To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

Drug therapy is a common method to cure diseases and relieve symptoms.The value of patient-reported outcome(PRO)in evaluating the effect of drug therapy has been increasingly paid attention.The PRO scale is a standardized questionnaire,which can scientifically evaluate the experiences and subjective effects of drug use from a patient-centered perspective,and help patients and clinicians make more reasonable medication decisions.By reviewing and sorting out relevant global literature,this paper found that the content of the PRO scales relevant to drug therapy focused on five fields:"medication satisfaction""medication adherence""drug treatment burden""medication-related quality of life"and"adverse drug reactions".This paper described the basic information,measurement characteristics and application of common scales in recent years respectively,and summarized and analyzed the problems and enlightenment of scale development,aiming to provide theoretical reference for the selection,application and development of PRO scales.

Objective:To explore the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Methods:The subjects were 1 241 pairs of pregnant women and their children in Ma'anshan maternal and infant health cohort. The food frequency questionnaire was used to collect the maternal diet data during pregnancy. The cohort children were followed up at birth, month 3, 6, 12, 18 and 24, respectively. The body height and weight data of the cohort children were collected. The principal component analysis was used to determine the categories of maternal dietary patterns during pregnancy, group-based multi-trajectory modeling was used to fit the early childhood BMI change trajectory, and the multiple classification logistic regression model was used to evaluate the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Results:The maternal dietary patterns during pregnancy included protein type, healthy type, vegetarian type, processing type and beverage type, which could explain 50.04% of the total dietary variation. Among them, the protein type, main dietary pattern, could explain 21.34% of the total dietary variation. The early childhood BMI change trajectory was from thinnish stature to average stature, then to mild obesity, accounting for 42.9%, 45.6% and 11.5% respectively. After controlling the potential confounding factors, it was found that there was a statistical correlation between healthy type and beverage type of maternal dietary patterns during pregnancy and early childhood BMI change trajectory ( P<0.05). Comparison of change trajectories between thinnish type and average stature type, children in the low-level group of healthy diet pattern tended to have a thinnish type change trajectory in early life ( OR=1.286, 95% CI: 1.002-1.651). Comparison of change trajectories between mild obesity type and average stature type, children in the high-level group of beverage diet pattern tended to have a mild obesity type change trajectory in early life ( OR=0.565, 95% CI: 0.342-0.935). The other dietary patterns had no statistical correlation with the early childhood BMI change trajectory. Conclusions:Maternal dietary patterns during pregnancy can affect the early childhood BMI change trajectory, and the low-level healthy type diet is an independent risk factor for thinnish type change trajectory, and the high-level beverage type diet is an independent risk factor for the mild obesity type change trajectory.

Objective To characterize the distribution and assess the exposure to phthalic acid esters （PAEs） in the indoor dust of Shanghai City. Methods Samples were collected from 33 sampling sites， including homes， hotels， offices and public places， in Shanghai in 2018， 2019， and 2020. The samples were pretreated by 100 sieves， extracted and concentrated， and then analyzed by gas chromatography-mass spectrometry in selected ion mode （SIM）. Results Results on the characteristics of PAEs in indoor dust in different places showed that concentrations of PAEs were in a range of <0.01-2 464 mg·kg^-1.The average concentration of 16 PAEs was 613 mg·kg^-1. Bis（2-ethylhexyl） phthalate （DEHP）， di-iso-butyl phthalate （DiBP）， di-n-butyl phthalate （DBP） and di-n-octyl phthalate （DnOP） were the main components of PAEs in indoor dust， accounting for approximately 99.5% of 16 PAEs. The intake of DEHP， DBP， DEP and BBP was lower than the tolerable daily intake （TDI） and reference doses （RfD） set by EU CSTEE and U.S. EPA. Conclusion Average daily dose （ADD） via indoor dust is estimated， and the order of intake through different pathways is hand-oral intake>skin contact>respiratory inhalation. Exposure risk of PAEs in children is greater than that in adults.

Objective:To analyze the associations between prenatal and 1-year-old exposure to antibiotics and allergic symptoms in children aged 6-11 months and 18-23 months.Methods:In this study, a prospective birth cohort study was adopted. A total of 2 122 pregnant women were enrolled in Maternal and Child Health Care Center of Ma′anshan from June 2015 to June 2016, and they were followed up from the beginning of pregnancy to children′s 24 months of age. Excluding 564 pairs of mothers and children who were lost to follow-up or with incomplete information on the use of antibiotics and children′s allergic symptoms, a total of 1 558 pairs of mothers and children were included in the analysis of this study. The parents and children′s general demographic information, early-life antibiotic exposure and other data were collected, the information about allergic symptoms in children aged 6-11 months and 18-23 months were investigated by reference to the "International Study of Asthma and Allergies in Childhood (ISAAC)". The univariate and multivariate binary unconditional logistic regression model was used to was used to estimate associations between the effects of early-life antibiotic exposure on allergic symptoms in 2-year-old children.Results:The antibiotic usage rate of pregnant women during pregnancy was 3.4% (53), and the antibiotic usage rates of children between 0 to 2 months, 3 to 5 months, and 6 to 11 months were separately 15.2%(237), 15.5%(242) and 17.3%(269). The total prevalence of allergic diseases in children aged 6 to 11 months was 24.1% (375 children), and the total prevalence of allergic diseases in children aged 18 to 23 months was 22.0% (342 children). After adjust parental (maternal) education level, family monthly income per capita, parental (maternal) allergy history, parental (maternal) age at pregnancy, mother′s Body Mass Index (BMI) before pregnancy, exposure to second-hand smoke during pregnancy, delivery method, child gender, birth weight, preterm birth, the use of antibiotics when children were 3-5 months old ( RR=1.61,95% CI:1.19-2.17) and 6-11 months old ( RR=1.43,95% CI:1.06-1.93) were the risk factors for allergic symptoms at 6-11 months of age; and the use of antibiotics when children were 0-2 months old (RR=1.41, 95% CI: 1.03-1.95), 3-5 months old ( RR=1.54, 95% CI: 1.12-2.11) and 6-11 months old ( RR=1.58, 95% CI: 1.17-2.14) were the risk factors for allergic symptoms at 18-23 months of age. Conclusion:Children′s exposure to antibiotics within 1 year of age was a risk factor for allergic symptoms in children aged 6-11 months and 18-23 months, children should avoid unnecessary antibiotic use in infancy.

Objective:To analyze the associations between prenatal and 1-year-old exposure to antibiotics and allergic symptoms in children aged 6-11 months and 18-23 months.Methods:In this study, a prospective birth cohort study was adopted. A total of 2 122 pregnant women were enrolled in Maternal and Child Health Care Center of Ma′anshan from June 2015 to June 2016, and they were followed up from the beginning of pregnancy to children′s 24 months of age. Excluding 564 pairs of mothers and children who were lost to follow-up or with incomplete information on the use of antibiotics and children′s allergic symptoms, a total of 1 558 pairs of mothers and children were included in the analysis of this study. The parents and children′s general demographic information, early-life antibiotic exposure and other data were collected, the information about allergic symptoms in children aged 6-11 months and 18-23 months were investigated by reference to the "International Study of Asthma and Allergies in Childhood (ISAAC)". The univariate and multivariate binary unconditional logistic regression model was used to was used to estimate associations between the effects of early-life antibiotic exposure on allergic symptoms in 2-year-old children.Results:The antibiotic usage rate of pregnant women during pregnancy was 3.4% (53), and the antibiotic usage rates of children between 0 to 2 months, 3 to 5 months, and 6 to 11 months were separately 15.2%(237), 15.5%(242) and 17.3%(269). The total prevalence of allergic diseases in children aged 6 to 11 months was 24.1% (375 children), and the total prevalence of allergic diseases in children aged 18 to 23 months was 22.0% (342 children). After adjust parental (maternal) education level, family monthly income per capita, parental (maternal) allergy history, parental (maternal) age at pregnancy, mother′s Body Mass Index (BMI) before pregnancy, exposure to second-hand smoke during pregnancy, delivery method, child gender, birth weight, preterm birth, the use of antibiotics when children were 3-5 months old ( RR=1.61,95% CI:1.19-2.17) and 6-11 months old ( RR=1.43,95% CI:1.06-1.93) were the risk factors for allergic symptoms at 6-11 months of age; and the use of antibiotics when children were 0-2 months old (RR=1.41, 95% CI: 1.03-1.95), 3-5 months old ( RR=1.54, 95% CI: 1.12-2.11) and 6-11 months old ( RR=1.58, 95% CI: 1.17-2.14) were the risk factors for allergic symptoms at 18-23 months of age. Conclusion:Children′s exposure to antibiotics within 1 year of age was a risk factor for allergic symptoms in children aged 6-11 months and 18-23 months, children should avoid unnecessary antibiotic use in infancy.

Objective:To investigate the developmental behavior of early term infants at 6 months and its difference from that of complete full-term infants.Methods:A healthy maternal and infant birth cohort in maanshan city, established in Maanshan Maternal and Child Health Hospital from June 2015 to June 2016. Birth outcomes were copied from the hospital electronic medical record system after delivery. The Chinese Ages and Stages Questionnaires was used to assess developmental behavior. The chi-square test and multivariate unconditional logistic regression model were used to analyze the differences in the behavioral development of early and full term infants.Results:The birth rate of early term infants was 24.74% (500/2 021). The detection rates of communication, gross motor, fine motor, problem solving and individual-social areas in early term infants were 2.1%, 3.2%, 6.1%, 6.3% and 2.7%, respectively. The detection rate of problem-solving area in early term infants was significantly higher than that in the full-term infants (6.3% vs. 3.7%, χ 2=5.42, P<0.05). After controlling for confounding factors, compared with full-term infants, the risk of problem-solving area in early infants was significantly increased ( OR=1.65, 95%CI:1.01-2.70, P<0.05). Conclusion:The risk of behavioral retardation in Early term infants is significantly higher than that in full-term infants, and long-term follow-up and appropriate early development promotion interventions are needed to improve their quality of life.

Objective To assess the association between early adiposity rebound (AR) and indices of obesity and metabolic risk in 5-year-old children. Methods Based on Ma’anshan Birth Cohort Study (MABC), single live births born in Ma'anshan of Anhui province from October 2013 to April 2015 were followed for up to 5 years consecutively. As of August 2019, 720 children with continuous measurements (≥8 times) and metabolic indicators were obtained. Physical examination and laboratory tests were used to obtain information on the birth status, length/height, weight, waist circumference, body composition and metabolic indicators of children. The 2 test, F test, t-test, non-parametric test, general linear model and logistic regression model were used for statistical analysis. Results 43.5% of the children had AR≤4 years. After controlling for gender, it was found that earlier AR was associated with overweight/obesity (OR=2.71, 95%CI: 1.81~4.05), larger waist circumference (OR=1.88, 95%CI: 1.25~2.82), and body fat percentage ≥90th percentile (OR=2.09, 95%CI: 1.26~3.48). In the earlier AR group, the insulin resistance and metabolic score were higher, but the difference was not statistically significant. At 5 years of age, the prevalence of obesity and overweight was 6.0% and 12.8%, respectively. Children with overweight/obesity, larger waist circumference, higher waist-to-weight ratio and body fat percentage ≥ 90th percentile were associated with higher insulin resistance and metabolic score, and all the differences were statistically significant (all P<0.001). Conclusion Earlier AR increased the risk of overweight/obesity, larger waist circumference, and body fat percentage ≥90th percentile at age of 5 years. Each index of the commonly used measures of childhood obesity was closely related with insulin resistance and metabolic risk factors at 5 years old.

Objective:To examine the relationship between pre-pregnancy BMI, gestational diabetes (GDM) and different indicators of childhood obesity at the age of 4.Methods:Based on Ma’anshan Birth Cohort Study, singleton children who were born in Ma’anshan of Anhui province from October 2013 to April 2015, were followed for 4 years, consecutively. During the first questionnaire survey, data including pre-pregnancy weight, height and socio-demography were collected. During 24-28 week of gestation, 75 g oral glucose tolerance test was conducted for them. Childhood height, weight, waist circumference and body composition were measured at the age of 4. Comparisons between groups were performed using chi-square test, analysis of variance or t-test. The relationship between pre-pregnancy overweight/obesity, GDM and childhood obesity-related characteristics were analyzed by logistic regression model and generalized linear model analysis. Results:The prevalence rates of overweight and obesity in children at the age of 4 were 13.08% and 6.03%, respectively. After adjustment for characteristics related to mothers and their children, significantly increased risk of obesity ( OR=3.27, 95% CI: 2.15-4.98), larger waist circumference ( OR=2.32, 95% CI: 1.72-3.14) and higher waist-to-weight ratio ( OR=2.29, 95% CI: 1.73-3.02) were seen in the offspring of women with pre-pregnancy overweight/obesity. Body composition (skeletal muscle, body fat, body fat percentage) of the offspring were strongly correlated with pre-pregnancy overweight/obesity of the mothers ( P<0.05). Maternal GDM was associated with higher risk of childhood obesity ( OR=1.78, 95% CI: 1.14-2.79), on mothers without GDM during pregnancy. However, neither larger waist circumference, or higher waist-to-weight ratio seemed to increase the risk. Moreover, maternal GDM was not associated with body composition measures (skeletal muscle, body fat, body fat percentage). Conclusion:Pre-pregnancy BMI and maternal GDM were independent risk factors for obesity in 4-year-old children, and pre-pregnancy BMI was correlated with various indicators of body composition in children.

Objective To investigate the changes of left ventricular systolic and diastolic function before left ventricular morphologic changes in obstructive sleep apnea syndrome (OSAS) patients.Methods A total of 111 OSAS patients were divided into left ventricular hypertrophy (LVH) group (n=29) and non-LVH group (n=82).Meanwhile,50 healthy subjects were enrolled as normal control group.Routine echocardiography and two-dimensional speckle tracking imaging (2D-STI) were performed.The differences of conventional echocardiography and 2D-STI parameters were compared among the three groups.The correlations between echocardiography and clinical parameters were analyzed.Results Compared with those of the other 2 groups,left ventricular mass index (LVMI),diastolic thickness of interventricular septum (IVST),diastolic ventricular posterior wall thickness (PWT),left ventricular internal diastolic dimension (LVIDd),the ratio between early diastolic peak velocity of mitral valve and early diastolic velocity of mitral annular (E/e') and left atrial volume index (LAVI) increased (all P＜0.05),and mitral annular early diastolic velocity (e') at interventricular septum and lateral wall decreased in LVH group (all P＜0.05).The mitral annular systolic velocity (s') in LVH group was less than that in normal control group (P =0.013).Compared with those of the other 2 groups,left ventricular global longitudinal systolic strain (S) and early diastolic strain rate (SRE) decreased (all P＜0.05),and the ratio of early diastolic peak velocity of mitral valve to SRE (E/SRE) increased in LVH group (both P＜0.05).Compared with normal control group,systolic strain rate (SRS) decreased in LVH group (P=0.001).S,SRS,SRE in non-LVH group were less than those in normal control group (all P＜0.05),and E/SRE was higher than that in normal control group (P＜0.001).S,E/SRE were independently associated with apnea hypopnea index (both P＜0.05).LVMI was independently associated with mean arterial oxygen saturation (β =-0.299,t =-3.273,P =0.001).Conclusion OSAS can affect the structure and functions of left ventricular independently.The systolic and diastolic functions of left ventricular have been impaired before morphology changed.