To the Editor : In China, depression is a common mental illness with a lifetime prevalence of 6.8% and a 12-month prevalence of 3.6%.

The occurrence of gastroesophageal reflux disease (GERD) and symptom onset are closely associated with diet. We aimed to compare the dietary and lifestyle triggers between non-erosive reflux disease (NERD) and reflux esophagitis (RE) in Chinese patients and to provide evidence for development of practical dietary modifications for GERD. A multicenter cross-sectional survey was conducted. A total of 396 GERD patients with typical gastroesophageal reflux symptoms who received upper endoscopy in the previous month were enrolled, including 203 cases of NERD patients and 193 cases of RE patients. All participants completed questionnaires including demographic data, reflux symptoms, previous management, dietary and lifestyle habits, triggers of reflux symptoms, psychological status, and quality of life. There were no significant differences in GERD symptom scores between NERD and RE. RE patients had a higher male proportion and smoking/drinking and overeating rates than NERD patients. In the NERD group, more patients reported that fruits, dairy products, yogurt, bean products, cold food, and carbonated beverages sometimes and often induced reflux symptoms and had more triggers compared to RE patients. The number of triggers was positively correlated to GERD symptom score and GERD-HRQL score in both NERD and RE patients. However, 74.0% of GERD patients still often consumed the triggering foods, even those foods that sometimes and often induced their reflux symptoms, which might be related to the reflux relapse after PPI withdrawal considering NERD and RE patients had similar GERD symptom severity. There were some differences in terms of dietary habits, dietary and lifestyle triggers, and related quality of life between NERD and RE, and these results may provide evidence of different approaches toward the dietary modification of NERD and RE patients.

BACKGROUND:The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome (IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort (seen in Rome III but not Rome IV) are different from those with abdominal pain (Rome IV).AIM:To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain & discomfort.METHODS:We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS patients.RESULTS:Of the 367 Rome III IBS patients enrolled, 33.8% (124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group (n = 233) and the discomfort group (n = 83) for the following: (1) Frequency of defecatory abdominal pain or discomfort; (2) Bowel habits; (3) Coexisting extragastrointestinal pain; (4) Comorbid anxiety and depression; and (5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group (22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort (all P < 0.001).CONCLUSION:IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting experience.

The purpose of this cross-sectional study is to use a representative sample of the Chinese population and the atherosclerotic cardiovascular disease (ASCVD) risk assessment tool developed specifically for the Chinese to explore the prevalence of hyperuricemia (HUA) and the relationship between hyperuricemia and 10-year ASCVD risk in Chinese adults. Data was collected from the Chinese Physiological Constant and Health Condition survey. In this study, 12,988 subjects aged between 35 and 74 were selected by two-stage, cluster and random sampling. The sex-specific 10-year ASCVD risk scores equations, which were conducted by China-PAR project and specifically designed for Chinese adults, were used to assess the risk of developing ASCVD 10 years later. The ordinal regression model was used to explore the relationship between hyperuricemia and ASCVD risk. The total prevalence of hyperuricemia was 12.69%, and males’ prevalence was significantly higher than females (17.7% vs. 8.5%). Compared with people without hyperuricemia, the 10-year ASCVD risk scores of female with hyperuricemia increased significantly, but no significant increased happened in male. The ordinal regression model indicated that hyperuricemia subjects were 1.3 (males, 95% CI: 1.11–1.52) and 4.34 (females, 95% CI: 3.16–5.91) times more likely to increase their ASCVD risk levels than those without hyperuricemia. In conclusion, Hyperuricemia is prevalent among Chinese adults. In both genders, hyperuricemia was related with higher risk of 10-year ASCVD, and the relationship is much stronger in females than in males. Thus, sex-specific serum uric acid management and intervention strategies should be done in the prevention and control of cardiovascular events.

目的 探讨单纯体重指数(BMI)、体脂百分比(FMP)分类肥胖及二者交叉分组与心血管代谢危险因素的关联,为儿童肥胖及相关代谢异常的防控提供依据.方法 基于在6省(黑龙江、内蒙古、宁夏、四川、云南和湖南)完成的横断面调查,选取10～18岁的学龄儿童11 542人为研究对象.分别以[BMI(+-)]和[FMP(+-)]单独或交叉分类肥胖状况分组,采用Logistic回归模型分析比较心血管代谢危险因素异常的风险.结果 不调整腰围(WC)的影响,[BMI(-)+FMP(+)]组低高密度脂蛋白胆固醇(HDL-C)和血糖升高风险较低,其余各组与肥胖相关代谢异常的关联较高.调整WC后,男生中[BMI(+)+FMP(+)]组高三酰甘油(TG)[OR(95％CI):2.55(1.29～5.02)]、合并血脂异常[OR(95％CI):2.07(1.19～3.61)]和血压升高[OR(95％CI):2.20(1.29～3.77)]的风险较高.女生中[BMI(+)+FMP(+)]组合并血脂异常[OR(95％CI):2.02(1.09～3.74)]的风险较高.结论 结合FMP对儿童肥胖评价可提高对血脂异常和血压升高的筛查效果.

OBJECTIVE:This study aims to investigate the association of metabolic phenotypes that are jointly determined by body mass index (BMI) or fat mass percentage and metabolic health status with the ten-year risk of cardiovascular disease (CVD) among Chinese adults.METHODS:Data were obtained from a cross-sectional study. BMI and body fat mass percentage (FMP) combined with the metabolic status were used to define metabolic phenotypes. Multiple linear regression and logistic regression were used to examine the effects of metabolic phenotypes on CVD risk.RESULTS:A total of 13,239 adults aged 34-75 years were included in this study. Compared with the metabolically healthy non-obese (MHNO) phenotype, the metabolically unhealthy non-obese (MUNO) and metabolically unhealthy obese (MUO) phenotypes defined by BMI showed a higher CVD risk [odds ratio, OR (95% confidence interval, CI): 2.34 (1.89-2.89), 3.45 (2.50-4.75), respectively], after adjusting for the covariates. The MUNO and MUO phenotypes defined by FMP showed a higher CVD risk [ OR (95% CI): 2.31 (1.85-2.88), 2.63 (1.98-3.48), respectively] than the MHNO phenotype. The metabolically healthy obese phenotype, regardless of being defined by BMI or FMP, showed no CVD risk compared with the MHNO phenotype.CONCLUSION:General obesity without central obesity does not increase CVD risk in metabolically healthy individuals. FMP might be a more meaningful factor for the evaluation of the association of obesity with CVD risk. Obesity and metabolic status have a synergistic effect on CVD risk.

Abstract BackgroundMost epidemiological surveys paid more attention to the occurrence of depression in the elderly and adolescents, while ignored the young and middle-aged people. Besides, depression resulted from a complex interaction of heredity, biochemistry, social, psychological and biological factors. The aim of our study was to examine the prevalence of depression and the relationship between depression and lifestyle factors in Chinese adults based on a large-scale cross-sectional survey. MethodsThe Composite International Diagnostic Interview Short Form for Major Depression was used to assess the depression status of all subjects. We used multi-level generalized estimating equation model to determine the relationship between depression and lifestyles. ResultsOf the 7985 respondents, 4252 were considered as being depressive with a prevalence of 53.25%. After controlling for the cluster effect of living environment and confounding effect of demographic characteristics, the following factors increased the risk of depression: overweight(OR=1.269, 95% CI: 1.117-1.444), obesity(OR=1.415, 95%CI: 1.152-1.740), single status(OR=2.003, 95% CI: 1.635-2.457), alcohol drinking(OR=1.333, 95%CI: 1.137-1.563), sleeping less than 6h a day(OR=1.485, 95% CI: 1.267-1.743), poor sleep quality (OR=1.553, 95% CI: 1.392-1.732), feeling stressed(OR=2.133, 95% CI: 1.744-2.621), adverse life events(OR=1.513, 95% CI: 1.333-1.718),unhealthy dietary patterns(OR=1.472, 95% CI: 1.324-1.638), irregular meal times (OR=2.482, 95% CI: 2.138-2.887) and suboptimal health status(OR=7.919, 95% CI: 6.843-9.185). Those with medical insurance (OR=0.774, 95% CI: 0.649-0.921) was less likely to have depression.ConclusionsUnhealthy lifestyles were found closely associated with depression. By altering lifestyle behaviors for the better, the depressive symptoms could be effectively improved.

Chinese children are facing health challenges brought by chronic non-communicable diseases, such as physical problems and psychological related health problems. Childhood represents a critical life period when the long-term dietary and lifestyle behaviors are formed. It is necessary to survey the prevalence of suboptimal health status (SHS) among Chinese children and to research the relationship between SHS and lifestyles. This study aimed to examine the prevalence of SHS among Chinese children using a large-scale population survey sample covering school students and nonstudent children, and clarified the relationships between SHS and lifestyle factors using multi-level models controlled for the cluster effect of location and the confounding effect of demographics. Multi-level generalized estimating equation models were used to examine the relationships between SHS and lifestyle factors. Prevalence ratios (PR) and 95% confidence intervals (CI) were used to assess the strength of these relationships. Of the 29,560 children, 14,393 reported one or more SHS symptoms, giving a SHS prevalence of 48.69%. The prevalence of SHS for boys (46.07%) was lower than that for girls (51.05%). After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, lifestyle factors associated with SHS were: less sleep duration, current smokers (PR = 1.085, 95%CI: 1.027-1.147), current drinkers (PR = 1.072, 95%CI: 1.016-1.131), children' parents suffering from chronic diseases (PR = 1.294, 95%CI: 1.179-1.421), poor sleep quality (PR = 1.470, 95%CI: 1.394-1.550), stress (PR = 1.545, 95%CI: 1.398-1.707), negative life events (PR = 1.237, 95%CI: 1.088-1.406), hypertension (PR = 1.046, 95%CI: 1.009-1.084), unhealthy diet choice (PR = 1.091, 95%CI: 1.051-1.133) and irregular meal time (PR = 1.210, 95%CI: 1.163-1.259). Children who could exercise regularly (PR = 0.897, 95%CI: 0.868-0.927) and those with regular medical checkup (PR = 0.891, 95%CI: 0.854-0.929) were associated with lower prevalence probability of SHS. SHS has become a serious public health challenge for Chinese children. Unhealthy lifestyles were closely associated with SHS. Implementation of preventative strategies are needed to reduce the potential SHS burden associated with these widespread high-risk unhealthy lifestyle behaviors.

This study examined the prevalence of suboptimal health among Chinese adults based on a large-scale national survey and clarified the relationship between suboptimal health and lifestyle factors. We used multi-level generalized estimating equation models to examine the relationships between suboptimal health and lifestyle factors. Of the 48,978 respondents, 34,021 reported one or more suboptimal health symptoms, giving a suboptimal health status prevalence of 69.46%. After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, factors associated with suboptimal health were: current smoking (odds ratio (OR) = 1.083, 95% confidence interval (CI): 1.055–1.111), drinking alcohol (OR = 1.075, 95% CI: 1.025–1.127), family history of disease (OR = 1.203, 95% CI: 1.055–1.111), sleeping <6 h per day (OR = 1.235, 95% CI: 1.152–1.256), poor sleep quality (OR = 1.594, 95% CI: 1.515–1.676), stress (OR = 1.588, 95% CI: 1.496–1.686), negative life events (OR = 1.114, 95% CI: 1.045–1.187), unhealthy diet choices (OR = 1.093, 95% CI: 1.033–1.156), and not regularly having meals at fixed hours (OR = 1.231, 95% CI: 1.105–1.372). Respondents who exercised regularly had lower odds of having suboptimal health status (OR = 0.913, 95% CI: 0.849–0.983). Suboptimal health has become a serious public health challenge in China. The health status of the population could be effectively improved by improving lifestyle behaviors.

People living in the same area are more likely to experience similar socioeconomic characteristics, which leads to cluster effect and influences the generalizability of data regarding metabolic syndrome (MetS). However, previous studies did not consider or adjust for the cluster effect of living circumstances. The aim of this study was to determine the prevalence of MetS and associated lifestyle factors in Chinese adults 18 to 80 years of age, using multi-level generalized estimation equation (GEE). The participants came from a large-scale cross-sectional population survey. A total of 28,062 participants underwent all the blood tests. Participants meeting at least 3 of the 5 diagnostic criteria were defined as having MetS. Multi-level GEE was used to evaluate the relationship between MetS and lifestyle covariates to control the cluster effect of living circumstances. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to assess the strength of each relationship. A total of 65.70% of the participants had at least 1 clinical feature of MetS, and 2926 were diagnosed with MetS (prevalence 14.03%). 32.74%, 18.93%, 10.25%, 3.25%, and 0.53% of the participants had 1, 2, 3, 4, and 5 components, respectively. The prevalence of MetS in men (12.31%) was lower than in women (15.57%). After controlling for the cluster effect of living circumstances, many demographic and lifestyle characteristics were associated with MetS. Overweight (OR = 1.670, 95%CI: 1.600-1.743), obesity (OR = 2.287, 95% CI: 2.136-2.449), current alcohol consumption (OR = 1.053, 95% CI: 1.020-1.086), physical labor (OR=1.070, 95% CI: 1.040-1.101), a high-salt diet (OR=1.040, 95% CI: 1.009-1.071), hyperuricemia (OR=1.264, 95% CI: 1.215-1.316), short sleep duration (OR=1.032, 95% CI: 1.009-1.055), and a family history of cardiovascular disease (OR=1.065, 95% CI: 1.019-1.113), or cerebrovascular disease (OR=1.055, 95% CI: 1.007-1.104) increased the risk of MetS. The risk of MetS increased 6.9% (OR = 1.069, 95% CI: 1.053-1.085) with each 5% increase in body fat percentage. MetS has become a serious public health challenge in China. Many lifestyle factors have been found to be closely associated with MetS, including obesity, a high-salt diet, alcohol consumption, and short sleep duration. Therefore, changes in lifestyle are very important for adults to reduce the prevalence of MetS.

To explore the natural history of and risk factors for gastroesophageal reflux (GER) in a prospective cohort in Beijing, China. We selected adult participants using a stratified randomized method and performed initial surveys in 1996 and the current survey in 2008. Well-trained investigators administered the survey questionnaire using face-to-face interviews. Reflux symptoms were evaluated by their intensity and frequency. GER was defined as heartburn, acid reflux, and food regurgitation at least once a week, and monthly reflux was defined as at least one of the above symptoms occurring 1-3 days per month. The resurvey response rate was 47.8% (1189/2486). Over 12 years, 66.9% of the respondents remained unchanged, and one-third changed, with a GER new onset rate of 7.0 per 1000 person-years and a GER disappearance rate of 64.6 per 1000 person-years. This kept the GER prevalence stable at 8.2% to 9.5% ( P = 0.28). GER and monthly reflux exhibited significant differences in their tendency to persist or become aggravated to GER (22.4% vs 11.9%, P = 0.02). Participants who initially had single, mild to moderate, daily GER were more likely to recover from reflux over time. Participants with persistent and aggravated GER had more severe heartburn and acid reflux than those with new-onset GER in the current survey. Multiple logistic regression analysis showed that emotional depression is a risk factor for GER aggravation (odds ratio 3.52, 95% confidence interval 1.43-8.67, P = 0.006). The initial symptom profile of reflux determines the outcome of GER over time.

Lower urinary tract symptoms (LUTS) have detrimental impact on health-related quality of life. This study has 2 aims: first to identify the optimum model for LUTS study and then to explore the potential associated factors of LUTS and bother LUTS with the optimum model among adult women in China. The survey was conducted in 6 regions of China between February and July 2006. A modified Chinese Bristol Female LUTS questionnaire was administered. The number of LUTS was the main outcome measure. The fitting goodness was compared to identify the optimum model with likelihood ratio test statistics. Zero-inflated negative binomial (ZINB) model was used to explore the potential associated factors of LUTS and bother LUTS. Of all 18,992 respondents, 55.5% of respondents reported one (any LUTS) or more LUTS (mixed LUTS) and 36.5% of respondents reported one or more bother LUTS. With the largest log likelihood and smallest AIC and BIC, ZINB model showed the best goodness of fit. In the ZINB model, we identified multiple associated factors for any LUTS and mixed LUTS; older age (beta=0.2), overweight [beta=0.059, 95%CI (0.016 similar to 0.102)], obese [beta=0.143, 95%CI (0.087 similar to 0.198)], postmenopausal status [beta=0.099, 95%CI (0.023 similar to 0.175)], prolonged labor [beta=0.188, 95%CI (0.104 similar to 0.272)], constipation [beta=0.309, 95%CI (0.262 similar to 0.357)], coexisting pelvic organ prolapse (POP) [beta=0.348, 95%CI (0.224 similar to 0.473)], diabetes (beta=0.178, 95%CI (0.100 similar to 0.257), hypertension [beta=0.092, 95%CI (0.041 similar to 0.143)], smoking (beta=0.192, 95%CI (0.127 similar to 0.258) and alcohol consumption [beta=0.063, 95%CI (0.001 similar to 0.126)] increased the odds of mixed LUTS. We identified multiple associated factors for bother LUTS and mixed LUTS; older age (beta=0.1), prolonged labor [beta 0.153, 95%CI (0.031 similar to 0.275)], constipation [beta=0.359, 95%CI (0.292 similar to 0.426)] coexisting POP (beta=0.212, [95% CI (0.031 similar to 0.393)], diabetes [beta=.154, 95%CI (0.030 similar to 0.278)], and smoking [beta=0.169, 95%CI (0.076 similar to 0.262)] increased the odds of bother mixed LUTS. ZINB model was the optimum model to explore the potential associated factors of LUTS. Older age, coexisting POP and constipation were both closely related to any and bother LUTS, also the severity of LUTS. Compared to nulliparity, single or multiple deliveries and women who had perineal laceration had nothing to do with the severity of LUTS.

Objective: We aimed to investigate the prevalence and risk factors of fecal incontinence in China. Methods: A cross-sectional study of fecal incontinence was conducted in China from February 2014 to March 2016. In total, 55,477 women were recruited. All the subjects were asked to complete a questionnaire that included questions about their age, job, parity, diseases and so on. After excluding the missing data, our total number was 52,946 . Fecal incontinence (FI) was defined as any involuntary loss of liquid, solid stool or gas in the past with no time restrictions. The "Colorectal-Anal Distress Inventory 8, CRADI-8" questionnaire was used to evaluate bowel function and the influences of personal lives. Multivariable logistic regression was used to assess the factors associated with fecal incontinence. Results: The prevalence of FI was 0.54%. There was a consistent trend toward an increasing prevalence of FI with increasing age, ranging from 0.13% to 1.39%. Women aged 50-59 years were more likely to have FI than women aged 20-29 years. FI was positively associated with POP stage (OR 3.47, 95% CI 2.52-5.34). Urban residence was a significant protective factor (OR 0.96, 95% CI 0.93-0.99 ) compared with rural residence. Multivariate logistic regression analysis showed that chronic cough, alcohol consumption, gynecological diseases, and other physical diseases were also associated with FI. Conclusions: FI affects a substantial proportion of women in China. We did not find a FI prevalence as high as that in developed countries. Older age, urban residence, POP stage, chronic cough, alcohol consumption, gynecological diseases, and coexisting physical diseases significantly increased the odds of FI. Thus changing habits can avoid the incidence of FI; however, additional research is needed. Additional healthcare campaigns are needed to educate women about FI in developing countries.Funding: This study received financial support from the 12th Five-Year Plan National Project of the Chinese government, which consists of cross-sectional national health surveys conducted by the National Health and Family Planning Commission for Disease Control Prevention. Declaration of Interest: None.Ethical Approval: Ethics committee approval and written informed consent were obtained from each participant before data collection.

Objective To explore the natural history of and risk factors for gastroesophageal reflux (GER) in a prospective cohort in Beijing, China. Methods We selected adult participants using a stratified randomized method and performed initial surveys in 1996 and the current survey in 2008. Well-trained investigators administered the survey questionnaire using face-to-face interviews. Reflux symptoms were evaluated by their intensity and frequency. GER was defined as heartburn, acid reflux, and food regurgitation at least once a week, and monthly reflux was defined as at least one of the above symptoms occurring 1-3 days per month. Results The resurvey response rate was 47.8% (1189/2486). Over 12 years, 66.9% of the respondents remained unchanged, and one-third changed, with a GER new onset rate of 7.0 per 1000 person-years and a GER disappearance rate of 64.6 per 1000 person-years. This kept the GER prevalence stable at 8.2% to 9.5% (P = 0.28). GER and monthly reflux exhibited significant differences in their tendency to persist or become aggravated to GER (22.4% vs 11.9%, P = 0.02). Participants who initially had single, mild to moderate, daily GER were more likely to recover from reflux over time. Participants with persistent and aggravated GER had more severe heartburn and acid reflux than those with new-onset GER in the current survey. Multiple logistic regression analysis showed that emotional depression is a risk factor for GER aggravation (odds ratio 3.52, 95% confidence interval 1.43-8.67, P = 0.006). Conclusion The initial symptom profile of reflux determines the outcome of GER over time.

Objective To evaluate the efficacy and safety of higenamine hydrochloride(HG) stress echocardiography for diagnosis of coronary artery disease (CAD). Methods The study was designed as prospective,randomized,open-labled,positively controlled and crossover phase II multi-center clinical research.Ninety subjects who were suspected to have CAD were enrolled.HG dosage was titrated at 0.5,1, 2,4 μg.kg -1.min-1every 3 min.Adenosine was injected 140 μg.kg -1.min-1for 6 min with total dosage 0.8 mg/kg.Visual assessment of the left ventricle wall motionand 17-segment model were used for analysis of stress echocardiography.CAD was defined as identifying >50% diameter stenosis in at least one major coronary artery by coronary angiogram.All adverse reaction were recorded. Results For HG group,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 28.9%,89.7%, 57.1%,76.5% and 47.8%,respectively;for adenosine group,they were 26.7%,94.9%,58.3%,85.7%and 47.1%,respectively. There was no significant difference between the two groups( P > 0.05). The diagnostic sensitivities of HG and adenosine echocardiography for single vessel stenosis were 11.1% and 5.6%,respectively( P >0.05).Both HG and adenosine echocardiography have the same sensitivity with 37.5% for double vessel stenosis and 44.4% for triple vessel stenosis.Advers reaction rate was 84.4% in HG group and 92.2% in adenosine group( P >0.05).Conclusions HG stress echocardiography for CAD diagnosis has high specificity,good safety and low sensitivity,which are similar to adenosine echo.

Objective: To evaluate the efficacy and safety of testa triticum tricum purif for the treatment of functional constipation(FC) in the late middle-aged and elderly patients. Methods: This study was designed as a multicenter randomized controlled trial. Patients who met Rome Ⅲ diagnostic criteria of FC were enrolled, with age between 55-85 years old. Those with organic diseases were excluded. The patients were randomly allocated to receive testa triticum tricum purif (3.5 g bid) or polyethylene glycol 4000 powder (PEG4000, 10g bid) for 8 weeks, followed by single dose of maintenance therapy for 4 weeks. Follow-up visits were at 4 and 12 weeks after treatment discontinuation. The independent investigators in each center evaluated the constipation symptoms scores. The primary endpoints included rates of significant improvement, improvement and overall improvement at the end of 2, 4 and 8 weeks of therapy, which were calculated by the reduction of symptom scores ≥75%, 50%-74%, ≥25% respectively. Results: A total of 127 FC subjects were enrolled from 3 centers, and 122 cases valid for final analysis. The mean age was (69.4±6.9) years old, including 62 cases in testa triticum tricum purif group and 60 cases in PEG4000 group. The demographic data, constipated symptoms scores and proportion of FC subtypes at baseline were comparable. The rates of significant improvement, improvement and overall improvement in testa triticum tricum purif and PEG4000 groups at the end of 2, 4 and 8 weeks were 37.70% (23/61) vs 59.32% (35/59) (P=0.018), 57.38% (35/61) vs 74.14% (43/58) (P=0.054), and 64.41% (38/59) vs 79.31% (46/58) (P=0.073) respectively. Testa triticum tricum purif therapy significantly improved the proportion of spontaneous bowel movement(SBM) ≥3 times/week from 43.55% (27/62) to 80.33% (49/61), 83.61% (51/61) and 93.22% (55/59) at 2, 4, and 8 weeks respectively (all P<0.01), which were comparable with PEG4000 group (all P>0.05). The proportion of normalized stool forms in study group was significant higher than that of control group at the end of 8 weeks [86.44% (51/59) vs 67.24% (39/58), P=0.014]. Only one patient complained mild abdominal distension during testa triticum tricum purif therapy. Conclusions: The efficacy of testa triticum tricum purif for the treatment of FC in late middle-aged and older patients is comparable with osmotic laxatives PEG4000, which has significant effect on normalization of fecal forms and reliable safety.

Background: Female sexual dysfunction (FSD) is a highly prevalent and often underestimated problem. However, large-scale, population-based epidemiological surveys of FSD are scarce in China. The present study was conducted to evaluate the prevalence and the potential risk factors of FSD across a selection of social groups in Beijing, China, based on the Female Sexual Function Index (FSFI). Methods: A cross-sectional study based on the multiple-stage cluster sampling was performed with adult women throughout the Dongcheng and Shunyi districts of Beijing. The Chinese version of FSFI was used, as well as questions on demographic characteristics, the disease-related context, and social relationships. Results: A total of 6000 consecutive women entered this study, with an actual response from 5024 women, corresponding to a response rate of 83.7%. A total of 4697 (78.3%) questionnaires were effective. The prevalence of adult FSD in Beijing was 2973 (63.3%) using a score of 26.55 as the boundary value, whereas the total mean FSFI score was 23.92 ± 6.37. However, 1423 (30.3%) women did not seek help. By multivariate logistic regression analysis, the possible potential risk factors included age (odds ratio [OR] = 1.051), dissatisfaction with the spouse's sexual ability (OR = 3.520), poor marital affection (OR = 2.087), spouse sexual difficulties (OR = 1.720), dissatisfaction with married life (OR = 1.476), living in a rural area (OR = 1.292), chronic pelvic pain (OR = 1.261), chronic disease (OR = 1.534), previous pelvic surgery (OR = 1.605), vaginal delivery (OR = 2.285), lower education (OR = 3.449) and postmenopausal (OR = 3.183). Conclusions: As suggested by the FSFI scores, female sexual problems are highly prevalent in Beijing. Dissatisfaction with the spouse's sexual ability, poor marital affection, sexual difficulties of the spouse, dissatisfaction with the marriage, rural life, CPP, and postmenopausal were conceivable risk factors for FSD in Beijing women.

Objectives The number of depression symptoms can be considered as count data in order to get complete and accurate analyses findings in studies of depression. This study aims to compare the goodness of fit of four count outcomes models by a large survey sample to identify the optimum model for a risk factor study of the number of depression symptoms. Methods 15 820 subjects, aged 10 to 80 years old, who were not suffering from serious chronic diseases and had not run a high fever in the past 15 days, agreed to take part in this survey; 15 462 subjects completed all the survey scales. The number of depression symptoms was the sum of the ‘positive’ responses of seven depression questions. Four count outcomes models and a logistic model were constructed to identify the optimum model of the number of depression symptoms. Results The mean number of depression symptoms was 1.37±1.55. The over-dispersion test statistic O was 308.011. The alpha dispersion parameter was 0.475 (95% CI 0.443 to 0.508), which was significantly larger than 0. The Vuong test statistic Z was 6.782 and the P value was <0.001, which showed that there were too many zero counts to be accounted for with traditional negative binomial distribution. The zero-inflated negative binomial (ZINB) model had the largest log likelihood and smallest AIC and BIC, suggesting best goodness of fit. In addition, predictive probabilities for many counts in the ZINB model fitted the observed counts best. Conclusions All fitting test statistics and the predictive probability curve produced the same findings that the ZINB model was the best model for fitting the number of depression symptoms, assessing both the presence or absence of depression and its severity.

Objective Sub-health status has progressively gained more attention from both medical professionals and the publics. Treating the number of sub-health symptoms as count data rather than dichotomous data helps to completely and accurately analyze findings in sub-healthy population. This study aims to compare the goodness of fit for count outcome models to identify the optimum model for sub-health study. Methods The sample of the study derived from a large-scale population survey on physiological and psychological constants from 2007 to 2011 in 4 provinces and 2 autonomous regions in China. We constructed four count outcome models using SAS: Poisson model, negative binomial (NB) model, zero-inflated Poisson (ZIP) model and zero-inflated negative binomial (ZINB) model. The number of sub-health symptoms was used as the main outcome measure. The alpha dispersion parameter and O test were used to identify over-dispersed data, and Vuong test was used to evaluate the excessive zero count. The goodness of fit of regression models were determined by predictive probability curves and statistics of likelihood ratio test. Results Of all 78 307 respondents, 38.53% reported no sub-health symptoms. The mean number of sub-health symptoms was 2.98, and the standard deviation was 3.72. The statistic O in over-dispersion test was 720.995 (P<0.001); the estimated alpha was 0.618 (95% CI: 0.600-0.636) comparing ZINB model and ZIP model; Vuong test statistic Z was 45.487. These results indicated over-dispersion of the data and excessive zero counts in this sub-health study. ZINB model had the largest log likelihood (-167 519), the smallest Akaike's Information Criterion coefficient (335 112) and the smallest Bayesian information criterion coefficient (335455), indicating its best goodness of fit. The predictive probabilities for most counts in ZINB model fitted the observed counts best. The logit section of ZINB model analysis showed that age, sex, occupation, smoking, alcohol drinking, ethnicity and obesity were determinants for presence of sub-health symptoms; the binomial negative section of ZINB model analysis showed that sex, occupation, smoking, alcohol drinking, ethnicity, marital status and obesity had significant effect on the severity of sub-health. Conclusions All tests for goodness of fit and the predictive probability curve produced the same finding that ZINB model was the optimum model for exploring the influencing factors of sub-health symptoms.