37.02%vs 21.83%),respectively(P<0.001).CONCLUSION Peripartum females with PLC have no difference in survival rates compared with those patients without peripartum.Menopausal females with PLC have worse survival rates compared with those patients without menopause.

Research on the Reform and Development of School Sports Education under the Perspective of Lifetime Sports and Nationwide Fitness

In this paper, we conduct research on the reform and development of school sports education under the perspective of lifetime sports and nationwide fitness. School physical education is the foundation and the strategic focus of the development of sports which is the foundation of the national fitness program which is also an important part of the whole education career. Our proposed approach and reform combines the advances of the state-of-the-art methodologies which will not only enhance the current model but set up for prospect and rnnrlifieatinn as well

Plans for implementing the Outline released nationwide

To well implement the National Standardization Development Outline released in October 2021,the local governments nationwide,such as Jilin,Hebei,Hainan,Anhui,Shandong,Jiangsu,Shaanxi,Yunnan,Liaoning,Guangxi,Beijing,Shanghai and Chongqing,have released future plans for standardization work successively since the end of 2021.

China hikes non-residential electricity price nationwide

On Wednesday, China announced adjustments for the prices of non-residential power and thermal coal in order to ease power shortages and reduce financial pressure on power companies. The National Development and Reform Commission (NDRC) announced that it will raise the retail price