The global rise in Type 2 Diabetes (T2D) is a particularly evident in China, where dietary patterns have shifted towards a Western diet, potentially exacerbating the issue. This necessitates effective prevention strategies, and objective dietary pattern analysis can inform such strategies. To preliminarily reveal the health benefits of the EAT-Lancet Diet in preventing T2D among adults in Shanghai, China. Information gathered from the Shanghai Suburban Adult Cohort and Biobank (SSACB) were utilized, encompassing 29 507 participants with complete dietary and health assessments. Adherence to the EAT-Lancet diet was quantified by employing a semi-quantitative Food Frequency Questionnaire (FFQ) that included 29 food categories based on participants’ responses recalling food frequency and average consumption amount over a 12-month period. The EAT-Lancet Index (ELDI) was obtained based on the intake level and reference range of 14 food components defined in the EAT-Lancet Diet (0–3 points per component; 0–42 points in total). Incident T2D cases were identified through medical records until February 28, 2023. Hazard ratios (HRs) and 95

This study aimed to evaluate the prognostic factors influencing the survival of patients with lung cancer identified from a lung cancer screening cohort in the community. A total of 25,310 eligible participants were enrolled in this population-based prospective cohort study, derived from a community lung cancer screening program started from 2013 to 2017. Survival analyses were conducted using the Kaplan–Meier method and the log-rank test. Cox proportional hazards regression models were utilized to identify prognostic factors, including demographic characteristics, risk factors, low-dose CT (LDCT) screening, and treatment information. The screening cohort identified a total of 429 patients with lung cancer (276 men, 153 women) during the study period. The 1-year, 3-year, and 5-year survival rates were 74.4

AmisChemotherapy-induced hepatotoxicity (CIH) is a significant concern in colorectal cancer (CRC) patients treated with the CAPEOX (capecitabine and oxaliplatin) regimen. Identifying predictive factors for CIH is crucial for clinical management.Patients and MethodsThis study analyzed colorectal tissue (CRT), plasma, and urine samples from CRC patients. Differentially expressed metabolites (DEMs) across these tissues were integrated for multi-omics analysis, and predictive models for CIH susceptibility were developed. An independent set of 75 plasma samples was used for validation.ResultsA total of 492 differentially expressed compounds were identified in samples from 63 CRC patients, including 105, 149, and 238 DEMs in CRT, plasma, and urine, respectively. Lipids and lipid-like molecules were predominant in all samples. Among these, urine samples exhibited the highest variability and provided the strongest predictive power for CIH susceptibility. Principal component analysis (PCA) effectively differentiated normal patients from those with CIH. The study revealed steatosis as the primary pathological feature of CIH, with disrupted lipid metabolism emerging as a key characteristic. Predictive models constructed from multi-tissue metabolites profile exhibited high accuracy, with the plasma model achieving an AUC of 0.933 in external validation set. Our study underscores the importance of individual metabolic variations in CIH susceptibility, reflecting the complex interplay of genetic, environmental, and lifestyle factors.ConclusionThis study emphasizes the critical role of alterations in lipid, polyamine, and purine metabolism, as well as impaired tissue repair mechanisms, were identified as key endogenous factors underlying CIH susceptibility. The developed predictive models demonstrate potential for clinical application in assessing CIH risk in CRC patients undergoing CAPEOX chemotherapy.

Background: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with growing evidence linking risk to lifestyle and dietary factors. However, nutrition-related exposures have rarely been integrated into existing CRC risk prediction models. This study aimed to develop and validate a lifestyle-based 10-year CRC risk prediction model using longitudinal data from a large-scale population-based screening cohort to facilitate early risk stratification and personalized screening strategies. Methods: Data were obtained from 21,358 individuals participating in a CRC screening program in Shanghai, China, with over 10 years of active follow-up until 30 June 2021. Of these participants, 16,782 aged ≥40 years were used for model development, and 4576 for external validation. Predictors were selected using random survival forest (RSF) and elastic net methods, and the final model was developed using Cox regression. Machine learning approaches (RSF and XGBoost) were additionally applied for performance comparison. Model performance was evaluated through discrimination, calibration, and decision curve analysis (DCA). Results: The final model incorporated twelve predictors: age, gender, family history of CRC, diabetes, fecal immunochemical test (FIT) results, and seven lifestyle-related factors (smoking, alcohol use, body shape, red meat intake, fried food intake, pickled food intake, and fruit and vegetable intake). Compared to the baseline demographic-only model (C-index = 0.622; 95% CI: 0.589-0.657), the addition of FIT improved discrimination, and further inclusion of dietary and lifestyle variables significantly enhanced the model's predictive accuracy (C-index = 0.718; 95% CI: 0.682-0.762; ΔC-index = 0.096, p = 0.003). Conclusions: Incorporating dietary and lifestyle variables improved CRC risk stratification. These findings highlight the value of dietary factors in informing personalized screening decisions and providing an evidence-based foundation for targeted preventive interventions.

Menarche, marking the onset of female reproductive potential. Understanding the secular trends in age at menarche (AAM) is crucial for public health, as earlier menarche is associated with adverse health outcomes in adulthood. This study sought to explore the long-term trends of AAM among Han Chinese females in Shanghai, China, and to explore its correlation with overweight/obesity in adulthood. We utilized baseline data from the Shanghai Suburban Adult Cohort and Biobank (SSACB), a large-scale community-based study. A total of 38,396 Han females born between 1942 and 1995 were included. Participants were divided into 11 birth-year cohorts and five percentile groups (10th, 25th, 50th, 75th, and 90th) based on AAM. The overweight/obesity status was defined using BMI criteria. Quadratic and quantile regression analyses were conducted to evaluate the time trends of AAM. The mean AAM decreased from 17.45 ± 2.50 years in females born in 1942 to 14.20 ± 1.33 years in those born in 1995, with an average decline of 0.68 years per decade (p < 0.001). This trend was consistent across all percentile groups, with the most significant decline observed in the 90th percentile group. Females who experienced a greater decline in AAM (a decrease of 0.076 years per year) had a higher prevalence of overweight/obesity (OO) — compared to females with a smaller decline in AAM (a decrease of 0.064 years per year), who were currently non-overweight/obese (NOO). This study highlights a secular trend towards earlier menarche among Han Chinese females in Shanghai over the past half-century. Women with earlier menarche are more likely to be overweight or obese in adulthood, suggesting that earlier menarche may increase the risk of obesity in adulthood, and attention should be paid to early weight control intervention. Our findings provide valuable insights for public health policies aimed at improving Han women’s health in highly urbanized regions.

Metabolic syndrome (MS) is a well-established risk factor for chronic kidney disease (CKD), especially in hypertensive patients. These patients are more likely to exhibit additional components of MS, further elevating their risk of developing CKD. This study aimed to investigate the association between the components of MS and the risk of CKD in hypertensive patients. This retrospective cohort study included 51,470 hypertensive patients who participated in the national basic public health services for hypertension management in Minhang District, Shanghai, China. Cases of CKD were identified through linkage with elderly physical examination statistics. Multivariable-adjusted Cox proportional hazard models were used to assess the relationship between the number of MS components and the risk of CKD. Additionally, the study explored the associations between different combinations of MS components and CKD. During the 3-year follow-up period, the incidence of CKD was significantly higher in hypertensive patients with MS compared to those without MS (33.77 vs. 25.67 per 1000 person-years). Hypertensive patients with MS had a 15

ObjectiveTo develop a reliable and valid health self-management competence assessment questionnaire for primary and secondary school students in Shanghai, so as to provide an effective tool to evaluate and improve their health management competencies.MethodsBased on the theory and process of scale development, an initial item pool was formed. After two rounds of Delphi consultation with 22 experts in related fields, assessment indicators suitable for evaluating the health self-management ability of Shanghai primary and secondary school students were determined. A total of 666 students were selected using stratified cluster sampling method to carry out the survey. The questionnaire content was refined and items were screened for reliability and validity analyses.ResultsAfter the two rounds of Delphi expert consultation, the original three-dimensional structure (individual management behaviors, personal health cognition and self-management environment) was revised into four dimensions: self-health cognition, self-health skills, self-will quality and self-action level. The initial 50 items were reduced, merged, or newly created, yielding a final 30-item questionnaire. Expert response rates for the two rounds of Delphi consultation were 86.36% and 90.91%, respectively, with an expert authority coefficient of 0.91. The KMO value was 0.936 and Bartlett’s sphericity test yielded a P value of <0.001, indicating that the questionnaire demonstrated good construct validity. The results of internal consistency testing showed that the overall Cronbach’s α coefficient was 0.932, and the split-half reliability coefficient was 0.920. The Cronbach’s α coefficient of each dimension ranged from 0.716 to 0.884, and the split-half reliability coefficient ranged from 0.733 to 0.900. Finally, an evaluation scale with 30 items across 4 dimensions was constructed.ConclusionThe health self-management competence evaluation scale for primary and secondary school students in Shanghai demonstrates good homogeneity and high reliability. It can be used as a tool for evaluating the health self-management competency of primary and secondary school students in Shanghai and provide theoretical support for targeted health interventions.

Background With the comprehensive implementation of the family doctor system in China, community health service resources have been widely utilized. However, there is a lack of research on the utilization tendency of primary outpatient medical resources for adult diabetic patients using objective medical visit data. Objective To understand the characteristics of outpatient visits for diabetic patients in the community, analyze the factors influencing frequent visits by patients enrolled in family doctor services, correctly identify the utilization tendency of primary outpatient medical resources by enrolled patients, and provide a basis for promoting the high-quality development of family doctor contract services. Methods In August 2023, outpatient visit records of adult diabetic patients from 13 community health service centers in Minhang District, Shanghai, for the year 2021 were retrieved. Personal information such as names and contact details were forcibly anonymized, while data on sex, age, enrollment in family doctor services, triggered diagnosis records, frequency of medical treatment, department of medical treatment, and Chinese medicine services during visits were collected. The characteristics of outpatient visits for adult diabetic patients in the community were analyzed, and multiple logistic regression and decision tree models were used to analyze the factors influencing frequent visits by enrolled patients. Results There were 66 838 adult patients, resulting in 1 281 972 outpatient records. Among them, 48.96% (32 723) were male; the median age of the patients who visited the hospital was 71 (66, 77) years old; the median number of diagnosis types was 6 (3, 10) ; the median frequency of visits was 15 (9, 26), 10.28% (6 871) of the adult patients frequently visited the hospital for 362 068 times; 1-2 departments were the main ones (60.38%), and 9.33% (6 233) of the patients with≥5 departments involved; 39.53% (26 423) visited Chinese medicine services. During the year, Contracted patients accounted for 92.77% (62 005) of all the patients, while non-contracted patients only accounted for 7.23% (4 833). There were significant differences between contracted patients and non-contracted patients in sex, age, complexity of illness, frequency of medical treatment, department of medical treatment, Chinese medicine service (P<0.05). The results of multivariate Logistic regression analysis showed that sex, age, complexity of illness, department of medical treatment, Chinese medicine service were the influencing factors of frequent visits by contracted patients (P<0.05). The results of decision tree model analysis showed that the complexity of the disease was the most important factor affecting the frequent visits of contracted patients. Conclusion The signing rate of adult diabetic patients in community primary clinics in Minhang District of Shanghai was high, the effect of family doctor signing system was remarkable, the aging of adult diabetic patients in community primary clinics was prominent, the contracted patients' condition was more complicated, and the demand for Chinese medicine treatment was stronger. The frequent visits of contracted patients were affected by many factors, especially the complexity of their condition. Therefore, it is suggested that relevant departments identify frequent patients efficiently according to the patients' condition, so as to make more rational use of medical resources in primary clinics.

ObjectiveTo analyze the impact of diabetes-related deaths on the probability of premature mortality and life expectancy in Minhang District of Shanghai from 2004 to 2023, and to provide reference data for the optimization of targeted prevention and control strategies.MethodsAll death cases involving diabetes among the registered residents of Minhang District from 2004 to 2023 were collected. The probability of premature mortality and life expectancy was computed using the abridged life table method. The average annual percent change (AAPC) was calculated with Joinpoint 4.9.0.0. The Arriaga decomposition method was employed for statistical analyses of the influence of cause-specific and age-specific mortality related to diabetes on life expectancy.ResultsThe total number of diabetes-related mortality, crude mortality, and standardized mortality for both males and females in Minhang District from 2004 to 2023 exhibited an increasing trend (P<0.001). The primary causes of death among diabetes-related cases were cardiovascular disease (37.68%), diabetes mellitus (31.95%), and malignant tumor (17.80%). From 2004 to 2023, probability of premature mortality to diabetes-related diseases demonstrated a rising trend (P<0.001), contrasting with the declining trend observed in the overall population (P=0.001). Males showed a significant upward trajectory (P<0.001), while females displayed a stable pattern. Among the diseases exerting considerable influence, cardiovascular disease and malignant tumor revealed a marked increase over time (P<0.001), whereas diabetes mellitus maintained a stable trend; both factors negatively impacted the reduction in probability of premature mortality. From 2004 to 2023, diabetes-related mortality reduced life expectancy among residents by an average of 1.22 years (-49.89%), indicating a negative impact; the reduction was 1.41 years in males and 0.90 years in females. The age groups exhibiting greater negative contributions differed by genders, namely males aged 50‒54 years and females aged 70‒74 years. Cardiovascular disease, diabetes mellitus, and malignant tumor contributed significantly to this decline (-0.46 years, -0.42 years, -0.20 years, respectively), with male experiencing higher negative contributions than females.ConclusionIn Minhang District, the rising mortality associated with diabetes-related diseases negatively impact both the reduction of the probability of premature mortality and the increase in life expectancy. This trend is primarily attributed to the rapid escalation of mortality and younger age demographic of male residents, which warrants significant attention. It is recommended that, based on the enhancement of case management, efforts should be directed towards the targeted prevention and control of risk factors and high-risk populations.

ObjectiveTo investigate the general situation of defect of vertebral column among primary and middle school students in Minhang District of Shanghai and analyze the related factors， to provide a scientific basis for prevention and treatment.MethodsFrom September to October 2022， a total of 5 715 students were selected from two primary schools， two middle schools， and two high schools in Minhang District for physical examinations and screening for defect of vertebral column.ResultsTotally 219 students had defect of vertebral column， accounting for 3.83% of the sampled population. Anteroposterior spinal abnormalities were found in 4 individuals， accounting for 0.07%， and 218 students had scoliosis， accounting for 3.81%. The detection rate of defect of vertebral column was higher in girls （6.27%） than that in boys （1.51%）， and higher in high school students （10.74%） than in primary school students （1.31%） and middle school students （10.97%）. Students who are mildly underweight （5.95%） and who are moderately to severely underweight （7.46%） had a higher detection rate of defect of vertebral column than those with normal weight （4.54%）， overweight （2.83%）， and obesity （1.60%）. The detection rate among students with poor vision （4.32%） was significantly higher than those with normal vision （2.24%）， with all differences statistically significant （all P<0.05）.ConclusionThe positive rate of defect of vertebral column in primary and middle school students in Minhang District， Shanghai is nearly 4%， with most cases being scoliosis. Factors such as being female， increasing age， being underweight， and poor vision are associated with a higher probability of detecting defect of vertebral column.

[Objective]To investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai,and to provide scientific evidence for the community management.[Methods]A retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District,Shanghai from January 1,2011 to December 31,2017.The study end-point was the occurrence of hypertension,and the followup was finished in December 2021.A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study.Log-rank test and Cox regression analysis were used to determine the influencing factors.[Results]After 6.04 years of follow-up,the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%.Family history of hypertension(HR=1.250,95%CI:1.168‒1.338),family history of stroke(HR=1.295,95%CI:1.080‒1.553),history of diabetes(HR=1.203,95%CI:1.076‒1.345),daily smoking(HR=1.187,95%CI:1.087‒1.296),overweight(HR=1.393,95%CI:1.308‒1.484),obesity(HR=1.903,95%CI:1.719‒2.106),high values of normal blood pressure(HR=1.275,95%CI:1.195‒1.359)and advanced age(HR=1.033,95%CI:1.030‒1.036)were all risk factors.Emaciation(HR=0.649,95%CI:0.500‒0.840)was a protective factors.[Conclusion]Blood pressure monitoring should be strengthened for people elderly,with family history of hypertension,family history of stroke,diabetes or high values of normal blood pressure,so as to diagnose hypertension early.Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking,overweight and obesity.

BACKGROUND:Low-dose spiral computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. However, evidence from Chinese populations was limited due to the different criteria for high-risk populations and the short-term follow-up period. This study aimed to evaluate the effectiveness in Chinese adults based on the Lung Cancer Screening Program in Minhang District of Shanghai initiated in 2013.METHODS:A total of 26,124 subjects aged 40 years or above were enrolled in the Lung Cancer Screening Program during the period of 2013 and 2017. Results of LDCT examination, and screen-detected cancer cases in all participants were obtained from the Reporting System of the Lung Cancer Screening Program. The newly-diagnosed cases and their vital status up to December 31, 2020 were identified through a record linkage with the Shanghai Cancer Registry and the Shanghai Vital Statistics. Standardized incidence ratio (SIR) and 95%CI were calculated using the local population at ages of 40 or above as the reference. Proportions of early-stage cancer (stage 0-I), pathological types, and 5-year observed survival rates of lung cancer cases were estimated and compared between the cases derived from the screened and non-screened populations. Cox regression models were applied to evaluate the hazard ratio (HR) and 95%CI of LDCT screening with all-cause death of the lung cancer cases.RESULTS:The crude and age-standardized incidence of lung cancer in screened population were 373.3 (95%CI: 343.1-406.1) and 70.3 per 100,000 person-years, respectively, with an SIR of 1.8 (95%CI: 1.6-1.9), which was observed to decrease with following-up time. The early-stage cancer accounted for 49.4% of all lung cancer cases derived from the screened population, significantly higher than 38.4% in cases from the non-screened population during the same period (P<0.05). The proportion of lung adenocarcinoma (40.7% vs 35.9%) and 5-year survival rate (53.7% vs 41.5%) were also significantly higher in the cases from the screened population (all P<0.05). LDCT screening was associated with 30% (HR=0.7, 95%CI: 0.6-0.8) reduced all-cause deaths of the cases.CONCLUSIONS:The participants of the screening program are at high-risk of lung cancer. LDCT favors the early-detection of lung cancer and improves 5-year survival of the screened cases, indicating a great potential of LDCT in reducing the disease burden of lung cancer in Chinese populations.

Hyperuricemia, a major worldwide burden on public hygiene, is closely connected with dietary habits. However, few studies have evaluated the association of dietary diversity with hyperuricemia. To preliminarily reveal the status of a diversified diet in preventing hyperuricemia based on a neighborhood-based, massive-scale cohort in China, a total of 43,493 participants aged 20–74 years old, with no history of hyperuricemia at baseline, were enrolled in the research from April 2016 to December 2019. The Dietary Diversity Score (DDS) was utilized to evaluate the dietary variety and split the participants into the low-, medium-, and high-DDS groups. Information on participants was connected to regional health information systems that acquired data on hyperuricemia instances up to 28 February 2023. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by Cox proportional hazards models. Restricted cubic splines (RCS) were implemented to analyze dose–response correlation. A total of 1460 individuals with newly diagnosed hyperuricemia were observed over a median follow-up period of 5.59 years. Compared to the low-DDS group, HRs for the medium- and high-DDS groups were 0.87 (95% CI 0.76–0.99) and 0.80 (95% CI 0.70–0.91) in the fully adjusted model, respectively. The risk of hyperuricemia incidence was reduced by 5% for each 1 unit of DDS increase. A linear correlation of DDS with hyperuricemia emerged and further revealed that the intake of 8–10 broad categories of food could decrease the incidence of hyperuricemia. Our results validate the dietary principle of “food diversification” recommended in guidelines. Conclusions should be applied with caution considering the paucity of related evidence in additional nations.

Both body mass index (BMI) and family history of cancer are established risk factors for female breast cancer. However, few studies explored the potential interaction between both factors. We assessed the association of BMI and its interaction with family cancer history on the risk of female breast cancer in Shanghai, China. Based on a population-based prospective cohort study started from 2008 to 2012 with 15,055 Chinese female participants in Minhang district, Shanghai. Cox regression models were used to estimate the association of BMI and its interaction with a family history of cancer on breast cancer risk. The additive interaction was evaluated by the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP), and the multiplicative interaction was assessed by the product term (BMI* family history of cancer) in the Cox regression model. Compared with BMI of < 24 kg/m2 and no family history of cancer, women with BMI of ≥ 24 kg/m2 and a family history of cancer had a higher risk for breast cancer with HR 2.06 (95% CI 1.39, 3.06). There was an additive interaction between BMI and family history of cancer on breast cancer incidence, with the RERI being 0.29 (95% CI 0.08, 0.51) and the AP being 0.37 (95% CI 0.08, 0.66). The coexistence of obesity and cancer family history may exacerbate breast cancer incidence risk, highlighting the importance of weight management in women with a family history of cancer.

Purpose:The association between body mass index (BMI) and all-cause mortality may vary among hypertensive patients of different ages. This study aimed to investigate the age-dependent association between BMI and all-cause mortality among patients with hypertension.Patients and Methods:A total of 212,394 participants with hypertension aged 20-85 years from Minhang Hypertension Standardization Management System in Shanghai of China were included. Follow-up began at the time when individuals were first recorded and ended at death, loss to follow-up, or December 31, 2018, whichever came first. Additive Cox proportional hazards models with thin plate smoothing functions and conventional Cox proportional hazards models were adopted to examine the relationship between BMI, age, and mortality. The joint effect of BMI and age on mortality was assessed using a bivariate response model.Results:We found that the BMI-mortality relationship followed a U-shaped pattern, with a trough at 26-27 kg/m2. Compared with normal weight, underweight was associated with a 50% increased risk of premature mortality (hazard ratio 1.50, 95% confidence interval 1.43 to 1.57). Whereas among those aged 45-59 and 60-85 years, overweight was associated with 13% (0.87, 0.80 to 0.94) and 18% (0.82, 0.80 to 0.84) reduction in risk of death, respectively. Bivariate response model indicated a significant interaction between BMI and age (P < 0.05). Among younger and older patients, we found a descending trend for mortality risk, with BMI increasing at different age levels, whereas a reverse J-shaped relation pattern was observed among middle-aged patients.Conclusion:The impact of BMI on all-cause mortality in hypertensive patients varies with age, and moderate weight gain may benefit longevity in middle-aged and older patients.

Abstract Background Hypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses. Methods This cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex. Results 28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41–1.72) and 1.29(1.21–1.37) for males aged 60–69 years, 1.25(1.14–1.36) and 1.13(1.06–1.20) for males aged 70–85 years, 1.48(1.32–1.67) and 1.29(1.19–1.40) for females aged 60–69 years, and 1.19(1.10–1.29) and 1.08(1.01–1.15) for females aged 70–85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71–0.93 RERI: 0.59, 95% CI: 0.09–1.07) and females (HR: 0.81, 95% CI: 0.70–0.93 RERI: 0.66, 95% CI: 0.10–1.23). Conclusions Diagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60–69 years compared with those with age at diagnosis of 70–85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.

Colorectal cancer (CRC) is the third most common and second most lethal cancer globally. It is highly heterogeneous with different clinical-pathological characteristics, prognostic status, and therapy responses. Thus, the precise diagnosis of CRC subtypes is of great significance for improving the prognosis and survival of CRC patients. Nowadays, the most commonly used molecular-level CRC classification system is the Consensus Molecular Subtypes (CMSs). In this study, we applied a weakly supervised deep learning method, named attention-based multi-instance learning (MIL), on formalin-fixed paraffin-embedded (FFPE) whole-slide images (WSIs) to distinguish CMS1 subtype from CMS2, CMS3, and CMS4 subtypes, as well as distinguish CMS4 from CMS1, CMS2, and CMS3 subtypes. The advantage of MIL is training a bag of the tiled instance with bag-level labels only. Our experiment was performed on 1218 WSIs obtained from The Cancer Genome Atlas (TCGA). We constructed three convolutional neural network-based structures for model training and evaluated the ability of the max-pooling operator and mean-pooling operator on aggregating bag-level scores. The results showed that the 3-layer model achieved the best performance in both comparison groups. When compared CMS1 with CMS234, max-pooling reached the ACC of 83.86 % and the mean-pooling operator reached the AUC of 0.731. While comparing CMS4 with CMS123, mean-pooling reached the ACC of 74.26 % and max-pooling reached the AUC of 0.609. Our results implied that WSIs could be utilized to classify CMSs, and manual pixel-level annotation is not a necessity for computational pathology imaging analysis.

目的:评价社区卫生服务中心诊室血压标准化测量用于首诊测压的效果.方法:回顾性分析2020年上海市闵行区社区卫生服务中心的首诊测压数据,按照血压来源将其分为当日有标准化测压数据并同步入首诊测压组、当日有标准化测压数据未同步入首诊测压组、年内有但当日无标准化测压组、常规测量血压组,分析不同组别血压末位数值分布均衡性和血压升高检出率的差异.结果:当日有标准化测压数据并同步入首诊测压组血压末位数值频率范围为8.9％～11.3％,血压升高检出率为21.9％;当日有标准化测压数据但未同步入首诊测压组、年内有但当日无标准化测压组、常规测量血压组均对血压测量数值存在末位"0"偏好,当日有标准化测压数据并同步入首诊测压组血压升高检出率高于其他3组;多因素logistic回归分析结果显示,性别、年龄、不同血压测量模式均为血压升高检出率的影响因素.结论:社区卫生服务中心诊室血压标准化测量可以提高首诊测压的真实性和有效性.

BackgroundThe prevalence of malnutrition in older adults is high. Early use of appropriate screening scales for malnutrition risk and early intervention can effectively improve life quality of the elderly in communities. ObjectiveTo evaluate the risk of malnutrition among the community-dwelling elderly in a district of Shanghai and explore its influencing factors. MethodsFrom October to December 2021, a total of 960 seniors aged 65 years and above in community committees (villages) of Minhang District were selected by stratified random sampling. Trained investigators conducted one-to-one interviews with included seniors using questionnaires. The questionnaires included the Geriatric Depression Scale (GDS), the Activity of Daily Living Scale (ADL), and the malnutrition risk assessment for elderly adults. Height, weight, waist circumference, and calf circumference were measured. Chi-square test and logistic regression were used to analyze potential influencing factors of malnutrition in the elderly. ResultsAmong the 960 community-dwelling seniors of Minhang District, 13 (1.35%) were malnourished and 311 (32.40%) were at the risk of malnutrition. There were statistically significant differences in nutritional status across different categories of age, sex, monthly family income, education level, marital status, waist circumference, dental health status, activity of daily living, nutrition knowledge, suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, depression symptoms, sleeping duration, daily outdoor activity time, number of daily food species (milk/soy products/fish/meat/poultry/eggs), daily intake of vegetables and fruits, daily consumption of cooking oil, frequency of physical exercise, frequency of smoking, and living alone (P < 0.05). The logistic regression analysis results showed that poor dental conditions, insufficient daily intake of milk/soy products/fish/meat/poultry/eggs (<3 kinds), insufficient daily intake of vegetables and fruits (<500 g), excessive daily consumption of cooking oil (>25 g), insufficient daily outdoor activities (<1 h·d−1), living alone, low educational level (primary school and below), suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, and being single/widowed/divorced were the main risk factors for nutritional abnormalities in the elderly (P< 0.05). ConclusionThe elderly in Minhang District of Shanghai have a high malnutrition risk, and their nutritional status is affected by multiple factors, including poor dental status, irrational dietary structure, insufficient time for outdoor activities, suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, low educational level, living alone, and being single/widowed/divorced.

目的:研究闵行区疾病预防控制中心实践基地带教效果,确定预防医学专业和临床医学专业学生对实践技能带教内容需求,为进一步规范化建设实践基地提供参考依据.方法:采用自行设计的问卷,对预防医学专业55名学生和临床医学专业141名学生开展实践效果和实践质量满意度调查.结果:预防医学专业学生实践总体评价认为有收获者占92.7％(51/55),在具体公共卫生实践经验85.5％(47/55)、疾控工作流程与基本网络83.6％(46/55)、人际沟通83.6％(46/55)、团队协作83.6％(46/55)以及独立思考83.6％(46/55)方面收获较大;对实践基地带教老师工作态度92.7％(51/55)、专业水平89.1％(49/55)和疾控培训设施89.1％(49/55)等方面满意度较高.临床医学专业学生对带教老师工作态度97.9％(138/141)、培训设施95.7％(135/141)和带教老师专业水平95.0％(134/141)方面评价较高.但两类学生对实践基地总体评价满意度,分别为80.0％(44/55)和7.8％(11/141)的学生满意.结论:开展公共卫生技能实践对预防医学本科生和临床医学专业学生很有必要,但实践基地还需进一步优化带教内容,制作具有品牌效应的公共卫生带教课件,建立完善的带教工作质量评价制度.