Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Met...Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.展开更多
Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengtheni...Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengthening exercise(MSE:push-ups/sit-ups,using weight machines)has more favorable associations with optimal weight status.However,few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.Methods:Based on cross-sectional analyses of the European Health Interview Survey Wave 2(2013-2014),we examined prevalence ratios(PRs)of joint and stratified associations between MVPA(4 categories:(ⅰ)0 min/week,(ⅱ)1-149 min/week,(ⅲ)150-299 min/week,and(ⅳ)≥300 min/week)and MSE(3 categories:(ⅰ)0 day/week,(ⅱ)1 day/week,and(ⅲ)>2 days/week)with body mass index-defined obesity(body mass index of>30.0 kg/m2)using Poisson regression with robust error variance.PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics(e.g.,sex,age,education,income,and smoking status).Results:Data were available for 280,456 adults(≥18 years),of which 46,166(15.5%)were obese.The interaction MVPA x MSE guideline adherence was statistically significant for obesity(p≤0.05).The joint MVPA-MSE analysis showed that compared to the reference group(i.e.,no MVPA and no MSE),the PRs followed a dose-dependent pattern,with the lowest observed among those reporting≥150 MVPA min/week and≥1 MSE days/week(PR:0.43;95%confidence interval:0.41-0.46).When stratified across each MVPA strata,the PRs were mostly lower among those engaging in MSE 1 day/week,as compared to those doing MSE≥2 days/week.Conclusion:"There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity.Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.展开更多
Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association betwe...Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.展开更多
Objective: To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China.Setting: Seven cities/counties, representing three econom...Objective: To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China.Setting: Seven cities/counties, representing three economical-geographical regions(Eastern, Central and Western) in China, were selected as screening centers: three in high-risk areas and four in non-high-risk areas.Participants: Villages/communities in these seven centers regarded as clusters were randomly assigned to either intervention group(screening by endoscopic examination) or control group(with normal community care) in a 1:1ratio stratified by each center. Eligible participants are local residents aged 40–69 years in the selected villages/communities with no history of cancer or endoscopic examination in the latest 3 years who are mentally and physically competent. Those who are not willing to take endoscopic examination or are unwilling to sign the consent form are excluded from the study. Totally 140,000 participants will be enrolled.Interventions: In high-risk areas of upper gastrointestinal cancer, all subjects in screening group will be screened by endoscopy. In non-high-risk areas, 30% of the subjects in screening group, identified through a survey,will be screened by endoscopy.Primary and secondary outcome measures: The primary outcome is the mortality caused by upper gastrointestinal cancer. The secondary outcomes include detection rate, incidence rate, survival rate, and clinical stage distribution. Additional data on quality of life and cost-effectiveness will also be collected to answer important questions regarding screening effects.Conclusions: Screening strategy evaluated in those areas with positive findings may be promoted nationally and applied to the majority of Chinese people. On the other hand, negative findings will provide scientific evidence for abandoning a test and shifting resources elsewhere.Trial registration: The study has been registered with the Protocol Registration System in Chinese Clinical Trial Registry.展开更多
1.Introduction China has been transforming.Since the late 1970s,China’s economy has increased many fold,the proportion of Chinese living in urban areas has more than doubled,life expectancy has increased by 10 years^...1.Introduction China has been transforming.Since the late 1970s,China’s economy has increased many fold,the proportion of Chinese living in urban areas has more than doubled,life expectancy has increased by 10 years^1 and the country has transitioned from the'bicycle kingdom'to the world’s largest'auto market'.~2 As a result,China is now challenged by the'side effects'of eco-展开更多
The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific e...The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.展开更多
AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We c...AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13 C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test). The detection of bacterial 23 S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive(PPV) and negative(NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio(LR), together with 95% confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninetyfive(32.3%) participants had a positive ^(13)C-urea breath test. Twenty-three(7.8%) participants underwent upper endoscopy with histology, with a full concordance between ^(13)C-urea breath test and histology in detecting H. pylori infection. Four(1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2%(CI: 84.2%-96.3%), specificity 98.5%(CI:96.8%-100%), PPV 96.5%(CI: 92.6%-100%), NPV 95.6%(CI: 92.8%-98.4%), accuracy 95.9%(CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10(CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34(41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27(32.5%) had bacterial strains resistant to clarithromycin, 3(3.6%) to levofloxacin, and 4(4.8%) to both antibiotics. CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.展开更多
Background:Home advantage(HA) is well documented in a wide range of team sports including association football(soccer).Although much attention has been paid to differences in the overall magnitude of HA between footba...Background:Home advantage(HA) is well documented in a wide range of team sports including association football(soccer).Although much attention has been paid to differences in the overall magnitude of HA between football competitions and across time,few studies have investigated HA at the team level.Methods:A novel method of estimating HA for individual teams,based solely on home performance,was used to compare HA between the highest performing teams and countries in the Union of European Football Associations(UEFA) Champions League over a 10-year period(2003/2004 to 2012/2013).Away disadvantage(AD) was also estimated based on each team's performance away from home.Poisson regression analysis was used to estimate covariate adjusted HA and AD in terms of the percentage of goals scored at home(HA) and conceded away from home(AD).Results:When controlling for differences in team ability,HA did not vary significantly between the 13 selected teams.There was evidence(p < 0.1),however,of between-team variation in AD,ranging from 45%(away advantage) to 68%(away disadvantage).When teams were grouped into the 11 selected countries,both HA and AD varied significantly(p < 0.02) between countries:HA ranged from 52% for Turkish teams to 70%for English teams,while AD ranged from 52%(France) to 67%(Turkey).Conclusion:Differences in style of play and tactical approaches to home and away matches may explain some of the variation in HA and AD between teams from different countries.展开更多
Objective:We assessed the trends in lung cancer incidence over a 25-year period by socioeconomic groups for men in New South Wales(NSW),Australia.Methods:Men diagnosed with lung cancer between 1987 and 2011 were divid...Objective:We assessed the trends in lung cancer incidence over a 25-year period by socioeconomic groups for men in New South Wales(NSW),Australia.Methods:Men diagnosed with lung cancer between 1987 and 2011 were divided into five quintiles according to an Index of Education and Occupation(IEO).We assessed relative socioeconomic differences over time by calculating age-standardized incidence ratios(SIRs)by 5-year period of diagnosis,and estimated absolute differences by comparing the observed and expected numbers of cases using the highest IEO quintile as the reference.Results:Lung cancer incidence for men decreased from 1987 to 2011 for all IEO quintiles,with a greater rate of decline for men living in the highest IEO areas.Thus,the relative disparity increased significantly over the 25-year period(P=0.0006).For example,the SIR for the lowest IEO quintile increased from 1.28 during 1987–1991 to 1.74during 2007–2011.Absolute differences also increased with the proportion of"potentially preventable"cases doubling from 14.5% in 1987–1991 to 30.2% in 2007–2011.Conclusions:Despite the overall decline in lung cancer incidence among men in NSW over the past 25 years,there was a significant increase in disparity across socioeconomic areas in both relative and absolute terms.展开更多
过度诊断对不同的人而言意义不一样。S M Carter及其同事们认为,我们应该使用一个宽泛的术语,如倡导使用过度医疗,并根据研究和临床目的,逐步制定精确的过度诊断定义。支撑卫生保健的隐性社会契约能减少疾病和可预防性的死亡,并改善生...过度诊断对不同的人而言意义不一样。S M Carter及其同事们认为,我们应该使用一个宽泛的术语,如倡导使用过度医疗,并根据研究和临床目的,逐步制定精确的过度诊断定义。支撑卫生保健的隐性社会契约能减少疾病和可预防性的死亡,并改善生活质量。但有时这些承诺并未实现。展开更多
文摘Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.
文摘Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengthening exercise(MSE:push-ups/sit-ups,using weight machines)has more favorable associations with optimal weight status.However,few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.Methods:Based on cross-sectional analyses of the European Health Interview Survey Wave 2(2013-2014),we examined prevalence ratios(PRs)of joint and stratified associations between MVPA(4 categories:(ⅰ)0 min/week,(ⅱ)1-149 min/week,(ⅲ)150-299 min/week,and(ⅳ)≥300 min/week)and MSE(3 categories:(ⅰ)0 day/week,(ⅱ)1 day/week,and(ⅲ)>2 days/week)with body mass index-defined obesity(body mass index of>30.0 kg/m2)using Poisson regression with robust error variance.PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics(e.g.,sex,age,education,income,and smoking status).Results:Data were available for 280,456 adults(≥18 years),of which 46,166(15.5%)were obese.The interaction MVPA x MSE guideline adherence was statistically significant for obesity(p≤0.05).The joint MVPA-MSE analysis showed that compared to the reference group(i.e.,no MVPA and no MSE),the PRs followed a dose-dependent pattern,with the lowest observed among those reporting≥150 MVPA min/week and≥1 MSE days/week(PR:0.43;95%confidence interval:0.41-0.46).When stratified across each MVPA strata,the PRs were mostly lower among those engaging in MSE 1 day/week,as compared to those doing MSE≥2 days/week.Conclusion:"There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity.Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.
基金supported by the National Key Research and Development Program of China(grant number 2020YFC2006300)the Young Scientists Fund of the National Natural Science Foundation of China(grant number 82103835)。
文摘Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.
基金supported by the Special Fund for Health Research in the Public Interest(No.201502001)
文摘Objective: To evaluate the efficacy and feasibility of screening procedure for upper gastrointestinal cancer in both high-risk and non-high-risk areas in China.Setting: Seven cities/counties, representing three economical-geographical regions(Eastern, Central and Western) in China, were selected as screening centers: three in high-risk areas and four in non-high-risk areas.Participants: Villages/communities in these seven centers regarded as clusters were randomly assigned to either intervention group(screening by endoscopic examination) or control group(with normal community care) in a 1:1ratio stratified by each center. Eligible participants are local residents aged 40–69 years in the selected villages/communities with no history of cancer or endoscopic examination in the latest 3 years who are mentally and physically competent. Those who are not willing to take endoscopic examination or are unwilling to sign the consent form are excluded from the study. Totally 140,000 participants will be enrolled.Interventions: In high-risk areas of upper gastrointestinal cancer, all subjects in screening group will be screened by endoscopy. In non-high-risk areas, 30% of the subjects in screening group, identified through a survey,will be screened by endoscopy.Primary and secondary outcome measures: The primary outcome is the mortality caused by upper gastrointestinal cancer. The secondary outcomes include detection rate, incidence rate, survival rate, and clinical stage distribution. Additional data on quality of life and cost-effectiveness will also be collected to answer important questions regarding screening effects.Conclusions: Screening strategy evaluated in those areas with positive findings may be promoted nationally and applied to the majority of Chinese people. On the other hand, negative findings will provide scientific evidence for abandoning a test and shifting resources elsewhere.Trial registration: The study has been registered with the Protocol Registration System in Chinese Clinical Trial Registry.
基金funded by an Australian National Health and Medical Research Council Early Career Fellowship (#1072223)
文摘1.Introduction China has been transforming.Since the late 1970s,China’s economy has increased many fold,the proportion of Chinese living in urban areas has more than doubled,life expectancy has increased by 10 years^1 and the country has transitioned from the'bicycle kingdom'to the world’s largest'auto market'.~2 As a result,China is now challenged by the'side effects'of eco-
文摘The risk of breast cancer(BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards(a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis;(b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and(c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.
文摘AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H. pylori), using ^(13)Curea breath test as the reference standard, and explore bacterial antibiotic resistance. METHODS We conducted a prospective two-center diagnostic test accuracy study. We enrolled consecutive people≥ 18 years without previous diagnosis of H. pylori infection, referred for dyspepsia between February and October 2017. At enrollment, all participants underwent 13 C-urea breath test. Participants aged over 50 years were scheduled to undergo upper endoscopy with histology. Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test). The detection of bacterial 23 S rRNA subunit gene indicated H. pylori infection. We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin. Independent investigators analyzed index test and reference test standard results blinded to the other test findings. We estimated sensitivity, specificity, positive(PPV) and negative(NPV) predictive value, diagnostic accuracy, positive and negative likelihood ratio(LR), together with 95% confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age: Median 37.0 years, IQR: 29.0-46.0 years; men: 39.8%). Ninetyfive(32.3%) participants had a positive ^(13)C-urea breath test. Twenty-three(7.8%) participants underwent upper endoscopy with histology, with a full concordance between ^(13)C-urea breath test and histology in detecting H. pylori infection. Four(1.4%) out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing. In the 290 participants who completed the study, the THD fecal test sensitivity was 90.2%(CI: 84.2%-96.3%), specificity 98.5%(CI:96.8%-100%), PPV 96.5%(CI: 92.6%-100%), NPV 95.6%(CI: 92.8%-98.4%), accuracy 95.9%(CI: 93.6%-98.2%), positive LR 59.5(CI: 19.3-183.4), negative LR 0.10(CI: 0.05-0.18). Out of 83 infected participants identified with the THD fecal test, 34(41.0%) had bacterial genotypic changes consistent with antibiotic-resistant H. pylori infection. Of these, 27(32.5%) had bacterial strains resistant to clarithromycin, 3(3.6%) to levofloxacin, and 4(4.8%) to both antibiotics. CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H. pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.
文摘Background:Home advantage(HA) is well documented in a wide range of team sports including association football(soccer).Although much attention has been paid to differences in the overall magnitude of HA between football competitions and across time,few studies have investigated HA at the team level.Methods:A novel method of estimating HA for individual teams,based solely on home performance,was used to compare HA between the highest performing teams and countries in the Union of European Football Associations(UEFA) Champions League over a 10-year period(2003/2004 to 2012/2013).Away disadvantage(AD) was also estimated based on each team's performance away from home.Poisson regression analysis was used to estimate covariate adjusted HA and AD in terms of the percentage of goals scored at home(HA) and conceded away from home(AD).Results:When controlling for differences in team ability,HA did not vary significantly between the 13 selected teams.There was evidence(p < 0.1),however,of between-team variation in AD,ranging from 45%(away advantage) to 68%(away disadvantage).When teams were grouped into the 11 selected countries,both HA and AD varied significantly(p < 0.02) between countries:HA ranged from 52% for Turkish teams to 70%for English teams,while AD ranged from 52%(France) to 67%(Turkey).Conclusion:Differences in style of play and tactical approaches to home and away matches may explain some of the variation in HA and AD between teams from different countries.
文摘Objective:We assessed the trends in lung cancer incidence over a 25-year period by socioeconomic groups for men in New South Wales(NSW),Australia.Methods:Men diagnosed with lung cancer between 1987 and 2011 were divided into five quintiles according to an Index of Education and Occupation(IEO).We assessed relative socioeconomic differences over time by calculating age-standardized incidence ratios(SIRs)by 5-year period of diagnosis,and estimated absolute differences by comparing the observed and expected numbers of cases using the highest IEO quintile as the reference.Results:Lung cancer incidence for men decreased from 1987 to 2011 for all IEO quintiles,with a greater rate of decline for men living in the highest IEO areas.Thus,the relative disparity increased significantly over the 25-year period(P=0.0006).For example,the SIR for the lowest IEO quintile increased from 1.28 during 1987–1991 to 1.74during 2007–2011.Absolute differences also increased with the proportion of"potentially preventable"cases doubling from 14.5% in 1987–1991 to 30.2% in 2007–2011.Conclusions:Despite the overall decline in lung cancer incidence among men in NSW over the past 25 years,there was a significant increase in disparity across socioeconomic areas in both relative and absolute terms.
