Changes in the Prevalence of Hyperuricemia in Clients of Health Examination in Eastern China, 2009 to 2019

Background: With the continuous improvement of people's living standards, the incidence of hyperuricemia (HUA) is increasing globally. The prevalence of HUA ranged in terms of region, race, and age. This study aims to investigate the changes in the prevalence of HUA in clients of health examination in Eastern China between 2009 and 2019. Methods: Chinese men and women aged 20-79 years (n = 4847 in the 2009 cohort and n = 12188 in 2019) who had received health examinations were enrolled. Serum uric acid (UA) levels and biochemical parameters, including fasting blood-glucose (FBG), triglyceride (TG), total cholesterol (CHOL), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (Cr) and blood urea nitrogen (BUN) were evaluated. The prevalence of HUA in different age groups were measured, and the correlation of biochemical parameters with the onset of HUA were analyzed. Results: The prevalence of HUA was 18.7% in the 2019 cohort, which was significantly higher than that in 2009 (13.3%). In females, the prevalence of HUA was significantly higher in 2019 than 2009 for age groups of 20-29 and 30-39 years. In male population, 2019 cohort had significantly higher age-specific prevalence for all age groups than 2009 cohort. Young men aged 20-29 years became the main population of HUA in the 2019 male cohort, whereas middle-aged men aged 40-49 years had the highest prevalence of HUA in the 2009 male cohort. The prevalence rates of HUA in all BMI groups in 2019 cohort were significantly higher than those in 2009 cohort. Spearmen’s correlation analysis and Logistic regression analysis indicated that BMI was positively correlated with the onset of HUA. The receiver-operating characteristic curve (ROC) analysis showed BMI＞24.48kg/m2 and BMI＞23.84 kg/m2 displayed good capacities to discriminate the population with HUA from those without HUA in 2009 and 2019 cohort, respectively. Conclusions: In recent 10 years, the prevalence of HUA was increased rapidly in Chinese adults, especially in males. Young men aged 20-29 years in the 2019 cohort replaced the middle-aged males (40-49 years old) in the 2009 cohort, and became the main population of male HUA in the 2019 cohort. BMI was positively correlated with HUA, and might be a potential risk factors to predict the onset of HUA.

Relationship between Cardiovascular Calcium and Atrial Fibrillation

Coronary artery calcium score (CACS) is associated with increased risk of atrial fibrillation (AF). However, the relationship between the burden of CACS and extra-coronary calcium and the AF is unclear. This cross-sectional study retrospectively analyzed the data of 143,529 participants (74.9% men; mean age, 41.7 ± 8.6 years) who underwent health examination including non-contrast cardiac CT and electrocardiography, from 2010 to 2018 to evaluate the association between cardiac calcium and AF. AF was diagnosed in 679 participants. The prevalence of AF was significantly increased as the CACS increased (p < 0.01). Multivariable analysis adjusted for age, sex, body mass index, hypertension, diabetes, hyperlipidemia, smoking, alcohol, and history of coronary artery disease showed a significant association between a high CACS ≥1000 and AF (OR 2.26, 95% CI 1.07–4.77, p = 0.032). In a subgroup analysis of participants with a CACS ≥100, aortic valve and thoracic aorta calcium were significantly associated with AF (OR 3.49, 95% CI 1.57–7.77, p = 0.002 and OR 2.19, 95% CI 1.14–4.21, p = 0.01, respectively). High CACS was associated with AF, and extra-coronary atherosclerosis was associated with AF in participants with a moderate to very high CACS.

Annual Health Examination Didn’t Perform a Positive Effect in the Prevention of Hyperlipidemia and Hyperglycemia Through an Eight-Year Study in China

Background: Annual health examination is recommended for the prevention and treatment of cardiovascular diseases and diabetes. However, whether it is effective for the prevention of hyperlipidemia and hyperglycemia remains unclear. Methods: A retrospective analysis of clinical samples using the laboratory information system was performed. From 2012 to 2019, 5043 participants (1755 males and 3288 females) have completed the annual health examination for 8 consecutive years, which was the follow-up group. In the same period, 136,994 participants (the control group) had a health examination only 1 time. Serum levels of fasting triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and glucose (GLU) were measured.Results: Compared with 2019 of the control group, serum TC and GLU in the 8th year of the follow-up group increased markedly in some of age groups (p < 0.001). Serum TG and TC in the 8th year were much higher compared with the 1st year of the follow-up group, especially for the female (p < 0.001). Moreover, the prevalence of hyperlipidemia and hyperglycemia in the 8th year showed significant increase compared with the 1st year of the follow-up group and 2019 of the control group (all p < 0.05).Conclusions: Annual health examination didn’t perform a positive effect in the prevention of hyperlipidemia and hyperglycemia. Health management should be paid more attention to prevent cardiovascular disease and diabetes.

Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

Seroprevalence Study of Pertussis in Adults at Childbearing Age and Young Infants Reveals the Necessity of Booster Immunizations in Adults in China

In China, the vaccination strategy against pertussis is started from 3 months of age, with no booster dose used after the booster given at two years. Despite a high vaccination coverage, pertussis has been increasingly reported since the last decade. This study evaluates the prevalence of serum anti-pertussis toxin (PT) IgG antibodies in adults at childbearing age and infants before the age of primary immunization in Beijing, China. A total of 1175 serum samples randomly selected from individuals who attended an annual health examination at the Sixth Medical Center of the PLA General Hospital, Beijing, in 2019, was included. The geometric mean concentration (GMC) and median concentration of anti-PT IgG antibodies among adults aged 20–39 years were 3.81 IU/mL and 3.24 IU/mL, and the corresponding concentrations were 1.72 IU/mL and 1.43 IU/mL among infants under 3 months of age. The seroprevalence of PT IgG antibodies ≥ 40 IU/mL in adults and infants was 2.0% (15/735) and 1.1% (5/440). In total, 65.99% (485/735) of adults and 83.41% (367/440) of infants had non-detectable pertussis-specific antibodies (<5 IU/mL). Our results showed that the majority of adults at a reproductive age and young infants are vulnerable to pertussis, suggesting that booster vaccinations in adults should be considered in this country.

Prevalence of Schistosoma mono- and co-infections with multiple common parasites and associated risk factors and morbidity profile among adults in the Taabo health and demographic surveillance system, South-Central Côte d’Ivoire

Background Schistosomiasis remains an important public health problem, also among adults, and infected individuals not treated serve as a reservoir for continued transmission. Despite this fact, evidence on the epidemiology of schistosomiasis in adults in Côte d’Ivoire is scanty. This study aimed to determine the prevalence and risk factors of Schistosoma infection and co-infection with other helminth species and Plasmodium among adults in the Taabo region in the south-central part of Côte d’Ivoire. Methods A cross-sectional survey was carried out in April and May 2017 in the frame of the “Côte d’Ivoire Dual Burden of Disease Study” (CoDuBu). A total of 901 randomly selected individuals, aged 18–90 years, provided blood, stool and urine samples for the diagnosis of malaria and helminth infections. Stool samples were subjected to the Kato-Katz technique for detection of Schistosoma mansoni and soil-transmitted helminth eggs, while urine samples were examined for eggs of Schistosoma haematobium and circulating cathodic antigen of S. mansoni. Risk factors and morbidity profiles were assessed using health examination and questionnaires. Multinomial logistic regressions were employed to identify risk factors and morbidity patterns associated with S. mansoni mono- and co-infections. Results The prevalence of S. mansoni and S. haematobium was 23.2% and 1.0%, respectively. Most S. mansoni were mono-infections (81.3%). Independent determinants of S. mansoni infection were young age, low socioeconomic status (mono- and co-infection) and poor hygiene practices (co-infection) (P < 0.05). S. mansoni infection was independently associated with higher pain and symptom scores (mono-infection), poor self-rated health and low healthcare use (co-infection) (P < 0.05). Conclusions This study showed that adults represent a substantial reservoir of S. mansoni. To sustain schistosomiasis control and improve people’s wellbeing, it is important to expand preventive chemotherapy from school-aged children to adults, coupled with hygiene and health education.

Creating a Scientific Solution: Local Problem Solving in the Portuguese Health Examination Survey: A Mixed Method Study

BackgroundParticipation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.MethodsAfter a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.ResultsThe local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.ConclusionsThe theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

Blood pressure screening in midlife aids in prediction of dementia later in life

Background: There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer’s disease (AD), or vascular dementia (VaD) later in life. Methods: The community-based study population comprised 30,102 dementia-free individuals from the Westmannia Cardiovascular Risk Factors Study. The participants were aged 40 or 50 years when the health examination took place in 1990–2000. Diagnose registers from both hospitals and primary healthcare centers were used to identify individuals who after inclusion to the study developed dementia. The association between midlife high blood pressure (defined as systolic blood pressure >140 and/or diastolic blood pressure >90 mmHg) at a single timepoint and dementia was adjusted for age, gender, body mass index (BMI), fasting blood glucose, education, smoking, and physical activity level. Multivariate binary cox regression analyses were used. Results: After a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.02–1.45) and VaD (HR: 2.10, 95% CI: 1.47–3.00) but not AD (HR: 1.06, 95% CI: 0.81–1.38). Conclusion: This study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment.

A Metaphoric Design of Electronic Medical Record (EMR) for Periodic Health Examination Reports

The exponential growth of big data demands an efficient knowledge discovery. The electronic medical records of patients on medical data Clouds contain implicit medical information. Although the periodic health examination (PHE) reports describing a set of screening tests for healthy individuals performed periodically, common individuals require the assistance of an expert to interpret the results for a medical opinion. This research study proposes a metaphoric design of Electronic Medical Record (EMR) for PHE reports of patients. The outcomes of this study glimpses useful findings for the common people in the self-interpretation of their medical reports. Besides, among a variety of solutions, the study uses the metaphoric representation to convert the numerical data and medical terminology to familiar graphic representations from real life. The study identifies the detailed requirements to propose a conceptual architecture for metaphoric EMR reports. The future work will result in a prototype design, evaluation, and refinement of metaphors based on stakeholders' feedback.

Diagnostic Agents in the Pediatric Eye Examination

In this chapter, the author reviews the most common topical ophthalmic drops for diagnostic use in a pediatric eye exam. Topical diagnostic agents have become an integral part of an ocular health examination even in infants and young children. Topical local anesthetics are commonly used for eye procedures such as tonometry, gonioscopy, and minor office procedures. The proper use of mydriatic drugs allows clinicians to identify and diagnose various ocular abnormalities that might otherwise go undetected. Cycloplegic refraction is a reliable procedure to determine the true refractive status of patients with accommodative esotropia, pseudomyopia, and latent hyperopia. Cycloplegic refraction is also useful in non-communicative or uncooperative patients and when a functional vision problem is suspected such as when visual acuities do not correlate with symptoms or clinical expecteds. Many times, diagnostic drops can help a clinician be more confident of the patient's clinical findings.