Rising mortality from injury in urban China: demographic burden, underlying causes and policy implications

Severe Blunt Liver Injury Complicated by Delayed Massive Hemobilia in a Toddler: A Case Report and Literature Review

Introduction

Unintentional injuries remain a leading cause of disability among children. Although most of the pediatric patients suffering blunt liver injury can be successfully treated with non-operative therapy, the diagnosis and management of delayed life-threatening hemobilia following severe blunt liver injury, especially in the pediatric population, remain a challenge for clinicians.

Case Presentation

A previously healthy 2-year-old girl suffered a severe blunt liver injury related to an electric bike, which was inadvertently activated by herself. She initially received non-operative therapy and was in a stable condition in the first 2 weeks. On the 16th and 22nd postinjury days, the patient presented with life-threatening massive hemobilia, which was confirmed via repeat emergent gastroscopy and hepatic arterial angiography. An emergency selective transarterial embolization of the involved branch of the left hepatic artery was successfully performed. The patient recovered uneventfully, and long-term follow-up was needed owing to a mild dilatation of the left intrahepatic bile duct.

Discussion

Incidental injury in children should be considered as a major public health issue and preventive measures should be taken to reduce its occurrence. Delayed massive hemobilia after severe blunt liver trauma is rare, and its accurate and timely diagnosis via emergency hepatic arterial angiography and selective angioembolization may allow prompt and optimal management to achieve good outcomes in the pediatric population.

Social factors tend to decline age-standardized all-cause mortality rates in China during 2005-2015: evidence from an ecological study

OBJECTIVES

It is important to understand the factors that can substantially decrease mortality rates, as multiple strategies have been implemented to improve economic development and national health in China. We aimed to describe the geographic variations and changes in the all-cause mortality rates in 2005-2015 and to investigate the social factors that tend to decline age-standardized all-cause mortality rates.

STUDY DESIGN

Ecological study.

METHODS

The data used came from China's National Census Survey in 2005, 2010 and 2015 and China National Statistical Yearbooks. We conducted provincial-level thematic mapping of age-standardized all-cause mortality rate trajectory groups in 2005-2015 by using ArcGIS. Generalized estimating equation (GEE) models were used to clarify the social factors that may have long-term relevance to declining age-standardized all-cause mortality rates. We compared the characteristics of the three provinces with the lowest mortality rates and the three provinces with the highest mortality rates to further understand the health disparities.

RESULTS

The age-standardized mortality rates declined from 2000 to 2006 and from 2008 to 2019. Provinces in the low-trajectory tended to be located in the Northeast and Southeast China. The GEE results revealed that the greater the proportion of the population with senior high school education or above, the more families with flushing or pumping toilets that are not shared with other households, the more nurses per 1000 people and a stable economic growth rate were inclined to low age-standardized all-cause mortality rates (P < 0.05).

CONCLUSIONS

Health disparities between different regions were still in existence even in 2015. Thus, it is critical to improve equality in economic and educational development, the distribution of healthcare professionals, and sanitation facilities, to ensure the equality of opportunities in terms of healthy lives and well-being for all. Furthermore, for developing countries, the improvement of national health urgently needs to prevent the health risks relevant to rapid industrialization and urbanization.

Rural-Urban Differences in Adult Life Expectancy in Indonesia: A Parametric g-formula-based Decomposition Approach

BACKGROUND

Evidence on rural-urban differences in adult mortality in low- and middle-income countries (LMICs) is limited and mixed. We examined the size of and factors contributing to rural-urban life expectancy differences among adults in Indonesia, the third most populous LMIC.

METHODS

Data come from the 2000, 2007, and 2014/2015 waves of the Indonesian Family Life Survey, a population-representative longitudinal study with mortality follow-up. We used Poisson regression and life tables to estimate rural-urban differences in life expectancy among 18,867 adult respondents ≥30 years. We then used a novel g-formula-based decomposition to quantify the contribution of rural-urban differences in blood pressure (BP), body mass index (BMI), and smoking to life expectancy differences.

RESULTS

Compared with urban adults, life expectancy at age 30 was 2.2 (95% confidence interval [CI] = 0.4, 3.9) years higher for rural men and 1.2 (95% CI = -0.4, 2.7) years higher for rural women. Setting the BMI and systolic BP distribution equal in urban and rural adults reduced the urban mortality penalty by 22% for men and 78% for women, with the majority of this reduction coming from the contribution of rural-urban differences in BMI. Smoking did not contribute to the urban mortality penalty for either men or women.

CONCLUSIONS

Adult life expectancy is lower in urban than in rural areas in Indonesia and we estimate that this difference is partly related to differences in BMI and systolic BP.

The burden of the current curative expenditure of injury in Dalian, China-a study based on the "system of health accounts 2011"

BACKGROUND

Injury is one of the major public health problems and causes more than 5 million deaths in the world annually. Cases of specific types of injury are life-threatening and heavily-burdened to individuals and society. This study was aimed to assess the financial burden of injury on patients.

METHODS

A total of 565 medical institutions were selected with multistage stratified cluster random sampling, containing 152,553 valid samples. Subsequently, the distribution of injury current curative expenditure (CCE) in different dimensions (including age and site of injury) was analyzed under the framework of System of Health Accounts 2011 (SHA 2011) using the established database.

RESULTS

In China, both urban and rural injury mortality rates showed an upward trend of more than 5 percentage points from 2006 to 2016. In Dalian, the CCE of injury reached 1572.73 million RMB, accounting for 7.45% of the total CCE. Those aged 15-24 reported larger proportion of CCE than the other age groups. As for the injuries in body parts, injuries occurred to the spine, lower limb, head and foreign body cost most.

CONCLUSIONS

Dalian has a relatively serious burden of injury costs. The essential and primary goal is to reduce the cost. Young people should pay attention to protect their head and limbs from injury, and related government sectors should implement preventive and educative measures.

Temperature, precipitation, ozone pollution, and daily fatal unintentional injuries in Jiangsu Province, China during 2015–2017

Background

The correlation of unintentional injury mortality to rising temperatures found in several studies could result from changes in behavior that increases exposure to hazards or risk when exposed. Temperature, precipitation and air pollutants may contribute to symptoms and distractions that increase risk or avoidance behavior that reduces risk. This study examines data that allows estimates of the relation of daily maximum temperature, precipitation and ozone pollution to injury mortality risk, each corrected statistically for the correlation with the others.

Methods

Daily data on unintentional injury deaths and exposures to temperature, precipitation and ozone in 9 cities in Jiangsu Province, China during 2015–2017 were analyzed using Poisson regression. The regression estimates were adjusted for weekends, holidays, an anomalous difference in death rates in Nanjing, and population size.

Results

Non transport injury death risk increased substantially in relation to higher temperatures when temperatures were in the moderate range and even more so at temperatures 35 degrees (C) and higher. Transport deaths were related to increasing deaths when temperatures were low but the correlation reversed at higher temperatures. Deaths were lower on rainy days when temperatures were cool and moderate with the exception of non-transport injuries when temperatures were moderate. Higher ozone concentrations were associated with more deaths except when temperatures were low.

Conclusions

The variations in deaths in relation to temperature, precipitation and ozone suggest that people are behaving differently or are in different environments when specific combinations of the predictor variables are prevalent, putting them at greater or less risk. More study of the behaviors and circumstances that result in injury under those conditions is needed.

When the Ghosts Live in the Nursery: Postpartum Depression and the Grandmother-Mother-Baby Triad in Luzhou, China

In Luzhou, China, where grandmothers often serve as primary caregivers for infants, the past and the future haunt new mothers suffering from postpartum depression. In this article, I draw upon longitudinal interviews conducted with ten families in Luzhou as part of a larger multi-sited ethnography of postpartum depression and anxiety. I argue that the grandmother-mother-baby triad model of infant care in interior urban China accentuates the pain of depressed postpartum mothers by making it difficult for them to rid their homes of the ghosts of past trauma and lost futures. Mothers resent and fear grandmothers even as they rely on them to care for their babies. Memories of trauma, perceived displacement by the grandmother as the mother figure for their babies, and lack of control over their households and children characterize postpartum mothers' experiences. Mothers primarily blame their mothers-in-law for their unhappiness even as they depend on themselves to "self-adjust."

Xuefu Zhuyu decoction improves neurological dysfunction by increasing synapsin expression after traumatic brain injury

Xuefu Zhuyu decoction has been used for treating traumatic brain injury and improving post-traumatic dysfunction, but its mechanism of action needs further investigation. This study established rat models of traumatic brain injury by controlled cortical impact. Rat models were intragastrically administered 9 and 18 g/kg Xuefu Zhuyu decoction once a day for 14 or 21 days. Changes in neurological function were assessed by modified neurological severity scores and the Morris water maze. Immunohistochemistry, western blot assay, and reverse-transcription polymerase chain reaction were used to analyze synapsin protein and mRNA expression at the injury site of rats. Our results showed that Xuefu Zhuyu decoction visibly improved neurological function of rats with traumatic brain injury. These changes were accompanied by increased expression of synaptophysin, synapsin I, and postsynaptic density protein-95 protein and mRNA in a dose-dependent manner. These findings indicate that Xuefu Zhuyu decoction increases synapsin expression and improves neurological deficits after traumatic brain injury.

The joint effect of personality traits and perceived stress on pedestrian behavior in a Chinese sample

While improper pedestrian behavior has become an important factor related to road traffic fatalities, especially in developing countries, the effects of personality traits and/or stress on pedestrian behavior have been rarely reported. The current study explored the joint effects of five personality traits (i.e., extraversion, openness, neuroticism, normlessness and altruism) and global perceived stress (measured with the Perceived Stress Scale-10) on pedestrian behavior (measured with the Pedestrian Behavior Scale) in 311 Chinese individuals. Results showed that altruism, neuroticism and openness significantly affected different pedestrian behavior dimensions, while global perceived stress also significantly and positively predicted positive behavior. Moreover, the effect of neuroticism on positive behavior was fully mediated by stress. Some explanations and implications are provided in the discussion section.

Latin American Clinical Epidemiology Network Series - Paper 5: Years of life lost due to premature death in traffic accidents in Bogota, Colombia

OBJECTIVE

This study aimed to quantify the number of years of life lost in traffic accidents in Bogota, Colombia.

STUDY DESIGN AND SETTING

The years of life lost were calculated using the 'age-standardized expected years of life lost' method, the table of Japanese adjusted life expectancy and the database of the Institute of Legal Medicine and Forensic Science between September 2012 and August 2013.

RESULTS

During a period of 1 year, 430 people died and 10,056.3 years of life were lost in Bogota due to traffic accidents.

CONCLUSION

The mortality burden of traffic accidents in Bogota is high. Further studies are required in order to characterize the accidents and develop effective policy decisions.

Neurocritical Care in China: Past, Present, and Future

Despite the lack of resources and materials, there has been an increasing demand for acute neurologic care owing to the heavy burden of neurocritical illness in most developing countries, including China, where the morbidity and mortality of severe neurologic and neurosurgical disorders remains high. Neurointensive care units did not start appearing in China until the late 1980s. Although great progress has been made over the past 2 decades in the establishment of equipped neurocritical care centers, advancements in medical infrastructure, streamlining of resident training programs, and implementation of multidisciplinary care teams, there remain areas that warrant improvement to care for our growing patient population. Here we review and discuss the history, present state, and future of neurocritical care in the People's Republic of China.

Application of an autoregressive integrated moving average model for predicting injury mortality in Xiamen, China

OBJECTIVE

Injury is currently an increasing public health problem in China. Reducing the loss due to injuries has become a main priority of public health policies. Early warning of injury mortality based on surveillance information is essential for reducing or controlling the disease burden of injuries. We conducted this study to find the possibility of applying autoregressive integrated moving average (ARIMA) models to predict mortality from injuries in Xiamen.

METHOD

The monthly mortality data on injuries in Xiamen (1 January 2002 to 31 December 2013) were used to fit the ARIMA model with the conditional least-squares method. The values p, q and d in the ARIMA (p, d, q) model refer to the numbers of autoregressive lags, moving average lags and differences, respectively. The Ljung-Box test was used to measure the 'white noise' and residuals. The mean absolute percentage error (MAPE) between observed and fitted values was used to evaluate the predicted accuracy of the constructed models.

RESULTS

A total of 8274 injury-related deaths in Xiamen were identified during the study period; the average annual mortality rate was 40.99/100,000 persons. Three models, ARIMA (0, 1, 1), ARIMA (4, 1, 0) and ARIMA (1, 1, (2)), passed the parameter (p<0.01) and residual (p>0.05) tests, with MAPE 11.91%, 11.96% and 11.90%, respectively. We chose ARIMA (0, 1, 1) as the optimum model, the MAPE value for which was similar to that of other models but with the fewest parameters. According to the model, there would be 54 persons dying from injuries each month in Xiamen in 2014.

CONCLUSION

The ARIMA (0, 1, 1) model could be applied to predict mortality from injuries in Xiamen.

Burden and trend analysis of injury mortality in China among children aged 0-14 years from 2004 to 2011

OBJECTIVE

To track changes of the burden and trends of childhood injury mortality among children aged 0-14 years in China from 2004 to 2011.

DESIGN

National representative data from the Chinese Disease Surveillance Points system and Chinese Maternal and Child Mortality Surveillance system from 2004 to 2011 were used. Rates and 95% CIs of aged-standardised mortality, as well as the proportions of injury death, were estimated.

SETTING

Urban and rural China.

PARTICIPANTS

Children aged 0-14 years from 2004 to 2011.

RESULTS

The proportion of injury among all deaths in children increased from 18.69% in 2004 to 21.26% in 2011. A 'V' shape change was found in the age-standardised injury mortality rate during the study period among the children aged 0-14 years, with the age-standardised injury mortality rate decreasing from 29.71 per 100,000 per year in 2004 to 24.12 in 2007, and then increasing to 28.12 in 2011. A similar change was observed in the rural area. But the age-standardised mortality rate decreased consistently in the urban area. The rate was higher among boys than among girls. Drowning, road traffic accidents and falls were consistently the top three causes of death among children.

CONCLUSIONS

Childhood injury is an increasingly serious public health problem in China. The increasing trend of childhood injury mortality is driven by the rural areas rather than urban areas. More effective strategies and measures for injury prevention and control are needed for rural areas, boys, drowning, road traffic accidents and falls.

Current pre-hospital traumatic brain injury management in China

BACKGROUND

Traumatic brain injury (TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, pre-hospital service can significantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.

DATA SOURCES

A literature search was conducted in January 2014 using the China National Knowledge Infrastructure (CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identified articles.

RESULTS

Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions.

CONCLUSION

Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.