Shaonong Dang

Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial.

Music therapy has been used in multiple health care settings to reduce patient pain, anxiety, and stress. However, few available studies have investigated its effect on pain among breast cancer patients after radical mastectomy. The aim of this study was to explore the effects of music therapy on pain reduction in patients with breast cancer after radical mastectomy. This randomized controlled trial was conducted at the Surgical Department of Oncology Center, First Affiliated Hospital of Xi’an Jiaotong University from March to November 2009. A total of 120 breast cancer patients who received Personal Controlled Analgesia (PCA) following surgery (mastectomy) were randomly allocated to two groups, an intervention group and a control group (60 patients in each group). The intervention group accepted music therapy from the first day after radical mastectomy to the third admission to hospital for chemotherapy in addition to the routine nursing care, while the control group received only routine nursing care. Pain scores were measured at baseline and three post-tests using the General Questionnaire and Chinese version of Short-Form of McGill Pain Questionnaire. The primary endpoint was the change in the Pain Rating Index (PRI-total) score from baseline. Music therapy was found to reduce the PRI-total score in the intervention group significantly compared with the control group with a mean difference (95% CI) of −2.38 (−2.80, −1.95), −2.41 (−2.85, −1.96), and −1.87 (−2.33, −1.42) for the 1st, 2nd, and 3rd post-tests, respectively. Similar results were found for Visual Analogue Scale (VAS) and Present Pain Intensity (PPI) scores. The findings of the study provide some evidence that music therapy has both short- and long-term positive effects on alleviating pain in breast cancer patients following radical mastectomy.

A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay.

PURPOSEnTo examine effects of music therapy and progressive muscle relaxation training on depression, anxiety and length of hospital stay in Chinese female breast cancer patients after radical mastectomy.nnnMETHODSnA total of 170 patients were randomly allocated to the intervention group (n = 85) receiving music therapy and progressive muscle relaxation training plus routine nursing care and the control group (n = 85) receiving routine nursing care. Music therapy and progressive muscle relaxation training were performed twice a day within 48 h after radical mastectomy, once in the early morning (6a.m.-8a.m.) and once in the evening (9p.m.-11p.m.), for 30 min per session until discharged from the hospital.nnnRESULTSnA general linear model with univariate analysis showed that the intervention group patients had significant improvement in depression and anxiety in the effects of group (F = 20.31, P < 0.001; F = 5.41, P = 0.017), time (F = 56.64, P < 0.001; F = 155.17, P < 0.001) and group*time interaction (F = 6.91, P = 0.009; F = 5.56, P = 0.019). The intervention group patients had shorter length of hospital stay (12.56 ± 1.03) than that of the control group (17.01 ± 2.46) with statistical significance (F = 13.36, P < 0.001).nnnCONCLUSIONnMusic therapy and progressive muscle relaxation training can reduce depression, anxiety and length of hospital stay in female breast cancer patients after radical mastectomy.

Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle-aged and older adults in a rural area of Northwest China from 1982 to 2010.

Objectives To assess trends in average blood pressure levels and prevalence, awareness, treatment, and control of hypertension among adults in a rural area of Northwest China, and to determine associated risk factors. Methods Four cross-sectional population-based surveys were conducted between 1982 and 2010 among randomly selected adults in rural areas of Hanzhong, in Northwest China. Data on blood pressure, body mass index, family history of hypertension, and socio-demographic and lifestyle characteristics were collected in similar way by trained investigators in four surveys. Data of 8575 participants aged 35–64 years was analyzed. Averages and proportions were adjusted for age and sex. Results Average blood pressure in the population has increased since 1982 from 76.9 mm Hg to 79.6 mm Hg in 2010 (diastolic) and from 120.9 to 129.7 mm Hg (systolic). Prevalence of hypertension increased from 18.4% in 1982 to 30.5% in 2010, and awareness of hypertension increased from 16.8% to 38.4% in 2010. Treatment of hypertension increased from 1.0% in 1982 to 17.4% in 2010, and control of hypertension increased from 0.1% in 1982 to 3.5% in 2010. All these gradients were statistically significant (P<0.01 for trend). Population blood pressure and prevalence, awareness and treatment of hypertension were positively associated with increasing age, body mass index and having family history of hypertension. Conclusions Average blood pressure levels and the prevalence, awareness, treatment and control of hypertension among adults in rural areas of Hanzhong have increased since 1982. However, awareness, treatment and control rates remain low. Public health programs and practical strategies are required to improve prevention and control of hypertension in rural Northwest China. In particular, attention should be given to the elderly and obese, and to those with a family history of hypertension, while raising awareness and treatment among younger adults.

Hemoglobin levels and anemia evaluation during pregnancy in the highlands of Tibet: a hospital-based study

BackgroundAnemia is regarded as a major risk factor for unfavorable pregnancy outcomes, but there have been no previous studies describing the pattern of hemoglobin concentration during pregnancy in Tibet and the relationship between altitude and Hb concentration in the pregnant women living in Tibet still has not been clearly established. The main objectives of this study were to study the hemoglobin levels and prevalence of anemia among pregnant women living in the highlands of Tibet and to evaluate potential associations of hemoglobin and anemia with womens characteristics.MethodsThe hospital-based study was conducted in 380 pregnant women. Their blood samples were tested and related sociodemographic information was collected. Multiple linear regression model and multiple logistic regression model were used to assess the association of pregnant womens characteristics with hemoglobin level and the occurrence of anemia. Centers for Disease Control (CDC), Dirren et al. and Dallman et al. methods were used to adjust the hemoglobin measurements based on altitude for estimating the prevalence of anemia.ResultsThe mean hemoglobin concentration was 127.6 g/L (range: 55.0-190.0 g/L). Prevalence rate of anemia in this study was 70.0%, 77.9% and 41.3%, respectively for three altitude-correction methods for hemoglobin (CDC method, Dirren et al. method, and Dallman et al. method). Gestational age, ethnicity, residence and income were significantly associated with the hemoglobin concentration and prevalence of anemia in the study population. Specially, the hemoglobin concentration of pregnant women decreased with increase in gestational age.ConclusionThe hemoglobin level was low and prevalence rate of anemia was high among pregnant women in Lhasa, Tibet. Gestational age, ethnicity, residence and income were found to be significantly associated with the hemoglobin level and the occurrence of anemia in the study population.

Nutrient intakes of rural Tibetan mothers: a cross-sectional survey.

BackgroundTibetan food intake is influenced by the regions high altitude and unique culture. Few published studies of nutrient intakes among Tibetan women are available. The present study of Tibetan mothers with young children explores dietary patterns, nutrient intakes, and differences between socio-demographic groups.MethodsA cross-sectional survey of 386 women with a child aged less than 24 months was conducted in rural areas surrounding Lhasa, Tibet. All participants were recruited using simple random sampling and were interviewed face-to-face by trained investigators. Dietary information was collected via a food frequency questionnaire. Nutrient intakes were calculated using food composition tables. Non-parametric tests were used to compare nutrient intakes according to socio-demographic variables, and to compare results with the 2002 Chinese National Nutrition and Health Survey (2002 NNHS) and dietary reference intakes (DRIs).ResultsMedian intakes of energy (p < 0.001), protein (p < 0.001), fat (p < 0.001), vitamin A (p < 0.001), vitamin B1 (p < 0.001), vitamin B2 (p < 0.001), vitamin C (p < 0.001), and vitamin E (p < 0.001) were lower than the average levels reported in 2002 NNHS. The median intakes of calcium (517 mg/d, p < 0.001), iron (35 mg/d, p < 0.001), and zinc (17.3 mg/d, p < 0.001) were higher than the average levels in 2002 NNHS. The highest education subgroup had significantly higher intakes of vitamins A and C than the lowest education subgroup.ConclusionAlthough the diet of Tibetan mothers with young children has been partially influenced by other factors, their dietary patterns are still mostly composed of Tibetan traditional foods. Compared with the 2002 NNHS, Tibetan women with young children appear to have insufficient intakes of many nutrients, which will affect their nutritional status.

Evaluation of a portable hemoglobin photometer in pregnant women in a high altitude area: a pilot study

BackgroundAnemia is a widespread public health problem associated with an increased risk of morbidity and mortality, especially in pregnant women. This study examined the agreement between a portable hemoglobin photometer and a laboratory analyzer in determining hemoglobin level in pregnant women.MethodsThis study recruited 69 pregnant women in Tibet, China. Capillary blood samples were taken to measure hemoglobin concentration using the hemoglobin photometer and the laboratory analyzer. Limit of agreement, concordance and intraclass correlation coefficient were used to evaluate the agreement. Laboratory measurement was considered as the standard reference method. Sensitivity and specificity were calculated to assess the error in screening for anemia.ResultsMean difference between the two methods was -2.1 g/l. wide 95% limits of agreement were found (-22.6 g/l to 18.4 g/l). The intraclass correlation coefficient was 0.795, and concordance correlation coefficient was 0.793. Sensitivity and specificity were 94.9% and 76.7% respectively. Positive predictive value was 84.1%, and negative predictive value was 92.0%.ConclusionThis hemoglobin photometer is not recommended for determining hemoglobin concentration in pregnancy in a high altitude area.

Care-Seeking Pattern for Diarrhea among Children under 36 Months Old in Rural Western China

Objective To explore the caretakers care-seeking pattern and its determinants among children under 36 months old with diarrhea in rural western China. Methods The data of 14112 households was collected in 45 counties of 10 provinces of western China from June to August 2005. A generalized estimated equation (GEE) linear model was used to identify the determinants of the care-seeking. Results Village-level and township-level care were sought for childhood diarrhea by 67.02% of the caretakers. GEE model analysis shows that compared with the caretakers of the children delivered at county-level or above hospitals, those of the children delivered at home seldom sought a higher level care (−0.23, 95%CI: −0.45,−0.01, pu200a=u200a0.040); that the age of the children was negatively associated with seeking a higher level care (12 vs 36 months: 0.35, 95%CI: 0.16,0.55, p<0.001; 24 vs 36 months: 0.26, 95%CI: 0.08,0.44, pu200a=u200a0.004); that the more danger signs of diarrhea the caretakers recognized, the higher level care they sought for their children with diarrhea (0.04, 95%CI: 0.00,0.07, pu200a=u200a0.037); that the children with breastfeeding were given a higher level care than those without (0.15, 95%CI: 0.01,0.28, pu200a=u200a0.035); that the mothers with a higher education sought the higher level care than those with only primary education (0.29, 95%CI: 0.03,0.56, pu200a=u200a0.032); and that the farther the villages where these caretakers lived were from their townships, the lower level care for their children with diarrhea they sought (−0.09, 95%CI: −0.18,−0.01, pu200a=u200a0.039). Conclusion Village-level and township-level care were sought for childhood diarrhea by most of the caretakers. Birth settings, the distance from village to township, maternal education, caretakers awareness of the danger signs of diarrhea, breastfeeding status and age of children affected the care-seeking. These findings may have some implications for the improvement of health care services and care-seeking intervention against childhood diarrhea in rural western China.

Severity of Anemia among Children under 36 Months Old in Rural Western China

Objective To describe severity of anemia and explore its determinants among children under 36 months old in rural western China. Study Design The family information of 6711 children was collected and their hemoglobin was measured in 2005. A generalized estimated equation (GEE) linear model was used to identify the determinants of severity of childhood anemia. Results The prevalence of mild, moderate and severe anemia among these children was 27.4%, 21.9% and 3.2% respectively. GEE model analysis showed that province-level region and severity of maternal anemia affected the severity of childhood anemia not only in 0–5 months but also beyond 5 months. In addition, children aged 0–5 months in families using iron pot (coefficientu200a=u200a−0.26 95%CI −0.41,−0.12) had seldom more severe anemia, and children aged 6–36 months in families more than 4 members (coefficientu200a=u200a−0.03 95%CI −0.06,−0.01) or of Han ethnicity (coefficientu200a=u200a−0.08 95%CI −0.13,−0.04) seldom had more severe anemia but boys (coefficientu200a=u200a0.03 95%CI 0.01,0.06) or younger children (6–11 month vs 30–36 month: coefficientu200a=u200a0.23 95%CI 0.17, 0.28; 12–17 month vs 30–36 month: coefficientu200a=u200a0.19 95%CI 0.15,0.24; 18–23 vs 30–36 month: coefficientu200a=u200a0.09 95%CI 0.04,0.13) had more severe anemia. Conclusion The prevalence of moderate-to-severe anemia in these children was about 25%. Province-level region, iron pot use, family size, ethnicity, age and gender of children and severity of maternal anemia were important determinants of the severity of childhood anemia. These findings have some important implications for health policy decision for childhood anemia in rural western China.

Implication of World Health Organization growth standards on estimation of malnutrition in young Chinese children: Two examples from rural western China and the Tibet region

The aim of this study was to determine how malnutrition rates change in young Chinese children when 2006 World Health Organization (WHO) growth standards are used instead of 1978 WHO/National Center for Health Statistics reference. Cross-sectional survey data were used from rural western China and the Tibet region. The heights and weights of children of <36 months of age were measured. The nutritional status of the children was assessed by two references. Using 2006 reference instead of 1978 reference, the prevalence of stunting increased significantly (17.9% vs. 12.3% in rural western China and 37.5% vs. 28.1% in rural Tibet). The prevalence of underweight was lower in rural western China (7.7% vs. 11.7%) than rural Tibet (13.1% vs. 15.3%). For all ages, the prevalence of stunting increased and the greatest relative increase appeared in the first six months (102.9% in rural western China vs. 134.9% in rural Tibet). With respect to underweight, the relative increase occurred only during the first six months (314.3% in rural western China vs. 48.1% in rural Tibet); however, the reduction was observed in other age groups. For young Chinese Han and Tibetan children, the difference in estimation of malnutrition between two references differed in magnitude. The scale of change in the prevalence rates of stunting and underweight is much greater when 2006 reference was introduced.

Transfusion of Older Red Blood Cells Increases the Risk of Acute Kidney Injury After Orthotopic Liver Transplantation: A Propensity Score Analysis

BACKGROUND: Acute kidney injury (AKI) is a common and serious complication of orthotopic liver transplantation (OLT). Transfusion of older red blood cells (RBCs) has been implicated in poor outcomes in trauma, cardiac surgery, and critically ill patients. However, whether transfusion of older RBCs plays any role in post-OLT AKI remained unknown. The aim of this study was to investigate the effect of the age of transfused RBCs on post-OLT AKI. METHODS: The clinical data of consecutive adult patients who received donation after cardiac death and underwent OLT from December 2011 to December 2015 were analyzed. These patients were divided into 2 groups: the newer blood group, who received exclusively RBCs that had been stored for <14 days; and the older blood group, who received RBCs that had been stored for 14 days or more. The incidence of post-OLT AKI, severe AKI, lengths of intensive care unit and hospital stay, and in-hospital mortality after OLT were analyzed. RESULTS: Postoperative AKI occurred in 65.1% of patients in the older blood group and 40.5% of patients in the newer blood group (P < .01). The incidence of severe AKI after OLT was significantly higher, and the duration of intensive care unit stay was significantly longer, in the older blood group. After adjustment by the multivariable regression logistic analysis, transfusion of older blood was independently associated with post-OLT AKI (odds ratio [OR] = 2.47 [95% confidence interval {CI}, 1.13–5.41]; P = .024) and severe AKI (OR = 5.88 [95% CI, 2.06–16.80]; P = .001). After adjustment by the inverse probability of treatment weighting analysis, patients in the older blood group still had significantly higher incidences of postoperative AKI (OR = 2.13 [95% CI, 1.07–4.22]; P = .030) and severe AKI (OR = 3.34 [95% CI, 1.47–7.60]; P = .003) than those in the newer blood group. CONCLUSIONS: Transfusion of older RBCs significantly increased the risk of postoperative AKI in liver transplant recipients.