[Epidemic characteristics and trend analysis of major injuries deaths among children and adolescents in Jiangsu Province from 2012 to 2021]

Objective: To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes. Methods: The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed. Results: The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P=0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P<0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P=0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P<0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P<0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P<0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P<0.05). Conclusions: The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.

[Epidemiological characteristics of falls in the elderly in Jiangsu from 2006 to 2021]

Objective: To understand the epidemiological characteristics and influencing factors of elderly unintentional fall-related injuries (EUFI) in Jiangsu from 2006 to 2021 and provide a scientific basis for the prevention of falls in the elderly and the formulation of related policies. Methods: Data on EUFI was collected from the first diagnosed cases in the injury surveillance hospitals in Jiangsu from 2006 to 2021, and epidemiological characteristics of injuries were analyzed. logistic regression was performed to identify the risk factors for EUFI. Results: The number of EUFI increased from 2006 to 2021, ranked as the first cause of elderly unintentional injuries during these years. The proportion of EUFI among elderly unintentional injuries increased in the same period. The male-to-female ratio is 1∶1.4. Falls mainly occurred during 8:00-10:00 am (32.7%). The most common place where falls occurred was at home (63.6%). From 2006 to 2014, leisure activities (62.1%), housework/study (23.1%), and work (5.2%) were the top three activities when injuries occurred. During 2015-2021, leisure activities (41.7%), housework/study (22.6%) and walking (20.5%) were the top three activities when injuries occurred. The major fall-related injuries were fractures (39.9%), with the injured parts at low limbs (32.5%), of which most were mild injuries (60.3%), and the primary outcome was hospitalization after treatment (74.1%). logistic regression showed that the risk factors of EUFI were female, old age, immigrants, winter, public residence, housework/study, and leisure activities. Higher education, occupation of household and production and transportation equipment operators were protective factors (all P<0.05). Conclusions: Fall is the leading cause of unintentional injuries in the elderly in Jiangsu, especially the elderly female population. Corresponding measures should be taken to prevent and intervene in falls in the elderly in the community according to the distribution characteristics.

[Analysis of 18 cases of malignant rhabdoid tumor in children]

Objective: To investigate the clinical characteristics, treatment and prognosis of malignant rhabdoid tumor (MRT) in children. Methods: Clinical data total of 18 children with MRT treated in the Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University between June 2015 to June 2021 were analyzed retrospectively. The patients were grouped according to age, gender, tumor type, clinical stage and other factors.Progression free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method, survival differences among different groups were compared by Log-rank test, and prognostic factors were analyzed by Cox regression model. Results: Among the 18 patients, there were 5 males and 13 females. The age of disease onset was 30.5 (12.0, 75.0) months, the tumor diameter was (80±29) mm, and no integrase interactor 1 (INI-1) expression was detected by immunohistochemistry. There were 7 cases of malignant rhabdoid tumor of the kidney (MRTK), 6 cases of atypical teratoid rhabdoid tumor (ATRT) and 5 cases of extrarenal extracranial rhabdoid tumor (EERT). At the time of early diagnosis, 12 patients were clinically stage Ⅲ-Ⅳ, 11 patients had local or distant metastasis, and 4 patients had metastasis during treatment. Surgical excision is the preferred treatment. There were 3 cases with preoperative puncture biopsy, 13 cases with complete resection, 4 cases with partial resection, and 1 case without operation. Thirteen patients were treated with the domestic conventional chemotherapy regimen for Wilms' tumor, medulloblastoma and rhabdomyosarcoma, and 5 patients were treated with the international conventional chemotherapy regimen. Nine patients received radiotherapy, including 1 case of MRTK, 4 cases of ATRT and 4 cases of EERT. By the end of follow-up in January 2022, 7 patients survived and 11 patients died. The 3-year PFS and OS rates were (8±8) % and (14±12) %. Log-rank test showed that the 5-year OS of EERT group was higher than ATRT and MRTK groups (χ²=16.31, P<0.001), the tumor diameter <80 mm group was higher than that of the ≥80 mm group (χ²=4.49, P=0.034), and the radiotherapy group was higher than no radiotherapy group (χ²=3.97, P=0.046). The differences were statistically significant. There was no significant difference in the influence of tumor type, age, tumor diameter, radiotherapy and chemotherapy on OS by Cox regression model (all P>0.05). Log-rank test showed that the 3-year PFS of EERT group was higher than ATRT and MRTK groups (χ²=11.14, P=0.004),>3 years group was higher than ≤3 years group (χ²=10.10, P=0.001), the differences were statistically significant. Tumor type, clinical stage, tumor diameter, age, tumor rupture and radiotherapy were included in the Cox regression model, and the results showed that clinical stage (HR=0.49, 95%CI 0.26-0.94, P=0.031), tumor diameter (HR=8.67, 95%CI 1.84-40.89, P=0.006), age (HR=0.01, 95%CI 0.00-0.15, P=0.001) had statistical significance on PFS. Conclusions: MRT is one of the most aggressive and fatal cancers in early childhood and infancy. There is no standard treatment and the prognosis is extremely poor. Clinical stage, tumor size and age are risk factors for disease progression.

[Analysis of developmental coordination disorder in Chinese children]

Objective: To investigate the prevalence of children's developmental coordination disorder (DCD) and its distribution based on different family socioeconomic characteristics in China, in order to provide a theoretical basis for early prevention, diagnosis, and intervention for DCD. Methods: From June to October, 2016, 1 887 children aged 3-10 years from 20 kindergartens and 10 elementary schools from 8 cities in seven geographic areas of China using a stratified cluster sampling method were recruited. With a cross-sectional design, parents were asked to report on their basic information. Children' s motor ability was assessed using the movement assessment battery for children-second edition (MABC-2). Children were grouped by age, sex, body mass index (BMI), one-child status, and family structure. Chi-square test and one-way ANOVA were used to compare family socioeconomic characteristics of children between different groups. Results: Among the 1 887 children, there were 1 110 (58.8%) preschool children (3-6 years of age) and 777 (41.2%) school-aged children (7-10 years of age). There were 982 males (52.0%) and 905 females (48.0%). A total of 5.5% (104 cases) children were diagnosed with DCD, 10.4% (197 cases) with suspected DCD, and 84.1% (1 586 cases) as typical motor developing children. There were no significant differences in prevalence of diagnosed and suspected DCD among different regions (χ²=17.342 and 4.877, P=0.173 and 0.560), total motor coordination score (F=2.759, P<0.05), and the scores of all dimensions (manual dexterity, positioning and grabbing, balance: F=9.276, 5.277, 3.706, all P<0.01). The prevalence of DCD in preschool children was significantly higher than that in school-age children (χ²=11.891, P<0.01). Girls were significantly better than boys in total motor coordination, manual dexterity, and balance (all P<0.01). Boys were significantly better than girls in positioning and grabbing (P<0.01). The prevalence of DCD in boys was significantly higher than that in girls (70 boys (7.1%) and 34 girls (3.8%), χ²=28.508, P<0.01). The total motor coordination ability, manual dexterity and balance of children who are overweighted (BMI>18 kg/m²) were significantly lower than those of children of normal weight (BMI≤18 kg/m²) (all P<0.01). The prevalence of suspected DCD children who are overweighted was significantly higher than that of children of normal weight (χ²=4.369, P<0.05). The difference of total motor coordination ability (F=6.811, P<0.01) and the prevalence of DCD (χ²=14.902, P<0.01) among different family structures were statistically significant. The total motor coordination ability and balance ability of children from multi-child family were better than those of children from one-child family (both P<0.05). Conclusion: The motor coordination ability of Chinese children is well-developed, with differences among different regions, gender, age, BMI, and family structure.

[Prevalence and influencing factors of carotid plaque in population at high-risk for cardiovascular disease in Jiangsu province]

Objective: To understand the prevalence of carotid plaque (CP) in population at high-risk for cardiovascular disease (CVD) in Jiangsu province and identify related influencing factors. Methods: Based on the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project from 2015 to 2016, a total of 11 392 persons at high-risk for CVD were selected from six project areas in Jiangsu province for the questionnaire survey, physical measurement, laboratory test and bilateral ultrasound examination of carotid arteries. The prevalence of CP and influencing factors of abnormal carotid arteries, CP and plaque burden (CP≥2) were analyzed. Results: Among the persons surveyed, 4 821 (42.3%) were males. The age of the persons surveyed was (59.4±8.9) years. There were 5 971 abnormal carotid arteries cases (52.4%), including 1 782 carotid intima-media thickness thickening cases (15.6%), 3 811 CP cases (33.5%) and 378 carotid stenosis cases (3.3%). Older age (OR=2.253, 95%CI: 2.127-2.386), urban residence (OR=2.622, 95%CI: 2.375-2.895), hypertension (OR=1.439, 95%CI: 1.195-1.732), smoking (OR=1.441, 95%CI: 1.259- 1.650), pulse pressure difference (OR=1.270, 95%CI: 1.198-1.347), fasting plasma glucose (FPG) (OR=1.109, 95%CI: 1.059-1.161) and LDL-C/HDL-C (OR=1.225, 95%CI: 1.164-1.288) were possible risk factors of CP in population at high risk for CVD. Being women (OR=0.558, 95%CI: 0.494-0.630), high BMI (OR=0.948, 95%CI: 0.904-0.994), higher levels of education (OR=0.708, 95%CI: 0.531-0.945), and higher annual household income (OR=0.773, 95%CI: 0.669-0.894) were the possible protective factors. Conclusions: Over half of the population at high-risk for CVD in Jiangsu showed abnormal carotid arteries. High blood pressure, high blood glucose, high blood lipids and smoking were the main factors that could be changed.

[Prevalence, awareness, treatment and control of hypertension in adult residents in Jiangsu province]

Objective: To investigate the prevalence, awareness, treatment and control of hypertension in adult residents in Jiangsu province and provide evidence for the prevention and control of hypertension. Methods: A population-based cardiovascular disease screening project was conducted during 2015-2018 in Jiangsu, a total of 95 348 community-dwelling adults aged 35-75 years from 6 project areas were included in the study. The prevalence rate of hypertension and rates of awareness, treatment and control of hypertension in the adults with different characteristics were analyzed. Multilevel model was applied to identify the influencing factors. Results: Among 95 348 adults surveyed, 54 407 were hypertensive, the standardized prevalence rate was 48.1%. The prevalence rate was significantly higher in males than in females (62.1% vs. 54.0%, P<0.05). Among the hypertension patients, the rates of awareness, treatment and control of hypertension were 56.6%, 45.3% and 12.0% (standardized rates: 52.2%, 41.0% and 11.2%), respectively, and all the rates were positively associated with age (all P<0.05). Multilevel model analysis showed that those who were males, at older age, lived in rural area, suffered from diabetes, had frequent alcohol drinking and those who were overweight/obese had higher risk for hypertension (all P<0.05). Among people with hypertension, those who had younger age, lower education level, lower household income level and those who had frequent alcohol drinking had lower awareness, treatment and control rates of hypertension (all P<0.05). Conclusions: The prevalence rate of hypertension was high, but related awareness, treatment and control rates were low in adult residents in Jiangsu province. Comprehensive measures should be taken to improve awareness, treatment and control of hypertension in whole population, especially in young adults, and those with low education or income levels.

Seasonal hogget grazing as a potential alternative grazing system for the Qinghai-Tibetan plateau: weight gain and animal behaviour under continuous or rotational grazing at high or low stocking rates

The traditional transhumance grazing system on the Qinghai-Tibetan Plateau (QTP) is being replaced by a system in which pastoralists are allocated fixed areas for grazing. In this context, we conducted experiments to evaluate a possible change to seasonal grazing of young animals for weight gain, and the effects of grazing management (continuous grazing (CG) vs rotational grazing (RG)) and stocking rate (SR) on the performance and behaviour of Oura-type Tibetan sheep. In Experiment 1 (June–December 2014), 72 Tibetan sheep (initial bodyweight (BW) 32.2 ± 3.37 kg) were allocated to one of three treatments: (1) CG24 – eight sheep grazed continuously in a single 2-ha plot for the entire duration of the experiment; (2) RG24 – eight sheep grazed in a 1-ha plot from June to September (growing season), and then moved to a new plot for September–December grazing (early cold season); (3) RG48 – eight sheep grazed in a 0.5-ha plot, but otherwise as for RG24. All treatments had three replicates. In Experiment 2 (September–December 2014), 48 Tibetan sheep (initial BW 46.3 ± 1.62 kg) were used to repeat the RG24 and RG48 treatments imposed in the early cold season of the Experiment 1. In both experiments, increasing SR significantly reduced bodyweight gain (BWG) per head and increased BWG per ha in the RG treatments. In Experiment 1, RG, compared with CG, did not significantly affect BWG per head, BWG per ha, or feed utilisation efficiency. In both experiments weight gain was small or negative in the early cold season. These results indicate that removal of sheep at the onset of the cold season will be important for retention of the weight gain achieved in the growing season but choice between a CG and RG grazing system is unimportant for the production efficiency in the proposed grazing system of Tibetan sheep.