Publications by authors named "Wenzhe Qin"

28 Publications

  • Page 1 of 1

Warfarin maintenance dose prediction for Chinese after heart valve replacement by a feedforward neural network with equal stratified sampling.

Sci Rep 2021 Jul 2;11(1):13778. Epub 2021 Jul 2.

Department of Evidence-Based Medicine and Clinical Epidemiology, School of Medicine/West China Hospital, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.

Patients requiring low-dose warfarin are more likely to suffer bleeding due to overdose. The goal of this work is to improve the feedforward neural network model's precision in predicting the low maintenance dose for Chinese in the aspect of training data construction. We built the model from a resampled dataset created by equal stratified sampling (maintaining the same sample number in three dose-groups with a total of 3639) and performed internal and external validations. Comparing to the model trained from the raw dataset of 19,060 eligible cases, we improved the low-dose group's ideal prediction percentage from 0.7 to 9.6% and maintained the overall performance (76.4% vs. 75.6%) in external validation. We further built neural network models on single-dose subsets to invest whether the subsets samples were sufficient and whether the selected factors were appropriate. The training set sizes were 1340 and 1478 for the low and high dose subsets; the corresponding ideal prediction percentages were 70.2% and 75.1%. The training set size for the intermediate dose varied and was 1553, 6214, and 12,429; the corresponding ideal prediction percentages were 95.6, 95.1%, and 95.3%. Our conclusion is that equal stratified sampling can be a considerable alternative approach in training data construction to build drug dosing models in the clinic.
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http://dx.doi.org/10.1038/s41598-021-93317-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253817PMC
July 2021

Prevalence and risk factors of depression symptoms among Chinese seafarers during the COVID-19 pandemic: a cross-sectional study.

BMJ Open 2021 06 23;11(6):e048660. Epub 2021 Jun 23.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China

Background: To curb the spread of COVID-19, most countries have adopted measures such as banning shore leave at ports and placed restrictions on crew change. Seafarers may bear an excess pressure during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors associated with depression symptoms among Chinese seafarers during the COVID-19 pandemic.

Design: Cross-sectional study.

Methods: This field survey-based study was conducted at Rongcheng Port, Shandong Province, China, from 10 June 2020 to 25 July 2020. Sociodemographic and occupational characteristics and health-related behaviours were collected through a face-to-face questionnaire. The Self-Rating Depression Scale was used to evaluate depression status during the preceding week. Logistic regression models were used to explore factors related to depression.

Results: 441 male Chinese seafarers were enrolled. Overall, the proportions of seafarers with low, moderate and severe depression symptoms were 23.35%, 9.30% and 9.07%, respectively. Compared with those with good self-rated health (SRH), seafarers with poor SRH had higher odds of depression (OR, 2.24, 95% CI 1.22 to 4.11). Less leisure time or physical exercise was associated with more severe self-reported depression symptoms (1-3 per week vs ≥4 per week: OR, 1.72, 95% CI 0.71 to 4.14; none vs ≥4 per week: OR, 3.93, 95% CI 1.67 to 9.26). Poor sleep quality was associated with higher likelihood of reporting severe depression (fair vs good: OR, 2.78, 95% CI 1.54 to 5.01; poor vs good: OR, 4.30, 95% CI 1.65 to 11.24). The more frequent seafarers worked overtime a week, the higher the likelihood of reporting severe depression symptoms (1-2 per week vs none: OR, 1.82, 95% CI 1.04 to 3.18; ≥3 per week vs none: OR, 2.49, 95% CI 1.05 to 5.92). Also, high perceived work stress was linked to higher odds of being depressed (intermediate vs low: OR, 2.06, 95% CI 0.78 to 5.46; high vs low: OR, 3.83, 95% CI 1.35 to 10.90).

Conclusions: There is a high burden of depression associated with COVID-19 among seafarers. Special interventions that protect the mental health of seafarers are more critical than ever in the context of the pandemic.
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http://dx.doi.org/10.1136/bmjopen-2021-048660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230921PMC
June 2021

Network-Based Online Survey Exploring Self-Reported Depression Among University and College Students During the Early Days of the COVID-19 Outbreak.

Front Psychiatry 2021 13;12:658388. Epub 2021 May 13.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

The psychology of university and college students is immature, they are thus more likely to suffer from depression due to the COVID-19 pandemic. The present study aims to investigate the self-reported depression status of Chinese university and college students and explore its influencing factors. We conducted a network-based online survey, and a total of 17,876 participants completed the questionnaire. Depression was measured by the Self-Rating Depression Scale (SDS). Univariate analysis and multivariate logistic analysis were performed to explore the influencing factors of self-reported depression symptoms. The proportion of self-reported depression symptoms, mild self-reported depression symptoms, and moderate to severe (M/S) self-reported depression symptoms was 65.2, 53.7, and 11.5%, respectively. The mean score of self-reported depression was 54.8 ± 9.0. Female, personality type of partial introversion, junior college educational level, "moderate" or "high" self-perceived risk of infection, "moderately" or "highly" impacted by the outbreak, and being eager to go back to school were risk factors for M/S self-reported depression symptoms ( < 0.05). While, "moderate" or "high" concern about the outbreak, "moderate" or "high" satisfaction with pandemic prevention and control measures, and having health literacy on communicable diseases were protective factors for M/S self-reported depression symptoms ( < 0.05). The status of self-reported depression symptoms among university and college students was severer than expected, and the influencing factors were multifaceted. Government and school administrators should strengthen the dissemination of knowledge on disease prevention and control. Moreover, much attention should be paid to female and junior college students.
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http://dx.doi.org/10.3389/fpsyt.2021.658388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155487PMC
May 2021

Online-Based Survey on College Students' Anxiety During COVID-19 Outbreak.

Psychol Res Behav Manag 2021 29;14:385-392. Epub 2021 Mar 29.

Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, People's Republic of China.

Purpose: Studies have suggested that public health emergencies can have many psychological effects on college students, therefore, the aim of this study is to investigate current situation of college students' anxiety and its determinants in the time of an unexpected pandemic.

Patients And Methods: We conducted convenience sampling to collect the data through network-based online questionnaires in February 2020, a total of 17,876 college students were included in the analysis. Chi-square test and multivariate logistic were used to identify the associations between the outbreak experiences and anxiety detection.

Results: This study found that detection rate of anxiety among college students was 18.2%. The differences in male students, students whose self-perceived risk of infection were high, who were greatly affected by the outbreak, eager to go back to school, reluctant to leave home and stay at home enough were of statistical significance among different anxiety level (OR>1, P<0.05). And the severe anxiety rate of students who living in cities was significantly higher (2.337[1.468, 3.721]).

Conclusion: Although our results show that anxiety among college students was at a low level, various universities should focus on the online activities and develop appropriate epidemic management plans to prevent their feelings of worry, tension and panic.
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http://dx.doi.org/10.2147/PRBM.S298539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018558PMC
March 2021

Prevalence and Associated Factors of Self-Treatment among the Elderly-A Comparative Study between Empty and Non-Empty Nesters in Shandong, China.

Int J Environ Res Public Health 2020 10 27;17(21). Epub 2020 Oct 27.

School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

(1) Objectives: With an aging society in China, self-treatment now plays an important role in health care among older adults, but it can be problematic. This study aims to explore and compare the self-treatment behavior among empty and non-empty nesters. (2) Methods: Using a multi-stage stratified random cluster sampling method, a total of 4366 elderly people aged 60 and above from Shandong Province, China, were enrolled in this study. Data were collected through a structured questionnaire. Binary logistic regression was used to analyze the associated factors of self-treatment. (3) Results: The prevalence of self-treatment in empty nesters was significantly lower than that in non-empty ones (74.0% vs. 83.3%). Binary logistic regression analysis showed that higher educational level and poorer self-rated economic status were negatively associated with self-treatment in empty nesters, while unemployed and urban and rural residents' basic medical insurance were positively associated with self-treatment in non-empty ones. (4) Conclusions: The study indicated that empty nesters had lower likelihood of self-treatment than non-empty ones. Empty nesters with better socioeconomic status were more likely to use self-treatment; by contrast, non-empty nesters with relatively poorer socioeconomic status were more inclined to self-treatment. Targeted interventions should be developed to maximize the effectiveness of self-treatment and reduce health risks.
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http://dx.doi.org/10.3390/ijerph17217880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662221PMC
October 2020

Hearing impairment and loneliness in older adults in Shandong, China: the modifying effect of living arrangement.

Aging Clin Exp Res 2021 Apr 15;33(4):1015-1021. Epub 2020 Jun 15.

School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.

Background: Hearing impairment is a highly prevalent condition and potential risk factor of loneliness in older adults. There is little evidence on whether living arrangement modifies the effects of hearing impairment on loneliness in older adults.

Aims: (1) Explore the relationship between hearing impairment and loneliness in old adults; (2) investigate the modifying effect of living arrangement on the association between hearing impairment and loneliness.

Methods: A cross-sectional analysis was conducted of 7070 participants (aged 60-101) in Shandong province of China. Hearing impairment was measured by a single self-reported question. Variables about social demography and physical functioning were assessed using self-administered questionnaires, and loneliness using short-form UCLA Loneliness Scale. Linear regression models were performed to evaluate the association between hearing impairment and loneliness and possible effect modified by living arrangement.

Results: After controlling variables, older adults with hearing impairment reported significantly higher levels of loneliness than those with normal hearing (β = 0.024; P < 0.001). Living arrangement has a significant modifying effect on association between hearing impairment and loneliness.

Conclusions: Our results underscored the potential impact of hearing impairment on loneliness in older adults, and also suggested that having adult children in the same village/community may play a protective role in reducing the loneliness of older adults with hearing impairment.
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http://dx.doi.org/10.1007/s40520-020-01594-0DOI Listing
April 2021

Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study.

BMJ Open 2020 05 18;10(5):e036664. Epub 2020 May 18.

School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

Objectives: Whether the association between obesity-related anthropometric indices and multimorbidity differs by age among Chinese older adults (aged 65+) is unclear. We aimed to investigate the association between body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with multimorbidity among the young-old (aged 65-79) and old-old (aged 80+) adults.

Design: Cross-sectional population-based study.

Setting: Shandong province on the eastern coast of China.

Participants: 5493 subjects aged 65 years or above.

Measurements: Details on sociodemographics, lifestyle characteristics and chronic conditions were collected using a structured questionnaire. The respondents were assessed with anthropometric measurements including height, weight, WC, hip circumference.

Results: The overall prevalence of multimorbidity in older adults (aged 65+) was 35.2%. The BMI-obesity, WC-obesity and WHR-obesity rates were 7.4%, 57.5% and 80.4%, respectively. In the young-old adults (aged 65-79), the likelihood of multimorbidity was more than two times higher among the BMI-obese than the BMI-normal population (OR 2.08, 95% CI 1.66 to 2.60). Similar but less strong associations were found for the WC-obese and WHR-obese young-old population (OR 1.60, 95% CI 1.42 to 1.81; OR 1.31, 95% CI 1.10 to 1.56, respectively). For the old-old group (aged 80+), the BMI-obese, WC-obese and WHR-obese had a higher likelihood of having multimorbidity compared with the normal weight category (OR 2.10, 95% CI 0.96 to 4.57; OR 1.75, 95% CI 1.21 to 2.54; OR 2.15, 95% CI 1.18 to 3.93, respectively).

Conclusion: BMI-obesity, WC-obesity and WHR-obesity were associated with a greater risk of multimorbidity, and the associations were different between the young-old and the old-old adults. These age differences need to be considered in assessing healthy body weight in old age. These findings may be vital for public health surveillance, prevention and management strategies for multimorbidity in older adults.
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http://dx.doi.org/10.1136/bmjopen-2019-036664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239539PMC
May 2020

Rural-urban differences in home-based care willingness among older adults: A cross-sectional study in Shandong, China.

Int J Qual Health Care 2020 Apr;32(2):126-134

School of Public Health, Shandong University, Jinan, 250012, China.

Objective: To examine the rural-urban disparities of home-based care willingness among older adults and identify the influencing factors.

Design: A cross-sectional study.

Setting: The data used in this cross-sectional study were conducted in Shandong province.

Study Participants: 7070 older adults (60 years and older) with complete data were included in this analysis from the 2017 Survey of the Shandong Elderly Family Health Service.

Intervention: N/A.

Main Outcome Measure: The data were analyzed using logistic regression models to examine whether socio-demographic characteristic, physical health, loneliness score and other factors were associated with home-based care willingness in rural and urban older adults. After exploring the factors, we compared the difference.

Results: Of 7070 participants, 66.9% were rural older adults and 33.1% were urban. The urban older adults less likely chose home-based care than the rural (OR = 0.667; P < 0.05). Binary logistic regression analysis showed that age (P < 0.05), income (P < 0.05), current employment (P < 0.05) and loneliness (P < 0.05) were significantly associated with the home-based care willingness both in rural and urban residence. Besides, the number of family members (P = 0.010), education years (P = 0.026) and financial support from children (P = 0.017) were associated factors of rural respondents' home-based care willingness. The bad self-reported-health-status-urban-older adults (P = 0.026) were more willing for home-based care.

Conclusions: The research we have done suggests that there is a residence difference toward home-based care willingness among older adults. Targeted policies and an age-friendly environment should be made for different subgroups of older adults.
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http://dx.doi.org/10.1093/intqhc/mzz132DOI Listing
April 2020

Rural-urban differences in home-based care willingness among older adults: A cross-sectional study in Shandong, China.

Int J Qual Health Care 2020 Apr;32(2):126-134

School of Public Health, Shandong University, Jinan, 250012, China.

Objective: To examine the rural-urban disparities of home-based care willingness among older adults and identify the influencing factors.

Design: A cross-sectional study.

Setting: The data used in this cross-sectional study were conducted in Shandong province.

Study Participants: 7070 older adults (60 years and older) with complete data were included in this analysis from the 2017 Survey of the Shandong Elderly Family Health Service.

Intervention: N/A.

Main Outcome Measure: The data were analyzed using logistic regression models to examine whether socio-demographic characteristic, physical health, loneliness score and other factors were associated with home-based care willingness in rural and urban older adults. After exploring the factors, we compared the difference.

Results: Of 7070 participants, 66.9% were rural older adults and 33.1% were urban. The urban older adults less likely chose home-based care than the rural (OR = 0.667; P < 0.05). Binary logistic regression analysis showed that age (P < 0.05), income (P < 0.05), current employment (P < 0.05) and loneliness (P < 0.05) were significantly associated with the home-based care willingness both in rural and urban residence. Besides, the number of family members (P = 0.010), education years (P = 0.026) and financial support from children (P = 0.017) were associated factors of rural respondents' home-based care willingness. The bad self-reported-health-status-urban-older adults (P = 0.026) were more willing for home-based care.

Conclusions: The research we have done suggests that there is a residence difference toward home-based care willingness among older adults. Targeted policies and an age-friendly environment should be made for different subgroups of older adults.
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http://dx.doi.org/10.1093/intqhc/mzz132DOI Listing
April 2020

The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China.

Int J Environ Res Public Health 2020 01 6;17(1). Epub 2020 Jan 6.

School of Public Health, Shandong University, Jinan 250012, China.

: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. : The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. : Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor's advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines' reimbursement policy significantly correlated with older adults' willingness for downward referral. : The proportion of older adults who self-initiated downward referral was less than one-third. Doctors' advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors' advice.
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http://dx.doi.org/10.3390/ijerph17010369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981471PMC
January 2020

Gender Difference in General Self-Efficacy among Young-Old Elderly Aged 60-74 in Rural Shandong China: A Cross-Sectional Survey.

Int J Environ Res Public Health 2019 12 12;16(24). Epub 2019 Dec 12.

School of Public Health, Shandong University, Jinan 250012, China.

Objective: This study aims to explore the determinants of general self-efficacy (GSE) among young-old elderly, with focus on examining the gender difference of general self-efficacy.

Methods: Data were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. T-test was used to examine the gender difference in GSE. Univariate models and adjusted multiple linear regression model were used to explore the determinants of GSE by gender.

Results: The females' GSE score was lower than that of male participants (26.1 ± 8.1 vs. 28.7 ± 7.7), and there was a significant gender difference (t = 10.877, < 0.001). Multiple linear regression model showed that some factors are common significant determinants of GSE such as age, education level, activity of daily living (ADL), self-rated health, mental health, personality, and whether participants have intimate friends and interpersonal relationships. Hypertension and frequent communication with children were specific determinants of GSE among male young-old. Personal income was a specific determinant of female participants.

Conclusion: Some influencing factors of GSE in both genders are identical, the others are different. More attention should be paid for the poor young-old females, young-old males with hypertension, and disabled young-old people.
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http://dx.doi.org/10.3390/ijerph16245070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950069PMC
December 2019

Gender difference in the association of frailty and health care utilization among Chinese older adults: results from a population-based study.

Aging Clin Exp Res 2020 Oct 19;32(10):1985-1991. Epub 2019 Nov 19.

School of Public Health, Shandong University, Jinan, 250012, China.

Background: Frailty is a public health concern in the ageing population. Little is known about the role of gender in the relationship between frailty and health care utilization in older adults.

Aims: The study aims to examine gender differences in the association between different frailty status and health care utilization among Chinese older people.

Methods: A total of 7070 older adults (60+) from Shandong Province, China, were enrolled in this study. Frailty was assessed by frailty index constructed using 45 health deficits. Multivariate logistic regression models were employed separately for men and women to examine the impact of frailty on self-care, outpatient, and inpatient utilization.

Results: Overall, the prevalence of frailty was 7.9% in older adults, with 7.1% and 8.3% in men and women, respectively. 49.4% respondents reported they had self-care in the previous 2 weeks, and women were more likely to have self-care than men. Being pre-frail and frail was significantly associated with utilization of all types of health care among older men and women, and the relationship was stronger in the frail groups than that in the pre-frail groups except for self-care. Respective odds ratios for outpatient utilization were higher in men than that in women.

Conclusions: Frailty is a frequent condition in Chinese older adults. The association between frailty and health care utilization (except outpatient) tended to be stronger in women than men. The gender differences should be considered when designing the preventing or delaying the installation of frailty and geriatric care plans.
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http://dx.doi.org/10.1007/s40520-019-01410-4DOI Listing
October 2020

Association between frailty and life satisfaction among older people in Shandong, China: the differences in age and general self-efficacy.

Psychogeriatrics 2020 Mar 3;20(2):172-179. Epub 2019 Nov 3.

Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.

Background: Frailty and other functional declines may be related to life satisfaction (LS) in the general elderly population. This study aims to investigate the association between frailty and LS among older individuals (age ≥60) and the impacts of age and general self-efficacy on the relationships.

Methods: Using data from the 2017 Survey of the Shandong elderly Family Health Service, a cross-sectional study was conducted and 7070 older people aged 60+ were analysed. LS was measured using the Satisfaction with Life Scale. A Frailty Index (ranged 0~1) was determined as a proportion of accumulated deficits over 51 categories. General self-efficacy was measured using the Chinese version of the General Self-Efficacy Scale. Multiple weighted linear regression was used to examine possible relationships between the research variables.

Results: There was a negative association between frailty and LS. A dose-response-type relationship between net income and LS was observed. The interaction between frailty and age was found to be significantly associated with LS. Frailty has a stronger negative impact on LS among the young-old (60-69 years) than among the middle-old (70-79 years) and old-old (80+ years), which suggests a protective effect of ageing on LS reduction due to frailty. However, this protective effect was observed among individuals with low and medium level self-efficacy.

Conclusions: The relationship between frailty and LS generally weaken with age. The higher level of general self-efficacy may provide a partial buffer against the negative impact of frailty on LS. Interventions that target to prevent and manage frailty should consider being prioritised among the young-old population. Development of self-efficacy could serve as an important strategy to buffer the negative effect of frailty on LS among older people.
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http://dx.doi.org/10.1111/psyg.12482DOI Listing
March 2020

The Prediction Model of Warfarin Individual Maintenance Dose for Patients Undergoing Heart Valve Replacement, Based on the Back Propagation Neural Network.

Clin Drug Investig 2020 Jan;40(1):41-53

Department of Research Laboratory for Human Reproduction, Faculty of Medicine and School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Background And Objective: Because of the narrow therapeutic window and huge inter-individual variation, the individual precision on anticoagulant therapy of warfarin is challenging. In our study, we aimed to construct a Back Propagation Neural Network (BPNN) model to predict the individual warfarin maintenance dose among Chinese patients who have undergone heart valve replacement, and validate its prediction accuracy.

Methods: In this study, we analyzed 13,639 eligible patients extracted from the Chinese Low Intensity Anticoagulant Therapy after Heart Valve Replacement database, which collected data on patients using warfarin after heart valve replacement from 15 centers all over China. Ten percent of patients who were finally enrolled in the database were used as the external validation, while the remaining were randomly divided into the training and internal validation groups at a ratio of 3:1. Input variables were selected by univariate analysis of the general linear model; 2.0, the mean value of the international normalized ratio (INR) range 1.5-2.5, was used as the mandatory variable. The BPNN model and the multiple linear regression (MLR) model were constructed by the training group and validated through comparisons of the mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), and ideal predicted percentage.

Results: Finally, 10 input variables were selected and a three-layer BPNN model was constructed. In the BPNN model, the value of MAE (0.688 mg/day and 0.740 mg/day in internal and external validation, respectively), MSE (0.580 mg/day and 0.599 mg/day in internal and external validation, respectively), and RMSE (0.761 mg/day and 0.774 mg/day in internal and external validation, respectively) were achieved. Ideal predicted percentages were high in both internal (63.0%) and external validation (59.7%), respectively. Compared with the MLR model, the BPNN model showed a higher ideal prediction percentage in the external validation group (59.7% vs. 56.6%), and showed the best prediction accuracy in the intermediate-dose subgroup (internal validation group: 85.2%; external validation group: 84.7%) and a high predicted percentage in the high-dose subgroup (internal validation group: 36.2%; external validation group: 39.8%), but poor performance in the low-dose subgroup (internal validation group: 0%; external validation group: 0.3%). Meanwhile, the BPNN model showed better ideal prediction percentage in the high-dose group than the MLR model (internal validation: 36.2% vs. 31.6%; external validation: 42.8% vs. 37.8%).

Conclusion: The BPNN model shows promise for predicting the warfarin maintenance dose after heart valve replacement.
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http://dx.doi.org/10.1007/s40261-019-00850-0DOI Listing
January 2020

An exploratory spatial analysis of overweight and obesity among children and adolescents in Shandong, China.

BMJ Open 2019 08 22;9(8):e028152. Epub 2019 Aug 22.

Department of Global Health Systems and Development School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.

Objective: Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters.

Design: Cross-sectional study.

Setting: Shandong Province in China.

Participants And Methods: Data on 6 216 076 children and adolescents aged 7-18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran's ) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation.

Results: The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or 'hot spots') of childhood OW/OB in the eastern coastal region, central region and southwestern region.

Conclusions: The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.
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http://dx.doi.org/10.1136/bmjopen-2018-028152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707763PMC
August 2019

Gender differences in the association between body mass index and health-related quality of life among adults:a cross-sectional study in Shandong, China.

BMC Public Health 2019 Jul 31;19(1):1021. Epub 2019 Jul 31.

School of Public Health, Shandong University, Jinan, 250012, China.

Background: This study aims to assess the association between body mass index (BMI) and health-related quality of life (HRQOL), and to further explore gender differences in BMI-HRQOL association among adults.

Methods: We used data from the fifth Health Service Survey of Shandong Province, which was part of China's National Health Service Survey (NHSS), a total of 27,257 adults aged 18 and over were interviewed. The HRQOL was measured using the EuroQOL-5 Dimensions (EQ-5D) instrument. One-way ANOVA and Post hoc tests were used to compare EQ-5D utility values and visual analogue scale (VAS) scores between BMI categories. Tobit regression models were used to identify the association between BMI and HRQOL for male and female separately after controlling for influential confounders, and to assess gender differences on the relationship between BMI and HRQOL.

Results: The prevalence of underweight in men and women were 3.2 and 5.3%, respectively, while the prevalence of overweight/obesity in men and women were 35.7 and 34.6%, respectively. Men had higher EQ-5D utility values and VAS scores than women. The mean EQ-5D utility value and VAS score was highest in obese men and normal-weight women, respectively. After controlling potential confounders, being underweight was significantly and negatively associated with lower HRQOL among adults. The relationship between obesity and gender was that in women obesity was negatively and significantly associated with HRQOL, whereas in men this association was positive but not statistically significant. Results of gender by BMI interaction in regression model showed that this difference between men and women in this respect was significant.

Conclusions: The association between BMI and HRQOL differed by gender and the so-called "obesity-HRQOL paradox" phenomenon was verified in male adults. Gender difference should be considered when implementing targeted weight control programs and appropriate interventions to improve HRQOL.
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http://dx.doi.org/10.1186/s12889-019-7351-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668122PMC
July 2019

Gender differences in the association between body mass index and health-related quality of life among adults:a cross-sectional study in Shandong, China.

BMC Public Health 2019 Jul 31;19(1):1021. Epub 2019 Jul 31.

School of Public Health, Shandong University, Jinan, 250012, China.

Background: This study aims to assess the association between body mass index (BMI) and health-related quality of life (HRQOL), and to further explore gender differences in BMI-HRQOL association among adults.

Methods: We used data from the fifth Health Service Survey of Shandong Province, which was part of China's National Health Service Survey (NHSS), a total of 27,257 adults aged 18 and over were interviewed. The HRQOL was measured using the EuroQOL-5 Dimensions (EQ-5D) instrument. One-way ANOVA and Post hoc tests were used to compare EQ-5D utility values and visual analogue scale (VAS) scores between BMI categories. Tobit regression models were used to identify the association between BMI and HRQOL for male and female separately after controlling for influential confounders, and to assess gender differences on the relationship between BMI and HRQOL.

Results: The prevalence of underweight in men and women were 3.2 and 5.3%, respectively, while the prevalence of overweight/obesity in men and women were 35.7 and 34.6%, respectively. Men had higher EQ-5D utility values and VAS scores than women. The mean EQ-5D utility value and VAS score was highest in obese men and normal-weight women, respectively. After controlling potential confounders, being underweight was significantly and negatively associated with lower HRQOL among adults. The relationship between obesity and gender was that in women obesity was negatively and significantly associated with HRQOL, whereas in men this association was positive but not statistically significant. Results of gender by BMI interaction in regression model showed that this difference between men and women in this respect was significant.

Conclusions: The association between BMI and HRQOL differed by gender and the so-called "obesity-HRQOL paradox" phenomenon was verified in male adults. Gender difference should be considered when implementing targeted weight control programs and appropriate interventions to improve HRQOL.
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http://dx.doi.org/10.1186/s12889-019-7351-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668122PMC
July 2019

The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province-A Cross-Sectional Study.

Int J Environ Res Public Health 2019 02 13;16(4). Epub 2019 Feb 13.

Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.

This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results.
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http://dx.doi.org/10.3390/ijerph16040526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406556PMC
February 2019

Rural-urban difference in blood pressure measurement frequency among elderly with hypertension: a cross-sectional study in Shandong, China.

J Health Popul Nutr 2018 11 22;37(1):25. Epub 2018 Nov 22.

School of Public Health, Shandong University, Jinan, 250012, China.

Background: Blood pressure measurement is the first step in preventing and controlling hypertension. The objective of this study is to examine the rural-urban difference towards blood pressure measurement among elderly with hypertension.

Methods: A total of 2007 elderly (65+) were selected from the fifth Health Service Survey of Shandong Province in 2013. A standardized questionnaire was used to investigate the demographic characters, socioeconomic status, self-rated health, and blood pressure related index. Three logistic regression models were used to examine the difference in blood pressure measurement between rural and urban elderly. Unadjusted and adjusted logistic regression models were used to explore the associated factors of blood pressure measurement in both rural areas and urban areas.

Results: The prevalence of weekly blood pressure measurement in urban elderly was higher than that in rural elderly (63.9% vs 34.3%). The rural elderly had an odds ratio (OR) for weekly blood pressure measurement of 0.467 (95%CI = 0.380-0.575) compared with urban elderly. Binary logistic regression analysis showed that medication frequency and accepting health care professionals' guidance were common associated factors of blood pressure measurement among both rural and urban elderly; personal income was unique associated factor of blood pressure measurement among rural elderly; marital status, education level, self-rated health, and blood pressure level currently were unique associated factors of blood pressure measurement among urban elderly.

Conclusions: There is a big difference in blood pressure measurement between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, should be made to reduce such a gap.
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http://dx.doi.org/10.1186/s41043-018-0155-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249846PMC
November 2018

Rural-urban difference in blood pressure measurement frequency among elderly with hypertension: a cross-sectional study in Shandong, China.

J Health Popul Nutr 2018 11 22;37(1):25. Epub 2018 Nov 22.

School of Public Health, Shandong University, Jinan, 250012, China.

Background: Blood pressure measurement is the first step in preventing and controlling hypertension. The objective of this study is to examine the rural-urban difference towards blood pressure measurement among elderly with hypertension.

Methods: A total of 2007 elderly (65+) were selected from the fifth Health Service Survey of Shandong Province in 2013. A standardized questionnaire was used to investigate the demographic characters, socioeconomic status, self-rated health, and blood pressure related index. Three logistic regression models were used to examine the difference in blood pressure measurement between rural and urban elderly. Unadjusted and adjusted logistic regression models were used to explore the associated factors of blood pressure measurement in both rural areas and urban areas.

Results: The prevalence of weekly blood pressure measurement in urban elderly was higher than that in rural elderly (63.9% vs 34.3%). The rural elderly had an odds ratio (OR) for weekly blood pressure measurement of 0.467 (95%CI = 0.380-0.575) compared with urban elderly. Binary logistic regression analysis showed that medication frequency and accepting health care professionals' guidance were common associated factors of blood pressure measurement among both rural and urban elderly; personal income was unique associated factor of blood pressure measurement among rural elderly; marital status, education level, self-rated health, and blood pressure level currently were unique associated factors of blood pressure measurement among urban elderly.

Conclusions: There is a big difference in blood pressure measurement between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, should be made to reduce such a gap.
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http://dx.doi.org/10.1186/s41043-018-0155-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249846PMC
November 2018

Loneliness and Health Service Utilization among the Rural Elderly in Shandong, China: A Cross-Sectional Study.

Int J Environ Res Public Health 2018 07 11;15(7). Epub 2018 Jul 11.

School of Public Health, Shandong University, Jinan 250012, China.

Objectives: To examine the prevalence of loneliness and to explore the association between loneliness and health service utilization among the rural elderly in Shandong Province, China.

Methods: A total of 5514 rural people aged 60 and above from Shandong Province, China, were enrolled in this study. Loneliness was used as a binary variable based on a single-item question. Health service utilization was measured by recent two-week physician visits and annual hospitalizations rates. Multiple logistic regression analysis was performed to examine the association between loneliness and health service utilization.

Results: The prevalence of loneliness among the rural elderly in Shandong, China, was 25.0%. Loneliness was associated with higher rates of recent two-week physician visits (OR = 1.260, < 0.01) and annual hospitalizations (OR = 1.183, < 0.05). The regression results also showed that self-rated health status and chronic conditions were significant and positively associated with both physician visits and hospitalizations rates.

Conclusions: Loneliness had a significant association with higher odds of health service utilization among the elderly. The independent contribution of loneliness on health service utilization was smaller than self-rated health status and chronic conditions. Thus, healthcare policies need to shift from an emphasis on controlling health utilization and cost to a greater focus on enabling lonely older people to get more social support.
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http://dx.doi.org/10.3390/ijerph15071468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068910PMC
July 2018

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study.

Int J Equity Health 2018 05 18;17(1):61. Epub 2018 May 18.

Key Lab of Health Technology Assessment, National Health Commission of the Peoples Republic of China, School of Public Health, Fudan University, Shanghai, China.

Background: Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China's healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services.

Methods: Data from China's National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile's percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles.

Results: In urban populations, the CI value of GHS for primary care was negative. (- 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = - 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (- 0.4991,-0.1851 and - 0.1651; - 0.482, - 0.247and - 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich.

Conclusions: The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.
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http://dx.doi.org/10.1186/s12939-018-0775-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960158PMC
May 2018

Association of Anthropometric Indices of Obesity with Hypertension in Chinese Elderly: An Analysis of Age and Gender Differences.

Int J Environ Res Public Health 2018 04 19;15(4). Epub 2018 Apr 19.

School of Public Health, Shandong University, Jinan 250012, China.

This study aims to explore the association of anthropometric indices of obesity with hypertension in Chinese elderly and its possible gender and age differences. A total of 7070 adults age 60 or older were interviewed in a cross-sectional study conducted in 2017. Anthropometric indices for each participant were measured by using standard methods of trained doctoral/master students. We performed two binary logistic regression models to examine the association of the nine different anthropometric indices and hypertension by gender. Lastly, analyses were performed in two steps stratified for age. Comparing individuals with and without hypertension, there were statistically significant differences in anthropometric indices except height, a body shape index (ABSI), and hip index (HI) in males; and except height in females. There were gender differences in the relationship between anthropometric indices and the prevalence of hypertension in Chinese older adults. After stratification by age, the associations of all anthropometric indices became weaker, disappeared, or even went in the opposite direction. Furthermore, body mass index (BMI) in men (except individuals older than 80) and hip circumference (HC) in women showed a significant impact on the risk of hypertension. The association of anthropometric indices of obesity with hypertension in Chinese elderly differ by gender and age. These findings indicate a need to develop gender-specific strategies for the male and female elderly in the primary and secondary prevention of hypertension.
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http://dx.doi.org/10.3390/ijerph15040801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923843PMC
April 2018

A prediction study of warfarin individual stable dose after mechanical heart valve replacement: adaptive neural-fuzzy inference system prediction.

BMC Surg 2018 Feb 15;18(1):10. Epub 2018 Feb 15.

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.

Background: It's difficult but urgent to achieve the individualized rational medication of the warfarin, we aim to predict the individualized warfarin stable dose though the artificial intelligent Adaptive neural-fuzzy inference system (ANFIS).

Methods: Our retrospective analysis based on a clinical database, involving 21,863 patients from 15 Chinese provinces who receive oral warfarin after the heart valve replacement. They were allocated into four groups: the external validation group (A group), the internal validation group (B group), training group (C group) and stratified training group (D group). We used a univariate analysis of general linear models(GLM-univariate) to select the input variables and construct two prediction models by the ANFIS with the training and stratified training group, and then verify models with two validation groups by the mean squared error(MSE), mean absolute error(MAE) and the ideal predicted percentage.

Results: A total of 13,639 eligible patients were selected, including 1639 in A group, 3000 in B group, 9000 in C group, and 3192 in D group. Nine input variables were selected out and two five-layered ANFIS models were built. ANFIS model achieved the highest total ideal predicted percentage 63.7%. In the dose subgroups, all the models performed best in the intermediate-dose group with the ideal predicted percentage 82.4~ 86.4%, and the use of the stratified training group slightly increased the prediction accuracy in low-dose group by 8.8 and 5.2%, respectively.

Conclusion: As a preliminary attempt, ANFIS model predicted the warfarin stable dose properly after heart valve surgery among Chinese, and also proved that Chinese need lower anticoagulation intensity INR (1.5-2.5) to warfarin by reference to the recommended INR (2.5-3.5) in the developed countries.
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http://dx.doi.org/10.1186/s12893-018-0343-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815201PMC
February 2018

Diagnostic accuracy of pleural fluid tumor necrosis factor-α in tuberculous pleurisy: A meta-analysis.

J Res Med Sci 2015 Jul;20(7):701-6

West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China ; Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Background: Pleurisy is a common extra pulmonary complication of tuberculosis, but current methods for diagnosing it are fairly crude. Here we product a meta-analysis for the available evidence on the ability of tumor necrosis factor-α (TNF-α) in pleural fluid to serve as a diagnostic marker of tuberculous pleurisy (TP).

Materials And Methods: We searched the PubMed, EMBASE, and Google Scholar databases systematically for studies measuring sensitivity, specificity and other measures of diagnostic accuracy of pleural fluid TNF-α in the diagnosis of TP were meta-analyzed by Stata, version 12 and meta-disc.

Results: A total of six publications reporting seven case-control studies were identified. Pooled results indicated that pleural fluid TNF-α showed a diagnostic sensitivity of 0.89 (95% confidence interval [95% CI] 0.83-0.93; range, 0.42-1.0) and a diagnostic specificity of 0.82 (95% CI: 0.78-0.86; range, 0.58-0.98). The pooled positive likelihood ratio was 4.78 (95% CI: 3.32-6.89); the negative likelihood ratio, 0.16 (95% CI: 0.1-0.27); the diagnostic odds ratio, 32.43 (95% CI: 14.48-72.6); and the area under the curve was 0.8556 (standard error of mean 0.0559).

Conclusion: Pleural fluid TNF-α levels shows relatively high sensitivity but insufficient specificity for diagnosing TP. Pleural fluid TNF-α measurement may be useful in combination with clinical manifestations and conventional tests such as microbiological examination or pleural biopsy.
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http://dx.doi.org/10.4103/1735-1995.166230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638075PMC
July 2015

Accuracy of bronchoalveolar lavage enzyme-linked immunospot assay to diagnose smear-negative tuberculosis: a meta-analysis.

Int J Clin Exp Med 2015 15;8(8):12637-43. Epub 2015 Aug 15.

Respiratory and Critical Care Medicine, West China Hospital of Sichuan University Chengdu, Sichuan, China.

Purpose: While the bronchoalveolar lavage enzyme-linked immunospot assay (BAL-ELISPOT) shows promise for diagnosing smear-negative tuberculosis, its accuracy remains controversial. We meta-analyzed the available evidence to obtain a clearer understanding of the diagnostic accuracy.

Methods: Studies of the diagnostic performance of ELI-SPOT on smear-negative tuberculosis were identified through systematic searches of the PubMed and EMBASE databases. Pooled data on sensitivity, specificity and other measures of accuracy were meta-analyzed using a random-effects model. Summary receiver operating characteristic curves were used to assess overall test performance.

Results: A total of 7 studies were included in the meta-analysis. Diagnostic performance was as follows: sensitivity, 0.89 (95% CI 0.84 to 0.93); specificity, 0.78 (95% CI 0.74 to 0.81); positive likelihood ratio, 4.2 (95% CI 2.42 to 7.28); negative likelihood ratio, 0.14 (95% CI 0.06 to 0.33); diagnostic odds ratio, 36.16 (95% CI 9.70 to 134.73); and area under the curve, 0.9605 (SEM 0.0247).

Conclusions: Available evidence suggests that BAL-ELISPOT may perform better than blood-ELISPOT for both screening and confirming a diagnosis of smear-negative tuberculosis. Nevertheless, BAL-ELISPOT should be not used alone but rather in parallel with clinical manifestations and conventional tests to ensure reliable diagnosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612861PMC
November 2015

Diagnostic accuracy of exhaled nitric oxide in asthma: a meta-analysis of 4,691 participants.

Int J Clin Exp Med 2015 15;8(6):8516-24. Epub 2015 Jun 15.

Health Management Center, West China Hospital, Sichuan University Chengdu, Sichuan, China.

Asthma is a common airway inflammation, but current methods for diagnosing it are poor. Here we meta-analyze the available evidence on the ability of exhaled nitric oxide (eNO) in asthma to serve as a diagnostic marker of asthma. We systematically searched the PubMed and EMBASE databases, published data on sensitivity, specificity and other measures of diagnostic accuracy of eNO in the diagnosis of asthma were meta-analyzed. The methodological quality of each study was assessed by QUADAS-2 (quality assessment for studies of diagnostic accuracy). Statistical analysis was performed by employing Meta-Disc 1.4 software and STATA. And the measures of accuracy of eNO in the diagnosis of asthma were pooled using random-effects models. A total of nineteen publications reporting twenty-one case-control studies were identified. Pooled results indicated that eNO showed a diagnostic sensitivity of 0.78 (95% CI 0.76 to 0.80), specificity was 0.74 (95% CI 0.72 to 0.76). PLR was 3.70 (95% CI 2.84 to 4.81) and NLR was 0.35 (95% CI 0.26 to 0.47). DOR was 11.37 (95% CI 7.54 to 17.13). Exhaled nitric oxide show insufficient sensitivity and specificity for diagnosing asthma, eNO measurements may be useful in combination with clinical manifestations and conventional tests such as pulmonary function tests, assessment of bronchodilator response and bronchial challenge tests.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538098PMC
August 2015

Use of artificial neural network to predict warfarin individualized dosage regime in Chinese patients receiving low-intensity anticoagulation after heart valve replacement.

Int J Cardiol 2014 Oct 17;176(3):1462-4. Epub 2014 Aug 17.

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, China. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2014.08.062DOI Listing
October 2014