ABSTRACT
ObjectivesIn our Chinese biobank of half a million people, we use data gathered from health insurance agencies to supplement our follow-up. We have 217,000 participants with insurance ...records including a breakdown of what the insurance paid for, totalling 1.6 million insurance records and 60 million chargeable items. The objective was to find ways of using this information to enhance our Electronic Health Records (EHRs) by adding usable and reliable treatment data, as a basis for future research.
ApproachMachine translations of every charge description were produced so that early investigation could be done by analysts who were not Chinese speakers. Key phrases were produced by specialist clinicians in an iterative process. We began by focussing on haemodialysis treated ESRD, heart failure, and coronary revascularisation. With our refined techniques, key phrase searches were developed which could be tied into ongoing validation procedures elsewhere in the study (e.g. cancer) or which could be validated using existing data from other sources (e.g. death reporting).
ResultsMachine translation provided both problems and unexpected solutions. While it could be inaccurate (‘Divine Comedy’, ‘semen’, ‘corpse cuisine’), more often than not it provided unexpected advantages, converting regional, archaic, or otherwise uncommon Chinese terms into the most common English equivalent.The majority of chargeable elements in our insurance records are not treatment data per se, but instead hospital fees, generic care, and records of tests without result data. This makes identification of relevant treatment data challenging. Targeted key phrase searches proved successful, demonstrating that it was possible to use this data to answer research questions, even teasing out details which would otherwise not be available to us (e.g. ESRD, location and type of revascularisation).
Validation of these findings is ongoing. For example, we found that 395 of our participants have been charged for ‘corpse cuisine’ (more accurately ‘corpse preparation’). Comparing these figures to our death records (an independently gathered source) we confirmed that 326 are known to be dead, and we added the remaining 69 to our list for active follow-up. Similarly, will we be seeking hospital records for the 528 patients who are receiving cancer treatment with no record of cancer.
ConclusionOur methods for dealing with treatment data are still being refined, but early results are looking promising. We are investigating standardisation to ICD-10-PCS codes, developing more treatment-based diagnoses, and feeding our findings back into our ongoing validation program.
RURAL SURGERY TRAINING PROGRAMS IN THE UNITED STATES:
A REVIEW OF THE LITERATURE
Abstract: Rural surgery training programs have been developed to train general surgeons for community and rural ...service. There are 10 rural surgery training programs in the United States. Rural surgery training began in 1974 in LaCrosse, Wisconsin to prepare general surgery residents for rural service. There is a national shortage of general surgeons which translates into a deficit of surgeons in rural areas. The terms general surgeon and rural surgeon are not synonymous as rural surgery is more extensive, more broad-based and more subspecialty with more trauma, burn care and wound care and far more endoscopic and laparoscopic procedures. There are many advantages to rural general surgery training programs. A well-trained rural surgeon with OB/GYN experience can handle 66% of all inpatient operations in a rural hospital.
Rural surgery programs have been developed to address the above problems and attract graduating general surgeons to communities and rural areas. These programs have had high general surgery practice and high rural placement. Selection of appropriate campus, hospital and attending staff is critical for the educational experience to be maximal. Attending surgeons need to be general surgeons, rural surgeons and subspecialty surgeons. The American College of Surgeons (ACS) has developed the Advisory Council for Rural Surgery (ACRS). The ACRS has developed a repository of rural training experiences and training sites. There are five different types of training experience ranging from rotations to dedicated tracks to fellowships. Rural surgery training programs are a mechanism to attract more medical students to general surgery residencies, more graduating chief general surgery residents to private practice in community and rural areas, improve the case numbers and confidence of graduating surgery residents, and improve the quality of surgical care in this country.
•Pregnant women with depression and/or anxiety (i.e., mood-affected) sing less to their unborn fetuses.•Pregnant mood-affected women show a trend of reading less to their unborn fetuses.•Pregnant ...mood-affected mothers report less rubbing of their abdomen and playing less music to their fetuses than non-mood affected pregnant women.•Less vocalizations and sensorial stimulation directed toward their fetuses by pregnant mood-affected mothers may place fetuses at a disadvantage.
Abstract Objective Extravesical robot-assisted laparoscopic ureteral reimplantation (RALUR) is a popular alternative to open surgery. We report our experience with RALUR and evaluate clinical ...variables as predictors for failure. Methods We retrospectively evaluated the records of patients who underwent RALUR by a single surgeon for treatment of primary vesicoureteral reflux. Clinical and demographic variables were determined. Clinical variables were compared with surgical outcomes using the Student two-tailed type 2 t test. Results Fifty patients underwent a combined 78 extravesical RALURs. Median (range) age was 6.2 (1.9–18.0) years; median (range) preoperative reflux grade was 3 (0–5). Dysfunctional elimination syndrome (DES) was present in 32 (64%). Ten (20%) patients had prior deflux, and two (4%) had prior ureteroneocystostomy on the ipsilateral side. Postoperative cystogram was performed in 100% at a median (range) of 55 (27–133) days. Median (range) follow-up was 286 (27–2238) days. Febrile urinary tract infection occurred in five (10%), none of whom had reflux on initial follow-up postoperative cystogram. All five had a history of DES and were female. Six complications occurred in five (10%) patients, including ileus (2), ureteral obstruction (2), ureteral injury (1), and perinephric fluid collection (1). Transient urinary retention occurred in one. Five of 22 (22.7%) patients undergoing unilateral surgery had contralateral de novo reflux. Six of 78 ureters (7.7%) had persistent reflux postoperatively. Neither persistent nor de novo reflux was associated with any of the clinical variables assessed. Conclusions RALUR is an effective and safe option for patients with primary vesicoureteral reflux requiring surgery.
The epithelial sodium channel (ENaC) is composed of three homologous subunits termed α, β, and γ. Previous studies suggest that selected residues within a hydrophobic region immediately preceding the ...second membrane-spanning domain of each subunit contribute to the conducting pore of ENaC. We probed the pore of mouse ENaC by systematically mutating all 24 amino acids within this putative pore region of the α-subunit to cysteine and co-expressing these mutants with wild type β- and γ-subunits of mouse ENaC inXenopus laevis oocytes. Functional characteristics of these mutants were examined by two-electrode voltage clamp and single channel recording techniques. Two distinct domains were identified based on the functional changes associated with point mutations. An amino-terminal domain (α-Val569–α-Gly579) showed minimal changes in cation selectivity or amiloride sensitivity following cysteine substitution. In contrast, cysteine substitutions within the carboxyl-terminal domain (α-Ser580–α-Ser592) resulted in significant changes in cation selectivity and moderately altered amiloride sensitivity. The mutant channels containing αG587C or αS589C were permeable to K+, and mutation of a GSS tract (positions α587–α589) to GYG resulted in a moderately K+-selective channel. Our results suggest that the C-terminal portion of the pore region within the α-subunit contributes to the selectivity filter of ENaC.
To assess prospective associations of circulating metabolites with the risk of type 2 diabetes (T2D) among Chinese adults.
A case-cohort study within the 8-year prospective China Kadoorie Biobank ...comprised 882 participants with incident T2D and 789 subcohort participants. Nuclear magnetic resonance metabolomic profiling quantified 225 metabolites in stored baseline plasma samples. Cox regression related individual metabolites with T2D risk, adjusting for potential confounders and fasting time.
After correction for multiple testing, 163 metabolites were significantly associated with the risk of T2D (P < 0.05). There were strong positive associations of VLDL particle size, the ratio of apolipoprotein B to apolipoprotein A-1, branched-chain amino acids, glucose, and triglycerides with T2D, and inverse associations of HDL-cholesterol, HDL particle size, and relative n-3 and saturated fatty acid concentrations.
In Chinese adults, metabolites across diverse pathways were independently associated with T2D risk, providing valuable etiological insights and potential to improve T2D risk prediction.
Hypertension is a leading cause of premature death in China, but limited evidence is available on the prevalence and management of hypertension and its effect on mortality from cardiovascular disease ...(CVD).
To examine the prevalence, diagnosis, treatment, and control of hypertension and to assess the CVD mortality attributable to hypertension in China.
This prospective cohort study (China Kadoorie Biobank Study) recruited 500 223 adults, aged 35 to 74 years, from the general population in China. Blood pressure (BP) measurements were recorded as part of the baseline survey from June 25, 2004, to August 5, 2009, and 7028 deaths due to CVD were recorded before January 1, 2014 (mean duration of follow-up: 7.2 years). Data were analyzed from June 9, 2014, to July 17, 2015.
Prevalence and diagnosis of hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or receiving treatment for hypertension) and treatment and control rates overall and in various population subgroups.
Cox regression analysis yielded age- and sex-specific rate ratios for deaths due to CVD comparing participants with and without uncontrolled hypertension, which were used to estimate the number of CVD deaths attributable to hypertension.
The cohort included 205 167 men (41.0%) and 295 056 women (59.0%) with a mean (SD) age of 52 (10) years for both sexes. Overall, 32.5% of participants had hypertension; the prevalence increased with age (from 12.6% at 35-39 years of age to 58.4% at 70-74 years of age) and varied substantially by region (range, 22.7%-40.7%). Of those with hypertension, 30.5% had received a diagnosis from a physician; of those with a diagnosis of hypertension, 46.4% were being treated; and of those treated, 29.6% had their hypertension controlled (ie, systolic BP <140 mm Hg; diastolic BP <90 mm Hg), resulting in an overall control rate of 4.2%. Even among patients with hypertension and prior CVD, only 13.0% had their hypertension controlled. Uncontrolled hypertension was associated with relative risks for CVD mortality of 4.1 (95% CI, 3.7-4.6), 2.6 (95% CI, 2.4-2.9) and 1.9 (95% CI, 1.8-2.0) at ages 35 to 59, 60 to 69, and 70 to 79 years, respectively, and accounted for about one-third of deaths due to CVD (approximately 750 000) at 35 to 79 years of age in 2010.
About one-third of Chinese adults in this national cohort population had hypertension. The levels of diagnosis, treatment, and control were much lower than in Western populations, and were associated with significant excess mortality.
Summary
Background
There is limited evidence on the associations of dietary factors and patterns with risk of later‐onset ulcerative colitis (UC) in Chinese adults.
Aims
To investigate the ...associations of dietary factors and patterns with risk of later‐onset UC in Chinese.
Methods
The prospective China Kadoorie Biobank cohort study recruited 512,726 participants aged 30–79. Dietary habits were assessed using food frequency questionnaires. Dietary patterns were derived by factor analysis with a principal component method. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
During a median follow‐up of 12.1 years, 312 cases of newly diagnosed UC were documented (median age of diagnosis 60.1 years). Egg consumption was associated with higher risk of UC (HR for daily vs. never or rarely: 2.29 95% CI: 1.26–4.16), while spicy food consumption was inversely associated with risk of UC (HR: 0.63 0.45–0.88). The traditional northern dietary pattern, characterised by high intake of wheat and low intake of rice, was associated with higher risk of UC (HR for highest vs. lowest quartile of score: 2.79 1.93–4.05). The modern dietary pattern, characterised by high intake of animal‐origin foods and fruits, was associated with higher risk of UC (HR: 2.48 1.63–3.78). Population attributable fraction was 13.04% (7.71%–19.11%) for daily/almost daily consumption of eggs and 9.87% (1.94%–18.22%) for never/rarely consumption of spicy food.
Conclusions
The findings highlight the importance of evaluating dietary factors and patterns in the primary prevention of later‐onset UC in Chinese adults.
Eggs consumption and adherence to traditional northern or modern dietary patterns were associated with higher risk of later‐onset UC in Chinese adults, whereas spicy food consumption showed an inverse association with the risk. Dietary factors and patterns are important in the primary prevention of later‐onset UC in Chinese.
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