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Biomarkers in early diagnosis and screening of lung cancer

Shijia ZHANG ; Jing ZHAO ; Shengxiang REN ; Caicun ZHOU

Chinese Journal of Health Management.2017;11(4):383-387. doi:10.3760/cma.j.issn.1674-0815.2017.04.018

Early diagnosis and screening are of great significance for improving the prognosis of patients with lung cancer. Low-dose helical computed tomography (LDCT) reduces lung cancer mortality by about 20％, making it the most effective screening tool. However, high false-positive rates, costs, and potential harms highlight the need for complementary biomarkers. The diagnostic performance of biomarkers such as noninvasive autoantibody and plasma/serum microRNA (miRNA) were shown in several studies, making them approved for early diagnosis in our country, Europe and the United States, and their role in screening is being explored in ongoing studies.

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Fracture Liaison Services: different models and appropriate management

Hongfei SHI ; Hua LIN ; Jin XIONG

Chinese Journal of Health Management.2017;11(4):379-383. doi:10.3760/cma.j.issn.1674-0815.2017.04.017

Fragility fracture caused by osteoporosis affects the health of the elderly. The International Osteoporosis Foundation (IOF) advocate that the fracture liaison service (FLS) can improve the detection rate, treatment rate and compliance of patients with fragility fractures, and hence to reduce the incidence of secondary fractures. Currently, there are different models of FLS available globally, appropriate management is the key to effective implementation of FLS projects.

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Analysis of the cases of malignant tumor in the health checkup population of a 3A hospital in Quanzhou, 2009-2014

Yu WANG ; Xiaorong JIANG ; Shasha WANG

Chinese Journal of Health Management.2017;11(4):362-365. doi:10.3760/cma.j.issn.1674-0815.2017.04.013

Objective To analyze the cases of malignant tumors found in health examination in our hospital, and to determine the prevalence and characteristics of malignant tumor, and to provide evidence for the development of effective early screening program. Methods A total of 468673 subjects were included from those who had health checkup from July 2009 to December 2014 at the physical examination center. The subjects were between 4 to 96 years of age, with average age of (56.0±12.5) years. Of them, there were 278484 men, 190189 women. All cases found in the examination were confirmed with pathological testing. Prevalence comparison was done withχ2 test, statistic significance level was set at P<0.05. Results Totally 753 cases of malignant tumors were found in 6 consecutive years, with an overall prevalence rate at 160.7/100000. The prevalence rate increased yearly from 50.0/100000 for the first year, and 100.6/100000, 146.1/100000, 149.1/100000, 188.9/100000, 221.6/100000 thereafter. The difference between each 2 years was statistically significant (P<0.01). The top ten malignant tumors were liver cancer, cervical cancer, lung cancer, renal cell carcinoma, esophageal cancer, gastric cancer, colon cancer, breast cancer, leukemia and thyroid cancer. The prevalence rates of malignant tumors in the top three were liver cancer, lung cancer and kidney cancer for man and cervical cancer, lung cancer and breast cancer for women respectively. With the increase of age, the incidence of malignant tumor showed a rising trend, especially for the group of over 80 years old. But women with cervical cancer in the 50-years age group was the highest. Conclusion The number of cases of malignant tumors found in the health checkup population was rising. It is important to include early screening for malignant tumor in physical examination. We should also pay attention to the relevant departments, in order to improve the early cancer detection rate and decrease the morbidity and mortality of malignant tumors.

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Prevalence and related risk factors of hypothyroidism in adults of Gansu province

Feifei SHAO ; Jing LIU ; Ruifei YANG ; Wenjuan MA ; Yu WANG ; Limin TIAN

Chinese Journal of Health Management.2017;11(4):356-361. doi:10.3760/cma.j.issn.1674-0815.2017.04.012

Objective To investigate the prevalence and epidemiological characteristics of hypothyroidism, possible related lifestyle and metabolic risk factors of hypothyroidism in adults of Gansu province, and to provide scientific evidence for the prevention of hypothyroidism. Methods Stratified multi-stage cluster sampling with probability proportionate to size method was used to collect data from 10071 residents aged 18 to 79 years and who had lived in the local area for more than 5 years. All participants were asked to fill in the questionnaire, and to take physical examination including anthropometric measurements and venous blood samples. Risk factors of hypothyroidism were analyzed by Chi-square test and multivariate logistic regression analysis. Result The prevalence of hypothyroidism was 10.1％ (overt hypothyroidism: 1.5％, subclinical hypothyroidism: 8.7％). Female (12.1％) had a higher percentage when compared to male (7.5％). In addition to the increased odds with older age and female gender, current or previous smoking history (OR: 0.467, 95％CI: 0.289-0.754, P=0.002), salty taste preference (OR:0.355, 95％CI:0.162-0.776, P=0.022) and a frequent seafood intake (OR:0.148, 95％CI:0.057-0.385, P<0.001) were tended to be associated with reduced risk of hypothyroidism. Logistic regression analysis showed that positive thyroid peroxidase antibodies (OR:1.976, 95％CI:1.037-3.768, P=0.039), positive thyroglobulin antibodies (OR:2.419, 95％CI:1.160-5.043, P=0.018) and triglycerides (OR:1.241, 95％CI:1.044-1.474, P=0.014) were associated with increased risk of hypothyroidism. Conclusion The prevalence of hypothyroidism in Gansu province was high, affecting approximately one in ten adults, and majority of which were SCH. Both lifestyle factors and metabolic factor were associated with hypothyroidism. Developing a healthy lifestyle at work and home, and paying attention to the control of blood lipids are conducive to the prevention of hypothyroidism.

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Association of body mass index and waist circumference with dyslipidemia among adults in Suzhou Industrial Park District

Suqin DING ; Hui ZHOU ; Liangyue ZHOU ; Baohui XU ; Lugang YU

Chinese Journal of Health Management.2017;11(4):349-355. doi:10.3760/cma.j.issn.1674-0815.2017.04.011

Objective To study the association of body mass index (BMI) and waist circumference (WC) with dyslipidemia and the risk of dyslipidemia at different BMI and WC level among adults in Suzhou Industrial Park District. Methods A total of 6219 participants were chosen by stratified random cluster sampling method. Four streets were selected form the district first, then one community as a cluster was selected randomly from each street. Questionnaire survey, physical examination and laboratory tests were done by all subjects. Results The prevalence of dyslipidemia was 35.9％;the rates of overweight, obesity and central obesity were 36.6％, 9.6％ and 49.5％ respectively. The prevalence of dyslipidemia in underweight group, normal weight group, overweight group and obesity group were 13.6％, 30.2％, 47.7％and 59.0％ for male, and 17.2％, 27.3％, 38.6％和 48.8％ for female respectively. The prevalence of dyslipidemia for male and female both rose with BMI (χ2=139.848, P<0.001; χ2=92.387, P<0.001). The prevalence of dyslipidemia in the high waist circumference group and normal group were 50.2％and 30.9％for male, and 40.8％and 23.8％for female respectively. Prevalence of groups with high waist circumference for male and female were significantly higher than normal groups (χ2=108.669, P<0.001; χ2=110.642, P<0.001). Pearson correlation analysis showed that total cholesterol (TC), triglyceride(TG), and low density lipoprotein cholesterol (LDL-C) were positively correlated with BMI ( r=0.153, P<0.001;r=0.227, P<0.001;r=0.192, P<0.001), and were also positively correlated with WC(r=0.138, P<0.001; r=0.234, P<0.001; r=0.159, P<0.001). High density lipoprotein cholesterol(HDL-C) was negatively correlated with BMI (r=-0.189, P<0.001) and WC (r=-0.185, P<0.001). Logistic regression analysis after age adjustment showed that, compared to the group with BMI<24 kg/m2 and WC<85 cm(male)/WC<85 cm (female), odds ratios (OR) for male in group with BMI<24 kg/m2 and WC≥85 cm, group with BMI≥24 kg/m2 and WC<85 cm and group with BMI≥24.0 kg/m2and WC≥85 cm were 1.602, 1.834 and 3.064 respectively, and ORs for female in group with BMI<24.0 kg/m2 and WC≥80 cm and group with BMI≥24.0 kg/m2 and WC≥80 cm were 1.703 and 2.381 respectively, however, the OR for female in group with BMI≥24.0 kg/m2 and WC<85 cm was not statistically significant (P>0.05). Conclusions BMI, waist circumference and dyslipidemia were closely correlated. Waist circumference is more important than BMI for female.

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Analysis of test results for determining urine albumin-to-creatinine ratio among health examination population in a hospital

Xiaomei LIU ; Zengrong XIE ; Binlin CHEN ; Li ZHOU

Chinese Journal of Health Management.2017;11(4):338-343. doi:10.3760/cma.j.issn.1674-0815.2017.04.009

Objective To investigate the prevalence of high urine albumin-to-creatinine ratio (ACR) among health check up population and evaluate the potential predictors for ACR. Methods A cross-sectional study was conducted among health check up population in the Zhongshan Hospital during 2015. Potential participants completed urine ACR test,body mass index (BMI) and blood test. ACR level was divided into two groups according to the K/DOQI recommendation:ACR Group(male:ACR≥17 mg/g;female:≥25 mg/g), Normal Group (male:ACR<17 mg/g;female:ACR<25 mg/g). Univariate and multivariate logistic regression models were performed to evaluate the associations of ACR with potential predictors (including age,sex,over-weight or obesity,hypertension,glucose metabolism disorders, hypertriglyceridemia,hypercholesterolemia,high low HDL-C and hyperuricemia). Result Totally 670 people from the health check up population were screened for ACR test, 54 cases were positive, the prevalence was 8.1％. Age, BMI, waist-to-height ratio, SBP, DBP, blood sugar and uric acid had statistical significance between Normal group and ACR group[Age 47.62 ± 11.29 vs. 53.83 ± 11.93, t=-3.858, P<0.01;BMI (24.05±3.12) kg/m2 vs. (24.94±3.49) kg/m2, t=-1.982, P<0.05;waist-to-height ratio 0.51±0.52 vs. 0.53 ± 0.06, Z=-2.146, P<0.05; SBP (mmHg, 1 mmHg=0.133 kPa) 115.31 ± 15.59 vs. 130.91 ± 23.66, t=-4.755, P<0.01;DBP(mmHg) 72.31 ± 9.16 vs. 80.02 ± 9.81, t=-5.897,P<0.01;blood sugar (mmol/L) 4.64 ± 1.20 vs. 5.57 ± 2.77, t=-2.466, P<0.01;uric acid (μmol/L) 362.99 ± 92.80 vs. 397.76 ± 95.62, t=-2.633, P<0.01]. Age, hypertension, glucose metabolism, HDL reduction were risk factors for urinary albumin/creatinine ratio. In the multivariate logistic regression model, hypertension status was found to be associated with ACR positive [odd ratio (OR): 2.843, 95％ confidence interval [CI, 1.472-5.493, P<0.01], glucose metabolism disorders (OR, 2.132, 95％CI, 1.042-4.365, P<0.05). As the number of risk factors increases, the rate of positive of ACR showed marked increase, comparing persons with no risk factors to those with four or more risk factors , the OR value rose up to 18.281. Conclusion Hypertension and glucose metabolism disorder are risk factors of chronic renal dysfunction. With the increase of risk factors, the rate of positive of ACR was higher. ACR test is recommended routine screening for people over the age of 50.

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Influencing factors for suicidal behavior in bipolar disorder inpatients

Qian WANG ; Zhenyu LIU ; Qi GAO ; Hua FAN ; Weigang PAN ; Xin MA

Chinese Journal of Health Management.2017;11(4):333-337. doi:10.3760/cma.j.issn.1674-0815.2017.04.008

Objective To compare various risk factors of bipolar disorders with and without suicidal behavior. Methods A total of 5452 inpatients were divided into 2 groups; with (n=1739)and without (n=3713) suicidal behavior within 1 week. Socio-demographic and clinical data were compared between two groups. Multiple logistic regression models were used to assess risk factors of bipolar disorders with suicidal behavior. Results Compared to without suicidal behavior group, the suicidal behavior group had significantly higher rate of the following characteristics:older age [34.8±13.6 vs. 33.3±12.8, t=-3.46, P<0.01], female (58.3％vs. 52.7％,χ2=14.83, P<0.01), history of mental trauma (10.6％vs.7.8％,χ2=10.72, P<0.01), history of suicide (4.1％vs. 0.1％,χ2=140.11, P<0.01), family history of suicide (6.7％vs. 3.9％,χ2=20.22, P<0.01), family history of mental illness (33.8％vs. 29.6％,χ2=9.33, P<0.01) and history of suicide (4.1％ vs. 0.1％, χ2=140.11, P<0.01). Logistic regression analysis showed that female (OR: 1.192, 95％CI:1.043-1.363), older age (OR: 1.008, 95％CI: 1.003-1.013), history of mental trauma (OR: 1.355, 95％CI:1.083-1.696), history of suicide (OR:39.139, 95％CI:12.230-125.256) and family history of suicide (OR:1.648, 95％CI: 1.223-2.221) were significantly correlated with suicidal behavior in bipolar disorders. Conclusions The study indicates that female, older age, history of mental trauma, history of suicide and family history of suicide may be the key independent risk factors to suicidal behavior in bipolar disorders.

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Analysis of risk factors for perioperative complications and death following hip fractures in the elderly

Minmin CHEN ; Yanhua ZHANG ; Yanping DU ; Wei HONG ; Wenjing TANG ; Huilin LI ; Qun CHENG ; Songbai ZHENG

Chinese Journal of Health Management.2017;11(4):325-332. doi:10.3760/cma.j.issn.1674-0815.2017.04.007

Objective To analyze risk factors for the perioperative complications and death following hip fracture in the elderly. Methods The present study included 1352 elderly patients (≥65 years) who had received hip fracture surgery from January 2010 to June 2015 in Huadong hospital affiliated to Fudan University. Their clinical data were analyzed to determine risk factors for perioperative complications and death. Results Factors significantly affecting the perioperative complications included gender, preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ), respiratory system disease and blood transfusion. Factors significantly affecting the death included preoperative serum albumin, ASA grade (≥Ⅲ), cardiac functional grade (≥Ⅲ) and blood transfusion. Multivariate Logistic regression analysis revealed that the independent risk factors for perioperative complications included gender (B=-0.686, P=0.019), preoperative serum albumin (B=-0.808, P=0.006), cardiac functional grade (≥Ⅲ, B=1.181, P=0.004), blood transfusion (B=0.890, P=0.004) and respiratory system disease (B=3.118, P=0.000);while the independent risk factors for death included preoperative serum albumin (B=-2.516, P=0.000) and blood transfusion (B=1.396, P=0.010). Conclusions In elderly patients undergoing hip fracture surgery, the independent risk factors for perioperative complications included gender, preoperative serum albumin, cardiac functional grade, blood transfusion and respiratory system disease, while the independent risk factors for death included preoperative serum albumin and blood transfusion. Perioperative risk assessment and prevention are the keys of better prognosis.

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Risk screening of osteoporosis in community residents and its influencing factors

Pengfei LUO ; Xiaoqun PAN ; Jian SU ; Yanan WAN ; Ping LIN ; Yongqing ZHANG

Chinese Journal of Health Management.2017;11(4):319-324. doi:10.3760/cma.j.issn.1674-0815.2017.04.006

Objective To explore the influencing factors of high risk osteoporosis (OP) population. Methods Using multi-stage cluster sampling method, 1 district was selected from each of the 6 cities randomly, then 3 communities were selected from each district randomly. Questionnaire investigation and physical examination were applied to community residents aged 40-69 years old. The questionnaire mainly included basic information, OP risk assessment (using the 1 minute test method developed by the International OP Foundation), health status and lifestyle information (recent 12 months). The relationship between high-risk groups and influencing factors was analyzed by unconditional logistic regression. Results Totally 6577 valid questionnaires were collected, 2069 were male (31.46％) and 4508 were female (68.54％). A total of 166 cases (2.52％) were found as self-reported OP patients at the age of 40-69, self-reported rate of male (1.55％) was lower than that of female (2.97％) (χ2=11.719, P<0.01), the rate was higher among people aged 60-69 years than people aged 40-49 (χ2=44.766, P<0.01);3400 cases (52.28％) were found as high-risk individuals,there were more male at higher risk than female (OR=1.845). Among different age groups, the 50-59 and 60-69 years age groups had more high risk people than that of 40-49 years group (with OR=2.171 and OR=2.854 respectively). Comparative analysis was also conducted for the following factors: degree of education [college or above (OR=0.517) compared with primary school or junior middle school], occupation [compared with civil servants, technical management personnel (OR=2.289), business services (OR=2.224), farming/forestry/fishing (OR=2.258) and production/transportation staff (OR=2.552)], self-reported history of chronic disease (OR=1.596), fracture (OR=4.061), body pain (OR=2.286) and foot cramps (OR=1.923), as well as calcium/vitamin D intake (OR=1.357), increased sunlight (OR=1.256), daily walking steps>5000 (OR=1.336) and BMI>24.00 (OR=1.322), they were all related to a increased proportion of high risk population. Conclusion The proportion of OP high-risk groups is higher among people aged 40-69. Gender, age, cultural level, occupation, bad health status and lifestyle changes are closely related to higher OP risk. Community residents OP screening should be continued to further study the risk factors of OP.

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Analysis of controllable risk factors of osteoporotic vertebral fractures

Xiufen ZHU ; Zhande HE ; Lin BRIAN ; Wei CAO ; Xin CHEN ; Haiming YANG ; Hua LIN

Chinese Journal of Health Management.2017;11(4):308-313. doi:10.3760/cma.j.issn.1674-0815.2017.04.004

Objective To analyze the controlled risk factors of osteoporotic vertebral fractures, and determine the clinical value for the management of risk factors. Methods 626 cases of postmenopausal women were selected, age, height, weight and bone mineral density(BMD) of patients were collected.The Tetrax balance test system was used to assess the fall risks.Vertebral changes of patients were evaluated through X ray of thoracolumbar lateral. The clinical data were analyzed and compared between vertebral fracture group and non-vertebral fracture group. Spearman test was used to analyze the correlation between vertebral fracture and age, height, weight, body mass index(BMI), the risk of fall, body fat and BMD. Results 328 patients presented with osteoporotic vertebral fractures, while the other 298 cases did not suffer from osteoporotic vertebral fractures. There were 426 vertebral bodies involved. Comparing to non-vertebral fracture group, the vertebral fracture group showed higher age [(68.67±9.29)years vs.(63.04± 9.30)years], lower height[(151.10 ± 4.39)cm vs.(154.90 ± 5.86)cm], lower bone mineral density[lumbar spine BMD (0.85 ± 0.16)g/cm2 vs.(0.93 ± 0.17)g/cm2, hip spine BMD (0.72 ± 0.18)g/cm2 vs.(0.81 ± 0.13)g/cm2],higher body fat [(41.30 ± 5.20)％vs.(36.30 ± 5.90)％] and higher fall risk (41.38 ± 25.79 vs. 36.20 ± 26.22) ( P<0.001). While there were no statistical differences in weight and BMI between the two groups, age, height, BMI, body fat, fall risk, lumbar spine and hip BMD were significantly correlated with vertebral fracture (r=0.358,-0.323, 0.169, 0.186, 0.135,-0.398,-0.364, respectively, all P<0.001). Conclusions Decreased bone mineral density, increased age, abdomen fat content and increased fall risk, are the risk factors of osteoporotic vertebral fractures.

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