[Potential demand on cancer screening service in urban populations in China: a cross-sectional survey]

Objective: To understand the acceptance and personal demand for cancer screening service among the urban residents who had never been involved in any national level cancer screening programs in China and identify the key factors influencing the sustainability of cancer screening. Methods: A questionnaire survey was conducted among the local people aged 40-69 years selected through convenience sampling in 16 provinces of China to collect the general information about their demands for the screening service and others. Results: A total of 16 394 qualified questionnaires were completed. The average age of the people surveyed was (53.8±8.0) years, and men accounted for 44.6%. Without concerning the cost, 4 831 people (29.5%) had no demands for cancer screening services, the reasons are as follow: they would like to go to see doctors only when they were ill (61.8%); they had already received similar medical examinations (36.8%) and they would like to receive cancer screening directly without pre-health risk assessment (33.0%). Among the people surveyed, 10 795 (65.8%) had demands for cancer screening services, but they had choice on the screening settings, 43.7% wanted to receive the service in a general hospitals, while 36.5% would like to go to cancer-specialized hospitals. As for the level of medical institutes providing cancer screening service, 61.4% of the people surveyed would choose a higher level one, while 36.4% would choose an ordinary one. On screening procedures, 61.5% of the people surveyed would accept the mode of "clinical examination after questionnaire-assessment" . Conclusion: Most people surveyed had demands for cancer screening services and they would like to receive the screening services in higher level medical institutes. It is suggested to spread cancer screening know ledge, and strengthen the capability building of screening in grass root medical institutes to attract more people to receive cancer screening.

[Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China]

Objective: From an actual cancer screening service demanders' perspective, we tried to understand the preference on screening frequency and willingness-to-pay for the packaging screening program on common cancers and to evaluate its long-term sustainability in urban populations in China. Methods: From 2012 to 2014, a multi-center cross-sectional survey was conducted among the actual screening participants from 13 provinces covered by the Cancer Screening Program in Urban China (CanSPUC). By face-to-face interview, information regarding to preference to screening frequency, willingness-to-pay for packaging screening program, maximum amount on payment and related reasons for unwillingness were investigated. Results: A total of 31 029 participants were included in this survey, with an average age as (55.2±7.5) years and median annual income per family as 25 000 Chinese Yuan. People's preference to screening frequency varied under different assumptions ( " totally free" and "self-paid" ). When the packaging screening was assumed totally free, 93.9% of residents would prefer to take the screening program every 1 to 3 years. However, the corresponding proportion dropped to 67.3% when assuming a self-paid pattern. 76.7% of the participants had the willingness-to-pay for the packaging screening, but only 11.2% of them would like to pay more than 500 Chinese Yuan (the expenditure of the particular packaging screening were about 1 500 Chinese Yuan). The remaining 23.3% of residents showed no willingness-to-pay, and the main reasons were unaffordable expenditure (71.7%) and feeling'no need'(40.4%). Conclusions: People who participated in the CanSPUC program generally tended to choose high-frequency packaging screening program, indicating the high potential acceptance for scale-up packaging screening, while it needs cautious assessments and rational guidance to the public. Although about seven in ten of the residents were willing to pay, the payment amount was limited, revealing the necessity of strengthening individual's awareness of his or her key role in health self-management, and a reasonable payment proportion should be considered when establishing co-compensation mechanism.

[Willingness and preferences of actual service suppliers regarding cancer screening programs: a multi-center survey in urban China]

Objective: From the perspective of actual service suppliers regarding cancer screening, this study aimed to assess the long-term sustainability of cancer screening programs in China. Methods: Based on a Cancer Screening Program in Urban China (CanSPUC), our survey focused on all the hospitals, centers for disease control and prevention (CDC) and community service centers across 16 provinces in China which participated in the programs between 2013 and 2015. All the managers (institutional/department level) and professional staff involved in the program were interviewed using either paper-based questionnaire or online approach. Results: A total of 4 626 participants completed the interview. It showed that the main gains from providing screening service emphasized promotion in social value (63.6%), local reputation (35.9%), and professional skills (30.6%), whereas difficulties encountered included inadequate compensation (30.9%) and discordance among information systems (28.3%). When the service remuneration amounts to about 50 Chinese Yuan per screening item, those professional staff self-reported that they would like to work overtime. More than half (63.7%) of the staff expressed willingness to provide routine screening service, the main expectations were to promote their reputation to the local residents (48.7%) and to promote professional skills (43.1%). Those who were not willing to provide screening services were worried about the potential heavy workload (59.8%) or being interfered with their routine work (49.8%). Further detailed results regarding the different organization types and program roles were presented in the following detailed report. Conclusions: Findings of gains and difficulties showed that if cancer screening is expected to become a long-term running, incentive mechanism from the program, external promotion and advocacy as well as capacity building should be strengthened; furthermore, rewards to staff's screening services should be raised according to the local situations. Results regarding the "willingness to provide service" showed that management of the program should also be strengthened, including information system building and inter-agency and inter-department coordination at the government levels.

Mal de Debarquement Syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features

Introduction

Mal de Debarquement Syndrome (MdDS) is a neurological condition typically characterized by a sensation of motion, that persists longer than a month following exposure to passive motion (e.g., cruise, flight, etc.). The most common form of MdDS is motion triggered (MT). However, recently it has been acknowledged that some patients develop typical MdDS symptoms without an apparent motion trigger. These cases are identified here as spontaneous or other onset (SO) MdDS. This study aimed to address similarities and differences between the MdDS subtypes. Diagnostic procedures were compared and extensive diagnostic guidelines were proposed. Second, potential triggers and associated psychological components of MdDS were revealed.

Methods

This was a retrospective online survey study for MT and SO MdDS patients. Participants were required to respond to a set of comprehensive questions regarding epidemiological details, as well as the diagnostic procedures and onset triggers.

Results

There were 370 patients who participated in the surveys. It is indicated that MdDS is often misdiagnosed; more so for the SO group. In addition to the apparent self-motion, both groups reported associated levels of stress, anxiety and depression.

Discussion

It appears at present that both MdDS subtypes are still poorly recognised. This was the first attempt to evaluate the diagnostic differences between MdDS subtypes and to propose a set of comprehensive diagnostic guidelines for both MdDS subtypes. In addition, the current research addressed that associated symptoms such as stress, anxiety and depression should also be considered when treating patients. We hope this study will help the medical community to broaden their awareness and diagnostic knowledge of this condition.

Electronic supplementary material

The online version of this article (10.1007/s00415-017-8725-3) contains supplementary material, which is available to authorized users.

[Relationship between inflammatory markers and the risk of colorectal cancer in Kailuan male cohort]

Objective: To investigate whether elevated levels of high sensitivity C-Reactive Protein (hsCRP) and neutrophil (NE) at baseline are associated with an increased risk of colorectal cancer in Kailuan male cohort. Methods: Since May 2006, males from Kailuan cohort were included in this study. Information on demographics, medical history, anthropometry, hsCRP and NE were collectedat baseline for all subjects. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HR) of association between baseline hsCRP and NE and colorectal cancer risk. Results: By December 31, 2015, a total of 73 869 participants were enrolled in this study. During the follow-up, 336 incident colorectal cancer cases were identified. All participants were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The cumulative incidence of colorectal cancer were 456/10(5,) 510/10(5) and 746/10(5) in these 3 groups, respectively (χ(2)=10.79, P=0.005). Compared with participants with lower hsCRP levels (<1 mg/L), individuals with the highest hsCRP (>3 mg/L) levels had significant increased risks of colorectal cancer (HR=1.38, 95%CI: 1.05-1.81, P=0.020)after adjusting for age, gender, smoking, drinking, BMI, diabetes and income. Furthermore, subjects were divided into two groups according to the level of NE (≤ 4.08×10(9)/L and > 4.08×10(9)/L). Multivariable Cox proportional hazards regression models indicated that there is no statistical significance of association between NE and colorectal cancer. Conclusions: Elevated levels of hsCRP at baseline might increase the risk of colorectal cancer in males.

[A systematic review of international simulation models on the natural history of breast cancer: current understanding and challenges for Chinese-population-specific model development]

Objective: To systematically review the worldwide simulation model studies on the natural history of breast cancer and to summarize related parameters. Methods: A structured literature search was conducted in PubMed and the Cochrane Library to identify articles during 1980-2015. Articles were screened independently by two researchers. Health states in the natural history and relevant parameters were extracted. Results: A total of 36 studies were included for analysis, within the earliest one was published in 1990. Most studies were from Europe and America countries, and 2 studies from China. Markov model was mostly applied to evaluating breast cancer screening programs (n=32). Reported health status included "healthy" (n=36), ductal carcinoma in situ (DCIS, n=17), invasive breast cancer (IBC, n=36), and death (n=27). There were two definite classifications for IBC, tumor size (n=9) and TNM staging (n=9, 3 studies reported transition rates). The median (range) of annual transition rates from DCIS to stage-Ⅰ IBC, Ⅰ to Ⅱ, Ⅱ to Ⅲ, Ⅲ to Ⅳ were 0.279 (0.259-0.299), 0.150 (0.069-0.430), 0.100 (0.060-0.128) and 0.210 (0.010-0.625), respectively. A total of 15 studies reported the mean duration from predinical to clinical stage for IBC was 1.95-4.70 years, which gradually increased with age, and 7 studies reported that for DCIS. Conclusions: Despite closer attention was paid to breast cancer natural history models, in recent years atypical hyperplasia has been neglected. Data on the mean duration of DCIS requires reasonable conversion. Various classifications for IBC exist whereas transition rates are limited. Current findings would be valuable references but challenging for the Chinese-population specific natural history model, development.

Fellowship or Further Training for Family Medicine Residents?

BACKGROUND AND OBJECTIVES

The breadth of family medicine (FM) generates debate about the length of residency training. One argument used by proponents for lengthening training is that residents feel unprepared for practice. The objectives of our study were to (1) identify the proportion of FM residency graduates intending to pursue fellowship training and those who would have done an additional year of core residency training had it been available, and (2) determine whether an association exists between these two variables.

METHODS

We used data collected by the American Board of Family Medicine (ABFM) as part of resident certification examination application in 2014 and 2015. Data included fellowship intention, and interest in pursuing another year of residency training if it were available. We used descriptive and bivariate statistics.

RESULTS

The questionnaire was completed by 6,235 residents, of which 17.0% (n=1,063) intended to enroll in a fellowship. Overall 54.2% of residents were "not at all likely" to extend residency training, with 19.9% "extremely/moderately likely". Forty-six percent of those intending a fellowship were "not at all likely" to extend training and only 29% of those "extremely/moderately likely" to extend residency training intended to enroll in a fellowship.

CONCLUSIONS

We found a disconnect between fellowship intention and desire for another year of residency training. Desire for fellowship may be more about obtaining specific skills and expertise or additional certifications, and less about being prepared for general practice in family medicine.

[Economic burden of cancer in China during 1996-2014: a systematic review]

Objective: To explore the current status of research on economic burden of cancer in China from 1996 to 2014. Methods: The key words including cancer, economic burden, expenditure, cost were used to retrieve the literatures published in CNKI and Wanfang (the two most commonly used databases for literature in Chinese) and PubMed during 1996-2014. A total of 91 studies were included after several exclusionary procedures. Information on subjects and data source, methodology, main results were structurally abstracted. All the expenditure data were discounted to year of 2013 value using China's health care consumer price indices. Results: More than half of the included studies were published over the past 5 years, 32 of the studies were about lung cancer. Among the 83 individual-based surveys, 77 were hospital-based and obtained data via individually medical record abstraction, and most of which only considered the direct medical expenditure. Expenditure per cancer patient and expenditure per diem were the most commonly used outcome indicators. Majority of the findings on expenditure per cancer patient ranged from 10 thousands to 30 thousands Chinese Yuan (CNY), with larger disparity in lung and breast cancer (ranged from 10 thousands to 90 thousands CNY), narrower difference in esophageal and stomach cancer (ranged from 10 thousands to 50 thousands CNY), and most stable trend in cervical cancer (almost all the values less than 20 thousands CNY). Without exception, the expenditures per diem for all the common cancers were increasing over the period from 1996 to 2014 (3-7 fold increase). Only 8 population-level economic burden studies were included and the reported expenditure of cancer at national level ranged from 32.6 billions to 100.7 billions CNY. Conclusions: Evidence on economic burden of cancer in China from 1996 to 2014 are limited and weakly comparable, particularly at a population level, and the reported expenditure per patient may be underestimated.

[Economic burden of esophageal cancer in China from 1996 to 2015: a systematic review]

Objective: To explore existing evidence of economic burden of esophageal cancer in China over the past 20 years. Methods: Based on PubMed, CNKI and Wanfang, literatures published from 1996 to 2015 were retrieved with the key words such as " economic burden" , "cost of illness" and so on. Then the information excerpted from those literatures were analyzed after several exclusionary procedures for non-esophageal cancer related literatures. The information about subjects and data source, methodology, main results were structurally abstracted and then analyzed. Quality assessments were conducted independently by two investigators using an 11-item instrument recommended by the Agency for Healthcare Research and Quality (AHRQ) for cross-sectional studies. All the expenditure data were calculated according to year-specific personal health care consumer price index (CPI) of China, the annual growth rate was calculated according to the average speed of growth. Results: A total of 23 studies (21 individual surveys and 2 population-based surveys) were included in the analysis, in which 12 were published over the past 5 years. Among the 21 individual surveys, 17 were hospital-based and the data were obtained through medical record review, and most of which only considered the direct medical economic burden (including the average overall expenditure per patient, per time and per diem). The median expenditure per patient during 1996-2011 ranged from 7 463 to 37 647 yuan (RMB) and the average growth rate was 7.68%. The median medical expenditure per clinical visit during 1996-2013 ranged from 6 851 to 57 554 yuan (RMB) and the average growth rate was 11.89%. The median medical expenditure per diem during 1996-2010 ranged from 225 to 1 319 yuan (RMB) and the average growth rate was 12.53%. The direct medical expenditure per clinical visit varied greatly with area, which were much higher in Beijing, Shanxi and Hubei. In both individual survey and population-based survey, less data about the direct non-medical expenditure and the influence of indirect expenditure on the economic burden were reported. Conclusion: Less data are available on economic burden of esophageal cancer in China over the past 20 years and the data's comparability are poor, especially in terms of population level or indirect burden. Direct medical expenditure is on the rise, and regional differences.

[Relation between waist circumference and risk of male lung cancer incidence: a prospective cohort study]

Objective: To investigate the association between waist circumference and risk of male lung cancer incidence. Methods: Since May 1, 2006, all the male employees including the retirees in Kailuan Group had been recruited into a Chinese Kailuan Male Cohort study. Information on anthropometries including body weight, height and waist circumference were collected at the baseline investigation, as well as information on newly-diagnosed lung cancer cases during the follow-up period. Waist circumference was grouped by quintiles of the population waist circumference distribution and categorized into the following five groups: <80, 80-, 85-, 90- and ≥95 cm, with the relevant normal group, the second quintile group (80-cm), serving as the referent category. Multivariable Cox proportional hazards regression models were used to evaluate the association between levels of waist circumference and risk of lung cancer. Results: A total of 105 386 males were recruited in the study, with 739 651.13 person-years of follow-up and an average follow-up period of 7.00 years. By the end of 2014, a total of 707 lung cancer cases were identified in the cohort study. Compared with males having the 80-cm of waist circumference, the hazard ratio (HR) and 95% confidence intervals (CI) of lung cancer were 1.17(0.90-1.52), 0.96(0.74-1.23), 0.94(0.72-1.21) and 0.80(0.63-1.03) for the <80, 85-, 90- and ≥95 cm of waist circumference, after adjustment for potential confounding factors including age, education level, smoking status and pack-year amount, alcohol consumption, physical activities, environment for working place and the prevalence on diabetes. The inverse association existed in smokers (≥95 cm compared to 80-cm of waist circumference: HR=0.69, 95%CI: 0.48-0.99) and alcohol drinkers (≥95 cm compared to 80-cm of waist circumference: HR=0.65, 95%CI: 0.45-0.94) when analysis was conducted in subgroups stratified by smoking or alcohol drinking status. Conclusion: Waist circumference might be inversely associated with male lung cancer risk.

[Economic evaluation on breast cancer screening in mainland China: a systematic review]

Objective: To gather available evidence related to the economic evaluation on breast cancer screening in mainland China and to provide reference for further research. Methods: A systematic review was conducted to identify articles in PubMed and three Chinese databases (CNKI, Wanfang and VIP) during 1995-2015. Data related to descriptive characteristics, rates on participation and detection for population-based studies, methods for model-based studies, types of economic evaluation and results, were extracted. A Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the reporting quality of included studies. Results: Of the 356 records searched in the databases, 13 studies (all published between 2012 and 2015) were included in the current paper involving 11 population-based studies and 3 model-based evaluations (1 study using both methods). Age of the participants who started to be engaged in the screening program ranged from 18 to 45 years old, but terminated at the age of 59 years or older. The screening modalities included single-used clinical breast examination, mammography and ultrasound or combined applications. Study persepectives were described in 7 studies, with 5 from the healthcare providers, and 2 from societal angles. Only 5 studies discounted cost or effectiveness. Out of 11 papers, 9 showed the results on cost-effectiveness analysis (CEA) that reporting the cost per breast cancer detection, with median as 145.0 thousand Chinese Yuan (CNY), ranging from 49.7 thousand to 2 293.0 thousand CNY. From 4 papers with results of cost-utility analysis (CUA), the cost per quality adjusted life year (QALY) gained or cost per disability adjusted life year (DALY) averted, were evaluated. The incremental cost-effectiveness ratio (ICER) was from 2.9 thousand to 270.7 thousand CNY (GDP per capita of China was CNY 49.3 thousand in 2015). In 13 studies, the quality of reporting varied, with an average score of 14.5 (range: 9.5-21.0). In the domains of study perspective, discounting, ICER and uncertainty, all the scores of equalities were relatively levels. Conclusions: Currently, evidence on economic evaluation of breast cancer screening in mainland China remained limited and weakly comparable, particularly model-based studies. Comprehensive analysis from societal perspective and QALY or DALY related cost-utility analysis should be implemented.

Occupational metal exposures, smoking and risk of diabetes and prediabetes

BACKGROUND

Metal exposure and tobacco smoking have been independently associated with diabetes, but no study has been conducted to investigate the interaction between them on the risk of diabetes.

AIMS

To investigate the effect of occupational exposure to metals, and potential effect modification by smoking, on the risk of diabetes and prediabetes in a cohort of Chinese male workers.

METHODS

We assessed metal exposure and tobacco smoking at baseline in the Jinchang Cohort of male workers. We used Poisson regression analyses to estimate the interaction between smoking and metal exposures based on occupations, which we grouped according to the measured urinary metal levels.

RESULTS

Among the 26008 study subjects, compared with non-smokers, the adjusted prevalence ratio (PR) for diabetes was 1.8 [95% confidence interval (CI) 1.3-2.4] for smokers of >40 pack-years. The adjusted PRs were 1.2 (95% CI 1.1-1.4) among mining/production workers and 2.7 (95% CI 2.4-3.0) among smelting/refining workers, both compared with office workers. There was significant effect modification under the additive model between smoking and metal exposure on the prevalence of diabetes (Pinteraction = 0.001), with an adjusted PR of 3.6 (95% CI 2.4-5.4) for those with >40 pack-years of smoking who had the highest metal exposures, whereas no significant interaction was observed for prediabetes.

CONCLUSIONS

Both exposure to metals and heavy smoking were associated with an increased prevalence of diabetes in this large cohort of male workers. There was also strong interaction between these two exposures in affecting diabetes risk that should be confirmed in future studies.

[Natural history of breast cancer: a systematic review of worldwide randomized controlled trials of mammography screening]

Objective: To parameterize the 1-year transition probabilities between different health status of the natural history of breast cancer based on the data of randomized controlled trial of X-ray mammography screening worldwide. Methods: Based on the breast cancer screening randomized controlled trials defined by a mammography screening review from the Cochrane 2013 and the International Agency for Research on Cancer, a systematic review was initiated in PubMed by searching names of the key investigators of the trials, combined with the diseases, screening intervention and outcome indicators. If applicable, all the original cumulative incidence rates were converted into one-year transition rate, using the life-table approach considering time length of follow-up. Results: A total of 23 reports from 9 RCTs were included. The data on transition rate between the healthy status to precancerous lesions was absent. The 1-year transition rate from health to carcinoma in situ was 17.78 to 50.21 per 100 000 persons in the intervention group and 9.16 to 26.84 per 100 000 persons in the control group. Correspondingly, the 1-year transition rate from health to breast cancer (including carcinoma in situ and invasive cancer) were estimated as 143.75 to 316.97 per 100 000 persons in the intervention group, and 141.45 to 288.84 per 100 000 persons in the control group. Furthermore, the transition rate from the healthy status to invasive breast cancer was 159.79 to 264.60 per 100 000 persons in intervention group and 170.12 to 255.33 per 100 000 persons in control group. The transition rate from carcinoma in situ to invasive breast cancer varied among different pathological types. Conclusions: The most common natural history states of reported by the included trials involved the full healthy status, carcinoma in situ and invasive breast cancer. The findings of transition rates between different health statuses will be informative for future model development of natural history studies of breast cancer. Information in relation to breast precancerous lesions still limited and needs to be further addressed.

[Disease burden of famale breast cancer in China]

OBJECTIVE

To analyze the data on burden of female breast cancer in China.

METHODS

The data from Chinese Cancer Registry Annual Report 2012, three national death cause surveys in China, Disease Surveillance Points system(DSP), China Health Statistics Yearbook, GLOBOCAN 2012, Cancer Incidence in Five Continents(CI5), WHO Mortality Database and Global Burden of Disease(GBD)2013 were used to extract the incidence, mortality and disability-adjusted life years(DALY)of female breast cancer and analyze related trends in China.

RESULTS

The data from three national death cause surveys showed that the crude mortality of breast cancer doubled from year 1973-1975 to year 2004-2005, the increase was higher in urban area(127.4%)than in rural area(75.2%). WHO Mortality Database showed that average annual percentage change(AAPC)of breast cancer crude mortality increased by 3.1%(P<0.05)from 1987 to 2000, and China Health Statistics Yearbook showed that the AAPC in urban females increased by 2.7% from 2002 to 2013(P<0.05), whereas the AAPC in rural females showed no significant change(P>0.05). It was estimated by GLOBOCAN 2012 that in 2012 the age-standardized incidence and age-standardized mortality of breast cancer in China was 22.1 per 100 000 and 5.4 per 100 000, respectively. The age-specific incidence began to increase obviously at age of 40 years and peaked at age 45-59 years(GLOBOCAN 2012). Chinese Cancer Registry Annual Report 2012 showed that breast cancer incidence and mortality were 2-fold and 1.5-fold higher in urban females than in rural females in 2009. It was estimated that the breast cancer case number and death number in females in China would increase to 251 600 and 75 900, respectively, more increose in age group ≥65 years. Only GBD 2013 reported DALY, the DALY caused by breast cancer in China was 1 666.0 thousand in 2013, accounting for 12.7% of global DALY, and increased by 56.7% from 1990(1 062.6 thousand), the peak age-specific DALY rate was at 50 to 59 years, and national average ratio of years lived with disability(YLD)was 8.7%(ranging from 8.1% to 9.0% at provincial level).

CONCLUSIONS

Burden of disease caused by female breast cancer is becoming increasingly severe in China, especially in urban areas. It is necessary to strengthen the population-based prevention and control programs and further studies may focus on DALY.

[A prospective follow-up study on the association between serum level of C-reactive protein and risk of digestive system cancers in Chinese women]

Objective: It has been reported by some prospective studies that C-reactive protein (CRP) is associated with cancer risk. However, the correlation between CRP and digestive system cancers has not been evaluated in Chinese females. We conducted a large population-based cohort study to investigate whether elevated level of CRP in serum is associated with an increased risk of digestive system cancers in Chinese women. Methods: From the Chinese Kailuan Female Cohort, 19, 437 women were enrolled in this study in July 2006, and all of the subjects were followed up through 2014. At the baseline investigation, the serum levels of high-sensitivity CRP (hsCRP) were tested for all subjects, and demographic information and risk factor data were collected. Multivariable Cox proportional hazards regression model was used to calculate the hazard ratios (HR) and 95% confidence intervals (95% CI) for the baseline levels of hsCRP after adjusting for age, marital status, smoking, drinking, body mass index (BMI), diabetes and physical activity, and risk of digestive system tumors (including colorectal cancer, stomach cancer, pancreas cancer, liver and gallbladder cancer, and other cancers). Results: By Dec 31, 2014, a total of 100 incident cancer cases were observed, including 47 colorectal cancers, 17 stomach cancers, and altogether 29 pancreas, liver and gallbladder cancers. All the subjects investigated were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The 8-year cumulative incidence of digestive system cancers were 405/100 000, 520/100 000 and 787/100 000 in these 3 groups, respectively (Log rank test χ² = 8.37, P=0.015). Compared to those with lower hsCRP levels (<1 mg/L), the women with higher hsCRP (>3 mg/L) had a significantly increased risk of pancreas, liver and gallbladder cancers (HR = 2.70, 95% CI = 1.06-6.91; P_trend = 0.036). Conclusions: Elevated levels of hsCRP at baseline may be associated with increased risk of certain digestive system cancers.

Neonatal Kisspeptin is Steroid-Independently Required for Defeminisation and Peripubertal Kisspeptin-Induced Testosterone is Required for Masculinisation of the Brain: A Behavioural Study Using Kiss1 Knockout Rats

Rodents show apparent sex differences in their sexual behaviours. The present study used Kiss1 knockout (KO) rats to evaluate the role of kisspeptin in the defeminisation/masculinisation of the brain mechanism that controls sexual behaviours. Castrated adult Kiss1 KO males treated with testosterone showed no male sexual behaviours but demonstrated the oestrogen-induced lordosis behaviours found in wild-type females. The sizes of some of the sexual dimorphic nuclei of Kiss1 KO male rats are similar to those of females. Plasma testosterone levels at embryonic day 18 and postnatal day 0 (PND0) in Kiss1 KO males were high, similar to wild-type males, indicating that perinatal testosterone is secreted in a kisspeptin-independent manner. Long-term exposure to testosterone from peripubertal to adult periods restored mounts and intromissions in KO males, suggesting that kisspeptin-dependent peripubertal testosterone secretion is required to masculinise the brain mechanism. This long-term testosterone treatment failed to abolish lordosis behaviours in KO males, whereas kisspeptin replacement at PND0 reduced lordosis quotients in Kiss1 KO males but not in KO females. These results suggest that kisspeptin itself is required to defeminise behaviour in the perinatal period, in cooperation with testosterone. Oestradiol benzoate treatment at PND0 suppressed lordosis quotients in Kiss1 KO rats, indicating that the mechanisms downstream of oestradiol work properly in the absence of kisspeptin. There was no significant difference in aromatase gene expression in the whole hypothalamus between Kiss1 KO and wild-type male rats at PND0. Taken together, the present study demonstrates that both perinatal kisspeptin and kisspeptin-independent testosterone are required for defeminisation of the brain, whereas kisspeptin-dependent testosterone during peripuberty to adulthood is needed for masculinisation of the brain in male rats.

[Association between body mass index and risk of lung cancer in non-smoking males: a prospective cohort study]

Objective: To assess the association between baseline body mass index (BMI) and risk of lung cancer in non-smoking males. Methods: A dynamic non-smoking male cohort was established on May, 2006. Baseline information on demography, lifestyle, such as smoking status and alcohol consumption, anthropometry, such as body height and weight, were collected during the baseline interview, and the information of newly-diagnosed lung cancer cases were also collected during the follow-up period. Multivariable Cox proportional-hazards regression model was used to analyze the association between baseline BMI and lung cancer in non-smoking males. Results: By December 31, 2011, a total of 48 799 male non-smokers had been assessed in the study and there were 214 620.18 person-years of follow-up and 4.40 years of average follow-up period. During follow-up, 198 lung cancer cases were identified among the 48 799 non-smoking males. Compared with those with normal BMI (kg/m²) (18.5≤BMI<24.0), the hazard ratio (95%CI) of lung cancer were 1.14(0.53-2.45), 0.57(0.41-0.78) and 0.61(0.38-0.97) for underweight (BMI<18.5), overweight (24.0≤BMI<28.0) and obese males (≥28.0), respectively, after adjustment for potential confounding factors, including age, education level, alcohol consumption, physical activity, history of diabetes and work environment. Baseline BMI was negatively associated with the risk of lung cancer in non-smoking males and the risk would be reduced by 22% (HR=0.78, 95% CI: 0.64-0.95) for per 5 kg/m² BMI increase. The negative association between BMI and risk of lung cancer was significant among non-smoking males who aged ≥50 years, and in those who had physical exercise <4 times/week, never drunk and worked above the coal mine, and for per 5 kg/m² BMI increase, the risk of lung cancer would be reduced by 26%(HR=0.74, 95%CI: 0.60-0.92), 24%(HR=0.76, 95%CI: 0.62-0.95), 20% (HR=0.80, 95%CI: 0.65-1.00) and 23% (HR=0.77, 95%CI: 0.61-0.97), respectively. The result was similar after excluding the cancer patients newly diagnose within 1-year and their contribution person years. Conclusion: Baseline BMI might be negatively associated with risk of lung cancer in non-smoking males.

[The accuracy of mammography screening for breast cancer: a Meta-analysis]

Objective: To estimate the accuracy of mammography for population-based breast cancer screening. Methods: Studies of screening mammography performance were systematically reviewed in the Medline, Embase, Cochrane and China National Knowledge Infrastructure (CNKI) literature databases. The retrieval was performed by using related key words, including disease name, screening and intervention indicators and study type. A total of 1 167 records were retrieved by June 4, 2015 and those studies met the inclusion criteria were included for the current analysis. The numbers of true-positive, false-positive, false-negative and true-negative were originally extracted and calculated from each individual study. A QUADAS checklist was used to assess the quality of the studies. A curve of summary receiver operating characteristic (SROC) was applied as a comprehensive assessment of diagnosed accuracy. The pooled effect size of both sensitivity and specificity was quantitatively synthesized in both total population and subgroup with dense breast using the bivariate mixed-effects models. We conducted a sensitivity analysis in the studies with sample size over 100 000. Heterogeneity between studies was measured by the Q test and I² statistic, and publication bias was evaluated by a funnel plot and the linear regression test. Results: A total of 48 publications with 8 551 873 individuals were identified for the final qualitative synthesis, most of them were from Europe area and American (38 studies), 8 were from Asia area, and 2 were from Oceania area. The studies were conducted during period of 1975-2013, and the age of study women ranged mostly from 40 to 75 years. The area under the SROC curve (AUC) was 0.95 (95%CI: 0.93-0.97). It was estimated that the pooled sensitivity and specificity were 0.81 (95%CI: 0.77-0.84) and 0.96 (95%CI: 0.94-0.96), respectively. The results were indicated stable and robust in sensitivity analysis. In the subgroup with dense breast, the sensitivity and specificity were 0.74 (95% CI: 0.61-0.83) and 0.93 (95% CI: 0.89-0.96), respectively. Funnel plot and test results showed there was no significant publication bias among the included studies. Conclusion: The accuracy of mammography is high for population-based breast cancer screening in women, although the sensitivity is lower in women with dense breast.

Association of single-nucleotide polymorphisms, rs2235371 and rs2013162, in the IRF6 gene with non-syndromic cleft palate in northeast China

The aim of this study was to determine the association between two SNPs (rs2235371 and rs2013162) in the interferon regulatory factor 6 (IRF6) gene and non-syndromic cleft palate (NSCP) in northeast China. We genotyped these two SNPs in 104 NSCP cases, as well as in 178 parents and 300 controls. Case-control and case-parent analyses were performed using χ2 tests and family-based association tests (FBAT). Results indicated that there were significant differences in both genotypic and allelic distributions between patients and controls at rs2235371 and rs2013162 in the IRF6 gene. Case-parent analysis revealed over-transmission of the C allele in rs2235371 and the A allele in rs2013162. Lastly, FBAT showed over-transmission of the CA haplotype. This study demonstrated that the two SNPs, rs2235371 and rs2013162, are strongly associated with NSCP in the northeast Chinese population.

[Body mass index and the risk of lung cancer incidence in smokers: a prospective cohort study]

OBJECTIVE

To investigate the effect of baseline body mass index (BMI) on the risk of lung cancer incidence in male smokers.

METHODS

All the male employees and retirees of the Kailuan Group were recruited in the Chinese Kailuan Male Cohort Study, and they had been experienced routine physical examinations every two years since May, 2006. Up to 31st December 2011, a total of 3 rounds physical examinations had been completed. A total of 42 718 male smokers candidates from the Chinese Kailuan Male Cohort Study were enrolled in the present study. The date of entering this study was defined as that of taking first check-up, and the date of end-of-observation was defined as that of cancer diagnosis, death or end of follow-up (31 December 2011). Information on demographics, lifestyle such as smoking, alcohol consumption, anthropometries such as height and weight, as well as the information of newly-diagnosed cancer cases, were collected at the baseline investigation. Multivariable Cox proportional hazards regression models were used to investigate the association between levels of the baseline BMI and risk of lung cancer.

RESULTS

Of the 42 718 male smokers, there were 181 998.09 person-years of follow-up, taking 4.26 years of average follow-up period. During follow-up, 234 new lung cancer cases were identified among the 42 718 male smokers and the crude incidence density was 128.57/100 000. After the factors adjustment for age, education level, alcohol consumption, physical activity, work environment and cumulative smoking levels (pack-years), compared with subjects of normal BMI group, hazard ratio and 95% confidence intervals of lung cancer for subjects of underweight, overweight, and obesity were 1.63 (0.79-3.37), 0.79 (0.57-1.09) and 0.50 (0.27-0.91), respectively. After the facotors adjustment for age, education level, alcohol consumption, physical activity, work environment and cumulative smoking levels (pack-years), compared with subjects of normal BMI, hazard ratio and 95% confidence intervals of lung cancer for subjects of obesity among subjects who aged 50 years or above, smoked more than 20 pack-years, and exercised less than 4 times per week were 0.33 (0.15-0.71), 0.27 (0.10-0.75), and 0.44 (0.20-0.96), respectively. Obesity subjects who worked above the well had decreased risk of lung cancer (HR=0.38, 95% CI: 0.15-0.96) compared with normal BMI ones who worked above the well.

CONCLUSION

BMI was negatively correlated with the risk of lung cancer in male smokers. As for male smokers, one of the most effective approaches to prevent and control the lung cancer has been shown to quit smoking and keep fit.

Quantifying the Cost of Disability Transitions in Medicare

OBJECTIVE

To investigate the impact of disability transitions on annual Medicare Part A and B cost.

METHOD

We analyzed 6,385 community-dwelling beneficiaries who were continuously enrolled in fee-for-service Medicare Part A and B from 2008 to 2009. We estimated adjusted effects of disability transitions on Medicare cost using a generalized linear model.

RESULTS

Transitions to more severe disability states were associated with significantly higher average annual Medicare cost ranging from US$2,639 to US$5,405. Lower spending levels were observed for beneficiaries with improvements in functioning. Beneficiaries who transitioned from severe to moderate activities of daily living (ADLs) disability cost significantly less (-US$6,045) than those who remained severely disabled.

DISCUSSION

Interventions aimed at preventing disability progression and efforts to restore functional capacity are promising strategies for containing costs and generating savings for Medicare. Future research is needed to assess the longer term impact of disability in association with the progression of chronic conditions.

High precision relative attitude measurement for inner payload of new photoelectric platform

A new method for measuring the relative attitude of a load on an airborne photoelectric platform supported by three-axis universal joint structure is proposed. The mathematical model for angle measurement is established, based on which the linear relation between the angle and distance is derived by using the eccentric method. Furthermore, the relative attitude measurement method for a load rotating along the yaw and pitch directions is also proposed based on a unique eccentric structure. Finally, to validate the proposed new method, a comprehensive experiment for measurement angle from -5° to +5° in increments of 0.5° was performed by using the angular capacitive sensor. The experimental results show that the precision of the angular measurement is better than 15″ with maximum 1.24 kHz bandwidth, which meets the relative attitude measurement requirements of the internal load on the airborne photoelectric platform.