Public knowledge of stroke in Chinese urban residents: a community questionnaire study

BACKGROUND AND PURPOSE

Intensive control of the risk factors of stroke and the pre-hospital delay after stroke onset both depend on the level of knowledge of stroke in the general population. Our primary objective was to assess the public knowledge about stroke among urban residents in four cities in China.

METHODS

A semi-structured interview and questionnaire was delivered in a survey. Standardized risk factor and symptom statements were used to measure knowledge. The setting of two communities from four different cities of China was used to target a mix of social class and geography. Using systematic sampling and the household as a unit, at least 300 households were chosen in one community. Each household selected one person to fill in the self-designed questionnaire. Uniform training of community physicians was conducted before the survey, and the community physicians completed the survey by face to face indoor-investigation.

RESULTS

Total integral questionnaires numbered 2519. The investigation showed that (1) hypertension was identified as a risk factor by nearly 90% of residents. Dyslipidemia, smoking, diabetes, and non-modifiable risk factors were identified by less than 65%; (2) medical therapy of hypertension and diabetes was known by nearly 80% of residents, and the awareness of lifestyle modification was less; (3) weakness or numbness were the most common symptoms identified by community residents (80.2%), and the awareness of other symptoms of stroke ranged from 58.2 to 71.2%; (4) the stroke knowledge score and education level were positively correlated (r(s) = 0.088, P<0.001), and age was negatively correlated (r(s) = -0.142, P<0.001); (5) 53.0% of residents would call an emergency medical system once stroke symptoms began; (6) the main sources of information about stroke were television (74.4%), doctors (63.2%) and newspapers (61.8%).

CONCLUSION

At present, the urban community residents in China are lacking in knowledge about stroke. Going forward, we should strengthen health education through television, medical staff, newspapers, magazines. Targeted educational populations should be directed at those who are elderly, lower education, male and high risk.

Awareness, treatment and control of type 2 diabetes among Chinese elderly and its changing trend for past decade

BACKGROUND

This study aims to evaluate the awareness, treatment, control rate of type 2 diabetes and its risk factors among Chinese community elderly, and also examine the changing trend for the past decade.

METHODS

We conducted two population-based cross-sectional studies in a representative urban area of Beijing in 2001 and 2010 respectively, using with the same method. A total of 2,277 participants (943 male, 1,334 female) in 2001 and 2,102 participants (848 male, 1,254 female) in 2010 were recruited. All the participants diagnosed with diabetes were included in this study.

RESULTS

The prevalence of diabetes was 21.4% and 24.8% in 2001 and 2010 respectively. Among participants with diabetes, 74.2% were aware of the condition, 51.0% were treated, 20.1% well controlled the condition in 2001, and the corresponding rates were 78.5%, 69.3%,15.9% in 2010 respectively. Higher education level and a positive family history were related to better management of diabetes, while obesity and alcohol drinking showed a reverse direction.

CONCLUSIONS

The prevalence and awareness of diabetes stayed high for the past decade. The treatment increased 18.3% while the control rate decreased among community elderly for the past 10 years. It's urgent to carry out effective measures to raise awareness, treatment, and control rate of diabetes in order to avoid growing disease burden in China.

Prevalence of passive smoking in the community population aged 15 years and older in China: a systematic review and meta-analysis

OBJECTIVES

To estimate the prevalence and distribution of passive smoking in the community population aged 15 years and older in China.

DESIGN

A systematic review and meta-analysis of cross-sectional studies reporting the prevalence of passive smoking in China and a series of subgroup, trend and sensitivity analyses were conducted in this study.

DATA SOURCE

The systematic review and meta-analysis, which included 46 studies with 381,580 non-smokers, estimated the prevalence and distribution of passive smoking in China. All studies were published between 1997 and 2015.

RESULTS

The pooled prevalence of passive smoking was 48.7% (95% CI 44.8% to 52.5%) and was relatively stable from 1995 to 2013. The prevalence in the subgroups of gender, area, age and time varied from 35.1% (95% CI 31.8% to 38.3%) in the elderly (≥60 years) to 48.6% (95% CI 42.9% to 54.2%) in urban areas. The prevalence was lower in the elderly (≥60 years) than in those between 15 and 59 years of age (OR 1.61, 95% CI 1.44 to 1.81). The difference between females and males in urban and rural areas was not statistically significant (OR: 1.27, 95% CI 0.93 to 1.74 and OR: 1.14, 95% CI 0.82 to 1.58, respectively). In addition, a significantly increasing trend was found among males from 2002 to 2010. Heterogeneity was high in all pooled estimates (I(2)>98%, p<0.001).

CONCLUSIONS

The high and stable prevalence of passive smoking in China is raising increasing national concern regarding specific research and tobacco control programmes. Attention should be focused on young, middle-aged and male non-smokers regardless of region.

Association Between Family History and Hypertension Among Chinese Elderly

This study aimed to evaluate the association between family history and prevalence of hypertension among Chinese community elderly, and also explore the gender difference. A population-based cross-sectional study was conducted in Miyun district of Beijing, in 2014. The family history information was obtained from each subject and was divided into 3 categories, no family history (FH0), 1 generation of first-degree relatives with hypertension (FH1), and 2 generations of first-degree relatives with hypertension (FH2). The prevalence of hypertension was 53.0%. Participants with positive family history had a significantly higher prevalence of hypertension (67.5%, 95% CI: 63.3-71.7) than those without (47.9%, 95% CI: 45.2-50.6), and even among participants without hypertension, the blood pressure levels were higher with positive FH. Multiple logistic regression analysis showed that a significantly linear-trend increase in hypertension according to family history of first degree relative numbers was observed in both genders (P for trend < 0.001). This study suggests that family history had not only a significant but also graded association with hypertension and with blood pressure levels, and this association exists even among those without hypertension.

Change in stroke incidence from a population-based intervention trial in three urban communities in China

Stroke has been the main cause of death in most urban residents in China since the 1990s. A community-based intervention trial carried out in China aimed to reduce the incidence and mortality of stroke. In 1991, two well-matched communities each with approximately 50,000 people were selected as intervention or control communities in the urban areas of Beijing, Shanghai and Changsha. Regular health education and health promotion activities were carried out between 1991 and 2000 in the intervention communities but no special action was taken in the control communities. Both fatal and nonfatal stroke cases were meticulously registered during the study in the two communities to assess the effect of long-term intervention. The trend in stroke incidence and the effect of intervention on stroke incidence were analyzed using a Poisson regression model adjusted for age, sex, year and city. Between 1991 and 2000, 2,273 first-ever stroke cases were registered in the intervention communities and 3,015 in the control communities. Geographic variation and changes in the incidence of stroke and its subtypes were found among these 3 cities. Through 10 years of intervention, incidence risks of all, ischemic and hemorrhagic strokes decreased by 11.4% (relative risk 0.8959; 95% confidence interval, CI, 0.8483-0.9460; p < 0.0001), 13.2% (relative risk 0.8676; 95% CI 0.8054-0.9345; p = 0.0002) and 7.2% (relative risk 0.9283; 95% CI 0.8517-1.0117; p = 0.0899), respectively, in the intervention compared with control communities. Accordingly, comprehensive community-based intervention measures could effectively reduce the incidence of stroke in the population.

Hypertension detection, management, control and associated factors among residents accessing community health services in Beijing

The aim of this study was to analyse high blood pressure detection, management, control and associated factors among residents accessing community health services (CHSs) in Beijing. We screened for HBP in 9524 individuals aged 50 years or older who accessed care in four Beijing CHSs. Among the 9397 residents with questionnaire responses that qualified them for inclusion in the study, 5029 patients with HBP were identified, 1510 (i.e., 30% of the HBP patient group) of whom were newly identified cases. The rate of hypertension detection was 53.5%. Among the 5029 HBP patients, the rates of awareness, treatment and control of hypertension were 70.0%, 62.1% and 29.6%, respectively. In general, the rate of hypertension control was higher when the rates of hypertension awareness and treatment were higher in subgroups stratified by different sociodemographic and risk factors, except for the overweight and obesity subgroups. In conclusion, suboptimal HBP awareness, treatment, and control are still major problems confronting CHSs in Beijing. Control of hypertension in the population may be improved by increasing awareness and improving the treatment of hypertension in CHSs.

Association between sleep duration and the prevalence of hypertension in an elderly rural population of China

BACKGROUND

Previous studies have examined an association between sleep duration and hypertension, but the conclusions remain inconsistent.

METHODS

We conducted a cross-sectional study in a community-based rural elderly population of Beijing, China. A total of 2397 participants (967 male and 1430 female) completed the survey. Sleep duration was assessed in a face-to-face interview and was self-reported. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg and/or receiving treatment for hypertension. Multiple logistic regression was used to estimate the association between gender-specific sleep duration and hypertension prevalence.

RESULTS

Overall, no significant differences were observed among female participants and the total participants, and the differences were statistically significant only in men. After adjusting for potential confounding variables, the odds ratio (OR) and 95% confidential interval (CI) of having hypertension was 1.33 (1.00, 1.77) in men who slept for ≥9 h compared with those slept for six to eight hours per 24-h period. Furthermore, a one hour nap was associated with less likelihood of hypertension in men compared with those who did not nap, with an adjusted OR (95% CI) of 0.61 (0.41, 0.90).

CONCLUSION

In a community-based rural elderly population of China, we found that sleep duration of six to eight hours per 24-h period and a one hour nap were significantly associated with lower risk of hypertension only among male participants after adjustment for potential confounders. Further studies are still needed to determine the relationships between 24-h, nighttime, and daytime sleep duration separately with hypertension, and to explore the biological mechanisms underlying the gender-related association.

Association between muscle strength and health-related quality of life in a Chinese rural elderly population: a cross-sectional study

OBJECTIVE

To investigate the relationship between upper and lower limb muscle strength and the health-related quality of life (HRQoL) of a Chinese rural, elderly population.

DESIGN

A population-based, cross-sectional study.

SETTING

Miyun, Beijing, China.

PARTICIPANTS

The participants of this study were 2083 (834 men and 1249 women) older adults from a rural area, (average age of ≥60 years), living in Miyun county, located on the outskirts of Beijing. Data were collected between May and October 2014. Handgrip strength and timed up and go tests (TUGT) were conducted to measure the muscle strength of their upper and lower limbs, respectively. The Euro Quality of Life (Euroqol) (EQ-5D)-Visual Analogue Scale was used to evaluate participants' HRQoL.

RESULTS

A significant association between handgrip strength and the EQ-5D index (β=0.015 per SD, 95% CI: 0.008 to 0.023, p<0.001) was discovered, following adjustments. The association between handgrip strength and the EQ-5D index in the ≥80 years group was found to be stronger than that of the 60-79 years group, following adjustment (β per SD: 0.013 vs 0.035). Similar results were observed when comparing the non-chronic disease group, in terms of TUGT time, against those with chronic diseases.

CONCLUSIONS

There was a significant relationship between muscle strength (measured via handgrip strength and TUGT time) and HRQoL (measured via EQ-5D index and VAS score) in the Chinese rural elderly population. Furthermore, this relationship was stronger in the older population (aged ≥80 years), and in those participants diagnosed with chronic diseases.

Changes in BMI before and during economic development and subsequent risk of cardiovascular disease and total mortality: a 35-year follow-up study in China

OBJECTIVE

It is unclear whether changes in BMI during rapid economic development influence subsequent mortality.

RESEARCH DESIGN AND METHODS

We analyzed whether BMI in 1976 and 1994 and changes in BMI during 1976-1994 predict cardiovascular disease (CVD) and all-cause mortality in a 35-year follow-up cohort of 1,696 Chinese (1,124 men and 572 women, aged 35-65 years) in Xi'an, China. Participants were categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), and overweight (≥25.0 kg/m(2)).

RESULTS

During 51,611 person-years of follow-up, we identified 655 deaths from all causes and 234 from CVD. From 1976 to 1994, the prevalence of overweight rose from 9.2 to 27.8%. With each unit increment in 1976 BMI, multivariate hazard ratios (HRs) (95% CI) were 0.78 (0.72-0.84) for CVD and 0.91 (0.87-0.95) for all-cause mortality. In contrast, corresponding HRs were 1.14 (1.08-1.19) and 1.05 (1.01-1.08) in 1994 BMI. The HRs for each unit increment in BMI change from 1976 to 1994 were 1.35 (1.25-1.41) for CVD and 1.09 (1.05-1.13) for all-cause mortality. Compared with participants with stable normal weight in 1976 and 1994, HRs of all-cause mortality for those who had normal weight in 1976 but became overweight in 1994 and for those who were persistently overweight during 1976-1994 were 1.42 (1.12-1.80) and 1.80 (1.04-3.14), respectively.

CONCLUSIONS

Gaining weight with increased BMI at middle age in Chinese during economic development was associated with elevated risks of all-cause and CVD mortality. Higher BMI measured before economic development was associated with lower mortality risk, whereas BMI measured afterward was associated with increased mortality.

Prevalence and Altered Causes of Traumatic Brain Injury in China: A Nationwide Survey in 2013

BACKGROUND

Traumatic brain injury (TBI) is one of the leading causes of death and disability annually worldwide. However, the epidemiology of TBI had not been established in China. We conducted a nationally representative door-to-door survey in the general population across all age groups in 31 provinces in mainland China in 2013.

METHODS

All participants were reviewed for a history of physician-diagnosed TBI by trained investigators using a structured questionnaire. TBI survivors were considered as prevalent cases at the prevalent time. The present study also examined the odds of TBI as a function of sex, age, and other demographical variables using logistic regression model.

RESULTS

Of 583,870 participants, 2,673 individuals had suffered from a TBI during their past life, yielding a weighted prevalence of being 442.4 (95% CI 342.2-542.6) per 100,000 person. The TBI prevalence increased with increasing age. The present study observed the multiadjusted ORs of TBI were 1.9 (95% CI 1.8-2.1) for the male, 1.9 (95% CI 1.2-3.1) for the farmers, 1.9 (95% CI 1.2-3.3) for the retiree or homemakers, 3.4 (95% CI 1.5-7.7), and 2.8 (95% CI 1.1-6.6) for those whose education were primary school and high school, respectively. The most common external cause was road traffic accidents among those who were aged 18-34 years old and those whose educational levels were middle school in both genders.

CONCLUSIONS

Our results indicate TBI was substantially prevalent among Chinese population and underscore the need to develop national strategies to improve the safe education on road and traffic of TBI in rural residents and some subgroup population.

Community-Based Rehabilitation to Improve Stroke Survivors' Rehabilitation Participation and Functional Recovery

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a community-based rehabilitation appropriate technique (CRAT) intervention program in increasing rehabilitation participation and improving functional recovery of stroke survivors.

DESIGN

This study followed a quasi-experimental design. In each of 5 centers servicing approximately 50,000 individuals, 2 communities were designated as either the intervention or control community. A CRAT intervention program, including 2-year rehabilitation education and 3-month CRAT treatment, was regularly implemented in the intervention communities, whereas there was no special intervention in the control community. Two sampling surveys, at baseline and after intervention, were administered to evaluate the rehabilitation activity undertaken. In intervention communities, stroke survivor's motor function, daily activity, and social activity were evaluated pretreatment and posttreatment, using the Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire.

RESULTS

The proportion of individuals participating in rehabilitation-related activity was increased significantly (P < 0.05) in intervention communities, as compared with control communities. In intervention communities, the patients' Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire scores were significantly improved after rehabilitation (P < 0.05) across all ages and disease courses, except for the FAQ scores in patients younger than 50 years (P > 0.05).

CONCLUSIONS

Community-based rehabilitation appropriate technique increases rehabilitation participation rates and enhances motor function, daily activity, and social activity of stroke survivors.

GeographicalDifference, Rural-urban Transition and Trend in Stroke Prevalence in China: Findings from a National Epidemiological Survey of Stroke in China

Accurate and up-to-date provincial and regional-level stroke prevalence estimates are important for research planning and targeted strategies for stroke prevention and management. However, recent and comprehensive evaluation is lacking over the past 30 years in China. This study aimed to examine the geographical variations in stroke prevalence based on data from the National Epidemiological Survey of Stroke in China (NESS-China) and demonstrate urban-rural transition and trend over three decades. The stroke prevalence (prevalence day, August 31, 2013) was estimated using the world standard population. The stroke prevalence was 873.4 per 100,000 population, and varied from 218.0 in Sichuan to 1768.9 in Heilongjiang. Stroke prevalence exhibited a noticeable north-south gradient (1097.1, 917.7, and 619.4 in the north, middle, and the south, respectively; P < 0.001) and showed a 2.0-fold, 1.5-fold, and 1.2-fold increase in rural areas in the north, the middle, and the south, respectively, from 1985 to 2013. Overall, stroke prevalence was higher in the rural regions than in the urban (945.4 versus 797.5, P < 0.001) regions. However, the converse was depicted in 12 provinces. A noticeable geographical variation in stroke prevalence was observed and was evolving overtime in China. It is imperative that effective public health policies and interventions be implemented, especially in those regions with higher prevalence.

Changes in and patterns of smoking exposure in an elderly urban population in Beijing: 2001-2010

OBJECTIVE

The study aims to explore the patterns and changes of active and passive smoking in the elderly population.

METHODS

Two cross-sectional surveys with representative samples of urban populations, aged between 60 and 95 years old, were conducted in 2001 and 2010 in Beijing. A current smoker was defined as a person who smoked a tobacco product at the time of the survey, and a passive smoker was defined as a person who had been exposed to smoke exhaled by a smoker for more than 15 minutes per day more than once per week.

RESULTS

A total of 2,277 participants in 2001 and 2,102 participants in 2010 completed the survey. The current smoking prevalence changed slightly in males (24.7 vs. 21.2%, P = 0.081), while the prevalence in females decreased significantly from 8.8% (95% CI: 7.3-10.3%) in 2001 to 4.1% (95% CI: 3.0-5.2%) in 2010 (P<0.001). The prevalence of passive smoking was 30.5% (95% CI: 28.6-32.4%) in 2001 and 30.0% (95% CI: 28.1-32.0%) in 2010. The main source of secondhand smoke switched from a spouse in 2001 to offspring in 2010. This trend was observed in both sexes. Passive smoking in males from a smoking spouse decreased from 5.7% to 2.4% (P<0.001), while that from smoking offspring increased from 7.3 to 14.5% (P<0.001). Passive smoking in females from a spouse decreased from 30.6 to 17.6%, while that from offspring increased from 5.3 to 15.4% (P<0.001).

CONCLUSION

Offspring became the main source of secondhand smoke for the elderly. Our findings demonstrated the importance of implementing smoking prevention programs, to educate older adults who live with a smoking spouse and/or offspring.

Association between reproductive variables and metabolic syndrome in chinese community elderly women

OBJECTIVE

This study aimed to evaluate the association between reproductive variables and metabolic syndrome (MetS) among Chinese community elderly women.

METHODS

We conducted a cross-sectional study in a Beijing urban district. A two-stage stratified clustering sampling method was used and 1251 elderly women were included.

RESULTS

The prevalence of MetS was 65.1% in this population. Women with MetS had younger menarche age, a greater number of years after menopause, higher gravidity and parity. The prevalence of MetS showed an increasing trend for tertiles of years after menopause (p=0.002) and number of children (p<0.001), while decreasing trend for menarche age (p=0.021). Logistic regression showed ORs of age at menarche, years after menopause and number of children for MetS were 0.94, 1.40, and 1.36 for second and 0.63, 1.58, and 1.75 for last tertiles.

CONCLUSION

There is strong association between reproductive variables and higher risk of MetS. Simple information on timing of menarche and menopause could help identify women who may have higher risk of getting MetS and take early action to prevent related chronic diseases.

Effectiveness of additional follow-up telephone counseling in a smoking cessation clinic in Beijing and predictors of quitting among Chinese male smokers

BACKGROUND

No previous studies have investigated whether additional telephone follow-up counseling sessions after face-to-face counseling can increase quitting in China, and whether this strategy is feasible and effective for promoting smoking cessation is still unclear.

METHODS

A non-randomized controlled study was conducted in Beijing. We compared the quit rates of one group which received face-to-face counseling (FC) alone (one session of 40 min) to another group which received the same face-to-face counseling plus four follow-up sessions of brief telephone counseling (15-20 min each) at 1 week, 1, 3 and 6 month follow-up (FCF). No smoking cessation medication was provided. From October 2008 to August 2013, Chinese male smokers who sought treatment in a part-time regular smoking cessation clinic of a large general hospital in Beijing were invited to participate in the present study. Eligible male smokers (n = 547) were divided into two groups: FC (n = 149) and FCF (n = 398). Main outcomes were self-reported 7-day point prevalence and 6 month continuous quit rates at 12 month follow-up.

RESULTS

By intention to treat, at 12 month follow-up, the 7-day point prevalence and 6 month continuous quit rates of FC and FCF were 14.8 % and 26.4 %, and 10.7 % and 19.6 % respectively. The adjusted odds ratios (95 % confidence intervals) of quitting in FCF compared to FC was 2.34 (1.34-4.10) (P = 0.003) and 2.41 (1.28-4.52) (P = 0.006), respectively. Stepwise logistic regression showed that FCF, being married, unemployed and a lower Fagerström score were significant independent predictors of 6 month continuous quitting at 12 month follow-up.

CONCLUSIONS

Using systematically collected data from real-world practice, our smoking cessation clinic has shown that the additional telephone follow-up counseling sessions doubled the quit rate.

The Association of Hypertriglyceridemic Waist Phenotype with Chronic Kidney Disease and Its Sex Difference: A Cross-Sectional Study in an Urban Chinese Elderly Population

Background: The primary objective of this study was to explore the association of hypertriglyceridemic waist (HTGW) phenotype with chronic kidney disease (CKD) and its sex difference in an urban Chinese elderly population. Methods: In a cross-sectional study, a total of 2102 participants aged 60-95 years were recruited and classified into four phenotypes: normal waist-normal triglyceride (NWNT), normal waist-elevated triglycerides (NWET), elevated waist-normal triglycerides (EWNT), and HTGW. Logistic regression analysis was used to estimate the associations of interest. Results: Total prevalence of CKD was 12.6%, and the CKD prevalence in participants with EWNT and HTGW was higher than with NWNT and NWET without regard to sex. Compared to NWNT phenotype, the adjusted OR for CKD was 1.95 (95% CI: 1.32-2.88) in HTGW groups. In contrast with the null findings (OR: 1.66; 95% CI: 0.94-2.94) in women after additional adjustment for diabetes and hypertension, the OR with HTGW remained strong (OR: 1.88; 95% CI: 1.04-3.39) in men. Similar findings appeared with the EWNT phenotype. Conclusions: The HTGW phenotype is positively associated with CKD among Chinese community elderly and may have a greater impact on men. More attention should be paid to the association between triglycerides and waist circumference in clinical practice and to the further identification this uncertain sex-related association.

Gender difference in the association between aminotransferase levels and hypertension in a Chinese elderly population

Few epidemiological studies have examined the association between serum aminotransferase levels and hypertension, and have yielded inconsistent results.A cross-sectional study was performed in a Chinese rural elderly population. A total of 2174 participants with normal range of aminotransferase levels and without excessive drinking were included in the present study. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured on fasting morning serum samples using the Kinetic method. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or receiving treatment for hypertension. Multiple logistic regression was used to estimate the association between gender-specific aminotransferase levels and hypertension.Increased serum ALT but not AST level was positively associated with hypertension. After adjusting for potential confounding variables, the association of hypertension and ALT level was only significant in women: for each 1 IU/L elevation of ALT level, the adjusted odds ratio (OR), and corresponding 95% confidence interval (CI) of hypertension was 1.04 (1.01, 1.07); the ORs of hypertension increased across tertiles of ALT, and the ORs (95% CIs) were 1.00, 1.17 (0.85, 1.60), and 1.63 (1.15, 2.31 (P value for trend = .021). Furthermore, the association was only significant in central obesity women or nondrinking women.ALT level was significantly associated with hypertension only in women in a Chinese rural elderly population. Further studies are warranted to explore the possible gender-related association and to extend them to different populations.

The Gaps Between Current Management of Intracerebral Hemorrhage and Evidence-Based Practice Guidelines in Beijing, China

Background: The leading cause of death in China is stroke, a condition that also contributes heavily to the disease burden. Nontraumatic intracerebral hemorrhage (ICH) is the second most common cause of stroke. Compared to Western countries, in China the proportion of ICH is significantly higher. Standardized treatment based on evidence-based medicine can help reduce ICH's burden. In the present study we aimed to explore the agreement between the management strategies during ICH's acute phase and Class I recommendations in current international practice guidelines in Beijing (China), and to elucidate the reasons underlying any inconsistencies found. Method: We retrospectively collected in-hospital data from 1,355 ICH patients from 15 hospitals in Beijing between January and December 2012. Furthermore, a total of 75 standardized questionnaires focusing on ICH's clinical management were distributed to 15 cooperative hospitals. Each hospital randomly selected five doctors responsible for treating ICH patients to complete the questionnaires. Results: Numerous approaches were in line with Class I recommendations, as follows: upon admission, all patients underwent radiographic examination, about 93% of the survivors received health education and 84.5% of those diagnosed with hypertension were prescribed antihypertensive treatment at discharge, in-hospital antiepileptic drugs were administered to 91.8% of the patients presenting with seizures, and continuous monitoring was performed for 88% of the patients with hyperglycemia on admission. However, several aspects were inconsistent with the guidelines, as follows: only 14.2% of the patients were initially managed in the neurological intensive care unit and 22.3% of the bedridden patients received preventive treatment for deep vein thrombosis (DVT) within 48 h after onset. The questionnaire results showed that imaging examination, blood glucose monitoring, and secondary prevention of ICH were useful to more clinicians. However, the opposite occurred for the neurological intensive care unit requirement. Regarding the guidelines' recognition, no significant differences among the 3 education subgroups were observed (p > 0.05). Conclusions: Doctors have recognized most of ICH's evidence-based practice guidelines. However, there are still large gaps between the management of ICH and the evidence-based practice guidelines in Beijing (China). Retraining doctors is required, including focusing on preventing DVT providing a value from the National Institutes of Health Stroke Scale and Glasgow Coma Scalescores at the time of admission.

Additional follow-up telephone counselling and initial smoking relapse: a longitudinal, controlled study

OBJECTIVES

Smoking cessation services can help smokers to quit; however, many smoking relapse cases occur over time. Initial relapse prevention should play an important role in achieving the goal of long-term smoking cessation. Several studies have focused on the effect of extended telephone support in relapse prevention, but the conclusions remain conflicting.

DESIGN AND SETTING

From October 2008 to August 2013, a longitudinal, controlled study was performed in a large general hospital of Beijing.

PARTICIPANTS

The smokers who sought treatment at our smoking cessation clinic were non-randomised and divided into 2 groups: face-to-face individual counselling group (FC group), and face-to-face individual counselling plus telephone follow-up counselling group (FCF group). No pharmacotherapy was offered.

OUTCOMES

The timing of initial smoking relapse was compared between FC and FCF groups. Predictors of initial relapse were investigated during the first 180 days, using the Cox proportional hazards model.

RESULTS

Of 547 eligible male smokers who volunteered to participate, 457 participants (117 in FC group and 340 in FCF group) achieved at least 24 h abstinence. The majority of the lapse episodes occurred during the first 2 weeks after the quit date. Smokers who did not receive the follow-up telephone counselling (FC group) tended to relapse to smoking earlier than those smokers who received the additional follow-up telephone counselling (FCF group), and the log-rank test was statistically significant (p=0.003). A Cox regression model showed that, in the FCF group, being married, and having a lower Fagerström test score, normal body mass index and doctor-diagnosed tobacco-related chronic diseases, were significantly independent protective predictors of smoking relapse.

CONCLUSIONS

Within the limitations of this study, it can be concluded that additional follow-up telephone counselling might be an effective strategy in preventing relapse. Further research is still needed to confirm our findings.

Multimodal Retinal Imaging for Detection of Ischemic Stroke

Background: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke. Methods: A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis. Results: The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant (P = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant (P = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477-5.395], CRAE (OR = 0.980; 95% CI = 0.965-0.996), and SFChT (OR = 0.994; 95% CI = 0.989-0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy. Conclusion: SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.

Association between serum uric acid level and hypertension in a Chinese elderly rural population

Previous studies have examined the association between elevated serum uric acid (SUA) level and hypertension; however, the association in the Chinese elderly is still uncertain. A cross-sectional study was performed in a rural district of Beijing. A total of 2,397 participants (967 men and 1,430 women) completed the survey. The SUA levels of participants were categorized into four levels using the quartiles (P25, P50, and P75) as cutoff values. Participant was diagnosed as hyperuricemia if the SUA level was ≥417 μmol/L (male) or ≥357 μmol/L (female). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg and/or receiving antihypertensive drug treatment. Multiple logistic regression was used to estimate the association between SUA and hypertension. We found that higher SUA level was associated with the increased risk of hypertension in both sexes, even after adjusting for potential confounding variables. In total, the risk for having hypertension increased by 0.3% per 1 μmol/L increment in SUA level, increased by 95% for the highest vs. lowest quartile of SUA level, and increased by 111% in the hyperuricemia patients. Moreover, we found that the association was more pronounced in the male participants. There were approximately J-shaped relationships between SUA level (quartiles) and hypertension in all age groups. Higher SUA levels are positively associated with hypertension among the Chinese rural elderly. Further studies are still required to determine the relationship between SUA level and hypertension and to explore its potential biological mechanisms underlying the gender-related association in the elderly population.

ABBREVIATIONS

CVD; cardiovascular disease; BMI: body mass index; BP: blood pressure; SUA: serum uric acid; TC: total cholesterol; TG: triglycerides; HDL-C: high-density lipoprotein; LDL-C: low-density lipoprotein; FPG: fasting blood glucose; OR: odds ratio; CI: confidence interval; SD: standard deviation.

Difference of hospital charges for stroke inpatients between hospitals with different levels and therapeutic modes in Beijing, China

OBJECTIVES

The present study analyzed the hospital charges for stroke patients in China and determined the factors associated with hospital costs.

METHODS

Medical records of hospitalized patients with a primary diagnosis of acute stroke were collected from 121 hospitals in Beijing (2012). Distribution characteristics of hospital charges for different stroke types, hospital levels and types were studied. Factors influencing total hospital charges were analyzed.

RESULTS

60.8% of the 94 906 stroke patients were male and the mean age of these patients was 66.5 ± 13.2 years. The median length of hospital stay (LOHS) for these patients was 14 d (interquartile range, IQR 9-19). The mean hospital charge per patient was 19 270 Chinese Yuan. Forty-five percent of these charges were for medicine, 18% for laboratory and examination, 16% for material, 15% for therapy, 5% for service and 1% for blood product. The mean hospital charge for patients suffering from hemorrhagic stroke was significantly more than ischemic stroke (34 937 vs. 17 049, p < 0.001), and was significantly more for Level 3 than Level 2 hospitals (23 762 vs. 14 554, p < 0.001). LOHS, hospital level and stroke severity were key determinants of the hospital charge.

CONCLUSIONS

Though hospital charges for stroke patients in China were low, it brought a heavy economic burden for the larger stroke population. Medicine accounted for the largest percentage of hospital charges in China. LOHS emerged to be the main predictor of the cost. Decreasing medicine charge and LOHS might be strategies to decrease hospital charges and reduce economic burden of stroke in China.

The effect of a very brief smoking-reduction intervention in smokers who have no intention to quit: study protocol for a randomized controlled trial

BACKGROUND

Tobacco use is one of the most common preventable causes of death, but more than half of the Chinese men still use tobacco products. Moreover, 63.6% of Chinese smokers have stated that they would not consider quitting. Specialized and intensive smoking-cessation services are too expensive and passive to have major clinical and public health impacts in developing countries like China. Smoking cessation medications are not covered by medical insurance, and their high price prevents Chinese smokers from using them. Brief interventions are needed to provide cost-effective and timesaving tobacco dependence treatments in China mainland.

METHODS/DESIGN

We describe a two-arm randomized controlled trial for smokers who have no intention to quit. The project will be conducted in outpatient clinics at a large hospital in Beijing, China. Both arms include one face-to-face interview plus five follow-up interventions. Each intervention will last approximately one minute. Subjects allocated to the smoking-reduction intervention arm (SRI) will be advised to reduce smoking consumption to at least half of their current consumption level within the next month. All subjects in the SRI will be warned to bear in mind that an attempt to reduce smoking is an intermediate step before complete cessation. Smokers who have successfully reduced their smoking consumption will be encouraged to completely cease smoking. Controls are subjects allocated to the exercise- and diet-advice arm (EDA) and will be given advice about healthy diet and physical activity, but the advice will not include smoking cessation or reduction. Data collection will be done at baseline and at each follow-up interview using standardized questionnaires. The primary outcomes include self-reported and biochemically verified 7-day point prevalence and prolonged abstinence rates at 12-month follow-up.

DISCUSSION

We expect that an intention to quit in smoking outpatients can be motivated by physicians in the clinic setting. If this very brief smoking-reduction intervention can be demonstrated to have a positive impact on long-term smoking cessation, this strategy has the potential to be a viable and acceptable approach and may be used widely in China and elsewhere.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT02370147 (date of registration: 23 th February, 2015).

Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics

This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases.A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis.With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis.The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up.