Objective To understand the current situation and influencing factors of health state utility value of the Tibetan elderly in Tibet Autonomous Region.Methods The multi-stage stratified cluster sampling method was used to recruit 1 690 elderly aged 60 and above from 7 cities of Tibet Autonomous Region as the research subjects.The general status of the elderly was investigated by questionnaire survey,and health utility value of the population was measured and computed by EuroQol Five Dimensions Questionnaire(EQ-5D-3L).The influencing factors were analyzed using Tobit regression model.Results The mean visual analogue scale(VAS)score of EQ-5D-3L and the mean health state utility value were 56.36±21.19 and 0.901±0.145,respectively.Those who were male,aged between 60 to 69 years,received middle school education and above,got married,were employed,had medical examination in the past year,and had no hypertension,rheumatoid arthritis or other chronic diseases had higher health state utility value and VAS score.Conclusion The mean health state utility value of Tibetan elderly aged 60 and above in Tibet Autonomous Region was higher than that of other regions in China,while the average score of self-assessment EQ-VAS was lower than that of other regions in China.The health state utility value was affected by gender,age,employment status,education level,living area,different medical examination status in the past year,and chronic disease status.In the future,the health care of the elderly who are aged 70 years and above,are female,have never been to school,live in rural areas,are unemployed,and have chronic diseases should be strengthened.Regular medical examination should be performed to identify health problems timely so as to improve the quality of life of the elderly.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective:To investigate the iodine nutrition status of residents and its changing trend in Baoji City, Shaanxi Province during the 10 years implementation of a new salt iodine standard, evaluate the prevention and treatment effects, and provide a basis for implementing iodine supplementation measures scientifically.Methods:From 2013 to 2015, each county (district) in Baoji City, Shaanxi Province was divided into 5 districts based on east, west, south, north, and central regions. One town (street, referred to as the town) was selected from each district, and four administrative villages were selected from each town. Fifteen residents from each administrative village were selected to collect edible salt samples from their homes and test the iodine content of the salt. At the same time, one primary school was selected from each selected town, and 42 children (age and gender were balanced) aged 8 - 10 were selected from each primary school for thyroid palpation examination. From 2016 to 2022, each county (district) was divided into 5 districts based on east, west, south, north, and central regions. One town was selected from each district, and one primary school was selected from each town. Forty-two non boarding students aged 8 - 10 were selected from each primary school to undergo thyroid palpation examination, and edible salt samples were collected from their home to detect salt iodine content. At the same time, 4 administrative villages were selected from each town, and 10 households were selected from each administrative village to collect edible salt samples and test the salt iodine content; 21 pregnant women were selected from each of the 5 towns in each county (district) to collect edible salt samples and test the salt iodine content. From 2013 to 2022, synchronous collection of urine samples from children and pregnant women (early, middle, and late pregnancy were balanced) was conducted to detect urine iodine content. Direct titration method was adopted for determination of salt iodine content, and arbitration method was adopted for Sichuan salt and other fortified edible salt (GB/T 13025.7-1999). Thyroid examination was performed according to the Diagnostic Criteria for Endemic Goiter (WS 276-2007). Urine iodine was detected by Arsenic Cerium Catalytic Spectrophotometric Method for Determination of Iodine in Urine (WS/T 107 - 2006).Results:From 2013 to 2022, a total of 37 609 household edible salt samples were collected. The coverage rate of iodized salt, the qualified rate of iodized salt and the consumption rate of qualified iodized salt for each year ranged from 98.00% to 100.00%, 94.16% to 99.55%, and 92.28% to 99.67%, respectively. The median range of salt iodine was 22.42 to 26.80 mg/kg. A total of 25 437 children aged 8 - 10 were examined, and the annual incidence of thyroid enlargement (goiter) ranged from 0.35% to 3.02%. A total of 33 270 urine samples were collected, including 21 698 from children and 11 572 from pregnant women. The median range of urine iodine for children in each year was 203.70 - 275.47 μg/L, median range of urine iodine in pregnant women was 167.65 - 218.57 μg/L. The median urine iodine in children showed a decreasing trend from 2013 to 2022 ( Z = 3.04, P = 0.002); the median urine iodine of pregnant women did not show a significant decrease ( Z = 1.61, P = 0.110). Conclusions:During the 10 years implementation of the new salt iodine standard in Shaanxi Province, all indicators of iodine deficiency disorders monitoring in Baoji City have met the standards and maintained the elimination status of iodine deficiency disorders. The urine iodine levels of children have shown a downward trend, while urine iodine levels of pregnant women do not show significant changes. It is recommended that Baoji City expand the scope of iodine nutrition monitoring for key populations, and effectively carry out iodine supplementation measures scientificlly guided by monitoring information, tailored to local conditions, and classified guidance.

Objective:To analyze the iodine nutrition status of the population in Baoji City, Shaanxi Province after adjusting the salt iodine content, and evaluate the effectiveness of current prevention and control measures for iodine deficiency disorders (IDD).Methods:IDD surveillance data in Baoji City from 2016 to 2022 (from the Baoji Center for Disease Control and Prevention and the Baoji Maternity and Child Care Hospital) were collected, iodine content in urine of children aged 8 to 10, pregnant women and household salt was analyzed, and the thyroid stimulating hormone (TSH) of neonatal heel blood was determined. Mann-Kendall test and linear trend χ 2 test were used to test the trend. Results:A total of 26 812 salt samples were tested from 2016 to 2022, with a median salt iodine concentration of 24.09 mg/kg and a qualified iodine salt consumption rate of 97.84% (26 234/26 812). A total of 17 877 urine samples of children aged 8 to 10 were tested, with a median urine iodine of 218.41 μg/L, 8 935 urine samples of pregnant women were tested, with a median urine iodine of 184.59 μg/L, and 121 607 blood samples of newborns were tested, with a median TSH of 2.00 mU/L. With the increase of years, there was no significant trend in the median of salt iodine, child urine iodine and maternal urine iodine ( Ztrend = 1.80, - 1.50, 0.30, P > 0.05), however, the median of neonatal TSH showed an overall downward trend ( Ztrend = - 1.97, P = 0.048). As the years increase, the proportion of qualified iodized salt (18 - 33 mg/kg of salt iodine), adequate iodine content of children (100 - 299 μg/L of urine iodine) and appropriate iodine content of pregnant women (150 - 249 μg/L of urine iodine) showed an increasing trend (χ 2trend = 122.74, 26.56, 28.43, P < 0.001), however, the proportion of TSH > 5.0 mU/L in neonatal heel blood decreased linearly (χ 2trend = 1 634.43, P < 0.001). Conclusions:From 2016 to 2022, the salt iodine content and iodine nutrition level of the population in Baoji City have met the national standard for eliminating IDD. It is recommended to strengthen the health education of scientifically eating iodized salt and supplementing iodine.

Objective:To analyze the surgical types of patients with Kashin-Beck disease (KBD) in Shaanxi Province, and to provide reference for optimizing KBD surgery.Methods:Retrospective analysis was used to investigate KBD patients who underwent surgical treatment, and the patient's information was from the Shaanxi Provincial Endemic Disease Prevention and Control Information System. Patients with incomplete surgical treatment information were excluded, and χ 2 test was used to analyze the impact of factors such as gender, education level, living area, disease severity, and social environment on the selection of different surgical types (free body enucleation or joint replacement) for KBD patients. Using propensity score method to perform a 1 ∶ 1 match on patients with different surgical types, and analyzing the influencing factors of KBD patients receiving different types of surgical treatment through multivariate logistic regression. Results:From 2018 to 2020, a total of 1 084 KBD patients in Shaanxi Province underwent surgical treatment, including 555 males (51.20%) and 529 females (48.80%), with a median age of 64 years old. There were 917 patients (84.59%) in the Guanzhong region (Tongchuan, Xi'an, Weinan, Xianyang, Baoji), 120 patients (11.07%) in the northern Shaanxi region (Yulin, Yan'an), and 47 patients (4.34%) in the southern Shaanxi region (Ankang, Hanzhong, Shangluo). The number of patients with KBD grade Ⅰ,Ⅱ, and Ⅲ was 401 (36.99%), 525 (48.43%), and 158 (14.58%), respectively. Five hundred and forty-eight patients (50.55%) underwent free body enucleation surgery, and 536 patients (49.45%) underwent joint replacement surgery. Univariate analysis showed that different genders, educational levels, living areas, disease severity, economic status, whether to relocate, type of drinking water, type of staple food, and source of staple food were the influencing factors for KBD patients to choose the type of surgery (χ 2 = 81.82, 22.38, 93.68, 22.38, 5.17, 15.68, 13.82, 39.37, 49.63, P < 0.05). Among 374 pairs of patients who underwent free body enucleation and joint replacement through propensity score matching, multivariate logistic regression analysis found that high school and above education level [odds ratio( OR) = 0.42, P = 0.008], Guanzhong region ( OR = 0.12, P < 0.001), relocation ( OR = 0.60, P = 0.004), and drinking well water ( OR = 2.15, P = 0.001) were the influencing factors for KBD patients to choose different surgical types for treatment. Conclusion:When performing surgical treatment for KBD patients in Shaanxi Province, clinicians can consider the severity of the disease, as well as factors such as the education level, living area, relocation status, and type of drinking water of KBD patients, to provide more suitable surgical types for KBD patients.

Objective: To explore the associations of family structure with adolescent mental health and health associated behaviors, to support interventions to decrease the occurrence of psychological problems and adverse health associated behaviors among adolescents in families without two parents. Methods: The multi stage stratified random cluster sampling method was used to select 18 700 adolescents of the 13 districts and cities from Jiangsu Province for a questionnaire survey on mental health and health associated behaviors, to compare differences in mental health and health associated behaviors among adolescents with different family structures. Results: Among the adolescents, 82.1% had two parent families, 8.6% had single mother families, 4.0% had single father families, and 5.3 % had families with both parents absent. After controlling for age, urban/rural areas, gender, academic period and region, Logistic multivariate regression analysis showed that compared with adolescents from two parent families, the incidence of depression, social anxiety and bullying on campus of adolescents with single mother families increased significantly( OR=1.31, 1.15, 1.36，P ＜0.05). Compared with adolescents in two parent families, adolescents in families without two parents had significantly more types of health risk behaviors, and those in single mother families had significantly less frequent intake of a healthful diet( OR =0.81), significantly more smoking( OR =1.20), drinking behaviors( OR =1.22), and significantly less moderate intensity physical activity ( OR =0.84) and shorter duration of sleep( OR =0.87)( P <0.05). Conclusion Psychological and health associated problems were significantly higher among adolescents in families without two parents than in those with two parent families. Psychological problems and adverse health associated behaviors were particularly prominent among adolescents in single mother families.

Objective:To study the iodine nutrition status of pregnant women in Baoji City Shaanxi Province, and to provide basis for iodine supplementation scientifically in pregnancy period.Methods:From January 2018 to December 2020, 12 counties and districts in Baoji City were divided into 5 districts according to different directions each year, 1 township (sub-district office) was selected from each district and 21 pregnant women from each township (sub-district office) were selected, domestic salt samples and instant urine samples were collected to determine the contents of iodine.Results:A total of 3 783 pregnant women's domestic salt samples were collected, the median salt iodine was 24.00 mg/kg, the difference of median salt iodine among different years was statistically significant ( H = 118.22, P < 0.01). A total of 3 783 urine samples were tested, and the median urinary iodine was 192.44 μg/L. The median urinary iodine of pregnant women in urban, plain and mountainous areas (205.08, 193.61 and 182.75 μg/L) was significantly different ( H = 17.53, P < 0.01); the median urinary iodine of pregnant women in different pregnancy periods (early, mid and late: 194.47, 198.19 and 183.54 μg/L) was significantly different ( H = 6.18, P < 0.05). There was no significant difference in median urinary iodine of pregnant women among different ages ( H = 2.25, P > 0.05). Conclusions:The iodine nutrition of pregnant women in Baoji City is generally at an appropriate level. It is necessary to strengthen the health education for key populations, advocate scientific consumption of iodized salt for improving their iodine nutrition.

【Objective】 To explore the relationship of health literacy with COVID-19 prevention and control knowledge， attitude and practice （KAP） in general population so as to contribute scientific evidence for strengthening health education and promoting health literacy to resist the threat of major infectious disease outbreaks. 【Methods】 In September 2020， a questionnaire survey was conducted in residents selected by a multi-stage random sampling across all the twelve counties/districts of Baoji city. The questionnaire， which was issued by the Chinese Health Education Center， consisted of a health literacy questionnaire and a COVID-19 prevention and control KAP questionnaire. According to the national unified scoring method， the participants were divided into two groups： those who met and those who failed to meet the overall standard of health literacy. The results of the answer to each KAP question were compared between the two groups by Chi-square test or rank sum test. Multivariate binary Logistic regression was used to control confounding effects of socio-demographic characteristics to draw relatively reliable conclusions. 【Results】 A total of 4 544 valid questionnaires were collected， in which 664 （14.60%） met the overall standard of health literacy， but 3 880 （85.40%） failed to do so. Compared with the unmet group， the met group had a higher correct answer rate in 10 of the 11 knowledge-related questions （all P<0.001）； showed more positive answer to each attitude-related question in the three aspects， namely， responsibility for the prevention and control of infectious disease transmission， evaluation for COVID-19-related information release and reporting， and evaluation for the government’s COVID-19 prevention and control results （all P<0.001）； and acted more actively in 6 of the 7 practice concerning appropriate self-prevention and control behaviors during the COVID-19 outbreak （all P<0.001）. Logistic regression analyses confirmed that achieving the overall standard of health literacy played a positive role in each of the contents of COVID-19 prevention and control KAP in study （ORs were between 1.44 and 4.09， all P<0.001）. Moreover， the absolute value of regression coefficient of the overall standard of health literacy was the largest compared with all the socio-demographic factors. Logistic regression was used to further analyze relationships between each of the six health dimensions of health literacy and COVID-19 prevention and control KAP， which revealed that the association with safety and first aid， infectious diseases prevention， and health information was the closest. 【Conclusion】 Health literacy is closely related to COVID-19 prevention and control KAP in the general population of Baoji city. Promoting residents' health literacy by targeted health education can play an important and positive role in dealing with the threat of major infectious diseases outbreaks.