This study examined whether exposure to nitrate in drinking water is associated with increased risk for bladder cancer by conducting a comprehensive literature research. A meta-analysis was performed with and without adjustment for confounding factors. Three groups (reference, intermediate and high groups) were established in terms of different nitrate concentrations in each included study. Separate relative risk measures were calculated for intermediate and high groups. Heterogeneity was assessed by using the Q statistics. Publication bias was evaluated by Egger's and Begg's test. Quality assessment for studies was performed by using the Newcastle-Ottawa scale. Two cohorts, two case-controls, and one ecological study were included in this study. The adjusted data showed that the combined risk ratios (RRs) were 1.13 (95% CI: 0.81 to 1.57) and 1.27 (95% CI: 0.75 to 2.15) for intermediate and high groups respectively. For unadjusted data, the corresponding RRs were 1.18 (95% CI: 0.89 to 1.57) and 1.29 (95% CI: 0.81 to 2.07). Sensitivity test indicated that results were significantly underestimated when Ward's study was included. No significant publication bias was found. There was heterogeneity among studies. The results suggested that there was no sufficient evidence that nitrate in drinking water is associated with increased risks for bladder cancer.

Objective: To prepare and in vitro evaluate the self-microemulsifying drug delivery system (SMEDDS) of adefovir dipivoxil (ADV).Methods: The optimized formula was screened by solubility, compatibility, ternary phase diagram and orthogonal design with the self-emulsifying time and particle size of microemulsion as the indices.The property of self-emulsification and the dissolution in vitro of ADV-SMEDDS were also determined.Results: The optimized SMEDDS was composed of Cremophor EL35 (37.5%), Transcutol HP (37.5%) and PECEOL (25%), and the drug loading was 3%.The ADV-SMEDDS formed stable microemulsion after the dilution by 50-fold amount of water in 24 s, the average particle size was (26.30±0.46) nm, the zeta potential was (-8.96±0.57) mV, and the dissolution was more than 85% in 5 min.Conclusion: The optimized formula of ADV-SMEDDS has significantly enhanced solubility and dissolution of adefovir dipivoxil in vitro.

Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.

This study examined whether exposure to nitrate in drinking water is associated with increased risk for bladder cancer by conducting a comprehensive literature research. A meta-analysis was performed with and without adjustment for confounding factors. Three groups (reference, intermediate and high groups) were established in terms of different nitrate concentrations in each included study. Separate relative risk measures were calculated for intermediate and high groups. Heterogeneity was assessed by using the Q statistics. Publication bias was evaluated by Egger's and Begg's test. Quality assessment for studies was performed by using the Newcastle-Ottawa scale. Two cohorts, two case-controls, and one ecological study were included in this study. The adjusted data showed that the combined risk ratios (RRs) were 1.13 (95% CI: 0.81 to 1.57) and 1.27 (95% CI: 0.75 to 2.15) for intermediate and high groups respectively. For unadjusted data, the corresponding RRs were 1.18 (95% CI: 0.89 to 1.57) and 1.29 (95% CI: 0.81 to 2.07). Sensitivity test indicated that results were significantly underestimated when Ward's study was included. No significant publication bias was found. There was heterogeneity among studies. The results suggested that there was no sufficient evidence that nitrate in drinking water is associated with increased risks for bladder cancer.
Drinking Water ; adverse effects ; Humans ; Nitrates ; adverse effects ; Risk Factors ; Urinary Bladder Neoplasms ; etiology

Objective To evaluate the influence of data quality on the sensitivity of early warning syndromic surveillance system based on medical institutions in Qianjiang,Hubei province and explore the relationship between data quality and sensitivity of early warning of the system.Methods The delay reporting rate and underreporting rate were calculated for the evaluation of the data quality.Data obtained from semi-synthetic simulated outbreak and area under the curve (AUC) were used in combination to test the sensitivity of early warning of various models and select the optimal model.Time-series generalized additive model (GAM) was used to analyze the curve fitting and threshold effect between data quality and early warning sensitivity of the system.Results A total of 179 905 cases were reported from April 1,2012 to January 31,2014,in which 8 744 were not reported timely (16.45％).Averagely 416 reporting were delayed in each month.There were 2 566 cases which were underreported (4.83％).Compared with other early warning models,i.e.Cumulative Sum (CUSUM),Shewhart,Exponentially Weighted Moving Average (EWMA),Early Aberration Reporting System (EARS-3C),the MA model had the maximum area under the curve (AUC=0.93),and the difference was significant (P＜0.001).The early warning sensitivity ranged from 84.89％ to 97.25％ during the operation period of the syndromic surveillance system.Underreporting had influence on early warning sensitivity,when underreporting rate was over 2.78％,the sensitivity would decrease obviously.No obvious associations were observed between the delay reporting rate and early warning sensitivity of the system.Conclusion The data quality had influence on the early warning sensitivity of the syndromic surveillance system based on medical institution in Qianjiang.In the context of this study,underreporting had the main influence on the sensitivity of early warning.

OBJECTIVETo analyze absentees due to injury among primary school pupils in Hubei, 2012-2013; and to provide theoretical basis for the prevention and control of injuries.

METHODSA total of 32 primary schools in Qianjiang city and Shayang county were sampled to conduct injury absenteeism surveillance, and the total number of students was 21 493. The surveillance contents included absent dates, genders, grades, initial or return absent, and the detailed absent reasons. The classification of injury was based on the 10th Revision of the international classification of diseases developed by WHO. Data from 2012-2013 school-year were extracted from the surveillance system for analysis. The total surveillance period was 182 days, of which the fall semester was 98 days and the spring semester was 84 days. The absenteeism rate and injury rate in different characteristics of primary school students were compared by χ² test, and the possible risk factors of injury were preliminary explored by calculating the RR (95% CI) value.

RESULTSThe total daily injury absenteeism rate was 8.26/100 100 during 2012-2013 school-year in 32 primary schools in Hubei province, which was higher in fall semester (9.16/100 000), Qianjiang area (9.63/100 000), rural primary schools (13.44/100 000), boys (9.57/100 000), 1-2 grades (10.41/100 000), and the differences were significant (P < 0.05). The total injury rate was 0.46%. Rural primary schools (RR = 2.32, 95% CI: 1.46-3.70), boys (RR = 1.88, 95% CI: 1.23-2.87), and 3-4 grades (RR = 1.85, 95% CI: 1.10-3.09) were identified as high-risk factors, while using city primary schools, girls, and 5-6 grades as references, respectively.

CONCLUSIONThe injury absenteeism rate and injury rate were more higher in rural primary schools, boys and low or middle grades in Hubei province during 2012 to 2013 school year, so monitoring and preventive measures should be focused on those students.

Absenteeism ; Adolescent ; Child ; Female ; Humans ; Male ; Risk Factors ; Rural Population ; Schools ; Sex Factors ; Students ; Wounds and Injuries

Objective To analyze absentees due to injury among primary school pupils in Hubei , 2012-2013;and to provide theoretical basis for the prevention and control of injuries.Methods A total of 32 primary schools in Qianjiang city and Shayang county were sampled to conduct injury absenteeism surveillance , and the total number of students was 21 493.The surveillance contents included absent dates , genders, grades, initial or return absent , and the detailed absent reasons.The classification of injury was based on the 10th Revision of the international classification of diseases developed by WHO.Data from 2012-2013 school-year were extracted from the surveillance system for analysis.The total surveillance period was 182 days, of which the fall semester was 98 days and the spring semester was 84 days.The absenteeism rate and injury rate in different characteristics of primary school students were compared by χ2 test, and the possible risk factors of injury were preliminary explored by calculating the RR ( 95%CI ) value.Results The total daily injury absenteeism rate was 8.26/100 100 during 2012-2013 school-year in 32 primary schools in Hubei province , which was higher in fall semester ( 9.16/100 000 ) , Qianjiang area ( 9.63/100 000), rural primary schools (13.44/100 000), boys (9.57/100 000), 1-2 grades (10.41/100 000), and the differences were significant ( P<0.05 ).The total injury rate was 0.46%.Rural primary schools (RR=2.32, 95%CI:1.46-3.70), boys (RR=1.88, 95%CI:1.23-2.87), and 3-4 grades (RR=1.85, 95%CI:1.10-3.09) were identified as high-risk factors, while using city primary schools , girls, and 5-6 grades as references , respectively.Conclusion The injury absenteeism rate and injury rate were more higher in rural primary schools , boys and low or middle grades in Hubei province during 2012 to 2013 school year, so monitoring and preventive measures should be focused on those students .

Objective To analyze absentees due to injury among primary school pupils in Hubei , 2012-2013;and to provide theoretical basis for the prevention and control of injuries.Methods A total of 32 primary schools in Qianjiang city and Shayang county were sampled to conduct injury absenteeism surveillance , and the total number of students was 21 493.The surveillance contents included absent dates , genders, grades, initial or return absent , and the detailed absent reasons.The classification of injury was based on the 10th Revision of the international classification of diseases developed by WHO.Data from 2012-2013 school-year were extracted from the surveillance system for analysis.The total surveillance period was 182 days, of which the fall semester was 98 days and the spring semester was 84 days.The absenteeism rate and injury rate in different characteristics of primary school students were compared by χ2 test, and the possible risk factors of injury were preliminary explored by calculating the RR ( 95%CI ) value.Results The total daily injury absenteeism rate was 8.26/100 100 during 2012-2013 school-year in 32 primary schools in Hubei province , which was higher in fall semester ( 9.16/100 000 ) , Qianjiang area ( 9.63/100 000), rural primary schools (13.44/100 000), boys (9.57/100 000), 1-2 grades (10.41/100 000), and the differences were significant ( P<0.05 ).The total injury rate was 0.46%.Rural primary schools (RR=2.32, 95%CI:1.46-3.70), boys (RR=1.88, 95%CI:1.23-2.87), and 3-4 grades (RR=1.85, 95%CI:1.10-3.09) were identified as high-risk factors, while using city primary schools , girls, and 5-6 grades as references , respectively.Conclusion The injury absenteeism rate and injury rate were more higher in rural primary schools , boys and low or middle grades in Hubei province during 2012 to 2013 school year, so monitoring and preventive measures should be focused on those students .

Nosocomial infection poses a significant threat to patient safety and increase their disease burden. Outbreaks of nosocomial infection are the main harmfulness associated with nosocomial infection, which making them socially sensitive issues. Nosocomial infection surveillance and warning are core contents of nosocomial infection management. Accurate early warning technology for nosocomial infection outbreaks can reflect the management capability of infection prevention and control. This study designed an early warning system based on a multi-dimensional and multi-scale comprehensive information surveillance mode for nosocomial infection outbreaks which was launched in March 2023. This system extracted the process-related indicators of nosocomial infection from various hospital information systems into the nosocomial infection database center. Under the multi-dimensional and multi-scale surveillance mode, the process-related data were stratified according to the predefined dimensions and scales, then generating time-series datasets of numerous subgroups. The system conducted weekly for all time-series datasets of subgroups based on warning rules, and subsequently sent out warning signals to managers. These warning signals could be verified by managers through data check, case verification and epidemiological investigation. Once a nosocomial infection outbreak was confirmed, intervention measures could be implemented promptly. In practical application, the system generated warning signals for nosocomial infection clusters in 12 departments on August 7th, 2023. The traditional nosocomial infection case report system ultimately reported 54 nosocomial infection cases, which distributed across 13 departments, with clusters(more than 3 cases) observed in 6 departments. All these 6 departments received warning signals generated from our system. It has been demonstrated that our system could predicted the nosocomial infection clusters 5.3 days earlier than the traditional nosocomial infection case report system on average, with warning sensitivity of 100.0% and positive predictive value of 50.0%. Early warning under the multi-dimensional and multi-scale comprehensive information surveillance mode was able to transform the work pattern of nosocomial infection outbreaks control and management from passive to active. Particularly it has advantages in early detection for occult outbreaks, providing a valuable support for improving nosocomial infection management capability.