Objective To evaluate the strength of tobacco control at or below county-level governments of Zhejiang Province,to explore the strategies and measures on tobacco control,and promote a smoke-free government.Methods By multistage stratified random sampling method,12 government ageucies were selected in 4 counties.The information of tobacco control strength and smoke-free environment creation was collected by interview and field observation,and the scores were calculated by using the percentage assignment method.An intercept suuvey was carried out in four counties and there were 405 civil servants under investigation.The data were analyzed by frequency statistic and correlation analysis.Results The smoking rate of civil servants was 17.8％,and the secondhand smoking rate was 61.9％;84.7％ of civil servants adnmitted the harm of smoking and 96.8％ admitted the harm of secondhand smoking.Support for forbidding the cigarette advertisements was highest and increasing the cigarette price was the weakest.The scores of smoke-free environment creation of project counties showed that the average score was 50.60,Zhuji and Luqiao got a maximum score of 57.14,Haiyan got a minimum score of 42.86.The scores of tobacco control strength showed that the average score was 82.35,Zhuji got a maximum score of 92.16,followed by Luqiao,Jiande and Haiyan counties,82.35,80.39 and 74.51 respectively.The scores of tobacco control strength,include policy,political will,capacity,and tobacco control efforts were the highest in Zhuji county.The results of correlation analysis showed that the total score of tobacco control strength had significant association with the score of smoke-free environment creation,smoking rate of civil servants,and approval rate of anti smoking in public places (P＜0.05).Conclusion The overall situation of tobacco control strength at or below county-level governments of Zhejiang province is good,but there is a relative shortage of smoke-free environment creation.Civil servants master the knowledge related to tobacco and support tobacco control policy.We should further promote the construction of smoke-free government.More effective smoking control measures should be conducted in order to raise the strength of tobacco control and finally implement the tobacco control legislation.

Objective To understand the prevalence of tobacco use among college students in different populations by sex,age and major,and to provide evidence for smoking control and health decision.Methods A total of 4 638 college students selected in 21 colleges through stratified multi-stage cluster sampling from Zhejiang Province were surveyed by using questionnaire analysis.Indicators such as tried smoking,current smoking,and secondhand smoke exposure,etc.,were calculated by weight on age proportions from the numbers of college students in Zhejiang.Results The prevalence of tried smoking and currcut smoking among college students were 29.72％ and 10.57％,respectively.The prevalence of tried smoking was 46.52％ for men,18.25％ for women;28.57％ for undergraduate,31.53％ for junior college;the prevalence of current smoking was 18.86％ for men,3.86％ for women;8.88％ for undergraduate,13.23％ for junior college students.The snoking rate in college students increased with age,the group of ≥21 Years was the highest (37.87％,16.09％).The lowest level of smoking was medical student (21.76％,2.19％).The prevalence of secondhand smoke exposure in outdoor and indoor places,and dormitory among students were 65.49％,60.33％,and 23.66％,respectively.In the past 30 days,college students have seen tobacco advertisement (47.38％),smoking scenes (60.20％),and got tobacco related gifts (10.40％),free tobacco products (8.93％);college students have seen information about tobacco control (60.50％),cigarette pack warning labels (58.45％),and learned the tobacco knowledge in class in the past 12 months (14.03％).Conclusion Current prevalence of smoking in college students in Zhejiang province remained at a high level,the rate of secondhand smoke exposure is high and in college students there was lack of tobacco control education in class.The results indicated that the policy about tobacco control in school was not enough and the task of health promotion should be taken more arduously.

Objective To explore the determinants of willingness to quit smoking among pre-pregnancy male smokers, and to provide evidence for smoking cessation strategies. Methods An intercept survey was carried out in four cities in Zhejiang, and there were 552 pre-pregnancy male smokers from 1401 newly wedded couples under investigation. Result The pre-pregnancy male smoking rate was 39.82%, and only 6.88%of pre-pregnancy male smokers were categorized as highly nicotine-dependent. The rate of recent willingness to quit smoking was 50.54%, and reasons for quitting were as follows:a planned pregnancy (62.50%), an example for children (47.70%), and objections from family members (45.22%). The tobacco knowledge among pre-pregnancy male smokers is relatively poor, only 49.64% of smokers were aware 8 points in 11 questions; 88.75% of smoker's wives supported their husband to quit smoking. The associated factors of smoking cessation include: tobacco knowledge (OR=0.38), health self-assessment well (OR=1.90), wife's willing for husband to quit smoking (OR=2.87). Conclusion Compared to ordinary people, the proportion of intention to quit smoking was higher in pre-pregnancy male smokers. To strengthen health education and make wife initiating in husband's quitting programs would be more effective.

Objective To analyze the cerebral autoregulation capability in patients with chronic insomnia disorder (CID).Methods Sixty CID patients (54 with generalized anxiety disorder) and 40 healthy controls were enrolled in this study.Polysomnography was done in all the participants.Noninvasive continuous cerebral blood flow velocity of bilateral middle artery and arterial blood pressure were recorded simultaneously using transcranial Doppler and a servo-controlled plethysmograph.Transfer function analysis was used to derive the autoregulatory parameters, including phase difference and coherence function.Results The phase difference values of CID patients with generalized anxiety disorder were significantly lower than that of the healthy controls ((46.89±15.39)°vs (56.00±12.05)°, t=3.439, P=0.001).In the correlation analysis, we further found that there was no correlation among phase difference values and the score of Hospital Anxiety and Depression scale.Conclusions The dynamic cerebral autoregulation was compromised in CID patients with generalized anxiety disorder regardless of the degrees of anxiety and depression.Dynamic cerebral autoregulation may be a potential therapeutic target in improving neurological symptoms in patients with CID.

Objective: To evaluate the effect of a tobacco control intervention for college students under the advocate-promoting model, and to provide evidence for methods to improve smoking control and health decisions. Methods: Four colleges were selected from the list of colleges that participated in a survey of college student tobacco use in Zhejiang Province in 2015, and we conducted a tobacco control intervention with them under the advocate-promoting model for two years. A total of 1 007 students were selected using a random sampling method and surveyed before intervention, and 991 students were selected using a random sampling method and surveyed after the intervention. A chi-square test was used to compare the differences between tobacco use, second-hand smoke exposure, and tobacco knowledge among students before and after the intervention. Results: After the tobacco control intervention, the attempted smoking rate among students in the four colleges dropped from 34.36% to 22.30%, the current smoking rate dropped from 12.12% to 7.87%, the second-hand smoke exposure rate decreased from 75.47% to 70.53%, the difference was statistically significant (χ²=37.73, 9.99, 6.18, P<0.05). After intervention, the proportion of students who had seen tobacco advertisements in the past 30 days decreased from 60.38% to 54.4%, the proportion of students who "saw smoking scenes in video media" decreased from 25.02% to 19.58%, and the proportion of students who "learned smoking control knowledge in class" increased from 14.20% to 18.16%, the difference was statistically significant (χ²=7.08, 8.55, 5.79, P<0.05). Conclusion The advocate-promoting model of "advocacy alliance" can help colleges to establish a smoke-free campus environment and improve college students’ tobacco knowledge and reduce their attempted and current smoking rates.

Objective To assess the effectiveness of a novel mobile health patient management system involving doctors, nurses, and patients ( TRIO mode) on glycemic control and self-monitoring of blood glucose (SMBG) compliance among the type 2 diabetes mellitus ( T2DM) patients using basal insulin standardization treatment in China. Methods From April 2014 to April 2015, 416 hospitals in 110 cities of 30 provinces, municipalities, and autonomous regions across China were selected to participate in the program. A Online-to-Offline ( O2O) integrated mobile health patients management system with mobile terminals for the doctors, nurses, and patients was applied in the program for patient education, follow-up, and data collection. For all the newly recruited patients, the baseline information was collected and a first-day patient education program were provided by a designated nurse. In the 12-week follow-up period, data of basal insulin doses and fasting plasma glucose ( FPG) values were collected from the patients by text messages or tracking phone call by the nurse. The patients also received timely standardized patients health education and glycemic control guidance by participating in thepatient education forum anddoctors' hotline in order to help them achieve the glycemic control goals. Results A total of 102 524 patients using basal insulin treatment were eligible and enrolled in the program. 64 420 patients completed the 12 weeks follow-up and provided at least one FPG value at all five follow-ups. In total, 62. 6% (40 334 / 64 420) of the patients reached the FPG control target(FPG≤7. 0 mmol/ L) at the end of follow-up period. The weekly average FPG for patients with complete SMBG data decreased from 10. 58 mmol/ L to 6. 91 mmol/ L while the FPG control rates increased from 13. 4% to 69. 2% . The weekly average FPG for the patients provided incomplete SMBG data decreased from 10. 54 mmol/ L to 7. 13 mmol/ L while the FPG control rates increased from 13. 6% to 62. 2% . The FPG control rates for the patients provided complete SMBG were 1. 74 times higher than those patients provided incomplete SMBG. Based on a GEE model, the average decline of the FPG and the increase of the FPG control rates were significantly better for patients who provided complete SMBG as compared to the patients with incomplete SMBG data. The results of the multivariate logistic regression analysis showed that factors such as receiving the first-day education, participating in the follow-up patient education forum, and the doctors' hotline were significantly associated with the improvement of the SMBG compliance, the treatment adherence, and the FPG control rates. The SMBG compliance and the treatment adherence for patients who completed first-day education were 1. 68 times and 1. 22 times higher, respectively. For the patients who participated in follow-up education activities, their SMBG compliance and treatment adherence were 3. 17 times and 3. 36 times higher, respectively. Conclusion The innovativeTRIOmobile health patient management mode was feasible and effective for better managing the type 2 diabetes patients initiated on basal insulin treatment in China. Active participation in the first-day education program and the follow-up patient education activities can effectively improve the SMBG compliance and the treatment adherence, and therefore play an important role in helping patient achieving FPG control in a faster manner.

Objective To describe the prevalence of tobacco use among teenagers in different populations by sex and grades at school,and to provide evidence for the development of smoking control and health promotion programs.Methods A total of 4 797 teenagers selected from 36 schools through stratified multi-stage cluster sampling in Zhejiang province and were surveyed by using a questionnaire with 3 886 eligible ones for analysis.Indicators as tried smoking,current smoking,and secondhand smoke exposure,etc.,were calculated by weight on age proportions from the numbers of juniors in Zhejiang province.Results Prevalence rates of tried smoking and current smoking among teenagers were 10.91％ and 2.07％,respectively.7.72％ of the juniors were susceptible to future tobacco use.The prevalence rates of tried smoking were 15.65％ for boys and 5.58％ for girls,12.13％ in rural and 9.24％ in urban areas.Students from the 9th grade showed the highest rate (15.15％) while the 7th graders appeared the lowest level of susceptibility to future tobacco use (5.22％).The highest level of current smoking was seen in the group of "weekly allowance more than 30 Yuan,from parents"(4.07％).The prevalence of secondhand exposure to smoke in outdoor and indoor places,public transport,or at home were 57.60％,54.45％,46.97％,and 43.16％,respectively,among the teenagers.3 071 juniors (77.33％) saw the smoking scenes in the past 30 days but only 1 367 juniors (28.30％) were aware of the basic knowledge on tobaccos in class,in the past 12 months.Conclusions There were juniors who tried to smoke or were current smokers.The rate of secondhand exposure to smoking was high.A large number of the juniors were lack of education on knowledge related to tobacco control,in the classroom.It was important to promote and publicize the knowledge on tobacco so as to reduce the number of teenagers who were susceptible to future tobacco use.

Objective To describe the prevalence rates of smoking,quitting and passive smoking in different populations on their status of education,occupation and geographic distribution.Methods A total of 13 408 residents aged 15-69 from 45 counties through stratified multi-stage cluster sampling from Zhejiang province were selected and surveyed,using questionnaires.Data from 13 326 subjects were used for analysis.Indicators as smoking,current smoking,and secondhand smoke exposure,etc.,were calculated by weight on age proportions from the 2010 census.Results Among the adults aged 15 years and older,there were an estimated number of 12.90 million (29.59％) smokers,with 9.99 million (22.92％) current smokers,8.45 million (19.38％) daily current smokers.The prevalence rates of smoking were 41.18％ for men,3.69％ for women,with 45-54 year-old group the highest (51.66％) for men while the group of 65-69 year-olds was the highest (4.62％) in women.The overall rate of quitting was 22.56％.40.19％ of the smokers had thought about quitting,with the main means as self-restriction (87.59％) in conducting the behavior of smoking cessation.Among those non-smokers at age 15 or older,it was estimated that 67.90％ (22.77 million) of them had been exposed to secondhand smoke.SHS exposure was the highest in the indoor workplace (62.84％),among all the venues.Knowledge on tobacco among residents seemed to be relatively poor,with only 31.52％ of the population were aware that smoking could cause serious three diseases (stoke,heart disease,and lung cancer).34.04％ of the population were aware that secondhand smoking could cause all the three diseases (heart disease,lung disease,and lung cancer).Conclusion Current prevalence of smoking in males in Zhejiang province remained at a high level,indicating that the publicity programs on the knowledge of smoking tobacco was not strong enough and the task of control smoking should be taken more arduously.

Objective To investigate the unmet needs of thyroid cancer patients undergoing 131Itreatment and their relationship with psychological distress and quality of life.Methods From October 2014 to March 2016,a total of 338 patients (106 males,232 females,average age (35.50±9.98) years) with thyroid cancer who were receiving 131I treatment were enrolled.The 34 items of Supportive Care Needs Survey Short Form (SNCS-SF34) were used to investigate the unmet care needs of patients.Patients' perceptions of distress and main causes of distress were measured by Distress Thermometers (DT) and issue list.The 12-item Short-Form Health Survey (SF-12) was used to measure patients' quality of life.Pearson correlation analysis was used to analyze the data.Results The degrees of patients' unmet care needs from high to low were as following:health information needs (65.38％,221/338),psychological needs (47.93％,162/338),patients' care and support needs (44.08％,149/338),physical and daily needs (36.09％,122/338) and sexual needs (34.32％,116/338).There were 47.93％(162/388) patients with DT score ＞ 4.The top three causes of patients' distress were fears,fatigue and memory deterioration.Degree of unmet needs for patients had positive correlation with the degree of psychological distress (r values:0.232-0.462,all P＜0.01).The unmet physiological and daily needs and psychological needs of patients had negative correlations with several dimensions of quality of life (r values:from-0.367 to-0.202,all P＜ 0.05).Conclusions The unmet care needs of patients with thyroid cancer have correlations with their psychological distress and quality of life.Evaluation of the unmet care needs of patients with thyroid cancer could be beneficial for providing the targeted care.

Objective To study the value of whole tumors T2WI gray histogram analysis for differential diagnosis of three commonly presented pediatric posterior fossa tumors. Methods A retrospective analysis was conducted to compare brain MRI examination and pathology diagnosis of 133 cases of posterior fossa tumors in pediatric patients in our hospital.Among them, there were 49 cases of ependymoma(there were 25 males and 24 females), 36 cases of astrocytoma(WHO grade Ⅰ)(there were 19 males and 17 females), 48 cases of medulloblastoma(there were 36 males and 12 females),aged 1 to 14 years old, with an average (7±2) years old. Respectively draw the region of interest (ROI) in the T2 MR transaxial images of three groups on each layer of tumor level by using Mazda software and analyze the whole tumors gray histogram, including mean,variance, kurtosis,skewness, perc.01%,perc.10%,perc.50%,perc.90% and perc.99%.The histogram parameters of the three groups were not normally distributed. The Kruskal-Wallis test was used to compare the three groups. Bonferroni test was used to compare the two groups to find out statistical significance of each parameter. Results Through histogram analysis of 9 parameters, these 9 parameters were statistically significant (all P <0.05),including mean,variance,kurtosis,skewness, perc.01%,perc.10%,perc.50%,perc.90% and perc.99%. The sensitivity of skewness to differentiate ependymoma and the astrocytoma was 69.4％, the specificity was 77.8％, the area under the curve was 0.744, and the best cut-off value was-0.08. The sensitivity of kurtosis to differentiate astrocytoma and the medulloblastoma was 95.8％, the specificity was 97.2％ and the area under the curve was 0.972, the cut-off was 1.68. The sensitivity of kurtosis to differentiate ependymoma and the medulloblastoma was 91.7％, the specificity was 89.8％and the area under the curve was 0.932,the cut-off was 1.90.They had a high identification efficiency. Conclusions The T2WI gray histogram analysis based whole tumors is helpful for the dignosis of three types of pediatric posterior fossa tumors. Skewness has a high diagnostic efficiency to differentiate ependymoma and the astrocytoma. Kurtosis has a high diagnostic efficiency to differentiate ependymoma and the medulloblastoma. Kurtosis has a high diagnostic efficiency to differentiate ependymoma and medulloblastoma.