1.Epidemiological characteristics and disease burden of liver cancer in Guangdong Province
Ying ZHANG ; Yixuan CHEN ; Rong CAO ; Yue GAO ; Yutong HAN ; Ye WANG ; Ruilin MENG ; Xueyan ZHENG ; Yu LIAO ; Zhuanping ZENG
Journal of Public Health and Preventive Medicine 2026;37(1):68-72
Objective To analyze the epidemiological characteristics and disease burden of liver cancer in Guangdong Province in 2020, and to provide a scientific foundation for the development of regionalized prevention and control strategies for liver cancer. Methods According to the cancer registry data of Guangdong Province, the incidence, mortality and age-standardized rate by Chinese standard population in 2020 were calculated to analyze the epidemiological characteristics of liver cancer. The disability adjusted life years (DALYs), year of life loss (YLL), year of lived with disability (YLD), and cause-eliminated life expectancy were used to assess the disease burden of liver cancer. Results In 2020, the crude incidence rate and the age-standardized incidence rate of liver cancer in Guangdong Province were 27.79/100 000 and 20.84/100 000,respectively, and the crude mortality rate and the age-standardized mortality rate of liver cancer were 25.49/100,000 and 17.64/100 000, respectively. The total DALY and DALY rate of liver cancer in Guangdong Province were 515 311 person-years and 513.83/100 000, respectively. After eliminating the causes of death from liver cancer, the life expectancy in Guangdong Province increased from 84.60 years to 84.99 years. All indicators consistently demonstrated that the burden of liver cancer was higher in males than that in females, and the burden of liver cancer was higher in rural areas than that in urban areas. Conclusion Liver cancer in Guangdong Province exhibits a high incidence, mortality and disease burden level in 2020. There are obvious differences of gender, age and region in cancer burden. It is necessary to strengthen liver cancer screening and diagnosis and treatment in men, the elderly and those in rural areas to reduce the burden of liver cancer gradually in Guangdong Province.
2.Analysis of the Burden of Acute Lymphoid Leukemia in China and Globally from 1990 to 2021
Derong LIN ; Jingya FANG ; Yue LI ; Xiaohua XIE ; Xiaolin YE ; Xiaowen ZHANG ; Jiexuan LI ; Aiguo XUE
Medical Journal of Peking Union Medical College Hospital 2026;17(2):463-475
To analyze the disease burden of acute lymphoid leukemia(ALL) and its changing trends in China and globally from 1990 to 2021, aiming to provide a theoretical basis for disease prevention, treatment, and policy formulation. Data on the incidence, prevalence, mortality, and disability adjusted life years(DALYs) of ALL in China and globally from 1990 to 2021 were extracted from the Global Burden of Disease(GBD) 2021 database. The Joinpoint regression model was used to calculate the average annual percentage change(AAPC) to assess the trends in disease burden. Decomposition analysis was employed to identify and quantify the contributions of different factors to the changes in ALL disease burden. The population attributable fraction(PAF) was used to compare the risk factors for ALL in China and globally in 1990 and 2021. Stratified by the sociodemographic index(SDI), the locally estimated scatterplot smoothing(LOESS) method was used to assess the association between age-standardized incidence rate(ASIR), age-standardized mortality rate(ASMR), and SDI. The incidence-mortality ratio(IMR) was calculated to evaluate the diagnostic level and current treatment status of ALL. From 1990 to 2021, ASIR of ALL in the Chinese population increased from 3.385/100 000 to 3.637/100 000(AAPC: 0.005), the age-standardized prevalence rate(ASPR) increased from 6.596/100 000 to 22.022/100 000(AAPC: 0.478), the ASMR decreased from 3.051/100 000 to 1.357/100 000(AAPC: -0.056), and the age-standardized DALYs rate(ASDR) decreased from 195.792/100 000 to 74.063/100 000(AAPC: -3.996). Globally, the corresponding figures were: ASIR decreased from 1.789/100 000 to 1.371/100 000(AAPC: -0.014), ASPR increased from 4.122/100 000 to 5.425/100 000(AAPC: 0.039), ASMR decreased from 1.551/100 000 to 0.898/100 000(AAPC: -0.021), and ASDR decreased from 94.894/100 000 to 48.858/100 000(AAPC: -1.494). During this period, the aforementioned disease burden indicators were generally higher in males than in females, both in China and globally.In 2021, the peak incidence of ALL in China and globally was primarily concentrated in the 0-19 years age group, with the highest rate observed in those under 5 years of age. The burden of prevalence and DALYs was also mainly concentrated in this age group. Regarding mortality, the death burden in China was predominantly observed in the older adult age group, particularly among those aged ≥60 years. Globally, the mortality burden was highest in the under-5 age group, while remaining at a relatively high level in the older adult population. SDI correlation analysis based on data from 204 countries/regions globally from 1990 to 2021 showed that ASIR gradually increased with increasing SDI, whereas ASMR showed an initial increase followed by a decreasing trend. The ASIR and ASMR for the overall Chinese population and by sex were higher than expected. PAF results indicated that smoking and high body mass index were the main attributable risk factors for ALL mortality and DALYs burden, with their contribution consistently increasing. Decomposition analysis revealed that population growth and epidemiological changes were the primary drivers behind the changes in ALL incidence and mortality burden. Compared with 1990, the IMR for ALL in both China and globally increased in 2021. Over the past three decades, the ASMR and ASDR for ALL in China and globally have generally declined. During the same period, the ASIR and ASPR for ALL increased in China, while globally, the ASIR decreased and the ASPR increased. However, the disease burden of ALL remains high in males, children, and the older adult population. Differentiated prevention and control measures should be implemented in accordance with changes in SDI. The findings highlight the importance of strengthening prevention and early diagnosis, and suggest the need for targeted screening and treatment strategies for different age and sex groups. Concurrently, attention should be paid to the role of weight management and tobacco control in comprehensive prevention and control efforts to further reduce the disease burden of ALL.
3.Evaluation of the quality of Jingangteng capsules based on UPLC fingerprinting combined with multi-component content determination
Li SHEN ; Yue SHEN ; Yuying YANG ; Dandan ZHANG ; Yuxi WU ; Xuxiang ZHOU ; Jingyu YANG ; Peng HU ; Lei WANG ; Heming WU ; Dan LIU ; Xiaochuan YE
China Pharmacy 2026;37(10):1290-1294
OBJECTIVE To establish the UPLC fingerprint and the method for multi-component content determination in Jingangteng capsules, and to evaluate its quality by combining chemical pattern recognition analysis. METHODS An UPLC method was established. Separation was performed on a Zorbax SB-C 18 Rapid Resolution HD column, with acetonitrile-0.1% formic acid as the mobile phase for gradient elution.Using the Similarity Evaluation System for Chromatographic Fingerprints of Traditional Chinese Medicines (2012 edition), UPLC fi ngerprints were established for 10 batches of Jingangteng capsules, and similarity was evaluated. SPSS 22.0 and SIMCA 14.1 software were used to perform hierarchial-cluster analysis and orthogonal partial least squares discriminant analysis (OPLS-DA), respectively. The same UPLC method was employed to determine the contents of chlorogenic acid, 3,5-dihydroxy-2-methylbenzoic acid-3- O -glucoside (M1), caffeic acid, astilbin, oxyresveratrol, quercitrin and resveratrol in the 10 batches of samples. RESULTS A total of 17 common peaks were identified in UPLC fingerprints of the 10 batches of samples, of which 7 were identified as chlorogenic acid, M1, caffeic acid, astilbin, oxyresveratrol, quercitrin, and resveratrol. The similarities of 10 batches of samples ranged from 0.820 to 0.985. The results of hierarchial-cluster analysis showed that 10 batches of samples were grouped into four categories: S1-S4 formed one group, S5 and S6 formed another, S7, S8 and S10 formed a third, and S9 formed a fourth, consistent with the OPLS-DA results; the variable importance projection values for peaks 7, 10, 2, 16 (resveratrol), 13 (oxyresveratrol), 11, 6 (caffeic acid), 5 (M1) and 15 (quercitrin) were >1. Quantitative analysis results showed that the contents of chlorogenic acid, M1, caffeic acid, astilbin, oxyresveratrol, quercitrin, and resveratrol were 1.650 8-4.213 7, 0.636 2-2.161 7, 0.031 0-0.086 5, 0.239 1-1.069 3, 0.211 9-1.104 0, 0.488 8-2.399 2, and 0.164 0-0.699 8 mg/g, respectively. CONCLUSIONS UPLC fingerprint and content determination methods established in this study are simple to operate, accurate, reliable and reproducible; when combined with chemical pattern recognition analysis, they can be used to evaluate the quality of Jingangteng capsules. Nine components, such as resveratrol, oxyresveratrol, caffeic acid, M1 and quercitrin, may serve as markers of quality variation.
4.Umbrella decision-making model for diagnosis and treatment of elderly lung cancer patients: Construction and practice
Lunxu LIU ; Jian ZHOU ; Xiang DING ; Nan CHEN ; Jianxin XUE ; Xuelei MA ; Ye WANG ; Weiya WANG ; Liqing PENG ; Xin YOU ; Minggang SU ; Xu CHENG ; Jiao WANG ; Ning GE ; Deying KANG ; Yuchen HUANG ; Jinghan WANG ; Yu TONG ; Yaoxi ZHANG ; Jirong YUE ; Hu LIAO
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(06):833-839
With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.
5.Efficacy and safety of injectable platelet-rich fibrin in the treatment of mild to moderate female pattern hair loss
Man LI ; Yue BAI ; Zhenzhen YE ; Di ZHANG ; Zixuan HE ; Ziwei GE ; Ansheng TAN ; Yu HAN ; Anxin CHEN ; Wenhui WANG ; Fenglin ZHUO
Chinese Journal of Blood Transfusion 2026;39(7):853-858
Objective: To evaluate the clinical efficacy and safety of injectable platelet-rich fibrin (i-PRF) in the treatment of mild to moderate female pattern hair loss (FPHL), and to analyze the related clinical factors affecting the therapeutic efficacy of i-PRF. Methods: This was a secondary analysis of a prospective, randomized controlled trial. A total of 29 FPHL patients with Sinclair grade Ⅱ-Ⅲ, who attended the outpatient clinics of Beijing Friendship Hospital, Capital Medical University and Peking University Third Hospital from March 2024 to April 2025, were enrolled. All patients received i-PRF treatment once every 4 weeks for a total of 4 sessions, with follow-up up to 24 weeks. Standardized clinical photographs were taken at baseline, week 12 and week 24. Trichoscopic examination was performed to measure the non-vellus target area hair count (TAHC) and hair diameter (HD) in the target area, and all adverse events were recorded. The Mann-Whitney U test was used to compare the intergroup differences in efficacy for categorical influencing factors; Spearman rank correlation analysis was employed to assess the correlation between continuous influencing factors and efficacy; and multiple linear regression (enter method) was performed to identify independent influencing factors of efficacy. Results: A total of 27 patients completed the trial. At week 12, TAHC significantly increased from 112 (105, 120) hairs/cm
at baseline to 128 (110, 150) hairs/cm
, with a median increase of 12 (5, 28) hairs/cm
and a median growth rate of 10.5 (4.2, 24.5)% (P=0.045); hair diameter significantly increased from 42.5 (39.8, 45.2) μm to 52.0 (47.0, 58.0) μm, with a median increase of 7.5 (3.0, 12.5) μm and a median growth rate of 18.0 (7.5, 29.0)% (P<0.001). At week 24, TAHC further significantly increased to 141 (125, 158) hairs/cm
(P<0.001), with a median growth rate of 24.8 (18.5, 32.0)%; hair diameter continued to improve to 55.0 (50.0, 61.0) μm (P=0.008), with a median growth rate of 21.5 (16.0, 27.0)%. The overall incidence of adverse events was 10.34% (3/29), mainly presenting as mild scalp pruritus and transient headache, without severe adverse effects. Multiple linear regression analysis revealed that baseline TAHC was an independent influencing factor for i-PRF efficacy (P<0.05), while age, BMI, disease duration, Sinclair grade, family history of AGA, and baseline HD showed no significant independent effect on efficacy in this model (P>0.05). Conclusion: This preliminary study indicates that i-PRF can improve hair density and hair shaft diameter in patients with FPHL with a favorable safety profile. Patients with FPHL and lower baseline TAHC may achieve greater clinical improvement.
6.Study on antidepressant effects and mechanisms of total triterpenes from Poriae Cutis
Li SHEN ; Yuying YANG ; Jingyu YANG ; Yue SHEN ; Peng HU ; Yuxi WU ; Dan LIU ; Xiaochuan YE
China Pharmacy 2026;37(15):2003-2008
OBJECTIVE To investigate the antidepressant effect and underlying mechanism of total triterpenes from Poriae Cutis (PCTT). METHODS UPLC-Q-TOF-MS technology was adopted to analyze the chemical constituents of PCTT. Network pharmacology was applied to screen the antidepressant active ingredients, key targets and signaling pathways of PCTT, and molecular docking was performed to verify the binding capacity between potential active ingredients and core targets. In animal experiment, mice were intragastrically administered PCTT at doses of 80, 160 and 320 mg/kg for 14 consecutive days. Lipopolysaccharide was used to establish an acute depression mouse model. Subsequently, behavioral assays were conducted. The levels of serum inflammatory factors, hippocampal neurotransmitters and brain-derived neurotrophic factor (BDNF) were detected. Western blot and qPCR assays were adopted to validate the antidepressant mechanism of PCTT. RESULTS A total of 101 chemical constituents were identified in PCTT. Network pharmacology screened out 10 potential active ingredients (including poriacosone B, poriacosone A, pachymic acid, etc.), six core targets [including tumor necrosis factor (TNF), peroxisome proliferator-activated receptor, caspase-3, etc.], as well as multiple signaling pathways including TNF and interleukin-17 (IL-17). All 10 potential active ingredients exhibited strong binding affinity to the six core targets. Animal experimental results demonstrated that 320 mg/kg PCTT markedly increased the movement distance and movement speed of depression model mice (P<0.05), and shortened immobility time in tail suspension test and forced swimming test (P<0.05). PCTT reduced serum levels of IL-6, IL-1β and TNF-α, decreased hippocampal glutamate level; it also downregulated the relative mRNA expression of TNF-α, tumor necrosis factor receptor-2 (TNFR2), phosphoinositide 3-kinase (PI3K) and protein kinase B (AKT), as well as TNFR2 protein expression and the ratios of phosphorylated-PI3K/PI3K,phosphorylated-AKT/AKT in the prefrontal cortex. Meanwhile, PCTT elevated the levels of 5- hydroxytryptamine, dopamine and BDNF in the hippocampus. CONCLUSIONS PCTT exerts antidepressant effects possibly by regulating the TNF-α/PI3K/AKT signaling pathway to downregulate the expression of pro-inflammatory factors, thereby modulating the release of neurotransmitters and BDNF.
7.Application of multimodal neuromodulation guided by multidisciplinary team-based management in dynamic assessment and precision rehabilitation for a case of large-area cerebral infarction
Xiaoli WU ; Xiaoqian XIA ; Changqing YE ; Yunlei WANG ; Xingzhu LI ; LiXu LIU ; Fubiao HUANG ; Jingsong LIU ; Yichuan SONG ; Yue ZHANG ; Xiaoxia DU
Chinese Journal of Rehabilitation Theory and Practice 2026;32(10):1165-1176
ObjectiveTo explore the efficacy and potential neural mechanisms of individualized precision rehabilitation combining multimodal neuromodulation technologies under the guidance of multidisciplinary team (MDT)-based whole process dynamic assessment in a patient with large-area cerebral infarction who responded poorly to conventional rehabilitation. MethodsA 38-year-old male patient presented with hemiplegia and complete aphasia following large-area cerebral infarction in the left fronto-temporo-parietal lobe and basal ganglia due to arterial dissection. Under the MDT framework, the patient underwent six months of inpatient rehabilitation and one month of outpatient follow-up. Multimodal assessments were performed at multiple time points using diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), three-dimensional gait analysis and 128-channel electroencephalogram (EEG) monitoring, combined with standardized scales, such as Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), simplified Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI). The rehabilitation protocol integrated conventional therapies with multimodal interventions, including multi-target transcranial magnetic stimulation, brain-computer interface (BCI)-driven robotic hand training and task-oriented virtual reality upper limb training. ResultsAfter intervention, the patient showed significant improvements: LOTCA score increased by 16 points, CRRCAE subscale scores improved by 60% to 90%, total FMA score increased from 20 to 54, FMA-Balance reached 12, and MBI improved from 40 to 91. DTI revealed an increase in global fiber tract count, elevated fractional anisotropy in the corpus callosum and right corticospinal tract, and significantly increased amplitude of low-frequency fluctuations and regional homogeneity in specific brain regions on fMRI. Event-related desynchronization dynamically decreased during BCI training, and three-dimensional gait parameters showed overall improvement. ConclusionFor patients with large-area stroke who respond inadequately to conventional rehabilitation, an individualized precision rehabilitation system based on MDT whole-process dynamic assessment and integrating multimodal neuromodulation with conventional therapy can effectively enhance cognitive, language, motor functions and activities of daily living. Neuroimaging and electrophysiological findings suggest that the mechanism may involve promoting neural fiber remodeling and modulating regional brain activity.
8.Qidan Granules Improves Glucose and Lipid Metabolism in T2DM Rats via the PI3K/AKT/GSK3β Signaling Pathway
Yu YU ; Yuxi ZHOU ; Yue ZHANG ; Xuxi GUO ; Renqun YE
Journal of Guangzhou University of Traditional Chinese Medicine 2025;42(10):2531-2539
Objective To investigate the therapeutic effects and mechanism of Qidan Granules(QDG)on glucose and lipid metabolism disorders in type 2 diabetes mellitus(T2DM).Methods Rats were randomly divided into normal group,model group,QDG low-dose group,QDG high-dose group,and QDG high-dose+PI3K inhibitor group.The normal group received standard chow,while other groups were fed a high-fat/high-sugar diet and injected with streptozotocin(STZ)to establish T2DM.After modeling,rats received corresponding treatments.General conditions were monitored,with body mass,fasting blood glucose(FBG),lipid profiles[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],and fasting insulin levels recorded.Homeostatic model assessment of insulin resistance(HOMA-IR)was calculated.Hepatic mRNA expression of PI3K,AKT,and GSK3β was quantified via qRT-PCR,while protein levels of PI3K,AKT,GSK3β were measured by Western Blot.Results Compared with the model group,the QDG high-dose group showed reduced body mass(P<0.05),reduced FBG(P<0.05),decreased TC,TG,and LDL-C,elevated HDL-C,and lower HOMA-IR;mRNA levels of hepatic PI3K,AKT,and GSK3β and protein expression of p-PI3K,p-AKT,p-GSK3β were significantly upregulated,the differences being statistically significant(P<0.05).The QDG low-dose and QDG high-dose+PI3K inhibitor groups exhibited attenuated improvements in these parameters versus the QDG high-dose group.Conclusion QDG ameliorates body mass loss,glucose/lipid metabolism,and insulin resistance in T2DM rats,likely by activating the PI3K/AKT/GSK3β pathway.
9.The value of applying animal model teaching in improving scientific research ability of graduate students in interventional medicine
Yifan LI ; Pengchao ZHAN ; Zhen LI ; Huzhi RONG ; Yue GAO ; Wenguang ZHANG ; Kewei REN ; Tengfei LI ; Xin LI ; Shuwen YE ; Yuyuan ZHANG
Journal of Interventional Radiology 2025;34(1):96-100
Objective To evaluate the application of rabbit liver cancer model in teaching interventional medicine for graduate students.Methods A total of 10 first-year master graduate students majoring in Radiological Imaging(Interventional Medicine).who were studying at Zhengzhou University of China,were enrolled in this study.The rabbit liver cancer model was used as the experimental teaching materials.The teaching contents included the establishment of rabbit liver cancer model,the interventional operation of rabbit liver cancer,the method of scientific research and teaching,the evaluation of the teaching effect,and the survey of student satisfaction.Results Under the guidance of teaching tutor,the success rate of VX2 rabbit liver cancer modeling performed by the 10 master graduate students majoring in interventional medicine was 100%,and the mean operational quality assessment score was(11.5±2.0)points.During the operation of interventional surgery,the success rate of femoral artery puncture was also 100%,and the mean score for each interventional operation was(11.8±2.3)points.The students'experimental designs were evaluated by the expert group,the results were as follows:2 cases were rated as excellent,7 cases were rated as good,and one case was rated as moderate.The degree of students'satisfaction with experimental teaching method was high,the specific scores of each item are as follows:the understanding of the rabbit liver cancer model was(4.80±0.40)points,the command of interventional technology was(4.60±0.49)points,and the quality and practicability of teaching materials was(4.90±0.30)points.Conclusion This teaching method of using rabbit liver cancer model experiment can improve the animal experiment ability,interventional operation ability and scientific research innovation ability of graduate students.Animal model teaching method is an innovation of teaching mode for graduate students majoring in interventional medicine.
10.Impact of self-efficacy on quality of life in patients with inflammatory bowel disease:the chained mediating role of physical activity and disease burden
Yue ZHANG ; Yiqin CAO ; Yanyan WANG ; Yanqing ZHENG ; Hongfang YE ; Chang ZHENG
Journal of Clinical Medicine in Practice 2025;29(2):119-123
Objective To investigate the effects of physical activity and disease burden on self-ef-ficacy and quality of life in patients with inflammatory bowel disease(IBD).Methods A total of 312 IBD patients were selected by convenience sampling method.General information of patients was col-lected.Self-efficacy[Chronic Disease Management Self-Efficacy Scale(CDM-SES)],physical activi-ty[International Physical Activity Questionnaire-Short Form(IPAQ-SF)],disease burden[Inflamma-tory Bowel Diseases Disk(IBD-disk)Scale]and quality of life[Inflammatory Bowel Disease Ques-tionnaire(IBDQ)]were assessed in IBD patients.The chain-mediating effects of physical activity and disease burden on self-efficacy and quality of life in IBD patients were analyzed.Results There were statistically significant differences in self-efficacy of IBD patients with different ages,body mass index(BMI),places of residence,marital status,educational background and disease stages(P<0.05);there were statistically significant differences in physical activity among IBD patients with different gen-der,age,place of residence,marital status,education background,disease stage and whether to use biological agents(P<0.05);there were statistically significant differences in the disease burden of IBD patients with different BMI,place of residence,marital status,education background,payment method and disease stage(P<0.05);there were statistically significant differences in the quality of life of IBD patients with different ages,places of residence,marital status,education levels,pay-ment methods,disease stages and whether to use biological agents(P<0.05).The quality of life of IBD patients was positively correlated with self-efficacy and physical activity(r=0.605,0.482,P<0.01),and negatively correlated with disease burden and disease stage(r=-0.550,-0.362,P<0.01).Physical activity and disease burden partially mediated between self-efficacy and quality of life in IBD patients.Conclusion IBD patients exhibited moderate levels of self-effi-cacy,low levels of physical activity,and high disease burdens.Clinical healthcare professionals should actively take measures to improve patients'self-efficacy and physical activity levels to reduce disease burden.


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