Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no prop...Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.展开更多
Introduction and Objectives: Soil-Transmitted-Helminthiasis (STH) is a public health problem in Cameroon. The control strategies currently in place, particularly chemoprevention, has shortcomings linked to the target ...Introduction and Objectives: Soil-Transmitted-Helminthiasis (STH) is a public health problem in Cameroon. The control strategies currently in place, particularly chemoprevention, has shortcomings linked to the target population, which are school-age children. The objective was to determine the prevalence and the risk factors associated with geo-helminthiasis in children aged 0 to 3 years in a rural health district. Method: From December 2020 to May 2021, a descriptive and analytical cross-sectional study of 376 children between 6 and 36 months was carried out in the Akonolinga health district. This was a cluster sampling in 4 health areas. Stool samples were collected and analysed using the mini-FLOTAC method. The results expressed as the number of eggs per gram of stool. A questionnaire on socio-demographic and lifestyle data was administered to the parents. The Chi-squared test was used to measure the association between geo-helminth infection and the data collected. A multivariate analysis using logistic regression was performed (p 0.05). Results: The prevalence of STH was 19.4% (Ascaris lumbricoides: 16% and Trichuris trichiura: 8%). Risk factors were: consumption of contaminated water (AOR = 1.93 [1.03 - 3.6];p = 0.040), early contact of the child with the ground (before age of 4 months) (AOR = 4.9 [2.1 - 11.37];p .001), habit of walking barefoot (AOR = 2.91 [1.1 - 7.97];p = 0.038), and living in a habitat with unpaved ground (AOR = 7.4 [1.55 - 35.7];p = 0.012). Conclusion: The prevalence of STHs in infants was high. Preventive chemotherapy should be extended to this age-group, and other measures intensified.展开更多
We assessed the prevalence of non‐ communicable diseases(NCDs) risk factors with a focus on their clustering among healthy adults in Shenzhen, China. Data from the 2011 China Health and Nutrition Survey, comprising...We assessed the prevalence of non‐ communicable diseases(NCDs) risk factors with a focus on their clustering among healthy adults in Shenzhen, China. Data from the 2011 China Health and Nutrition Survey, comprising a regionally representative sample of 806 healthy adults aged 35 years or older, were obtained to determine the prevalence of five risk factors for NCDs. The prevalence of current smoking, central obesity, impaired fasting glucose, borderline hypertension, and borderline high total cholesterol was 19.97%, 28.29%, 4.47%, 10.55%, and 36.10%, respectively. A total 63.77% of participants had at least one risk factor. Upon examination of risk factor clustering, we observed that 7.57% of participants had at least three risk factors. Using this threshold as a cutoff, clustering of risk factors was associated with sex [odds ratio(OR) = 3.336, 95% confidence interval(CI): 1.782 to 6.246], physical activity(OR = 1.913, 95% CI: 1.009 to 3.628), and BMI(OR = 7.376, 95% CI: 3.812 to 14.270). The prevalence of risk factors for NCDs is fairly high among healthy adults in Shenzhen, with a clustering tendency.展开更多
AIM: To investigate the prevalence of and risk factors for non-alcoholic fatty liver disease(NAFLD) in a Chinese population.METHODS: A total of 1948 adults from China was followed for 8 years. A cross-sectional study ...AIM: To investigate the prevalence of and risk factors for non-alcoholic fatty liver disease(NAFLD) in a Chinese population.METHODS: A total of 1948 adults from China was followed for 8 years. A cross-sectional study was performed to investigate the prevalence of NAFLD at baseline, and then the participants were followed for 8 years to investigate risk factors for the development of NAFLD.RESULTS: A total of 1948 participants were enrolled at baseline, of whom 691 were diagnosed with NAFLD. During the 8-year follow-up, 337 baseline NAFLD-free participants developed NAFLD. They had a greaterincrease in body mass index(BMI), serum uric acid, fasting plasma glucose, very low-density lipoprotein cholesterol and a considerable decrease in high-density lipoprotein cholesterol. 123 participants who had NAFLD at baseline lost NAFLD during the 8-year follow-up period. They had a greater decrease in BMI, fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase.CONCLUSION: NAFLD is prevalent in Chinese population with a rapidly increasing tendency. It can be reversed when patients lose their weight, control their hyperlipidemia and hyperglycemia, and reduce the liver enzyme levels.展开更多
AIM:To analyze risk factors for refractoriness to proton pump inhibitors(PPIs) in patients with non-erosive reflux disease(NERD).METHODS:A total of 256 NERD patients treated with the PPI esomeprazole were enrolled.The...AIM:To analyze risk factors for refractoriness to proton pump inhibitors(PPIs) in patients with non-erosive reflux disease(NERD).METHODS:A total of 256 NERD patients treated with the PPI esomeprazole were enrolled.They were classified into symptom-free and residual symptoms groups according to Quality of Life in Reflux and Dyspepsia(QolRad) scale.All subjects completed questionnaires on psychological status(self-rating anxiety scale;selfrating depression scale) and quality of life scale(Short Form 36).Multivariate analysis was used to determine the predictive factors for PPI responses.RESULTS:According to QolRad,97 patients were confirmed to have residual reflux symptoms,and the remaining 159 patients were considered symptom free.There were no significant differences between the two groups in lifestyle factors(smoking and alcohol consumption),age,Helicobacter pylori infection,and hiatal hernia.There were significant differences between the two groups in relation to sex,psychological distress including anxiety and depression,body mass index(BMI),and irritable bowel syndrome(IBS)(P < 0.05).Logistic regression analysis found that BMI < 23,comorbid IBS,anxiety,and depression were major risk factors for PPI resistance.Symptomatic patients had a lower quality of life compared with symptom-free patients.CONCLUSION:Some NERD patients are refractory to PPIs and have lower quality of life.Residual symptoms are associated with psychological distress,intestinal disorders,and low BMI.展开更多
AIM:To study the prevalence and clinical biochemical,blood cell and metabolic features of lean-non-alcoholic fatty liver disease(lean-NAFLD)and its association with other diseases.METHODS:Demographic,biochemical and b...AIM:To study the prevalence and clinical biochemical,blood cell and metabolic features of lean-non-alcoholic fatty liver disease(lean-NAFLD)and its association with other diseases.METHODS:Demographic,biochemical and blood examinations were conducted in all the subjects in this study.We classified the subjects into four groups according to their weight and NAFLD status:lean-control,lean-NAFLD[body mass index(BMI)<24 kg/m2],overweight-obese control and overweight-obese NAFLD.One-way analysis of variance(ANOVA)was used to compare the means of continuous variables(age,BMI,blood pressure,glucose,lipid,insulin,liver enzymes and blood cell counts)and theχ2 test was used to compare the differences in frequency of categorical variables(sex,education,physical activity,smoking,alcohol consumption and prevalence of hypertension,hyperlipidemia,diabetes,metabolic syndrome central obesity and obesity).Both univariate and multivariate logistic regression models were adopted to calculate odds ratios(ORs)and predict hyperlipidemia,hypertension,diabetes and metabolic syndrome when we respectively set all controls,lean-control and overweightobese-control as references.In multivariate logistic regression models,we adjusted potential confounding factors,including age,sex,smoking,alcohol consumption and physical activity.RESULTS:The prevalence of NAFLD was very high in China.NAFLD patients were older,had a higher BMI,waist circumference,blood pressure,fasting blood glucose,insulin,blood lipid,liver enzymes and uric acid than the controls.Although lean-NAFLD patients had lower BMI and waist circumstance,they had significantly higher visceral adiposity index than overweightobese controls.Lean-NAFLD patients had comparable triglyceride,cholesterin and low-density lipoprotein cholesterin to overweight-obese NAFLD patients.In blood cell examination,both lean and overweightobese NAFLD was companied by higher white blood cell count,red blood cell count,hemoglobin and hematocrit value.All NAFLD patients were at risk of hyperlipidemia,hypertension,diabetes and metabolic syndrome(Met S).Lean-NAFLD was more strongly associated with diabetes(OR=2.47,95%CI:1.14-5.35),hypertension(OR=1.72,95%CI:1.00-2.96)and Met S(OR=3.19,95%CI:1.17-4.05)than overweight-obese-NAFLD(only OR for Met S was meaningful:OR=1.89,95%CI:1.29-2.77).NAFLD patients were more likely to have central obesity(OR=1.97,95%CI:1.38-2.80),especially in lean groups(OR=2.17,95%CI:1.17-4.05).CONCLUSION:Lean-NAFLD has unique results in demographic,biochemical and blood examinations,and adds significant risk for diabetes,hypertension and Met S in lean individuals.展开更多
AIM The impact of mild drinking habit(less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease(NAFLD) has not been determined. We examined the influence of a mild drinking habit on live...AIM The impact of mild drinking habit(less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease(NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD. METHODS A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with nonalcoholic steatohepatitis, 26% with advanced fibrosis(F3-4)] were divided into the mild drinking group withe thanol consumption of less than 20 g/d(mild drinking group, n = 93) and the non-drinking group(n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma(HCC) occurrence were compared between the groups.RESULTS We observed significant differences in male prevalence(P = 0.01), platelet count(P = 0.04), and gammaglutamyl transpeptidase(P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group(6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox's regression model revealed that hepatic advanced fibrosis(F3-4)(P < 0.01, risk ratio: 11.60), diabetes mellitus(P < 0.01, risk ratio: 89.50), and serum triglyceride(P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal(P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis(F3-4), however, a drinking habit(P = 0.04, risk ratio: 4.83), alpha-fetoprotein(P = 0.01, risk ratio: 1.23), and diabetes mellitus(P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence. CONCLUSION A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.展开更多
Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retro...Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.展开更多
The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of...The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize post-surgical outcomes.展开更多
AIM: To assess the relationship between non-alcoholic fatty liver disease(NAFLD) with metabolic risk factors and brachial ankle pulse wave velocity(ba PWV). METHODS: A total of 8603 subjects(6662 males and 1941 female...AIM: To assess the relationship between non-alcoholic fatty liver disease(NAFLD) with metabolic risk factors and brachial ankle pulse wave velocity(ba PWV). METHODS: A total of 8603 subjects(6662 males and 1941 females) were enrolled during an annual health check-up. Fatty liver was examined using a Philips HD 11 XE multi-function color Doppler diagnostic instrument, and ba PWV was determined using a novel arteriosclerosis detection device. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference( W C), p l a s m a t r i g l y c e r i d e s( TG), h i g h- d e n s i t y lipoprotein(HDL), total cholesterol(TC), low-density lipoprotein(LDL) and uric acid(UA) were measured using standard methods. The relationship between fatty liver with metabolic risk factors and ba PWV was analyzed using regression analysis and the χ2 test. RESULTS: The values and abnormal rates of ba PWV were significantly different between NAFLD patients and non-NAFLD subjects(P < 0.001). In addition, the values of ba PWV were different by gender between NAFLD patients and non-NAFLD subjects. The OR values in females, males, and the entire population were 3.33, 1.67, and 2.13, respectively(P < 0.001). The incidence of high ba PWV increased with increasing degree of NAFLD(levels 0, 1, 2, and 3)(P < 0.001), which was 45.9%, 54.5%, 60.2%, and 71.4% in malesand 27.0%, 49.1%, 55.60%, and 60.0% in females(P < 0.001), respectively. Logistic regression analysis showed that the OR value for ba PWV in the nonmetabolic syndrome group and the metabolic syndrome group was 1.28 vs 1.14(males) and 2.55 vs 0.98(females). The OR values for ba PWV in the non-high-BP and high-BP, non-high-WC and high-WC, non-high-FPG and high-FPG, non-high-TG and high-TG, non-high-HDL and high-HDL, non-high-TC and high-TC, non-high-LDL and high-LDL, non-high-UA and high-UA groups were 3.38 vs 1.19, 3.50 vs 1.44, 2.80 vs 2.30, 3.29 vs 1.88, 3.03 vs 3.28, 3.35 vs 2.70, 3.93 vs 1.66, and 3.20 vs 2.34, respectively, in females(P < 0.001), and were 1.37 vs 1.34, 1.56 vs 1.26, 1.51 vs 1.28, 1.49 vs 1.52, 1.71 vs 1.61, 1.59 vs 1.74, 1.76 vs 1.47, and 1.73 vs 1.54, respectively, in males(P < 0.01). The OR value for ba PWV was still higher than 1.2(1.21 in males and 1.40 in females) after adjustment for the metabolic component(0, 1, 2, 3, 4, 5, 6 and above)(P < 0.01).CONCLUSION: NAFLD is closely correlated with ba PWV, particularly in females. NAFLD has a large impact on ba PWV, no matter whether the metabolic index is increased or not. NAFLD may be a useful indicator for assessing early arteriosclerosis.展开更多
Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to...Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to cirrhosis. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in this subset of patients.展开更多
Objective:To study the differences between the lipid profiles of the subjects whose parents are having known non-modifiable risk factors such as obesity,hypertension(HTN),myocardial infarction and diabetes,and compare...Objective:To study the differences between the lipid profiles of the subjects whose parents are having known non-modifiable risk factors such as obesity,hypertension(HTN),myocardial infarction and diabetes,and compare them with the lipid profiles of the subjects whose parents are not having those risk factors.Methods:A total of 402 subjects were recruited to this study.A detailed questionnaire which included information on the past medical history,height,weight,blood pressure,physical activity,smoke,alcohol,family history of coronary heart disease,HTN.diabetics and obesity.Basic demographic data and dietary habits were completed by all participants.Blood samples were obtained from all subjects after 14 h.Lipid profiles were analyzed using automated analyzer.The results were analyzed using SPSS software packages.Results:The mean body mass index of the population was well below the cut-off value of obesity(>24.5 kg/m") and high risk of future cardiovascular disorder(CVD) events in this age group.The mean levels of total cholesterol(TC),triglycerides(TG) and TC/high density lipoprotein(HDL) were less than the risk levels indicative of future CVD events according to the ATP Ⅲ cut-off values.However the mean HDL level in our population was slightly greater than the cut-off value while the mean low density lipoprotein level was almost similar to the risk level.Differences were observed when the subjects without history of maternal obesity were compared with subjects with history of maternal obesity.The greater percentage of subjects who are having risk levels of body mass index.TC.low density lipoprotein.TG.and TC/HDI.indicated that maternal obesity contributed to the greater susceptibility of developing CVD risk in their offspring.Conclusions:Advancing age may result in changes that could be atherogenic in the future.Such atherogenic changes have already initialed when the subjects are about 21 years old.The incidence of atherogenic changes is far greater when mothers who are having any of the risk factors such as obesity,diabetes,HTN and myocardial infarction than that fathers who are havine similar risk factors.展开更多
Pro-apoptotic Bcl-2 protein BAX is an important member of mitochondrial dependent apoptosis regulation and ultimately plays a pivotal role in malignancies. A promoter G(-248)A polymorphism in the TP53 binding region o...Pro-apoptotic Bcl-2 protein BAX is an important member of mitochondrial dependent apoptosis regulation and ultimately plays a pivotal role in malignancies. A promoter G(-248)A polymorphism in the TP53 binding region of BAX results in differential binding capacity of TP53 protein there by regulating its expression, which has been found to be associated with different clinical outcomes in various malignancies. Presently we aimed to analyze the possible impact of the BAX G(-248)A polymorphism on the risk and other clinical features of non-small cell lung cancer in Indian population. The BAX promoter polymorphism was analyzed in blood samples of 320 subjects with 1:1 case/control ratio by primer-introduced restriction analysis PCR and survival curves were plotted using Kaplan-Meier analysis. It was observed that more than 3-fold increased risk of developing non-small cell lung cancer was associated with homozygous AA genotype of BAX G(-248)A promoter polymorphism in Indian population, with more predominant in smokers with pack-year > 45 (heavy) and using cigarette or huka as their smoking source than homozygous GG genotype. Significant associations was observed between TNM stage (p = 0.037) and histological type (0.02), of non-small cell lung cancer patients with the polymorphism. Patients homozygous for A allele exhibited a significant poor overall survival compared with patients displaying GA + AA or GA or GG genotype [median survival 6.0 vs 9.0, 11.0, and 30.0 months, respectively (p < 0.0001)]. Adenocarcinoma and advanced stage patients with AA genotype showed lower median survival time than squamous cell carcinoma and early stage non-small cell lung cancer patients (median 3.0 and 5.0 vs 8.0 and 9.0 months, respectively). We conclude that the genetic polymorphism G(-248)A in the TP53 binding promoter region of pro-apoptotic genes BAX may contribute to the risk of developing non-small cell lung cancer in Indian population and also may be an important factor for adverse clinical outcome for patients with non-small cell lung cancer.展开更多
Non-alcoholic fatty liver disease(NAFLD) has a prevalence of approximately 30% in western countries, and is emerging as the first cause of liver cirrhosis and hepatocellular carcinoma(HCC). Therefore, risk stratificat...Non-alcoholic fatty liver disease(NAFLD) has a prevalence of approximately 30% in western countries, and is emerging as the first cause of liver cirrhosis and hepatocellular carcinoma(HCC). Therefore, risk stratification emerges as fundamental in order to optimize human and economic resources, and genetics displays intrinsic characteristics suitable to fulfill this task. According to the available data, heritability estimates for hepatic fat content range from 20% to 70%, and an almost 80% of shared heritability has been found between hepatic fat content and fibrosis. The rs738409 single nucleotide polymorphism(SNP) in patatin-like phospholipase domain-containing protein 3 gene and the rs58542926 SNP in transmembrane 6 superfamily member 2 gene have been robustly associated with NAFLD and with its progression, but promising results have been obtained with many other SNPs. Moreover, there has been proof of the additive role of the different SNPs in determining liver damage, and there have been preliminary experiences in which risk scores created through a few genetic variants, alone or in combination with clinical variables, were associated with a strongly potentiated risk of NAFLD, non-alcoholic steatohepatitis(NASH), NASH fibrosis or NAFLD-HCC. However, to date, clinical translation of genetics in the field of NAFLD has been poor or absent. Fortunately, the research we have done seems to have placed us on the right path: We should rely on longitudinal rather than on cross-sectional studies; we should focus on relevant outcomes rather than on simple liver fat accumulation; and we should put together the genetic and clinical information. The hope is that combined genetic/clinical scores, derived from longitudinal studies and built on a few strong genetic variants and relevant clinical variables, will reach a significant predictive power, such as to have clinical utility for risk stratification at the single patient level and even to esteem the impact of intervention on the risk of disease-related outcomes. Well-structured future studies would demonstrate if this vision can become a reality.展开更多
AIM: To assess the risk factors for cost-related medication non-adherence(CRN) among older patients with diabetes in the United States. METHODS: We used data from the 2010 Health and Retirement Study to assess risk fa...AIM: To assess the risk factors for cost-related medication non-adherence(CRN) among older patients with diabetes in the United States. METHODS: We used data from the 2010 Health and Retirement Study to assess risk factors for CRN including age, drug insurance coverage, nursing home residence, functional limitations, and frequency of hospitalization. CRN was self-reported. We conducted multivariate regression analysis to assess the effect of each risk factor. RESULTS: Eight hundred and seventy-five(18%) of 4880 diabetes patients reported CRN. Age less than 65 years, lack of drug insurance coverage, and frequent hospitalization significantly increased risk for CRN. Limitation in both activities of daily living and instrumental activities of daily living were also generally associated with increased risk of CRN. Residence in a nursing home and Medicaid coverage significantly reduced risk.CONCLUSION: These results suggest that expandingprescription coverage to uninsured, sicker, and community-dwelling individuals is likely to produce the largest decreases in CRN.展开更多
文摘Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.
文摘Introduction and Objectives: Soil-Transmitted-Helminthiasis (STH) is a public health problem in Cameroon. The control strategies currently in place, particularly chemoprevention, has shortcomings linked to the target population, which are school-age children. The objective was to determine the prevalence and the risk factors associated with geo-helminthiasis in children aged 0 to 3 years in a rural health district. Method: From December 2020 to May 2021, a descriptive and analytical cross-sectional study of 376 children between 6 and 36 months was carried out in the Akonolinga health district. This was a cluster sampling in 4 health areas. Stool samples were collected and analysed using the mini-FLOTAC method. The results expressed as the number of eggs per gram of stool. A questionnaire on socio-demographic and lifestyle data was administered to the parents. The Chi-squared test was used to measure the association between geo-helminth infection and the data collected. A multivariate analysis using logistic regression was performed (p 0.05). Results: The prevalence of STH was 19.4% (Ascaris lumbricoides: 16% and Trichuris trichiura: 8%). Risk factors were: consumption of contaminated water (AOR = 1.93 [1.03 - 3.6];p = 0.040), early contact of the child with the ground (before age of 4 months) (AOR = 4.9 [2.1 - 11.37];p .001), habit of walking barefoot (AOR = 2.91 [1.1 - 7.97];p = 0.038), and living in a habitat with unpaved ground (AOR = 7.4 [1.55 - 35.7];p = 0.012). Conclusion: The prevalence of STHs in infants was high. Preventive chemotherapy should be extended to this age-group, and other measures intensified.
基金supported by National Project of NCDs High‐risk Population Health Management,Center for Chronic and Non‐communicable Diseases Control and Prevention,China CDC(Grant No.2013085)The Science and Technology Planning Project of Shenzhen City,Guangdong Province,China(Grant No.201602005)
文摘We assessed the prevalence of non‐ communicable diseases(NCDs) risk factors with a focus on their clustering among healthy adults in Shenzhen, China. Data from the 2011 China Health and Nutrition Survey, comprising a regionally representative sample of 806 healthy adults aged 35 years or older, were obtained to determine the prevalence of five risk factors for NCDs. The prevalence of current smoking, central obesity, impaired fasting glucose, borderline hypertension, and borderline high total cholesterol was 19.97%, 28.29%, 4.47%, 10.55%, and 36.10%, respectively. A total 63.77% of participants had at least one risk factor. Upon examination of risk factor clustering, we observed that 7.57% of participants had at least three risk factors. Using this threshold as a cutoff, clustering of risk factors was associated with sex [odds ratio(OR) = 3.336, 95% confidence interval(CI): 1.782 to 6.246], physical activity(OR = 1.913, 95% CI: 1.009 to 3.628), and BMI(OR = 7.376, 95% CI: 3.812 to 14.270). The prevalence of risk factors for NCDs is fairly high among healthy adults in Shenzhen, with a clustering tendency.
基金Supported by the National Natural Science Foundation of China,No.81372425 and No.81460634the Key Lab Project of the Xinjiang Science and Technology Bureau,No.2014KL002
文摘AIM: To investigate the prevalence of and risk factors for non-alcoholic fatty liver disease(NAFLD) in a Chinese population.METHODS: A total of 1948 adults from China was followed for 8 years. A cross-sectional study was performed to investigate the prevalence of NAFLD at baseline, and then the participants were followed for 8 years to investigate risk factors for the development of NAFLD.RESULTS: A total of 1948 participants were enrolled at baseline, of whom 691 were diagnosed with NAFLD. During the 8-year follow-up, 337 baseline NAFLD-free participants developed NAFLD. They had a greaterincrease in body mass index(BMI), serum uric acid, fasting plasma glucose, very low-density lipoprotein cholesterol and a considerable decrease in high-density lipoprotein cholesterol. 123 participants who had NAFLD at baseline lost NAFLD during the 8-year follow-up period. They had a greater decrease in BMI, fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyl transpeptidase.CONCLUSION: NAFLD is prevalent in Chinese population with a rapidly increasing tendency. It can be reversed when patients lose their weight, control their hyperlipidemia and hyperglycemia, and reduce the liver enzyme levels.
文摘AIM:To analyze risk factors for refractoriness to proton pump inhibitors(PPIs) in patients with non-erosive reflux disease(NERD).METHODS:A total of 256 NERD patients treated with the PPI esomeprazole were enrolled.They were classified into symptom-free and residual symptoms groups according to Quality of Life in Reflux and Dyspepsia(QolRad) scale.All subjects completed questionnaires on psychological status(self-rating anxiety scale;selfrating depression scale) and quality of life scale(Short Form 36).Multivariate analysis was used to determine the predictive factors for PPI responses.RESULTS:According to QolRad,97 patients were confirmed to have residual reflux symptoms,and the remaining 159 patients were considered symptom free.There were no significant differences between the two groups in lifestyle factors(smoking and alcohol consumption),age,Helicobacter pylori infection,and hiatal hernia.There were significant differences between the two groups in relation to sex,psychological distress including anxiety and depression,body mass index(BMI),and irritable bowel syndrome(IBS)(P < 0.05).Logistic regression analysis found that BMI < 23,comorbid IBS,anxiety,and depression were major risk factors for PPI resistance.Symptomatic patients had a lower quality of life compared with symptom-free patients.CONCLUSION:Some NERD patients are refractory to PPIs and have lower quality of life.Residual symptoms are associated with psychological distress,intestinal disorders,and low BMI.
基金Supported by National Natural Science Fund of China,No.81130049,No.8120218412~(th) China Five-Year Scientific and Technical Plan,No.2012BAI02B02
文摘AIM:To study the prevalence and clinical biochemical,blood cell and metabolic features of lean-non-alcoholic fatty liver disease(lean-NAFLD)and its association with other diseases.METHODS:Demographic,biochemical and blood examinations were conducted in all the subjects in this study.We classified the subjects into four groups according to their weight and NAFLD status:lean-control,lean-NAFLD[body mass index(BMI)<24 kg/m2],overweight-obese control and overweight-obese NAFLD.One-way analysis of variance(ANOVA)was used to compare the means of continuous variables(age,BMI,blood pressure,glucose,lipid,insulin,liver enzymes and blood cell counts)and theχ2 test was used to compare the differences in frequency of categorical variables(sex,education,physical activity,smoking,alcohol consumption and prevalence of hypertension,hyperlipidemia,diabetes,metabolic syndrome central obesity and obesity).Both univariate and multivariate logistic regression models were adopted to calculate odds ratios(ORs)and predict hyperlipidemia,hypertension,diabetes and metabolic syndrome when we respectively set all controls,lean-control and overweightobese-control as references.In multivariate logistic regression models,we adjusted potential confounding factors,including age,sex,smoking,alcohol consumption and physical activity.RESULTS:The prevalence of NAFLD was very high in China.NAFLD patients were older,had a higher BMI,waist circumference,blood pressure,fasting blood glucose,insulin,blood lipid,liver enzymes and uric acid than the controls.Although lean-NAFLD patients had lower BMI and waist circumstance,they had significantly higher visceral adiposity index than overweightobese controls.Lean-NAFLD patients had comparable triglyceride,cholesterin and low-density lipoprotein cholesterin to overweight-obese NAFLD patients.In blood cell examination,both lean and overweightobese NAFLD was companied by higher white blood cell count,red blood cell count,hemoglobin and hematocrit value.All NAFLD patients were at risk of hyperlipidemia,hypertension,diabetes and metabolic syndrome(Met S).Lean-NAFLD was more strongly associated with diabetes(OR=2.47,95%CI:1.14-5.35),hypertension(OR=1.72,95%CI:1.00-2.96)and Met S(OR=3.19,95%CI:1.17-4.05)than overweight-obese-NAFLD(only OR for Met S was meaningful:OR=1.89,95%CI:1.29-2.77).NAFLD patients were more likely to have central obesity(OR=1.97,95%CI:1.38-2.80),especially in lean groups(OR=2.17,95%CI:1.17-4.05).CONCLUSION:Lean-NAFLD has unique results in demographic,biochemical and blood examinations,and adds significant risk for diabetes,hypertension and Met S in lean individuals.
文摘AIM The impact of mild drinking habit(less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease(NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD. METHODS A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with nonalcoholic steatohepatitis, 26% with advanced fibrosis(F3-4)] were divided into the mild drinking group withe thanol consumption of less than 20 g/d(mild drinking group, n = 93) and the non-drinking group(n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma(HCC) occurrence were compared between the groups.RESULTS We observed significant differences in male prevalence(P = 0.01), platelet count(P = 0.04), and gammaglutamyl transpeptidase(P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group(6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox's regression model revealed that hepatic advanced fibrosis(F3-4)(P < 0.01, risk ratio: 11.60), diabetes mellitus(P < 0.01, risk ratio: 89.50), and serum triglyceride(P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal(P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis(F3-4), however, a drinking habit(P = 0.04, risk ratio: 4.83), alpha-fetoprotein(P = 0.01, risk ratio: 1.23), and diabetes mellitus(P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence. CONCLUSION A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.
基金supported by the National Key Research and Development Plan of China (No. 2017YFC1309100)the National Natural Scientific Foundation of China (No. 81771912, 81901910, and 81701782)the Provincial Science and Technology Plan Project of Guangdong Province (No. 2017B020227012)
文摘Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.
文摘The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize post-surgical outcomes.
基金Supported by Grants from Public Interest Research and Social Development Program of Zhejiang Province,No.2011C23098Biomedical Science and Technology Foundation of Zhejiang Province,No.2012B20123Education bureau of Zhejiang Province,China,No.Y201223481
文摘AIM: To assess the relationship between non-alcoholic fatty liver disease(NAFLD) with metabolic risk factors and brachial ankle pulse wave velocity(ba PWV). METHODS: A total of 8603 subjects(6662 males and 1941 females) were enrolled during an annual health check-up. Fatty liver was examined using a Philips HD 11 XE multi-function color Doppler diagnostic instrument, and ba PWV was determined using a novel arteriosclerosis detection device. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference( W C), p l a s m a t r i g l y c e r i d e s( TG), h i g h- d e n s i t y lipoprotein(HDL), total cholesterol(TC), low-density lipoprotein(LDL) and uric acid(UA) were measured using standard methods. The relationship between fatty liver with metabolic risk factors and ba PWV was analyzed using regression analysis and the χ2 test. RESULTS: The values and abnormal rates of ba PWV were significantly different between NAFLD patients and non-NAFLD subjects(P < 0.001). In addition, the values of ba PWV were different by gender between NAFLD patients and non-NAFLD subjects. The OR values in females, males, and the entire population were 3.33, 1.67, and 2.13, respectively(P < 0.001). The incidence of high ba PWV increased with increasing degree of NAFLD(levels 0, 1, 2, and 3)(P < 0.001), which was 45.9%, 54.5%, 60.2%, and 71.4% in malesand 27.0%, 49.1%, 55.60%, and 60.0% in females(P < 0.001), respectively. Logistic regression analysis showed that the OR value for ba PWV in the nonmetabolic syndrome group and the metabolic syndrome group was 1.28 vs 1.14(males) and 2.55 vs 0.98(females). The OR values for ba PWV in the non-high-BP and high-BP, non-high-WC and high-WC, non-high-FPG and high-FPG, non-high-TG and high-TG, non-high-HDL and high-HDL, non-high-TC and high-TC, non-high-LDL and high-LDL, non-high-UA and high-UA groups were 3.38 vs 1.19, 3.50 vs 1.44, 2.80 vs 2.30, 3.29 vs 1.88, 3.03 vs 3.28, 3.35 vs 2.70, 3.93 vs 1.66, and 3.20 vs 2.34, respectively, in females(P < 0.001), and were 1.37 vs 1.34, 1.56 vs 1.26, 1.51 vs 1.28, 1.49 vs 1.52, 1.71 vs 1.61, 1.59 vs 1.74, 1.76 vs 1.47, and 1.73 vs 1.54, respectively, in males(P < 0.01). The OR value for ba PWV was still higher than 1.2(1.21 in males and 1.40 in females) after adjustment for the metabolic component(0, 1, 2, 3, 4, 5, 6 and above)(P < 0.01).CONCLUSION: NAFLD is closely correlated with ba PWV, particularly in females. NAFLD has a large impact on ba PWV, no matter whether the metabolic index is increased or not. NAFLD may be a useful indicator for assessing early arteriosclerosis.
文摘Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to cirrhosis. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in this subset of patients.
基金Supported by Confederation of Epidemiological Associations registered under Govt of Kerala(Grant No.30-955/2012 CEA)
文摘Objective:To study the differences between the lipid profiles of the subjects whose parents are having known non-modifiable risk factors such as obesity,hypertension(HTN),myocardial infarction and diabetes,and compare them with the lipid profiles of the subjects whose parents are not having those risk factors.Methods:A total of 402 subjects were recruited to this study.A detailed questionnaire which included information on the past medical history,height,weight,blood pressure,physical activity,smoke,alcohol,family history of coronary heart disease,HTN.diabetics and obesity.Basic demographic data and dietary habits were completed by all participants.Blood samples were obtained from all subjects after 14 h.Lipid profiles were analyzed using automated analyzer.The results were analyzed using SPSS software packages.Results:The mean body mass index of the population was well below the cut-off value of obesity(>24.5 kg/m") and high risk of future cardiovascular disorder(CVD) events in this age group.The mean levels of total cholesterol(TC),triglycerides(TG) and TC/high density lipoprotein(HDL) were less than the risk levels indicative of future CVD events according to the ATP Ⅲ cut-off values.However the mean HDL level in our population was slightly greater than the cut-off value while the mean low density lipoprotein level was almost similar to the risk level.Differences were observed when the subjects without history of maternal obesity were compared with subjects with history of maternal obesity.The greater percentage of subjects who are having risk levels of body mass index.TC.low density lipoprotein.TG.and TC/HDI.indicated that maternal obesity contributed to the greater susceptibility of developing CVD risk in their offspring.Conclusions:Advancing age may result in changes that could be atherogenic in the future.Such atherogenic changes have already initialed when the subjects are about 21 years old.The incidence of atherogenic changes is far greater when mothers who are having any of the risk factors such as obesity,diabetes,HTN and myocardial infarction than that fathers who are havine similar risk factors.
文摘Pro-apoptotic Bcl-2 protein BAX is an important member of mitochondrial dependent apoptosis regulation and ultimately plays a pivotal role in malignancies. A promoter G(-248)A polymorphism in the TP53 binding region of BAX results in differential binding capacity of TP53 protein there by regulating its expression, which has been found to be associated with different clinical outcomes in various malignancies. Presently we aimed to analyze the possible impact of the BAX G(-248)A polymorphism on the risk and other clinical features of non-small cell lung cancer in Indian population. The BAX promoter polymorphism was analyzed in blood samples of 320 subjects with 1:1 case/control ratio by primer-introduced restriction analysis PCR and survival curves were plotted using Kaplan-Meier analysis. It was observed that more than 3-fold increased risk of developing non-small cell lung cancer was associated with homozygous AA genotype of BAX G(-248)A promoter polymorphism in Indian population, with more predominant in smokers with pack-year > 45 (heavy) and using cigarette or huka as their smoking source than homozygous GG genotype. Significant associations was observed between TNM stage (p = 0.037) and histological type (0.02), of non-small cell lung cancer patients with the polymorphism. Patients homozygous for A allele exhibited a significant poor overall survival compared with patients displaying GA + AA or GA or GG genotype [median survival 6.0 vs 9.0, 11.0, and 30.0 months, respectively (p < 0.0001)]. Adenocarcinoma and advanced stage patients with AA genotype showed lower median survival time than squamous cell carcinoma and early stage non-small cell lung cancer patients (median 3.0 and 5.0 vs 8.0 and 9.0 months, respectively). We conclude that the genetic polymorphism G(-248)A in the TP53 binding promoter region of pro-apoptotic genes BAX may contribute to the risk of developing non-small cell lung cancer in Indian population and also may be an important factor for adverse clinical outcome for patients with non-small cell lung cancer.
文摘Non-alcoholic fatty liver disease(NAFLD) has a prevalence of approximately 30% in western countries, and is emerging as the first cause of liver cirrhosis and hepatocellular carcinoma(HCC). Therefore, risk stratification emerges as fundamental in order to optimize human and economic resources, and genetics displays intrinsic characteristics suitable to fulfill this task. According to the available data, heritability estimates for hepatic fat content range from 20% to 70%, and an almost 80% of shared heritability has been found between hepatic fat content and fibrosis. The rs738409 single nucleotide polymorphism(SNP) in patatin-like phospholipase domain-containing protein 3 gene and the rs58542926 SNP in transmembrane 6 superfamily member 2 gene have been robustly associated with NAFLD and with its progression, but promising results have been obtained with many other SNPs. Moreover, there has been proof of the additive role of the different SNPs in determining liver damage, and there have been preliminary experiences in which risk scores created through a few genetic variants, alone or in combination with clinical variables, were associated with a strongly potentiated risk of NAFLD, non-alcoholic steatohepatitis(NASH), NASH fibrosis or NAFLD-HCC. However, to date, clinical translation of genetics in the field of NAFLD has been poor or absent. Fortunately, the research we have done seems to have placed us on the right path: We should rely on longitudinal rather than on cross-sectional studies; we should focus on relevant outcomes rather than on simple liver fat accumulation; and we should put together the genetic and clinical information. The hope is that combined genetic/clinical scores, derived from longitudinal studies and built on a few strong genetic variants and relevant clinical variables, will reach a significant predictive power, such as to have clinical utility for risk stratification at the single patient level and even to esteem the impact of intervention on the risk of disease-related outcomes. Well-structured future studies would demonstrate if this vision can become a reality.
文摘AIM: To assess the risk factors for cost-related medication non-adherence(CRN) among older patients with diabetes in the United States. METHODS: We used data from the 2010 Health and Retirement Study to assess risk factors for CRN including age, drug insurance coverage, nursing home residence, functional limitations, and frequency of hospitalization. CRN was self-reported. We conducted multivariate regression analysis to assess the effect of each risk factor. RESULTS: Eight hundred and seventy-five(18%) of 4880 diabetes patients reported CRN. Age less than 65 years, lack of drug insurance coverage, and frequent hospitalization significantly increased risk for CRN. Limitation in both activities of daily living and instrumental activities of daily living were also generally associated with increased risk of CRN. Residence in a nursing home and Medicaid coverage significantly reduced risk.CONCLUSION: These results suggest that expandingprescription coverage to uninsured, sicker, and community-dwelling individuals is likely to produce the largest decreases in CRN.