Objective To analyze the factors affecting the development of genome technology-based genetic testing services. Methods Purposive sampling was used to select experts in the field of genome or genetic testing. Following interview with 11 experts,data was obtained from 25 individuals and analyzed by using quantitative SWOT analysis, including the concept of SWOT method, Analytic Hierarchy Process,Internal Factor Evaluation ( IFE ) Matrix, and External Factor Evaluation ( EFE ) Matrix. Consistent ratio (CR) was chosen to test the logic. Results Of the 15 critical affecting factors, the weighting coefficient of deficiency of laws and market regulations, state supporting policies, and lack of intellectual property protection was 0. 099,0. 091 and 0. 087, respectively. The development of genetic testing services was found in the third quadrant of SWOT analysis. Conclusion These findings suggest that defensive strategy should be taken to improve genetic testing services and to reduce the risk of genetic testing.

Cervical cancer is one of the most common malignancies among women. Screening programs for cervical cancer have been implemented in many developed countries. Comprehensive systems for cervical cancer prevention and control have improved over the past 30 years, which has led to a significant decline in the morbidity and mortality of cervical cancer. Since 2009, the Chinese government has conducted the Cervical Cancer and Breast Cancer Screening Program for Rural Women on a national scale, which has substantially improved cervical cancer prevention and control. However, a comprehensive system for cervical cancer prevention has been not established in China. It is essential to investigate suitable strategies for cervical cancer prevention system in the country by referring to the experiences of developed nations in comparison with the situation in China, with respect to system operations, compatibility with the existing health care system, choice of suitable technologies, and information and evaluation platforms.

OBJECTIVETo compare design-based and model-based methods in descriptive analysis of complex sample.

METHODSA total of 1 000 samples were selected and a multistage random sampling design was used in the analysis of the 2010 China chronic disease and risk factors surveillance. For each simulated sample, cases with probability proportional age were randomly deleted so that sample age structure was deviated systematically from that of the target population. Mean systolic blood pressure (SBP) and prevalence of raised blood pressure, as well as their 95% confidence intervals (95%CI) were determined using design-based and model-based methods (routine method and multi-level model). For estimators generated from those 3 methods, mean squared error(MSE) was computed to evaluate their validity. To compare performance of statistical inference of these methods, the probability of 95%CI covering the true parameter(mean SBP and raised blood pressure prevalence of the population) was used.

RESULTSMSE of mean estimator for routine method, design-based analysis and multilevel model was 6.41, 1.38, and 5.86, respectively; and the probability of 95%CI covering the true parameter was 24.7%, 97.5% and 84.3%, respectively. The routine method and multi-level model probably led to an increased probability of type I error in statistical inference. MSE of prevalence estimator was 4.80 for design-based method, which was far lower than those for routine method (20.9) and multilevel model (17.2). Probability of 95%CI covering the true prevalence for routine method was only 29.4%, and 86.4% for multilevel model, both of which were lower than that for design-based method (97.3%).

CONCLUSIONCompared to routine method and multi-level model, design-based method had the best performance both in point estimation and confidence interval construction. Design-based method should be the first choice when doing statistical description of complex samples with a systematically biased sample structure.

Objective: To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area (NACCSPRA) on population-based screening rates. Methods: The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance (CDRFS2013), which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval (95%CI) were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by multivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1∶1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Results: Among 65 476 subjects, 48.6% (n=31 794) was in the screening areas. Before matching, in the rural area the screening rate in the screening areas (24.0% (4 763/19 838), 95%CI: 21.8%-26.3%) was higher than that in the control areas (15.6% (2 331/14 942), 95%CI: 13.4%-17.8%); whereas in the urban area the screening rate in the screening areas (28.5% (3 413/11 956), 95%CI: 26.1%-31.0%) was similar to that in the control areas (26.3% (4 923/18 740), 95%CI: 24.1%-28.4%). After matching, in rural area the screening rate in the screening areas (23.2% (3 454/14 875), 95% CI: 20.9%-25.5%) was higher than that in the control areas (15.6% (2 315/14 875), 95% CI: 13.3%-17.8%); in urban area the screening rate in the screening areas (28.7% (3 202/11 146), 95% CI: 26.2%-31.2%) was higher than that in the control areas (23.1% (2 571/11 146), 95%CI: 20.9%-25.3%). Multivariate conditional logistic regression model showed that the cervical cancer screening rates in intervention areas significantly increased among women aged 35-64 years both in urban areas (OR=1.44, 95%CI: 1.34-1.54) and rural areas (OR=1.78, 95%CI: 1.67-1.90) as compared with those in control areas. Conclusion The implementation of Chinese cervical cancer screening program during the five years substantially increased the population-based screening rates both in urban and rural areas.

Objective To understand the prevalence of chronic obstructive pulmonary disease (COPD) among the community population aged ≥40 years in China from 1990 to 2014.Methods The studies on the prevalence of COPD among the community population in China published from 1990 to 2014 were retrieved from the following databases:Chinese BioMedical Literature Database (CBM),Chinese Journal Full-text Database (CNKI),Wanfang Database,PubMed and EBSCO.Mantel-Haenszel fixed effect and random effect model and software Stata were used for statistical analysis.Results A total 30 studies were included in the Meta analysis.The pooled prevalence of COPD was 9.9％ (95％ CI:8.8％-11.0％).The prevalence was higher in males (13.0％,95％ CI:11.5％-14.4％) than in females (5.8％,95％CI:4.9％-6.6％),and the prevalence of COPD increased with age obviously from 3.2％ in age group 40-49 years (95％ CI:2.5％-3.9％) to 20.3％ in age group ≥70 years (95％CI:18.2％-22.4％).The differences in prevalence among different areas had no statistical significance.Conclusions The prevalence of COPD in population aged ≥40 years increased gradually in China in recent 20 years.Obvious heterogeneity was found among the results of the studies due to the different diagnostic standards and sample sizes.

Objective To analyze the relationship between N-nitrosodimethylamine (NDMA) and the risk of digestive tract cancers.Methods The papers about the relationship between NDMA and the risk of digestive tract cancers published from 1980 to 2012 were retrieved following databases:Chinese BioMedical Literature Database (CBM),the Chinese Journal Full-text Database (CNKI),Wanfang Database,PubMed and EBSCO.The fix and random effect model was used and statistical analyses were conducted by using RevMan 5.1 software.Results Thirteen papers were found,in which 7 about digestive tract cancers were used in this Meta analysis.The NDMA had significant positive effect on the incidence of digestive tract cancers (RR=1.12,95％ CI:1.03-1.21).The relationship between NDMA and esophageal cancer was not significant (RR =1.18,95 ％CI:0.98-1.41) but NDMA could increase the risk of gastric cancer (RR=1.08,95％ CI:1.00-1.18).For the subtypes of esophageal and gastric cancer,NDMA had positive relationship with esophageal squamous cell carcinoma (RR=l.72,95％ CI:1.01-2.96),but had no significant relationship with esophageal adenocarcinoma,cardiac carcinoma and gastric adenocarcinoma.Conclusion The population-based cohort studies have showed that the NDMA could significantly increase the risk of digestive tract cancers,but the effects differed with subtypes of esophageal and gastric cancer.However,it is necessary to collect more evidence due to the limited studies and obvious differences in the study design,sampling and exposure measurement of these cohort studies.

Objective:Biobank construction plays an irreplaceable role in the research of accurate prevention and treatment of diseases. Shared biobank network based on a large crowd queue is the way of the future. This subject is one of the key contents of national precision medicine "The Breast Cancer Cohort Study in Chinese Women: (BCCS-CW)" , aiming to solve the bottleneck of insufficient standardization and sharing.Methods:The establishment of "entity library-information library-extension library" , the widely Shared network of biobank of breast cancer specific disease cohort, and the establishment of strict standard setting and quality control standard to construct the standardized biobank.Results:This biobank provides a shared biobank resource for breast cancer risk assessment, prediction and early warning, early screening, classification, individualized treatment, efficacy and safety prediction and monitoring and other accurate prevention and treatment programs and clinical decision-making system research.Conclusion:The data of this biological sample bank is refined and complete, and the sample size of cases is sufficient, which can meet the research needs of medical big data, genomics, metabonomics, epigenetics and other fields.

Objective To analyze the mortality of cervical cancer and its temporal trend in women in China between 2006 and 2012.Methods The cause-of-death data about cervical cancer,which was abstracted from National Disease Surveillance Points and adjusted by special survey for underreporting,was used to analyze the age and area specific crude mortality rates of cervical cancer in China during 2006-2012.The age-standardized mortality rate was calculated by using world standardized population (Segi's).The Joinpoint regression model was used to obtain annual percentage change and 95％CI for assessing the time trend of mortality rate of cervical cancer from 2006 to 2012.Results In 2012,the crude mortality rate of cervical cancer was 3.15 per 100 000 in women in China.The mortality rate in rural area (3.45/100 000) was higher than that in urban area (2.76/100 000),while the central area had the highest mortality rate of cervical cancer (3.77/100 000) compared with western area (3.23/100 000) and eastern area (2.54/100 000).The Segi's age-standardized mortality rate in eastern area increased by 2.9％ (95％CI:0.8％-5.0％) annually,an increase of 6.0％ was observed in age group 30-59 years (95％CI:1.6％-10.5％).However,the Segi's age-standardized mortality rate in central area declined by 4.6％ (95％CI:-5.9％--3.3％),where the declines of 3.2％ and 5.7％ were observed in age groups 30-59 years and ≥60 years (95％ CI:-5.0％--1.4％ and 95％ CI:-9.3％--2.0％) and respectively.There was no significant change in cervical cancer mortality in western area.The similar trends were observed in the age-standardized mortality rate calculated according to the population of China.Conclusions The decline of overall mortality rate of cervical cancer tended to stop in China and significant differences still exist among different areas.Our results suggest that the central/western areas and rural areas are still key areas for cervical cancer prevention and control and close attention should be paid to the increase of cervical cancer mortality in women aged 35-59 years in eastern area.It is essential to establish a systematic cervical cancer prevention network with larger population coverage to reduce the deaths caused by cervical cancer.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective:To understand the rate of spirometry examination and its related factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China from 2014 to 2015, and provide evidence for diagnosis, treatment and management of COPD patients normatively.Methods:Data were obtained from 2014-2015 COPD surveillance, China. The previous lung function examination status and other information of the subjects were collected by face-to-face survey. We defined COPD as a post-bronchodilator FEV 1: FVC less than 70%. A total of 9 130 COPD patients were included in the analysis of this study. The rate of spirometry examination and its 95% confidence interval ( CI) were estimated in COPD patients aged ≥40 years with complicated sampling weights. Meanwhile, the spirometry examination related factors were analyzed. Results:The estimated rate of spirometry examination among COPD patients was 5.9% (95% CI: 4.9%-6.9%), 6.1% (95% CI: 5.2%-7.1%) for men and 5.3% (95% CI: 4.0%-6.6%) for women. The rate was significantly higher in urban population than in rural ( P<0.001). With the increase of education level, the rate of spirometry examination among COPD patients increased gradually ( P<0.001). The rate of spirometry examination was 4.0% (95% CI: 3.1%-4.9%) among COPD patients in agricultural industry. The rate of spirometry examination among COPD patients with awareness of pulmonary function test was 32.3% (95% CI: 26.4%-38.1%). The rate of spirometry examination among COPD patients with previous chronic respiratory disease and respiratory symptoms were 13.7%(95% CI:11.5%-15.9%), 8.8%(95% CI:7.2%-10.4%), respectively. The rate of spirometry examination among COPD patients exposed to occupational dust and/or harmful gases was 5.7% (95% CI: 4.6%-6.9%). The rate of spirometry examination in former smokers among COPD patients was 10.2% (95% CI: 8.0%-12.4%), higher than those in current smokers (4.2%, 95% CI: 3.3%-5.1%) and non-smokers (6.3%, 95% CI: 5.1%-7.6%). Conclusion:The rate of spirometry examination is extremely low among COPD patients aged ≥40 in China, and the standardized diagnosis, treatment and management of COPD patients need to be improved urgently.