[Cardiovascular diseases burden attributed to low physical activity in China, 1990-2019]

Objective: To analyze the burden of cardiovascular disease (CVD) attributed to low physical activity (LPA) and its changing trends in China from 1990 to 2019. Methods: On the basis of the province results of the Study of Global Burden of Disease 2019 in China, we described the distribution of CVD death and disability-adjusted life year (DALY) attributed to LPA by sex, age and province. Joinpoint 4.9.1.0 was used to calculate the average annual percentage change. Results: In 2019, the number of CVD deaths and DALY attributed to LPA in people aged ≥25 years were 0.127 million and 1.863 million person-years in China, respectively, The age-standardized mortality rate (ASMR) and standardized DALY rate of CVD attributed to LPA were slightly higher in men than in women, and much higher in ischemic heart disease patients than in ischemic stroke patients. The ASMR (8.85/100 000) and the standardized DALY rate (112.34/100 000) of CVD attributed to LPA in China in 2019 showed no obvious change compared with 1990, while decreased in the last decade. The largest increases in the mortality rate and DALY rate were observed in people aged ≥75 years from 1990 to 2019 (26.89%, 15.61%), but the mortality rate and DALY rate in people aged 60-74 years showed a decreasing trend. The mortality rate and DALY rate in men aged 25- 44 years showed the largest increases (37.50%, 35.49%), while women aged ≥75 years had the largest increases (31.00%, 18.02%). In 2019, the highest ASMR and standardized DALY rate of CVD attributed to LPA were found in Jilin, Inner Mongolia and Hebei. The largest increases were found in Qinghai (182.41%, 154.70%), Gansu (181.29%, 152.77%), and Chongqing (132.01%, 102.79%) and the largest decreases were found in Beijing (59.11%, 62.09%), Macau (41.89%, 39.37%) and Guangdong (36.93%, 40.72%) from 1990 to 2019. Conclusion: The disease burden of CVD attributed to LPA in China was quite high and showed gender, age and area specific differences.

[24 hours urinary sodium and potassium excretion and association with blood pressure among people aged 18-75 years old in six Chinese provinces]

Objective: To analyze the level of sodium and potassium intake and their association with blood pressure among people aged 18 to 75 years old in six provinces. Methods: From October to December 2018, participants aged 18 to 75 years were selected from Hebei, Hunan, Sichuan, Jiangxi, Qinghai and Heilongjiang provinces by using cluster random sampling method. Demographic characteristics and lifestyle information were collected by using questionnaire survey. Physical measurement and 24-hour urine collection were also conducted. Results: A total of 2 636 subjects were finally included in the analysis. The average urine sodium, potassium and sodium-to-potassium molar ratio were(4 438.4±1 822.8)mg/d, (1 566.2±646.3)mg/d, and 5.2±2.2, respectively. According to World Health Organization standards, 94.5% and 98.7% of the respondents had excessive sodium intake and insufficient potassium intake. After adjusting for related factors, each 1 000 mg increase in sodium excretion was associated with increased systolic blood pressure (1.65 mmHg, 95%CI: 1.07, 2.22) and diastolic blood pressure (0.53 mmHg, 95%CI: 0.21, 0.84), and each 1 000 mg increase in potassium excretion was associated with decreased systolic blood pressure (3.02 mmHg, 95%CI:-4.25, -1.80) and diastolic blood pressure (1.27 mmHg, 95%CI:-2.05, -0.48). Conclusion: The sodium intake in Chinese population remains excessive and potassium intake is insufficient. Sodium and potassium could be associated with blood pressure and the intervention of reducing sodium and supplementing potassium should be conducted in the corresponding population.

[Feasibility evaluation of estimating the 24-hour urinary sodium excretion in Chinese population with three spot urine methods]

Objective: To evaluate the feasibility of three spot urine methods (Kawasaki, INTERSALT and Tanaka) for estimating the 24 h urinary sodium excretion in the Chinese population. Methods: In 2017, 1 499 participants aged 18 to 69 years old were selected from Yiwu City, Haining City, Taishun County, Yinzhou District of Ningbo City and Liandu District of Lishui City of Zhejiang Province by using the multistage random sampling method. Sociodemographic information of the subjects was collected with questionnaires and physical measurements were performed. 24 h urine was collected and urinary volume was recorded. The concentrations of urinary sodium, potassium and creatinine were also measured. Kawasaki, INTERSALT and Tanaka spot urine methods were applied to estimate the 24 h urinary sodium excretion and compared with actual values among 1 426 participants who passed urine integrity test. Results: The age of participants was (46.71±14.04) years old, including 700 males, accounting for 49.1%. The actual value of 24 h urinary sodium excretion was (167.10±74.70) mmol, but Kawasaki method overestimated it as (184.61±57.10) mmol, and INTERSALT and Tanaka methods underestimated it as(134.62±39.21) and (143.20±35.66) mmol. Estimated difference (95%CI) (mmol) from small to large was Kawasaki method [17.51 (13.54, 21.47)], Tanaka method [-23.90 (-27.60, -20.20)] and INTERSALT method [-32.48 (-36.29, -28.67)]. With the increase of 24 h sodium intake, all estimation methods changed from the overestimation to underestimation. In those with 24 h sodium intake <9.0 g, the estimated difference (95%CI) of the INTERSALT method was the smallest as 43.15 (37.73, 48.57) and 1.26 (-2.10, 4.63) mmol for <6.0 and 6.0-8.9 g groups, respectively. In those with 24 h sodium intake≥9.0 g, the Kawasaki method had the smallest estimated difference (95%CI) as -12.50 (-18.14, -6.86) and -53.73 (-61.25, -46.22) for 9.0-11.9 g and ≥ 12.0 g group, respectively. The consistency analysis of the Bland-Altman method showed that the Kawasaki method had the best consistency with actual measured value and it had the least number of points outside the range (69 points accounting for 4.84%). Conclusion: Among the three spot urine methods, the Kawasaki method has better applicability in predicting the excretion of 24 h urine sodium in the Chinese population.

[Prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province in 2017]

Objective: To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods: A multi-stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results: The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion: The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

A Comparative Efficacy and Safety Study of Long-Acting Risperidone Injection and Risperidone Oral Tablets Among Hospitalized Patients: 12-Week Randomized, Single-Blind Study

OBJECTIVE

The superiority of risperidone long-acting injection (RLAI) over oral typical and atypical antipsychotics demonstrated in previous studies may be related to the improved drug compliance. The aim of the 12-week randomized, single-blind study was to test whether the superiority of RLAI remained among hospitalized patients that drug compliance could be optimally controlled.

METHODS

Fifty hospitalized stable schizophrenic patients, who had maintained on oral risperidone for more than 3 months, were randomized to the RLAI and oral risperidone group. Finally 49 patients (98 %) completed the study, and no dose change of oral risperidone, or RLAI was noted among all patients.

RESULTS

The RLAI group showed significantly increased positive score of Positive and Negative Syndrome Scale (PANSS) than the risperidone group (0.72 +/- 3.52 vs. -1.24 +/- 3.81, p = 0.022), but without significance difference for the PANSS total, negative and general psychopathology scores. The RLAI group also showed a significantly improved Udvalg for Kliniske Undersogelser (UKU) Scale (p = 0.037), social life domains of Short-Form Health Survey (SF-36) (p = 0.011), and reduced prolactin level (p = 0.001).

CONCLUSION

The results indicated that with optimal controlling of drug compliance among hospitalized patients, RLAI showed no benefit of efficacy over oral risperidone, but with advantages of improved side-effect profiles, social life ratings, and reduced prolactin levels.

Endoscopic screening and determination of p53 and proliferating cell nuclear antigen in esophageal multistage carcinogenesis: a comparative study between high- and low-risk populations in Henan, northern China

The objective of this study was to characterize the histologic changes from endoscopic screening for early esophageal cancer (EC) on subjects at high-incidence area (HIA) and low-incidence area (LIA) in Henan, China, and to further compare the changes in p53 and proliferating cell nuclear antigen (PCNA) in the multistage of human esophageal carcinogenesis from these two populations. The detection rate of basal cell hyperplasia (BCH) and dysplasia (DYS) was higher in the subjects from HIA than in those from LIA. Out of the 1568 symptom-free subjects examined at HIA, 10 (0.6%) cases with early squamous cell carcinoma (SCC) were identified. Immunoreactivity of p53 and PCNA was observed in cell nuclei of esophageal biopsies and surgically resected esophageal cancer specimens both in HIA and LIA. With the lesions progressed from normal epithelium to BCH to DYS to SCC, the positive-immunostaining cells expanded from basal layer to superficial layer, and the number of positive cells/mm2 for p53 and PCNA increased, and was significantly higher in HIA than in LIA among the similar morphological lesions (P < 0.01). The number of p53 positive cells/mm2 in SCC from HIA was almost fivefold higher than SCC from LIA (P < 0.01). The remarkable difference was also observed between HIA and LIA in DYS and BCH. The present results indicate that p53 protein accumulation is an important early biomarker for identifying high-risk subjects for EC.

Therapeutic effect of pirenzepine for clozapine-induced hypersalivation: a randomized, double-blind, placebo-controlled, cross-over study

The objective of this study was to investigate the efficacy of pirenzepine in the treatment of clozapine-induced hypersalivation. Pirenzepine is reported to counteract hypersalivation by its selective antagonistic activity on the M4-muscarinic receptor, which is stimulated by clozapine. Twenty patients with clozapine-induced hypersalivation underwent a random-order, double-blind, placebo-controlled, cross-over trial which lasted 8 weeks each for the pirenzepine and placebo investigations, with a 4-week washout period in between. The severity of hypersalivation was assessed using an objective measure: saliva production monitored through the diameter of wetted surface on tissue paper placed over the patient's pillow. Our study showed that pirenzepine had no significant therapeutic effect on hypersalivation compared with placebo, suggesting that hypersalivation induced by clozapine might have a neurobiological basis other than the M4-muscarinic receptor.

Emerging homosexual conduct during hospitalization among chronic schizophrenia patients

OBJECTIVE

The study investigated the emerging homosexual conduct during hospitalization among chronic schizophrenia patients.

METHOD

We interviewed 55 male and 58 female chronic schizophrenic patients to investigate their sexual history before and after admission. Those patients were under 45 years old, without significant deteriorated cognitive function, lived in a homogeneous gender chronic ward and did not demonstrate homosexual behaviour before admission.

RESULTS

Nineteen patients (16.8%) reported having homosexual conducts during hospitalization. Their characteristics were: 1) having sexual experience before admission; 2) with younger age at first sexual experience; and 3) female patients having more sexual partners before admission.

CONCLUSION

A significant proportion of patients need a sexual outlet during long-term hospitalization. Sexual education and counselling are greatly needed.

No evidence for association of alpha 1a adrenoceptor gene polymorphism and clozapine-induced urinary incontinence

Clozapine is an effective atypical antipsychotic that has high affinity for many neurotransmitter receptors. Among the adverse effects of clozapine, urinary incontinence is commonly found and is suggested to be caused by alpha-adrenergic blockade. We tested the hypothesis that clozapine-induced urinary incontinence is related to a genetic variant of the alpha(1a)-adrenoceptor. We also tested whether the alpha(1a)-receptor gene confers susceptibility to schizophrenic disorders. Our result indicated that the alpha(1a)-adrenoceptor gene polymorphism investigated plays no major role in the pathogenesis of schizophrenia or in clozapine-induced urinary incontinence. Considering the superior effects of clozapine and its potent adrenergic antagonistic effects, it is of interest to investigate the association between this polymorphism and the treatment response.

Apolipoprotein E genotype and schizophrenia

Schizophrenic disorders are complex genetic disorders and may involve multiple genes of small effect. The presence of apolipoprotein E (apoE) is associated with several neuropsychiatric disorders. Previous studies on apoE genotype distribution in schizophrenia have reported conflicting findings. We studied the genotype frequencies in a large group of schizophrenic patients. The genotype distribution was significantly different between the schizophrenic patients and the control subjects. Persons who were sigma3 carriers have an increased risk of schizophrenia. This result suggests that apoE isoforms may play a functional role in the pathogenesis of schizophrenic disorders. Some possible mechanisms regarding the effect of apoE on the development of schizophrenia are discussed.

No association between an intronic presenilin-1 gene polymorphism and schizophrenia in a Chinese population

We investigated the association between schizophrenic psychosis and an intronic polymorphism of the presenilin-1 (PS1) gene in a Chinese population. Schizophrenic and control groups had similar PS1 genotype distributions and allele frequencies, indicating that this polymorphism may not be involved in the development of schizophrenia.

Alpha-1-antichymotrypsin polymorphism in schizophrenia: frequency, age at onset and cognitive function

A common polymorphism in the alpha1-antichymotrypsin (ACT) gene is associated with Alzheimer's disease. ACT is also a trophic factor in the hippocampal neurons. In order to examine if the ACT gene plays a role in the pathogenesis of schizophrenic disorders, patients (n = 175) and control subjects (n = 114) were genotyped for ACT. We also investigated the relationship between genotypes and patients' cognitive function as evaluated by the Clinical Dementia Rating Scale and the Mini-Mental State Examination. The results demonstrated no association between schizophrenia and/or cognitive deficit in schizophrenia and ACT polymorphism. The data suggest that the ACT gene is not of major importance for the genesis of schizophrenia. Further studies measuring ACT expression as messenger RNA or serum ACT level may help to exclude the role of ACT in the pathogenesis of schizophrenia.

A retrospective study of clozapine and urinary incontinence in Chinese in-patients

OBJECTIVE

This study investigated the incidence of clozapine-associated urinary incontinence (UI) in schizophrenic patients, the percentage of these patients with persistent urinary incontinence (PUI), and the possible factors affecting the occurrence of UI.

METHOD

A total of 61 Chinese in-patients with schizophrenia (according to DSM-IV) treated with clozapine for more than 3 months were assessed retrospectively for the occurrence of UI. Patients who still had UI at the time of assessment were classified as having PUI. Patients whose UI had resolved at the time of assessment were classified as having self-limited urinary incontinence (SUI). We compared the characteristics of UI and non-UI cases and of PUI and SUI cases.

RESULTS

The results showed that urinary incontinence developed at some time in 27 of 61 patients (44.3%), and that it was persistent in 15 of 61 patients (25%). There were no statistically significant differences in age, sex, clozapine dose, duration of clozapine use, duration of index admission, duration of illness, age at onset of schizophrenia, or concurrent treatment with other psychiatric medications between the UI and non-UI groups and between the PUI and SUI groups.

CONCLUSION

Clozapine-associated urinary incontinence may be persistent in some patients, and it should be cautiously monitored in every patient taking clozapine.

Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese

An assessment of potential risk factors for substance use disorders was performed in 49 patients with major affective disorders in a general hospital acute care unit in Taiwan. The major depression patients were noted to have a higher prevalence of substance use disorder than bipolar disorder patients (p = 0.011). Those patients with substance use disorders were noted to be significantly male-predominated (p = 0.043), to have a later onset age of affective disorder (p = 0.009), and to have more visits to the emergency room in the recent one year (p = 0.009). The sedatives-hypnotics-anxiolytics was the most frequently used forms of drug abuse. The major depression patients had a significantly higher sedative-hypnotics-anxiolytics use disorder rate than the bipolar disorder patients (p = 0.001). All patients with alcohol use disorder were noted to have other substance use disorders as well. Fifty six percent of those patients with substance use disorder were polysubstance users. Eighty three percent of the male patients with substance use disorder had poly-substance use disorder.

Substance use disorders among inpatients with bipolar disorder and major depressive disorder in a general hospital

The prevalence and type of substance abuse and dependence were determined for 49 patients with mood disorders on a general hospital psychiatric unit. A standardized diagnostic interview was conducted with a high value of inter-rater reliability. This study found that 18.4% of mood disorder inpatients met the diagnostic criteria for psychoactive substance use disorders by DSM-III-R. Sedatives-hypnotics-anxiolytics was the most common substance use disorder (10.2%), followed by alcohol (6.1%). Patients with major depression had a higher rate of comorbidity with substance use disorders than did the bipolar disorder patients (p = 0.011). The prevalence of sedatives-hypnotics-anxiolytics use disorder among major depression patients was 35.7%, which was higher than that among bipolar disorder patients (0%). Male patients had a significantly higher percentage of substance use disorders than did female patients (p = 0.054). Seventy-seven percent of the patients with a dual diagnosis of mood and substance use disorder were not diagnosed as having substance use disorders by psychiatrists in charge.

Risk factors for parasuicide among psychiatric inpatients

To improve suicide prevention during hospitalization, this study examined risk factors for parasuicide among psychiatric inpatients. A group of 58 psychiatric inpatients (19 with schizophrenia, 20 with depression, and 19 with other diagnoses) who displayed suicidal behavior during hospitalization were compared with two control groups of nonparasuicidal inpatients. For inpatients with schizophrenia, a history of parasuicide was a risk factor; for those with depression, it was suicidal behavior on admission; and for patients with other diagnoses, it was violence during hospitalization.

Suicide and parasuicide in psychiatric inpatients: ten years experience at a general hospital in Taiwan

We investigated 64 suicidal acts of 62 psychiatric inpatients over a 10-yr. period. The findings indicated the frequency of suicidal behavior of psychiatric inpatients was 0.91% of total admissions, two thirds of the patients who attempted suicide were diagnosed with schizophrenia or depression, and patients suffering from depression, substance abuse, and personality disorders had a higher parasuicide rate, among whom those diagnosed bipolar disorder with depressive episode had an extremely high parasuicide rate. Most of the incidents occurred in concealed places, and most of the patients used nonviolent methods. About half of the incidents occurred during the evening shift and depressed patients tended to attempt suicide during the night shift. Most suicidal attempts were unsuccessful and led to minor injury. There were two deaths.