BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still...BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.展开更多
Objective Hepatitis B virus(HBV)infection,which has been recognized as an international public health challenge,has caused significant morbidity for the entire world.This research focused on patients with HBV in China...Objective Hepatitis B virus(HBV)infection,which has been recognized as an international public health challenge,has caused significant morbidity for the entire world.This research focused on patients with HBV in China to examine health utilization and expenses.Methods Patients hospitalized with HBV from 2017 to 2019 in tertiary hospitals in Hubei,a province located in central China,were selected as the study population.Healthcare information was collected from the provincial inpatient electronic system database.Univariate and regression analyses were performed to describe the basic situation of healthcare services and determine the influencing indicators of inpatient service expenditure.Results A total of 367381 cases of HBV infection were identified in the study area.Most of these cases were patients who were married(90.2%)and males(63%).With the great efforts by the universal coverage of the basic medical insurance(BMI)in China,the increasing rate of inpatient hospitalization for HBV was 3.5 times higher than that of the total inpatient health service cases in the study area.The average age of this group was 52.84±14.10 years and 11.1%of patients paid for their own medical expenditures without insurance.The average length of stay(LOS)was 11.10 days,and the average cost per patient was 15712.05 RMB.Both values were higher than the average level in study area.Gender,marital status,career,payment type,and kind of hospitals significantly influenced healthcare utilization.Males and the elderly might incur higher healthcare costs than their counterparts.Conclusion The BMI operated by government has played a role in the utilization release of health services for HBV carriers.However,researchers must pay more attention to the continuing increase in the medical expenses of this group.展开更多
Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expen...Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.展开更多
Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC...Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.展开更多
Purpose: To design a seamless healthcare system to provide the elderly in the community of Wuhan city with active, real-time and seamless health services. Method: All of the health services for the elderly in the comm...Purpose: To design a seamless healthcare system to provide the elderly in the community of Wuhan city with active, real-time and seamless health services. Method: All of the health services for the elderly in the community of Wuhan city, such as chronic disease management, first aid, and diagnosis have been systematically integrated based on the Radio Frequency Identification (RFID) technology combined with the existing high-tech, such as nano-sensor, network, information system technology, wireless technology, Bluetooth and Area Position System (APS) positioning. Results: The system has been constructed and put into use, initially achieving seamless health services for the elderly. The majority of both the elderly and healthcare workers are satisfied with the system. Conclusion: The study initially proposes the use of RFID technology to plan and design the elderly healthcare system, and has successfully carried the system out and got positive outcomes. It provides a new direction in the relevant research fields.展开更多
Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the dia...Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.展开更多
Background: Men appear less interested than women in engaging in health-promoting programs. We investigated the feasibility and proof of concept of a novel intervention program targeting male supporters of professiona...Background: Men appear less interested than women in engaging in health-promoting programs. We investigated the feasibility and proof of concept of a novel intervention program targeting male supporters of professional sports clubs. Methods: Our intervention is called ViSiT and the target population in this study was overweight male supporters aged 35 - 65 years with a body mass index ≥ 28 kg/m2, recruited through one football and one ice-hockey club. The participants (n = 22) participated in a 12-week lifestyle intervention with a 52-week follow-up. Body fat was assessed using bioelectrical impedance analysis. Results: The retention rate was high with 21 participants completing the 12-week program and 17 attending at least 10 of 12 sessions. Mean (standard deviation) body weight and fat reduction after 12 weeks was 8.2 (4.6) kg and 6.6 (3.6) kg, respectively. At 52 weeks, body weight and fat reduction were maintained at 6.4 (6.7) kg and 4.5 (6.5) kg. Even after 52 weeks follow-up, the participants appreciated most components of the ViSiT program and perceived the ViSiT program to have high impact on most health-related aspects investigated. Conclusions: The ViSiT program demonstrated a successful retention rate and clinically relevant weight reduction in Swedish overweight men. The maintenance of bodyweight reduction and positive experience after 1 year indicate a long-term effect of the ViSiT concept.展开更多
BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habi...BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habits.However,comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention.AIM To(1)Review the impact of COVID-19 on the healthcare system;(2)examine the relationship between liver diseases and COVID-19 in infected individuals;and(3)investigate the situation in the Portuguese population concerning these topics.METHODS For our purposes,we conducted a literature review using specific keywords.RESULTS COVID-19 is frequently associated with liver damage.However,liver injury in COVID-19 individuals is a multifactor-mediated effect.Therefore,it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19.CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries;the combination of COVID-19 with liver injury is common.Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.展开更多
Contextualization: Emptying the bladder is a challenging problem for the urological community. Intermittent catheterization is the most widely used method to restore bladder emptying mechanism. However, this procedure...Contextualization: Emptying the bladder is a challenging problem for the urological community. Intermittent catheterization is the most widely used method to restore bladder emptying mechanism. However, this procedure can have a negative impact on self-image and result in a decline in the quality of life of patients. In this context, the use of a bladder emptying device (SVCATH3D) proposes to be effective and have a positive impact on the quality of life of different patients. Objective: The objective of the study was to evaluate the functionality of a new device for both intermittent and controlled emptying of the bladder in both sexes and ages. Materials and methods: A randomized clinical trial was conducted with 251 patients, with different bladder problems, from March 2013 to January 2023. After randomization, the patients were divided into two groups: Group I (SVCATH3D) and Group II (Clean Intermittent Catheterization). The primary outcome was defined as the impact on quality of life. Data on episodes of urinary tract infection, adverse effects, number of diaper use and treatment costs were analyzed. Results: The apposition of the SVCATH3D was performed on an outpatient basis, with no complications during the procedures. The patients were followed up for 10 years. There was a significant improvement in quality of life when comparing the moments before and after the use of SVCATH3D (p Conclusion: The study using SVCATH3D showed promising results in relation to functionality, showing improvement in quality of life with a reduction in episodes of urinary infection and amount of diapers/day. This allows us to conclude that SVCATH3D can represent an important step in the treatment of patients suffering from various bladder problems both incontinence and affecting emptying mechanism.展开更多
Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curat...Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities(PAs).Methods:A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023.We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011.Results:A total of 47 studies were included,and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users(filing papers,light effort)to 11.8 metabolic equivalents for wheelchair users(Nordic sit skiing).Conclusion:In introducing the updated 2024 Wheelchair Compendium,we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.展开更多
Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was u...Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.展开更多
Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values ...Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values were obtained from a systematic search of studies published in 4 sport and exercise databases(PubMed,Embase,SPORTDiscus(EBSCOhost),and Scopus)and a review of articles included in the 2011 Adult Compendium that measured PA in older adults.MET values were computed as the oxygen cost(VO_(2),mL/kg/min)during PA divided by 2.7 m L/kg/min(MET_(60+))to account for the lower resting metabolic rate in older adults.Results:We identified 68 articles and extracted energy expenditure data on 427 PAs.From these,we derived 99 unique Specific Activity codes with corresponding MET_(60+)values for older adults.We developed a website to present the OA Compendium MET_(60+)values:https://pacompendium.com.Conclusion:The OA Compendium uses data collected from adults>60 years for more accurate estimation of the energy cost of PAs in older adults.It is an accessible resource that will allow researchers,educators,and practitioners to find MET_(60+)values for older adults for use in PA research and practice.展开更多
First developed 30 years ago,the Compendium of Physical Activities(Compendium)was created to provide a standardized way of measuring and classifying specific physical activities(PAs),allowing researchers and health pr...First developed 30 years ago,the Compendium of Physical Activities(Compendium)was created to provide a standardized way of measuring and classifying specific physical activities(PAs),allowing researchers and health professionals to assess the energy expenditure and health benefits associated with different PA.1Since its inception,the Compendium has been widely utilized and recognized as a fundamental PA and health resource.展开更多
BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist ...BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.展开更多
Background:Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring’s cognitive development during early childhood.This study aimed to investigate the prospective...Background:Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring’s cognitive development during early childhood.This study aimed to investigate the prospective associations between overall parental lifestyle and offspring’s cognitive performance during adolescence and young adulthood in China.Methods:We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies.A healthy parental lifestyle score(ranged 0-5)was constructed based on the following five modifiable lifestyle factors:Smoking,drinking,exercise,sleep,and diet.Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring’s fluid and crystallized intelligence in subsequent years(2012,2014,2016,and 2018).Results:Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence(multivariable-adjusted β=0.53,95%confidence interval[CI]:0.29-0.77)and overall crystallized intelligence(multivariable-adjusted β=0.35,95%CI:0.16-0.54)than those in the bottom tertile of parental healthy lifestyle scores.The results were similar after further adjustment for the offspring’s healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status.Additionally,maternal and paternal healthy lifestyle scores were independently associated with better offspring’s cognitive performance,with significant contribution observed for paternal never-smoking,weekly exercise,and diversified diet.When both parents and offspring adhered to a healthier lifestyle,we observed the highest level of the offspring’s overall crystallized intelligence.Conclusions:Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring’s cognitive performance during adolescence and early adulthood,regardless of socioeconomic status.These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.展开更多
Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because altera...Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk (RRpooled) 0.77, 95% confidence interval (95% CI) 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 (0.69-0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allowestimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.展开更多
Autoimmune pancreatitis (AIP) is a particular type of pancreatitis of presumed autoimmune etiology. Currently, AIP should be diagnosed based on combination of clinical, serological, morphological, and histopathologica...Autoimmune pancreatitis (AIP) is a particular type of pancreatitis of presumed autoimmune etiology. Currently, AIP should be diagnosed based on combination of clinical, serological, morphological, and histopathological features. When diagnosing AIP, it is most important to differentiate it from pancreatic cancer. Diagnostic criteria for AIP, proposed by the Japan Pancreas Society in 2002 first in the world, were revised in 2006. The criteria are based on the minimum consensus of AIP and aim to avoid misdiagnosing pancreatic cancer as far as possible, but not for screening AIP. The criteria consist of the following radiological, serological, and histopathological items: (1) radiological imaging showing narrowing of the main pancreatic duct and enlargement of the pancreas, which are characteristic of the disease; (2) laboratory data showing abnormally elevated levels of serum γ-globulin, IgG or IgG4, or the presence of autoantibodies; (3) histopathological examination of the pancreas demonstrating marked fibrosis and prominent infiltration of lymphocytes and plasma cells, which is called lymphoplasmacytic sclerosing pancreatitis (LPSP). For a diagnosis of AIP, criterion 1 must be present, together with criterion 2 and/ or criterion 3. However, it is necessary to exclude malignant diseases such as pancreatic or biliary cancer.展开更多
The incidence of colorectal cancer has been increasing in the developed world including South Korea and China.Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinat...The incidence of colorectal cancer has been increasing in the developed world including South Korea and China.Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations,such as the stool occult blood test,barium enema,and computed tomography colonography.Therefore,in recent years,the demand for colonoscopies has grown rapidly.New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies.However,it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications,such as perforation and bleeding,as compared to gastroscopy.Thus,considerable training and experience are required for optimal performance of colonoscopies.In order to perform a complete colonoscopic examination,there were a few important thingsto learn and remember,such as the position of examinee(e.g.,left and right decubitus,supine,and prone)and examiner(two-man method vs one-man standing method vs one-man sitting method),basic skills(e.g.,tip deflection,push forward and pull back,torque,air suction and insufflation),advanced skills(e.g.,jiggling and shaking,right and left turn shortening,hooking,and slide-by technique),assisting skills(e.g.,position change of examinee,abdominal compression,breathing-holding,and liquid-infusion technique),and intubation techniques along the lower gastrointestinal tract.In this article,we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician.We believe that this article may be helpful to the new beginners who wish to learn the procedure.展开更多
Objective: To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average(...Objective: To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average(SARIMA) model,Methods: The trend of cutaneous leishmaniasis was predicted using Mini tab software and SARIMA model,Besides,information about the disease and weather conditions was collected monthly based on time series design during January 2010 to March 2016,Moreover,various SARIMA models were assessed and the best one was selected,Then,the model's fitness was evaluated based on normality of the residuals' distribution,correspondence between the fitted and real amounts,and calculation of Akaike Information Criteria(AIC) and Bayesian Information Criteria(BIC),Results: The study results indicated that SARIMA model(4,1,4)(0,1,0)(12) in general and SARIMA model(4,1,4)(0,1,1)(12) in below and above 15 years age groups could appropriately predict the disease trend in the study area,Moreover,temperature with a three-month delay(lag3) increased the disease trend,rainfall with a four-month delay(lag4) decreased the disease trend,and rainfall with a nine-month delay(lag9) increased the disease trend,Conclusions: Based on the results,leishmaniasis follows a descending trend in the study area in case drought condition continues,SARIMA models can suitably measure the disease trend,and the disease follows a seasonal trend.展开更多
基金Supported by the Project of NINGBO Leading Medical Health Discipline,No.2022-B11Ningbo Natural Science Foundation,No.202003N4206Public Welfare Foundation of Ningbo,No.2021S108.
文摘BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.
基金the Fundamental Research Funds for the Central Universities(No.2020kfyXJJS057)China Association for Science and Technology Foundation(No.20200608CG111320).
文摘Objective Hepatitis B virus(HBV)infection,which has been recognized as an international public health challenge,has caused significant morbidity for the entire world.This research focused on patients with HBV in China to examine health utilization and expenses.Methods Patients hospitalized with HBV from 2017 to 2019 in tertiary hospitals in Hubei,a province located in central China,were selected as the study population.Healthcare information was collected from the provincial inpatient electronic system database.Univariate and regression analyses were performed to describe the basic situation of healthcare services and determine the influencing indicators of inpatient service expenditure.Results A total of 367381 cases of HBV infection were identified in the study area.Most of these cases were patients who were married(90.2%)and males(63%).With the great efforts by the universal coverage of the basic medical insurance(BMI)in China,the increasing rate of inpatient hospitalization for HBV was 3.5 times higher than that of the total inpatient health service cases in the study area.The average age of this group was 52.84±14.10 years and 11.1%of patients paid for their own medical expenditures without insurance.The average length of stay(LOS)was 11.10 days,and the average cost per patient was 15712.05 RMB.Both values were higher than the average level in study area.Gender,marital status,career,payment type,and kind of hospitals significantly influenced healthcare utilization.Males and the elderly might incur higher healthcare costs than their counterparts.Conclusion The BMI operated by government has played a role in the utilization release of health services for HBV carriers.However,researchers must pay more attention to the continuing increase in the medical expenses of this group.
基金co-supported by the National Natural Science Foundation of China (No. 81773521)CAMS Innovation Fund for Medical Sciences (No. 2017-I2M-1006, No. 2016-12M-2-004)+4 种基金the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2018RC330001)the National Key Projects of Research and Development of China (No. 2018 YFC1315000)China Scholarship Council (No. 201908110180)the Sanming Project of Medicine in Shenzhen (No. SZSM201911015)the Cancer Screening Program in Urban China funded by National Health Commission of People’s Republic of China
文摘Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.
基金supported by the grants from the Beijing Hope Run Special Fund(#LC2012YF44)National Natural Science Foundation of China(No.81402740)+1 种基金Specialized Research Fund for the Doctoral Program of Higher Education(No.20131106120014)The National Health and Family Planning Committee of P.R.China
文摘Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.
文摘Purpose: To design a seamless healthcare system to provide the elderly in the community of Wuhan city with active, real-time and seamless health services. Method: All of the health services for the elderly in the community of Wuhan city, such as chronic disease management, first aid, and diagnosis have been systematically integrated based on the Radio Frequency Identification (RFID) technology combined with the existing high-tech, such as nano-sensor, network, information system technology, wireless technology, Bluetooth and Area Position System (APS) positioning. Results: The system has been constructed and put into use, initially achieving seamless health services for the elderly. The majority of both the elderly and healthcare workers are satisfied with the system. Conclusion: The study initially proposes the use of RFID technology to plan and design the elderly healthcare system, and has successfully carried the system out and got positive outcomes. It provides a new direction in the relevant research fields.
基金supported by the National Health and Family Plan Commission of P. R. China
文摘Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.
文摘Background: Men appear less interested than women in engaging in health-promoting programs. We investigated the feasibility and proof of concept of a novel intervention program targeting male supporters of professional sports clubs. Methods: Our intervention is called ViSiT and the target population in this study was overweight male supporters aged 35 - 65 years with a body mass index ≥ 28 kg/m2, recruited through one football and one ice-hockey club. The participants (n = 22) participated in a 12-week lifestyle intervention with a 52-week follow-up. Body fat was assessed using bioelectrical impedance analysis. Results: The retention rate was high with 21 participants completing the 12-week program and 17 attending at least 10 of 12 sessions. Mean (standard deviation) body weight and fat reduction after 12 weeks was 8.2 (4.6) kg and 6.6 (3.6) kg, respectively. At 52 weeks, body weight and fat reduction were maintained at 6.4 (6.7) kg and 4.5 (6.5) kg. Even after 52 weeks follow-up, the participants appreciated most components of the ViSiT program and perceived the ViSiT program to have high impact on most health-related aspects investigated. Conclusions: The ViSiT program demonstrated a successful retention rate and clinically relevant weight reduction in Swedish overweight men. The maintenance of bodyweight reduction and positive experience after 1 year indicate a long-term effect of the ViSiT concept.
文摘BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habits.However,comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention.AIM To(1)Review the impact of COVID-19 on the healthcare system;(2)examine the relationship between liver diseases and COVID-19 in infected individuals;and(3)investigate the situation in the Portuguese population concerning these topics.METHODS For our purposes,we conducted a literature review using specific keywords.RESULTS COVID-19 is frequently associated with liver damage.However,liver injury in COVID-19 individuals is a multifactor-mediated effect.Therefore,it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19.CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries;the combination of COVID-19 with liver injury is common.Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.
文摘Contextualization: Emptying the bladder is a challenging problem for the urological community. Intermittent catheterization is the most widely used method to restore bladder emptying mechanism. However, this procedure can have a negative impact on self-image and result in a decline in the quality of life of patients. In this context, the use of a bladder emptying device (SVCATH3D) proposes to be effective and have a positive impact on the quality of life of different patients. Objective: The objective of the study was to evaluate the functionality of a new device for both intermittent and controlled emptying of the bladder in both sexes and ages. Materials and methods: A randomized clinical trial was conducted with 251 patients, with different bladder problems, from March 2013 to January 2023. After randomization, the patients were divided into two groups: Group I (SVCATH3D) and Group II (Clean Intermittent Catheterization). The primary outcome was defined as the impact on quality of life. Data on episodes of urinary tract infection, adverse effects, number of diaper use and treatment costs were analyzed. Results: The apposition of the SVCATH3D was performed on an outpatient basis, with no complications during the procedures. The patients were followed up for 10 years. There was a significant improvement in quality of life when comparing the moments before and after the use of SVCATH3D (p Conclusion: The study using SVCATH3D showed promising results in relation to functionality, showing improvement in quality of life with a reduction in episodes of urinary infection and amount of diapers/day. This allows us to conclude that SVCATH3D can represent an important step in the treatment of patients suffering from various bladder problems both incontinence and affecting emptying mechanism.
文摘Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities(PAs).Methods:A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023.We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011.Results:A total of 47 studies were included,and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users(filing papers,light effort)to 11.8 metabolic equivalents for wheelchair users(Nordic sit skiing).Conclusion:In introducing the updated 2024 Wheelchair Compendium,we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.
文摘Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.
文摘Purpose:To describe the development of a Compendium for estimating the energy costs of activities in adults>60 years(OA Compendium).Methods:Physical activities(PAs)and their metabolic equivalent of task(MET)values were obtained from a systematic search of studies published in 4 sport and exercise databases(PubMed,Embase,SPORTDiscus(EBSCOhost),and Scopus)and a review of articles included in the 2011 Adult Compendium that measured PA in older adults.MET values were computed as the oxygen cost(VO_(2),mL/kg/min)during PA divided by 2.7 m L/kg/min(MET_(60+))to account for the lower resting metabolic rate in older adults.Results:We identified 68 articles and extracted energy expenditure data on 427 PAs.From these,we derived 99 unique Specific Activity codes with corresponding MET_(60+)values for older adults.We developed a website to present the OA Compendium MET_(60+)values:https://pacompendium.com.Conclusion:The OA Compendium uses data collected from adults>60 years for more accurate estimation of the energy cost of PAs in older adults.It is an accessible resource that will allow researchers,educators,and practitioners to find MET_(60+)values for older adults for use in PA research and practice.
文摘First developed 30 years ago,the Compendium of Physical Activities(Compendium)was created to provide a standardized way of measuring and classifying specific physical activities(PAs),allowing researchers and health professionals to assess the energy expenditure and health benefits associated with different PA.1Since its inception,the Compendium has been widely utilized and recognized as a fundamental PA and health resource.
基金Supported by in part David W Crabb Professorship Endowment at Indiana University School of Medicine and an intramural grant from the Atrium Health Center for Outcomes Research and Evaluation(CORE)(to deLemos AS).
文摘BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.
基金supported by grants from the Zhejiang University Education Foundation Global Partnership Fund(to CZY)the Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province(No.2020E10004).
文摘Background:Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring’s cognitive development during early childhood.This study aimed to investigate the prospective associations between overall parental lifestyle and offspring’s cognitive performance during adolescence and young adulthood in China.Methods:We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies.A healthy parental lifestyle score(ranged 0-5)was constructed based on the following five modifiable lifestyle factors:Smoking,drinking,exercise,sleep,and diet.Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring’s fluid and crystallized intelligence in subsequent years(2012,2014,2016,and 2018).Results:Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence(multivariable-adjusted β=0.53,95%confidence interval[CI]:0.29-0.77)and overall crystallized intelligence(multivariable-adjusted β=0.35,95%CI:0.16-0.54)than those in the bottom tertile of parental healthy lifestyle scores.The results were similar after further adjustment for the offspring’s healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status.Additionally,maternal and paternal healthy lifestyle scores were independently associated with better offspring’s cognitive performance,with significant contribution observed for paternal never-smoking,weekly exercise,and diversified diet.When both parents and offspring adhered to a healthier lifestyle,we observed the highest level of the offspring’s overall crystallized intelligence.Conclusions:Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring’s cognitive performance during adolescence and early adulthood,regardless of socioeconomic status.These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.
基金Supported by Veterans' Affairs Health Services Research & Development fellowship, TPA 61-029 (Dr. Dublin)National Institute of Aging grant, AG028954-01A1 (Dr. Dublin)
文摘Irritable bowel syndrome (IBS) is a chronic condition affecting 3%-25% of the general population. As no curative treatment is available, therapy is aimed at reducing symptoms, often with little success. Because alteration of the normal intestinal microflora has been observed in IBS, probiotics (beneficial microbes taken to improve health) may be useful in reducing symptoms. This paper systematically reviews randomized, controlled, blinded trials of probiotics for the treatment of IBS and synthesizes data on efficacy across trials of adequate quality. PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and the Cochrane Central Register of Controlled Trials were searched from 1982-2007. We also conducted secondary searches of reference lists, reviews, commentaries, relevant articles on associated diseases, books and meeting abstracts. Twenty trials with 23 probiotic treatment arms and a total of 1404 subjects met inclusion criteria. Probiotic use was associated with improvement in global IBS symptoms compared to placebo [pooled relative risk (RRpooled) 0.77, 95% confidence interval (95% CI) 0.62-0.94]. Probiotics were also associated with less abdominal pain compared to placebo [RRpooled = 0.78 (0.69-0.88)]. Too few studies reported data on other IBS symptoms or on specific probiotic strains to allowestimation of a pooled RR. While our analyses suggest that probiotic use may be associated with improvement in IBS symptoms compared to placebo, these results should be interpreted with caution, given the methodological limitations of contributing studies. Probiotics warrant further study as a potential therapy for IBS.
基金Research for Intractable Disease of the Pancreas, Ministry of Health, Labor and Welfare of Japan
文摘Autoimmune pancreatitis (AIP) is a particular type of pancreatitis of presumed autoimmune etiology. Currently, AIP should be diagnosed based on combination of clinical, serological, morphological, and histopathological features. When diagnosing AIP, it is most important to differentiate it from pancreatic cancer. Diagnostic criteria for AIP, proposed by the Japan Pancreas Society in 2002 first in the world, were revised in 2006. The criteria are based on the minimum consensus of AIP and aim to avoid misdiagnosing pancreatic cancer as far as possible, but not for screening AIP. The criteria consist of the following radiological, serological, and histopathological items: (1) radiological imaging showing narrowing of the main pancreatic duct and enlargement of the pancreas, which are characteristic of the disease; (2) laboratory data showing abnormally elevated levels of serum γ-globulin, IgG or IgG4, or the presence of autoantibodies; (3) histopathological examination of the pancreas demonstrating marked fibrosis and prominent infiltration of lymphocytes and plasma cells, which is called lymphoplasmacytic sclerosing pancreatitis (LPSP). For a diagnosis of AIP, criterion 1 must be present, together with criterion 2 and/ or criterion 3. However, it is necessary to exclude malignant diseases such as pancreatic or biliary cancer.
文摘The incidence of colorectal cancer has been increasing in the developed world including South Korea and China.Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations,such as the stool occult blood test,barium enema,and computed tomography colonography.Therefore,in recent years,the demand for colonoscopies has grown rapidly.New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies.However,it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications,such as perforation and bleeding,as compared to gastroscopy.Thus,considerable training and experience are required for optimal performance of colonoscopies.In order to perform a complete colonoscopic examination,there were a few important thingsto learn and remember,such as the position of examinee(e.g.,left and right decubitus,supine,and prone)and examiner(two-man method vs one-man standing method vs one-man sitting method),basic skills(e.g.,tip deflection,push forward and pull back,torque,air suction and insufflation),advanced skills(e.g.,jiggling and shaking,right and left turn shortening,hooking,and slide-by technique),assisting skills(e.g.,position change of examinee,abdominal compression,breathing-holding,and liquid-infusion technique),and intubation techniques along the lower gastrointestinal tract.In this article,we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician.We believe that this article may be helpful to the new beginners who wish to learn the procedure.
基金financially supported by Shiraz University of Medical Sciences(grant No.94-01-04-10456)
文摘Objective: To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average(SARIMA) model,Methods: The trend of cutaneous leishmaniasis was predicted using Mini tab software and SARIMA model,Besides,information about the disease and weather conditions was collected monthly based on time series design during January 2010 to March 2016,Moreover,various SARIMA models were assessed and the best one was selected,Then,the model's fitness was evaluated based on normality of the residuals' distribution,correspondence between the fitted and real amounts,and calculation of Akaike Information Criteria(AIC) and Bayesian Information Criteria(BIC),Results: The study results indicated that SARIMA model(4,1,4)(0,1,0)(12) in general and SARIMA model(4,1,4)(0,1,1)(12) in below and above 15 years age groups could appropriately predict the disease trend in the study area,Moreover,temperature with a three-month delay(lag3) increased the disease trend,rainfall with a four-month delay(lag4) decreased the disease trend,and rainfall with a nine-month delay(lag9) increased the disease trend,Conclusions: Based on the results,leishmaniasis follows a descending trend in the study area in case drought condition continues,SARIMA models can suitably measure the disease trend,and the disease follows a seasonal trend.