Wenzhen Li

Consumption of fruit and vegetable and risk of coronary heart disease: A meta-analysis of prospective cohort studies

BACKGROUND Observational studies suggest that an association between fruit and vegetable consumption and coronary heart disease (CHD). However, the results are inconsistent. We conducted a meta-analysis to evaluate the relationship of fruit and vegetable consumption with CHD risk and quality the dose-response relationship between them. METHODS Relevant prospective studies were identified by a search of PubMed, Embase and Web of Science databases to July 2014. A random-effects model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CI). RESULTS Twenty-three studies involving 937,665 participants and 18,047 patients with CHD were included. Compared with the lowest consumption levels of total fruit and vegetable, fruit and vegetable, the RR of CHD was 0.84 (95% CI, 0.79-0.90), 0.86 (95% CI, 0.82-0.91), 0.87 (95% CI, 0.81-0.93), respectively. The dose-response analysis indicated that, the RR of CHD was 0.88 (95% CI: 0.85-0.91) per 477 g/day of total fruit and vegetable consumption, 0.84 (95% CI: 0.75-0.93) per 300 g/day of fruit intake and 0.82 (95% CI: 0.73-0.92) per 400 g/day of vegetable consumption. A nonlinear association of CHD risk with fruit or vegetable consumption separately was found (P for nonlinearity <0.001). In the subgroup analysis of location, a significant inverse association was observed in Western populations, but not in Asian populations. CONCLUSIONS This meta-analysis indicates that total fruit and vegetable, fruit and vegetable consumption, are significantly associated with a lower risk of CHD. The significant inverse association was found in Western populations, but not in Asian populations, which warrants further research.

Off‐Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta‐Analysis of 251 Cohorts

Background A considerable amount of studies have examined the relationship between off‐hours (weekends and nights) admission and mortality risk for various diseases, but the results remain equivocal. Methods and Results Through a search of EMBASE, PUBMED, Web of Science, and Cochrane Database of Systematic Reviews, we identified cohort studies that evaluated the association between off‐hour admission and mortality risk for disease. In a random effects meta‐analysis of 140 identified articles (251 cohorts), off‐hour admission was strongly associated with increased mortality for aortic aneurysm (odds ratio, 1.52; 95% CI, 1.30–1.77), breast cancer (1.50, 1.21–1.86), leukemia (1.45, 1.17–1.79), respiratory neoplasm (1.32, 1.20–1.26), pancreatic cancer (1.32, 1.12–1.56), malignant neoplasm of genitourinary organs (1.27, 1.08–1.49), colorectal cancer (1.26, 1.07–1.49), pulmonary embolism (1.20, 1.13–1.28), arrhythmia and cardiac arrest (1.19, 1.09–1.29), and lymphoma (1.19, 1.06–1.34). Weaker (odds ratio <1.19) but statistically significant association was noted for renal failure, traumatic brain injury, heart failure, intracerebral hemorrhage, subarachnoid hemorrhage, stroke, gastrointestinal bleeding, myocardial infarction, chronic obstructive pulmonary disease, and bloodstream infections. No association was found for hip fracture, pneumonia, intestinal obstruction, aspiration pneumonia, peptic ulcer, trauma, diverticulitis, and neonatal mortality. Overall, off‐hour admission was associated with increased mortality for 28 diseases combined (odds ratio, 1.11; 95% CI, 1.10–1.13). Conclusions Off‐hour admission is associated with increased mortality risk, and the associations varied substantially for different diseases. Specialists, nurses, as well as hospital administrators and health policymakers can take these findings into consideration to improve the quality and continuity of medical services.

Sleep duration and risk of stroke events and stroke mortality: A systematic review and meta-analysis of prospective cohort studies

BACKGROUND Numerous studies have suggested the relationship between sleep duration and risks of stroke mortality and morbidity, however, the effect estimates varied substantially across studies and it remains unknown how many hours of habitual sleep are associated with the lowest risk of stroke outcomes. Therefore, we performed a dose-response meta-analysis of prospective cohort studies to evaluate the relation of sleep duration with risk of total mortality and stroke events. METHODS PubMed and Embase databases were searched through January 2016, and multivariate-adjusted relative risks were pooled by using fixed-effects models. Semiparametric and dose-response methods were used to assess the relationship of sleep duration and risk of stroke and stroke mortality. RESULTS Eleven articles with 16 independent reports were included in our meta-analysis. An approximate J-shaped relationship was detected between sleep duration and risk of stroke and stroke mortality. No evidence of a curve linear relationship was seen between sleep duration and risk of stroke or stroke mortality. Compared with 7-h sleep duration per day, the pooled relative risks for stroke events were 1.07 (95% CI 1.02-1.12) for each 1-h shorter sleep duration among individuals who slept <7h per day and 1.17 (1.14-1.20) for each 1-h increase of sleep duration among individuals with longer sleep duration and the pooled RR for stroke mortality was 1.17 (95% CI 1.13-1.20) per 1-h increase of sleep duration. CONCLUSIONS Both short and long duration of sleep are predictors of stroke outcomes, and long sleep duration is significant marker of stroke mortality.

Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study.

AbstractThe gate-keeping function of primary healthcare facilities has not been fully implemented in China. This study was aiming at assessing the willingness on community health centers (CHCs) as gatekeepers among a sample of patients and investigating the influencing factors.A cross-sectional survey was conducted in 2013. A total of 7761 patients aged 18 to 90 years from 8 CHCs in Shenzhen (China) were interviewed using a structured questionnaire. Descriptive and multivariable logistic regression analyses were used to analyze the characteristics of patients, their willingness on the gatekeeper policy, and identify the associated factors.On willingness of patients to select CHCs as gatekeepers, 70.03% of respondents were willing, 18.95% were neutral, and 9.02% were unwilling. Multivariable analysis indicated that female patients (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.02–1.30); patients with health insurance (OR = 1.21, 95% CI: 1.07–1.36); patients who lives near CHC (OR = 1.89, 95% CI: 1.17–3.05); and patients who were more familiar with the gatekeeper policy (OR = 2.09, 95% CI: 1.85–2.36), had higher level of willingness on the policy. Conversely, reporting with good health status was independently associated with the decreased willingness on gatekeeper policy (OR = 0.69, 95% CI: 0.53–0.90).The findings indicated that patients’ willingness on CHCs as gatekeepers is high. More priority measures, such as expanding medical insurance coverage of patients, strengthening the propaganda of gatekeeper policy, and increasing the access to community health service, are warranted to be taken. This will help to further improve the patients’ willingness on CHCs as gatekeepers. It is thus feasible to implement the gatekeeper policy among patients in China.

Sleep duration and risk of coronary heart disease: A systematic review and meta-analysis of prospective cohort studies

BACKGROUND Epidemiological studies suggest an association between sleep duration and risk of coronary heart disease, however, the results are controversial. We conducted this systematic review and meta-analysis to summarize the potential dose-response relationship between sleep duration and risk of coronary heart disease. METHODS The electronic reference databases (PubMed and Embase) were searched through January 2016 with selection criteria for relevant studies. Both semiparametric and parametric methods were used to calculate the pooled risk estimates. RESULTS Seventeen articles with 22 independent reports involving 17,841 incident cases of coronary heart disease among 517,440 participants were included in our meta-analysis. A U-shaped relationship was detected between sleep duration and risk of coronary heart disease, with the lowest risk at 7-8h per day. Compared with 7h sleep duration per day, the combined relative risk of coronary heart disease were 1.11 (95% CI=1.05-1.16) for an reduction of 1h and 1.07 (95% CI=1.00-1.15) for an increment of 1h. And the results almost did not change in the subgroup analysis of gender and fatal cases. Exclusion of any single study did not alter the combined relative risk. In addition, visual inspection of funnel plots, Beggs and Eggers tests failed to identify publication bias. CONCLUSIONS Both short and long sleep durations are significantly associated with increased risk of coronary heart disease. Compared with 7h sleep duration per day, the risk of coronary heart disease increases 11% for an hour decrease and increases 7% for an hour increase.

Chinese Version of the EQ-5D Preference Weights: Applicability in a Chinese General Population.

Objectives This study aimed to test the reliability, validity and sensitivity of Chinese version of the EQ-5D preference weights in Chinese general people, examine the differences between the China value set and the UK, Japan and Korea value sets, and provide methods for evaluating and comparing the EQ-5D value sets of different countries. Methods A random sample of 2984 community residents (15 years or older) were interviewed using a questionnaire including the EQ-5D scale. Level of agreement, convergent validity, known-groups validity and sensitivity of the EQ-5D China, United Kingdom (UK), Japan and Korea value sets were determined. Results The mean EQ-5D index scores were significantly (P<0.05) different among the UK (0.964), Japan (0.981), Korea (0.987), and China (0.985) weights. High level of agreement (intraclass correlations coefficients > 0.75) and convergent validity (Pearson’s correlation coefficients > 0.95) were found between each paired schemes. The EQ-5D index scores discriminated equally well for the four versions between levels of 10 known-groups (P< 0.05). The effect size and the relative efficiency statistics showed that the China weights had better sensitivity. Conclusions The China EQ-5D preference weights show equivalent psychometric properties with those from the UK, Japan and Korea weights while slightly more sensitive to known group differences than those from the Japan and Korea weights. Considering both psychometric and sociocultural issues, the China scheme should be a priority as an EQ-5D based measure of the health related quality of life in Chinese general population.

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Background and Purpose— Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. Methods— A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Results— Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients’ stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. Conclusions— A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke.

Tryptophan for the sleeping disorder and mental symptom of new-type drug dependence: A randomized, double-blind, placebo-controlled trial

Introduction: New-type drugs are popular with adolescents and could lead to psychiatry disorders, but no medications have been proven to be effective for these disorders of new-type drug dependence. We aimed to evaluate the efficacy of tryptophan on sleeping disorders and mental symptoms in detoxified individuals with new-type drug dependence. Methods: This randomized, placebo-controlled trial included 80 detoxified individuals with new-type drug dependence, recruited successively from a Compulsory Residential Drug Abstinence Institution in Wuhan, China, from April 2012 to November 2012. Eligible participants were randomly allocated to be treated with tryptophan (1000 mg/d, n = 40) or placebo (n = 40) for 2 weeks. The sleeping disorders and mental symptoms were assessed using Athens Insomnia Scale and Symptom Check-List-90 at baseline and 2 weeks. Results were analyzed according to the “intention-to-treat” approach. Results: Forty-five participants completed the 2-week study, 24 in the tryptophan group and 21 in the placebo group. There were no statistically significant differences in baseline characteristics between groups and the treatment adherence was similar between groups. The reduction in the Athens Insomnia Scale score in the tryptophan group was significantly greater than that in the placebo group (P = 0.017). However, no significant differences were found in Symptom Check-List-90 scores (either by individual dimension or the overall score) between groups (all P > 0.05). The frequency of adverse events was similar and no serious adverse events were reported during the study. Conclusion: Tryptophan was unlikely to be effective for mental symptoms, but could alleviate sleep disorders in short term among detoxified individuals with new-type drug dependence. Future large-scale trials are required to confirm findings from this study.

The effect of body mass index and physical activity on hypertension among Chinese middle-aged and older population

Few studies have been conducted to explore the independent and combined associations of body mass index (BMI) and physical activity with risk of hypertension in Chinese population. A cross-sectional study of 5291 individuals (aged ≥ 40 years) selected using multi-stage sampling method was conducted from October 2013 to December 2015. In the present analysis, 55.64% of the participants were women, and the mean age of participants was 55.37 ± 10.56. Compared with individuals in normal group, the risks of hypertension were nearly double in overweight subjects (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.53–2.05) and more than three times higher in obese subjects (3.23, 2.62–4.13). Multi-adjusted odds for hypertension associated with low, moderate, and high physical activity were 1.44 (1.17–1.86), 1.40 (1.09–1.79) and 1.000, respectively. In comparison with normal weight subjects who reported high levels of physical activity, subjects who reported both low levels of physical activity and obesity showed the highest risk of hypertension (5.89, 3.90–8.88). In conclusion, both elevated BMI and reduced physical activity appear to play an important role in the risk of hypertension among Chinese middle-aged and older population. The risk of hypertension associated with overweight and obesity can be reduced considerably by increased physical activity levels.

Prevalence and risk factors associated with stroke in middle-aged and older Chinese: A community-based cross-sectional study

Although the prevalence of stroke and its risk factors has been widely reported in some Western countries, information on essential stroke parameters is lacking in China, the most populous nation. A community-based cross-sectional study with 8,018 Chinese adults aged ≥40 years was used to determine the prevalence of stroke and associated risk factors. Within the screened population, the prevalence of stroke was 2.21% for both sexes, 1.60% for females, and 3.18% for males. Prevalence increased with age in both sexes (P < 0.0001). In a multivariable model, factors significantly associated with stroke were increasing age (odds ratio [OR] = 1.87, 95% CI: 1.58–2.24), male gender (OR = 2.03, 95% CI: 1.42–2.90), family history of stroke (OR = 4.33, 95% CI: 2.89–6.49), history of hyperlipidemia (OR = 1.87, 95% CI 1.31–2.68), history of hypertension (OR = 1.47, 95% CI 1.02–2.12), and physical inactivity (OR = 1.74, 95% CI: 1.16–2.59). The findings indicate that stroke prevalence in middle-aged and older Chinese adults is higher in males than in females, and increases with age in both sexes. Population-based public health intervention programs and policies targeting hyperlipidemia and hypertension control and encouragement of physical activity should be highly prioritized for middle-aged and older adults in Shenzhen, China.