Description: Introduction Emergence agitation after intracranial surgery is an important clinical issue during anaesthesia recovery. The aim of this multicentre cohort study is to investigate the incidence of emergence agitation, identify the risk factors and determine clinical outcomes in adult patients after intracranial surgery under general anaesthesia. Additionally, we will deliberately clarify the relationship between postoperative pneumocephalus and agitation. Methods and analysis The present study is a prospective multicentre cohort study. Five intensive care units (ICUs) in China will participate in the study. Consecutive adult patients admitted to the ICUs after intracranial surgery will be enrolled. Sedation-Agitation Scale (SAS) or Richmond Agitation-Sedation Scale (RASS) will be used to evaluate the patients 12 h after the enrolment. Agitation is defined as an SAS score of 5–7, or an RASS score of +2 to +4. According to the maximal SAS and RASS score, patients will be divided into two cohorts: the agitation group and the non-agitation group. Factors potentially related to emergence agitation will be collected at study entry, during anaesthesia and operation, during postoperative care. Univariate analyses between the agitation and the non-agitation groups will be performed. The stepwise backward logistic regression will be carried out to identify the independent predictors of agitation. Patients will be followed up for 72 h after the operation. Accidental self-extubation of the endotracheal tube and removal of other catheters will be documented. The use of sedatives and analgesics will be collected. Ethics and dissemination Ethics approval has been obtained from each of five participating hospitals. Study findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration number NCT02318199.

Description: Objectives We compared the differences in median age at spermarche among 11 ethnic minorities in 2010, estimated the trends regarding age at spermarche in different ethnic minorities from 1995 to 2010, and explored the association of spermarche with body mass index (BMI). Methods We used four cross-sectional Chinese National Surveys on Students’ Constitution and Health (CNSSCH, 1995, 2000, 2005 and 2010), and the total sample size was 40 113 children aged 11–18 years. The median age at spermarche of each ethnic minority was determined by using probit analysis. Logistic regression was used to assess the association of spermarche with BMI. Results In 2010, the ethnic minorities with earliest age at spermarche were Qiang (12.03 years), Zhuang (12.91 years) and Kirghiz (13.17 years); the three ethnic minorities with latest age at spermarche were Dong (14.73 years), Yao (14.60 years), and Naxi (14.36 years). From 1995 to 2010, age at spermarche showed a decline in almost each minority group except Yao and Dong. A higher BMI was associated with an increased likelihood of having reached spermarche after adjusting for age, regions or ethnic minorities. Conclusions A large variation in age at spermarche was observed among different ethnic minorities. The age at spermarche showed a downward shift in almost each of the 11 ethnic minorities with different patterns over time, and the children with higher BMI are more likely to enter puberty early.

Description: Objective and design We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting ED. Participants Children. Interventions Procedural sedation. Outcomes Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs. Results A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (≤18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decision-making, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.

Description: Objective This study aimed to evaluate daily cholesterol intake across demographic factors and its food sources in elderly Chinese. Design A longitudinal study was conducted using demographic and dietary data for elders aged 60 and above from eight waves (1991–2011) of the China Health and Nutrition Survey. Setting The data were derived from urban and rural communities of nine provinces (autonomous regions) in China. Participants There were 16 274 participants (7657 male and 8617 female) in this study. Outcomes The primary outcome was daily cholesterol intake, which was calculated by using the Chinese Food Composition Table, based on dietary data. Results Daily consumption of cholesterol in the elderly significantly increased by 34% from 1991 to 2011 (p〈0.0001) and reached 253.9 mg on average in 2011. Secular trends in the proportion of subjects with an intake of 〉300 mg/day increased significantly during 1991–2011 (p〈0.0001). The major food sources of cholesterol by ranked order were eggs, pork, and fish and shellfish in 1991 and 2011, while organ meats which ranked fourth in the contribution to total intake in 1991 was replaced by poultry in 2011. Moreover, younger elders, male elders and elders from a high-income family or a highly urbanised community had higher cholesterol intakes and larger proportions of subjects with excessive cholesterol consumption in each survey year. Conclusions The large growth in daily cholesterol intake may pose major challenges for the health of elders in China. Reduced exposure to food enriched in cholesterol is required for elderly Chinese.

Description: Objectives Regular exercise is a key component of obesity prevention and 48% of Americans do not meet minimum guidelines for weekly exercise. Social support has been shown to help individuals start and maintain exercise programmes. We evaluated social support among endurance athletes and explored the relationship between social support for exercise, health behaviours and health status. Design Survey. Setting The largest Nordic ski race in North America. Participants 5433 past participants responded to an online questionnaire. Outcome measures Social support, health behaviours and health status. Results The mean overall support score was 32.1 (SD=16.5; possible range=–16.0 to 88.0). The most common forms of social support were verbal such as discussing exercise, invitations to exercise and celebrating the enjoyment of exercise. We found that an increase of 10 points in the social support score was associated with a 5 min increase in weekly self-reported exercise (5.02, 95% CI 3.63 to 6.41). Conclusions Physical activity recommendations should incorporate the importance of participation in group activities, especially those connected to strong fitness cultures created by community and competitive events.

Description: Objectives To study the correlation between dietary factors and the number of altered metabolic syndrome components (MetS) in Chinese adults systematically. Setting A cross-sectional study using demographic and dietary data of adults aged 18–75 years from the China Health and Nutrition Survey (2009) was conducted in nine provinces in China. Participants There were 6034 eligible subjects (2800 men and 3234 women) in this study. Outcomes The primary outcome of this study were diet assessments and the number of altered MetS components. Dietary intake was measured using a combination of a 3-day period with 24-hour and household food inventory; average daily intakes of nutrients were estimated according to the Chinese Food Composition Table. Blood samples were analysed in a national central laboratory and the number of clustering MetS components was calculated by adding the presence of each MetS component. Results After adjusting for covariates, and taking zero MetS as comparison, the high risk factors correlating with increased numbers of altered MetS components in men were higher intake of protein (70.4–73.4 g; P trend=0.0004), cholesterol (238.7–266.6 mg; P trend=0.004), meat (90.6–105.7 g; P trend=0.016), fish/seafood (30.4–42.3 g; P trend=0.001), and lower intake of coarse cereals (16.5–12.7 g; P trend=0.051), tubers (37.3–32.7 g; P trend=0.030), and dietary fibre (11.7–11.5 g; ANCOVA p=0.058). Meanwhile, the high risk factors correlating with the increased number of altered MetS components in women were higher intake of wheat (101.9–112.6 g; P trend=0.066) and sodium (3862.3–4005.7 mg, P trend=0.032), and lower intake of β-carotene (1578.6–1382.7 µg; P trend=0.007), milk, and dairy products (17.8–11.5 g; P trend=0.002). Conclusions Some foods and nutritional factors correlate with an increased number of altered MetS components in Chinese adults. More prospective, multicentre and clinical research work to further examine these associations is underway.

Description: Objective To examine the association between early-life exposure to the Chinese famine and the risk of chronic lung diseases in adulthood. Design Data analysis from a cross-sectional survey. Setting and participants 4135 subjects were enrolled into the study from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2012 baseline survey to analyse the associations between prenatal and early postnatal famine exposure and the risk of chronic lung diseases in adulthood. Main outcome measures Chronic lung diseases were defined based on self-reported information. Results The prevalence of self-reported chronic lung diseases in fetus-exposed, infant-exposed, preschool-exposed, and non-exposed groups was 6.5%, 7.9%, 6.8%, and 6.1%, respectively. The risk of chronic lung diseases in the infant-exposed group was significantly higher (OR 1.95, 95% CI 1.10 to 3.44) than the non-exposed group in severely affected areas, even after adjusting for gender, smoking, and drinking, family economic status, and the highest educational attainment of the parents (OR 2.57, 95% CI 1.26 to 5.25). In addition, after stratification by gender and famine severity, we found that only infant exposure to the severe famine was associated with the elevated risk of chronic lung diseases among male adults (OR 3.16, 95% CI 1.17 to 8.51). Conclusions Severe famine exposure during the period of infancy might increase the risk of chronic lung diseases in male adults.

Description: Background The short-term outcomes and prognostic factors of patients with spinal dural arteriovenous fistulas (SDAVFs) have not been defined in large cohorts. Objective To define the short-term clinical outcomes and prognostic factors in patients with SDAVFs. Methods A prospective cohort of 112 patients with SDAVFs were included consecutively in this study. The patients were serially evaluated with the modified Aminoff and Logue’s Scale (mALS) one day before surgery and at 3 months, 6 months and 12 months after treatment. Univariate and multivariate analyses were performed to identify demographic, clinical and procedural factors related to favourable outcome. Results A total of 94 patients (mean age 53.5 years, 78 were men) met the criteria and are included in the final analyses. Duration of symptom ranged from 0.5 to 66 months (average time period of 12.7 months). The location of SDAVFs was as follows: 31.6% above T7 level, 48.4% between T7 and T12 level (including T7 and T12) and 20.0% below T12 level. A total of 81 patients (86.2%) underwent neurosurgical treatment, 10 patients (10.6%) underwent endovascular treatment, and 3 patients (3.2%) underwent neurosurgical treatment after unsuccessful embolisation. A total of 78 patients demonstrated an improvement in mALS score of one point or greater at 12 months. Preoperative mALS score was associated with clinical improvement after adjusting for age, gender, duration of symptoms, location of fistula and treatment modality using unconditional logistic regression analysis (p〈0.05). Conclusion Approximately four fifths of the patients experienced clinical improvement at 12 months and preoperative mALS was the strongest predictor of clinical improvement in the cohort.

Description: Objective To evaluate the trend of catastrophic health expenses (CHE) for inpatient care in relation to the commencement of the New Cooperative Medical Scheme (NCMS) in rural China from 2003 to 2013, and the roles of NCMS in protecting affected households from CHE. Methods We assessed the 10-year trend of the incidence and severity of CHE in rural households with hospitalised members using data from the Chinese National Health Services Survey. Generalised estimating equations were used to estimate the OR and 95% CI of the association between incidence rates of CHE ( RCHE ) and NCMS reimbursement. Results The incidence and severity of CHE after NCMS reimbursement both decreased and their changes increased rapidly from 2003 to 2013. After adjustment of the covariates, RCHE before reimbursement was significantly higher than that after reimbursement, and the OR (95% CI) was 1.50 (1.24 to 1.81), 1.79 (1.69 to 1.90) and 2.94 (2.77 to 3.11) in 2003, 2008 and 2013, respectively. Conclusion The incidence and severity of CHE both reduced after NCMS reimbursements in each year. Excluding some confounding factors, RCHE was significantly associated with NCMS reimbursement. NCMS partly protected the rural households with hospitalised members from CHE. However, the inequalities between different income groups still existed. RCHE in rural households with hospitalised members was still rather high in 2003, 2008 and 2013 even though they were covered by NCMS. This study will provide suggestions for further reforms in China and guidance for other low-income/middle-income countries.

Description: Objectives To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China. Design Community-based cross-sectional study. Setting Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance. Participants A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis. Outcome measures Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking. Results Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts. Conclusions High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public’s health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.