Xiaoxv Yin

A systematic review of antibiotic utilization in China

OBJECTIVES Reliable data about antibiotic utilization in the large pharmaceutical market of the worlds most populous country, the Peoples Republic of China, are in short supply. Although many primary studies have investigated the use of antibiotics in China, most of the relevant studies were published in the Chinese language. This systematic review aims to summarize reported percentages of outpatient encounters resulting in the prescription of antibiotics in China. METHODS We systematically searched and reviewed studies of antibiotic prescribing patterns in China, published in Chinese or English between 2000 and August 2012. The study quality was assessed and the overall percentage of outpatient encounters resulting in the prescription of antibiotics was calculated using random-effects meta-analysis. Subgroup analyses were conducted to investigate heterogeneity across studies. RESULTS We included 57 eligible studies (with a total of 556 ,435 outpatient encounters). The overall percentage of outpatients prescribed antibiotics was 50.3% (95% CI: 47.4%-53.1%). Of the outpatients prescribed antibiotics, 74.0% (95% CI: 71.3%-76.6%) were prescribed one antibiotic, 23.3% (95% CI: 21.1%-25.7%) were prescribed two antibiotics and 2.0% (95% CI: 1.3%-2.8%) were prescribed three or more antibiotics. The proportion of antibiotic utilization differed greatly across hospital levels and geographical regions and fluctuated over time. CONCLUSIONS The percentage use of antibiotics is high in China. The excessive use of antibiotics is particularly more problematic in lower-level hospitals and in less developed western China. The implementation and impact of the national efforts to control the excessive use of antibiotics should be appropriately evaluated.

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.

Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study.

Background Physicians’ poor mental health not only hinders their professional performance and affects the quality of healthcare provided but also adversely affects patients’ health outcomes. Few studies in China have evaluated the mental health of physicians. The purposes of this study are to quantify Chinese physicians’ anxiety and depressive symptoms as well as evaluate associated risk factors. Methods In our study, 2641 physicians working in public hospitals in Shenzhen in southern China were recruited and interviewed by using a structured questionnaire along with validated scales testing anxiety and depressive symptoms. Multivariable logistic regression models were used to identify risk factors for anxiety and depressive symptoms. Results An estimated 25.67% of physicians had anxiety symptoms, 28.13% had depressive symptoms, and 19.01% had both anxiety and depressive symptoms. More than 10% of the participants often experienced workplace violence and 63.17% sometimes encountered it. Among our study population, anxiety and depressive symptoms were associated with poor self-reported physical health, frequent workplace violence, lengthy working hours (more than 60 hours a week), frequent night shifts (twice or more per week), and lack of regular physical exercise. Conclusions Our study demonstrates that anxiety and depressive symptoms are common among physicians in China, and the doctor-patient relationship issue is particularly stressful. Interventions implemented to minimize workload, improve doctor-patient relationships, and assist physicians in developing healthier lifestyles are essential to combat anxiety and depressive symptoms among physicians, which may improve their professional performance.

Prevalence of depressive symptoms and work-related risk factors among nurses in public hospitals in southern China: A cross-sectional study

Poor mental health among nurses not only hinders professional performance but also affects the quality of healthcare provided. To improve the prevention and management of depression among nurses in mainland China, we investigated the association between working conditions and depressive symptoms using a cross-sectional study with a sample of 3474 nurses with more than 1 year of work experience in public hospitals in Shenzhen in southern China. Participants completed a structured questionnaire and a validated measure of depressive symptoms. Multivariable linear mixed models were used to identify work-related risk factors for depressive symptoms scores. An estimated 38% of nurses had depressive symptoms. More than 10% of the nurses often experienced workplace violence, and 64.22% encountered it occasionally. Depressive symptoms were associated with frequent workplace violence, long working hours (more than 45 hours per week), frequent night shifts (two or more per week), and specific departments. These findings indicate that interventions to minimize workload and improve nurse–patient relationships are essential to combat depressive symptoms among nurses. Additionally, in the prevention and management of depression among nurses, we must consider inter-department differences.

Non-adherence to anti-tuberculosis treatment among internal migrants with pulmonary tuberculosis in Shenzhen, China: a cross-sectional study

BackgroundNon-adherence to tuberculosis (TB) treatment threatens the success of treatment, increases the risk of TB spread, and leads to the development of drug resistance. The present study assessed non-adherence to anti-TB treatment among internal migrants with pulmonary TB living in Shenzhen, China, and examined risk factors for non-adherence in order to identify targets for intervention.MethodsA total of 794 internal migrants with TB treated at Bao’an Hospital for Chronic Disease Prevention and Cure, Shenzhen, were recruited. Structured questionnaires were used to collect data on these patients’ history and experiences with TB treatment. Ordinal logistic regression model were used to identify risk factors for non-adherence.ResultsThe proportion of patients who had missed one dose of medication within two weeks was 93/794 (11.71%), and those who missed at least two doses of medication within two weeks was 167/794 (21.03%), with a total of 33.74% of patients not adhering to TB treatment. Lack of knowledge about TB treatment and longer travel time to the nearest community health centers are significant predictors for non-adherence.ConclusionsThe present study shows that non-adherence is common among internal migrants with TB. Patients who lack knowledge about TB treatment or have to travel far to get treated are prone to miss one or more doses of medication. Interventions to improve health education and healthcare access are essential to reduce non-adherence to TB treatment among internal migrants.

Hepatitis B virus status and the risk of pancreatic cancer: a meta-analysis.

Objective Whether hepatitis B virus (HBV) infection increases the risk of pancreatic cancer (PaC) is controversial. We carried out a meta-analysis to evaluate the association between HBV status and the risk of PaC. Methods PubMed, Embase, and the China National Knowledge Infrastructure were searched from their inception through April 2012 for case–control and cohort studies that have reported an association between HBV status and the risk of PaC. The reference lists of pertinent publications were also reviewed for potential studies. Methodological quality was assessed using the Newcastle–Ottawa Quality Assessment Scale. A random-effects model was used to summarize odd ratios (ORs) and 95% confidence intervals (CIs). Results We included seven case–control studies and three cohort studies, involving 5883 PaC cases. The summary OR of developing PaC was 1.22 (95% CI: 0.90–1.67) for individuals who were HBV surface antigen (HBsAg)-positive. Compared with the individuals who were never exposed to HBV infection, the summary OR of the risk of PaC was 1.60 (95% CI: 1.26–2.05) for chronic or inactive HBsAg carriers (HBsAg-positive) and 1.76 (95% CI: 1.05–2.93) for anti-HBc-positive but anti-HBs-negative individuals. Conclusion Inactive HBsAg carrier status and possible occult HBV infection may increase the risk of PaC. Large population-based multicenter prospective studies are required to further confirm this finding.

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.

Consumption of hot beverages and foods and the risk of esophageal cancer: a meta-analysis of observational studies

BackgroundPrevious studies have mostly focused on the effects of specific constituents of beverages and foods on the risk of esophageal cancer (EC). An increasing number of studies are now emerging examining the health consequences of the high temperature of beverages and foods. We conducted a meta-analysis to summarize the evidence and clarify the association between hot beverages and foods consumption and EC risk.MethodsWe searched the PubMed, Embase, and Web of Science databases for relevant studies, published before May 1, 2014, with the aim to estimate the association between hot beverage and food consumption and EC risk. A random-effect model was used to pool the results from the included studies. Publication bias was assessed by using the Begg test, the Egger test, and funnel plot.ResultsThirty-nine studies satisfied the inclusion criteria, giving a total of 42,475 non-overlapping participants and 13,811 EC cases. Hot beverage and food consumption was significantly associated with EC risk, with an odds ratio (OR) of 1.82 (95% confidence interval [CI], 1.53–2.17). The risk was higher for esophageal squamous cell carcinoma, with a pooled OR of 1.60 (95% CI, 1.29–2.00), and was insignificant for esophageal adenocarcinoma (OR: 0.79; 95% CI: 0.53–1.16). Subgroup analyses suggests that the association between hot beverage and food consumption and EC risk were significant in Asian population (OR: 2.06; 95% CI: 1.62-2.61) and South American population (OR: 1.52; 95% CI: 1.25-1.85), but not significant in European population (OR: 0.95; 95% CI: 0.68-1.34).ConclusionsHot beverage and food consumption is associated with a significantly increased risk of EC, especially in Asian and South American populations, indicating the importance in changing people’s dietary habits to prevent EC.

Development and Validation of a Tuberculosis Medication Adherence Scale

Background Medication adherence is critical in Tuberculosis (TB) treatment success, but existing tools are inadequate in identifying non-adherents, reasons for non-adherence or interventions to improve adherence. This study intended to fill the gap by developing and validating a TB medication adherence scale (TBMAS). Methods An initial 41-item TBMAS was designed through review of literature, consultation from an 8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as external criteria for medication adherence. After removing redundant and cross-loading items, the internal consistency, reliability and validity of TBMAS in identifying non-adherents were examined. Results The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded in nine distinct factors that explained 65% of cumulative variance among respondents. Cronbachs alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent validity was supported by statistically significant associations between TBMAS scores and adherence measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in identifying non-adherents. Conclusion TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying TB patients with poor adherence and potential causes for non-adherence.

Pseudo-parallel genetic algorithm for reactive power optimization

In this paper, static voltage stability is considered in reactive optimization via the minimum singular value of the Jacobian matrix of converged power flow, and a pseudo-parallel genetic algorithm is introduced to find the global optimal results and avoid premature of conventional simple genetic algorithm. Two simple test systems are employed to verify the effectiveness of the proposed model and algorithm. Simulations results show that both operational and economical performances of test power systems are improved after optimization, and either the optimal results or the convergent characteristics of the proposed algorithm are superior to those of the simple genetic algorithm.