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1. Study on Normal Level of Blood Pressure and Diagnostic Criteria for Hypertension in Adult Women #br#
XU Chun-qi,SHANG Ya-dong,CHENG Ren-li,WANG Ai-hong,YOU Jia-cong,ZHONG Ping
Chinese General Practice    2018, 21 (26): 3170-3174.   DOI: 10.12114/j.issn.1007-9572.2018.00.157
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Objective To investigate the diagnostic criteria for hypertension in women and understand their normal blood pressure level by comparing the gender differences in blood pressure.Methods Women at the age of 18-20,21-30,31-40,41-50,51-60,and over 61 years from five villages in Suzhou,Anhui Province,who voluntarily went to the local clinic for examination were selected from May to December 2016,each age group with 150 cases via convenient sampling methods.The same number of male adults of the same age range in each village were enrolled by using the same sampling method and screening criteria.Blood pressure was measured by using a bench-top mercury sphygmomanometer,ventricular septal and/or left posterior wall thickening measured by echocardiography,and left ventricular high voltage and/or left axis deviation measured by electrocardiogram.Results Except for 51-60 years group,the SBP and DBP of women were significantly lower than that of men (P<0.05).The proportion of women in 18-20 years,21-30 years,31-40 years groups whose blood pressure were <90/60 mm Hg (1 mm Hg=0.133 kPa)was higher than that of men (P<0.05).In people whose blood pressure were <90/60 mm Hg,SBP and DBP of female were (85.6±2.4) mm Hg,(55.4±1.0) mm Hg,and SBP and DBP of male were (87.9
±2.4) mm Hg,(58.7±0.7) mm Hg,respectively,and there was a statistically significant difference (t=-2.947,-10.694,P<0.05).There was no significant difference in the ratio of people whose blood pressure were ≥140/90 mm Hg,120-139/80-89 mm Hg between men and women in all age groups (P>0.05).In women with blood pressure of 120-139/80-89 mm Hg,incidence of symptoms such as headache,dizziness,palpitation,chest tightness,ventricular septal and/or left posterior wall thickening,and left ventricular high voltage and/or left axis deviation were higher than those of men (P<0.05).Conclusion There may be differences in normal blood pressure level and diagnostic criteria for hypertension in different gender.Normal blood pressure level in women maybe lower than that in men.Normal SBP and DBP in women may be 85-120 mm Hg,55-80 mm Hg,respectively.Female whose blood pressure are higher than 120/80 mm Hg may have hypertension.
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2. Age-Period-Cohort Analysis of Trends of Breast Cancer Incidence and Mortality among Chinese Females from 1990 to 2019
LIU Xuewei, WANG Yuan, WEI Danmei, LU Wenli
Chinese General Practice    2023, 26 (01): 34-41.   DOI: 10.12114/j.issn.1007-9572.2022.0619
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Background

Breast cancer is the leading cause of death among women worldwide, characterized by high incidence and heavy disease burden.

Objective

To assess the secular trend of breast cancer incidence and mortality in Chinese females from 1990 to 2019.

Methods

The data on breast cancer incidence and mortality in Chinese females aged ≥15 years from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019. The Bayesian age-period-cohort (APC) model was used to fit breast cancer incidence and mortality trends during 1990—2019 to assess the effects of age, period and cohort on breast cancer incidence and mortality.

Results

The crude incidence of breast cancer among Chinese females increased from 14.14/100 000 to 52.81/100 000, and the crude mortality increased from 7.22/100 000 to 13.40/100 000 during 1990—2019.The standardized incidence of breast cancer showed an increasing trend in general (17.07/100 000 in 1990, 35.61/100 000 in 2019) , while the standardized breast cancer mortality was basically stable (9.16/100 000 in 1990, 8.98/100 000 in 2019) .The results of the APC model showed that the average net drift value of breast cancer incidence in females of all age groups was 2.58%〔95%CI (2.34%, 2.83%) 〕, and the highest value of local drift was 3.46%〔95%CI (3.11%, 3.80%) 〕 in the 65-69 years old group. The average net drift value of mortality was -0.75%〔95%CI (-1.09%, -0.41%) 〕. The local drift value was stable in 15-44-year-olds, and was above 0 in age groups above 60 years old. The incidence and mortality of breast cancer increased with age. The period effect of incidence showed an increasing trend (RR: 0.79-1.47) , while the period effect of mortality showed a decreasing trend (RR: 1.08-0.90) when the period of 2000—2004 was set as the control group. The cohort effect of breast cancer incidence increased (RR: 0.27-2.48) , and the cohort effect of breast cancer mortality risk increased firstly and decreased after then (RR: 0.78-1.06-0.44) when the cohort of 1955—1959 was set as the control group.

Conclusion

The incidence and mortality of breast cancer in Chinese females increased continuously from 1990 to 2019, which was dominantly influenced by age and cohort.

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3. Consensus on Health Management of Climacteric Women in Primary Medical Institutions Edition 
Chinese Medical Doctor Association (CMDA)'s General Practitioners Sub-association,The Primary Care Branch of Beijing Institute of Obstetrics & Gynecology
Chinese General Practice    2021, 24 (11): 1317-1324.   DOI: 10.12114/j.issn.1007-9572.2021.00.402
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In order to standardize the health management of climacteric women in primary medical institutions,identify and intervene menopausal related problems positively at early stage to reduce menopausal related health problems and lay the foundation for health in old age.Experts from the Community and Primary Branch of the Beijing Obstetrics and Gynecology Association formulated the “Consensus on climacteric Women's Health Management in primary medical institutions edition” based on evidence-based medical evidence,the status quo of primary medical institutions,and relevant guidelines for menopausal management.The health management of climacteric women mainly includes the establishment of health records,systematic health education,regular health examinations,general health guidance and drug treatment,etc.The issuance of this consensus is of great significance to improve the health management of climacteric women in primary medical institutions.
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4. A Newly Discovered Disease Affecting Women's Physical and Mental Health: Research Status and Expert Consensus Interpretation of Persistent Genital Arousal Disorder
ZHANG Yunxu, WANG Tingting, WEI Junling, XING Yanyun, SU Li
Chinese General Practice    2023, 26 (23): 2830-2835.   DOI: 10.12114/j.issn.1007-9572.2022.0815
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Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) are jointly known as PGAD/GPD, which is a newly discovered condition in recent years, featured by spontaneous or secondary persistent genital arousal and/or dysesthesia in the genital and pelvic areas. PGAD/GPD mainly affects women, which can seriously influence the physical and mental health of the sufferers due to the specificity of its symptoms. Most patients have anxiety, depression, and even the suicidal tendency. The medical community abroad has paid attention to PGAD/GPD, and included it in the International Classification of Diseases-11th Revision (ICD-11) . Given the fact that this newly discovered condition is under-recognized among domestic health providers at present, we summarized the current research on PGAD/GPD abroad and introduced the epidemiological characteristics, pathophysiological mechanisms, diagnosis and treatment methods of PGAD/GPD based on the review of the latest expert consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) , and discussed the future research direction of PGAD/GPD and the coping strategies that should be taken by the domestic medical community, with a view to arousing medical workers' attention to the disease in China.

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5.

Ovarian Cancer in ChinaTrends in Incidence and Mortality20052016

HUANG Haitao, CHEN Shuyu, GENG Xu, WAN Xiao, JIA Ruiying, LIANG Dandan, CHEN Chaoran
Chinese General Practice    2022, 25 (08): 990-994.   DOI: 10.12114/j.issn.1007-9572.2021.01.606
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Background

The health impairment caused by ovarian cancer in female population has become a global focus. However, there is a lack of research on ovarian cancer incidence and mortality trends in Chinese female population.

Objective

To describe the trends of ovarian cancer incidence and mortality in China from 2005 to 2016 by analyzing the incidence and death data of ovarian cancer collected from Chinese Cancer Registry Annual Report, providing a basis for the scientific prevention and control of ovarian cancer in China.

Methods

The incidence and mortality of ovarian cancer in China during 2005 to 2016 were collected and input into Excel spreadsheets, then the annual age-standardized incidence rate, age-standardized mortality rate, age-specific incidence rate and age-specific mortality rate were computed. Joinpoint Regression Program was used to estimate the annual percentage change (APC) , and average annual percentage change (AAPC) to analyze the temporal trends of annual ovarian cancer incidence and mortality rates.

Results

The incidence rate of ovarian cancer showed a trend of rapid increase over the period of 2005 to 2016 (AAPC=7.25%, P<0.05) . The annual age-standardized ovarian cancer incidence rate in urban areas was higher than that in rural areas in each year. The ovarian cancer incidence rate increased obviously with age in women over the age of 35, and peaked in those aged 55 years old. From 2005 to 2016, the overall ovarian cancer mortality rate showed a rapid upward trend (AAPC=6.06%, P<0.05) . The age-standardized ovarian cancer mortality rate in urban areas was higher than that in rural areas. The mortality rate increased rapidly with age in women over 35 years of age, but decreased gradually in those aged over 75 years.

Conclusion

Both ovarian cancer incidence and mortality rates during 2005 to 2016 in China increased rapidly, but with age-specific and urban-rural differences. Therefore, targeted interventions should be taken, and strategies for ovarian cancer prevention and treatment should be developed to reduce the risk of ovarian cancer.

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6. Menopause or Chronologic Aging? A Prospective Cohort Study on Risk Factors for Coronary Heart Disease in Middle-aged Women
YANG Mukun, JIA Xiaoxiang, REN Zhenghong, GU Bei, BAI Wenpei
Chinese General Practice    2024, 27 (03): 280-285.   DOI: 10.12114/j.issn.1007-9572.2023.0306
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Background

Menopause will cause series of pathophysiologic changes and long-term complications (coronary heart disease, cerebrovascular disease, osteoporosis, etc.), among which coronary heart disease is a major health threat.

Objective

To investigate the effects of menopausal status and aging on common risk factors for coronary heart disease (CHD) in middle-aged women, such as increased carotid intima-media thickness (CIMT), hypertension, dyslipidemia, diabetes, and obesity.

Methods

A total of 556 healthy premenopausal women aged 45 to 54 years who received regular physical examinations at the physical examination center of Beijing Shijitan Hospital affiliated to Capital Medical University in 2018 were initially selected, with 89 excluded according to relevant criteria, and 467 women were finally included as study subjects. The included subjects were divided into the pre-menopausal group (n=176) and postmenopausal group (n=291) according to whether they were postmenopausal during a 3-year follow-up period. Changes in BMI, waist circumference, blood glucose, blood pressure, blood lipids and other indicators were monitored, inter- and intra-group comparisons were performed before and after the follow-up period. Multivariate Logistic regression analysis was used to explore the effects of menopausal status and age on the incidence of risk factors for coronary heart disease in middle-aged women.

Results

The average age of 467 subjects was (47.6±2.3) years old. Compared with baseline, waist circumference, uric acid (UA), total cholesterol (TC), triglyceride (TG), and low density lipoprotein cholesterol (LDL-C) levels increased, fasting blood glucose (FBG) level decreased after 3 years (P<0.05). The results of inter-group comparison showed that there was no significant difference in waist circumference, BMI, TG, FBG and high density lipoprotein cholesterol (HDL-C) levels between the two groups after three years (P<0.05) ; the levels of UA, TC and LDL-C in the menopausal group were higher than those in the pre-menopausal group, and the difference was statistically significant (P<0.05). The results of intra-group comparison showed that the waist circumference in the two groups after 3 years was higher than baseline (P<0.05) ; the levels of UA, TC and TG in the pre-menopausal group after 3 years were higher than the baseline (P<0.05) ; the levels of UA, TC, TG and LDL-C in the postmenopausal group after 3 years were higher than the baseline (P<0.05). Multivariate Logistic regression analysis showed that age ≥50 years old was a high-risk factor for increased CIMT in middle-aged women (OR=2.475, 95%CI=1.049-5.838, P=0.038) .

Conclusion

The changes in waist circumference and TG in middle-aged women are mainly affected by age, the changes of LDL-C are mainly affected by menopausal status, and the changes of TC and UA are affected by both menopausal status and increased age. Age ≥50 years is a high risk factor for increased CIMT in middle-aged women, and the changes of metabolic indicators such as UA, TC and LDL-C precede changes in CIMT after menopause.

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7. Incidence of Perimenopausal Syndrome in Chinese Women Aged 40 to 65 Years: a Meta-analysis
JIA Yu, ZHOU Zitong, CAO Xuehua, HU Wanqin, XIANG Feng, XIONG Langyu, WANG Xiaoxia
Chinese General Practice    2023, 26 (32): 4080-4088.   DOI: 10.12114/j.issn.1007-9572.2023.0303
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Background

With the rapid development of economy and society in China, the living standards and health care awareness have been improved significantly, the average life expectancy of our population is gradually prolonged, causing increasing population of perimenopausal women, therefore, the health management of perimenopausal women has become more important. Perimenopausal syndrome can be seen in women aged 40-65 years, which can seriously affect the physical and mental health and quality of life of patients.

Objective

To systematically review the incidence of perimenopausal syndrome in Chinese women aged 40-65 years.

Methods

PubMed, Embase, Web of Science, CNKI, Wanfang Data, CBM and VIP were searched by computer to collect cross-sectional studies on the occurrence of perimenopausal syndrome in Chinese women aged 40-65 years from inception to February 1, 2023. Two investigators independently screened the literature, extracted data and evaluated the quality of included literature. Meta-analysis was performed using Stata 17.0 software.

Results

A total of 62 cross-sectional studies were included, with a total sample size of 82 340 cases. Meta-analysis showed that the incidence of perimenopausal syndrome in Chinese women aged 40-65 years was 61.0%. The results of subgroup analysis showed that the incidence of perimenopausal syndrome in women aged 40-45 years, >45-50 years, >50-55 years, >55-60 years and >60 years was 42.6%, 53.8%, 64.6%, 59.7% and 56.1%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with normal, disordered and postmenopausal menstrual status was 43.6%, 56.9% and 61.3%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with and without chronic diseases was 85.9% and 68.3%, respectively. The incidence of perimenopausal syndrome was highest in women aged 40-65 years in Southwest China at 71.3%, and at 57.4%, 57.9%, 50.5%, 59.2%, 69.5%, and 68.6% in North, East, South, Northwest, Northeast, and Central China, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with education level of junior high school and below, high school or technical secondary school, university and above was 54.1%, 55.7% and 49.6%, respectively. The incidence of perimenopausal syndrome in Han Chinese and ethnic minority women aged 40-65 years was 62.1% and 64.7%, respectively.

Conclusion

The incidence of perimenopausal syndrome is high in women aged 40 to 65 years in China. Among them, women aged >50-55 years, menopausal, suffering from chronic diseases, living in southwest region, with education level of high school or below, and ethnic minorities are at high risk of perimenopausal syndrome. We should pay attention to the prevention, screening and intervention of perimenopausal syndrome in relevant population to lay the foundation of elderly health in women.

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8. Establishment of a Reference Range for AMH and Correlation between AMH and Cardiovascular Risk Factors in Healthy Women of Reproductive Age in Urumqi
Zynat JAZYRA·, Kaidi ZHANG, Fuhui MA, Danyang DU, Lingling DONG, Yan HENG, Xiaoyuan MA, Yanying GUO
Chinese General Practice    2022, 25 (22): 2740-2745.   DOI: 10.12114/j.issn.1007-9572.2022.0200
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Background

In the social situation of "three child" policy opening and late marriage to become the norm, the topic of female reproduction and health has attracted increasing attention. As one of the important markers of ovarian reserve in women, the relationship between anti-Mullerian hormone (AMH) and cardiovascular disease and cardiovascular risk indicators has become a hot research issue.

Objective

To establish a reference range of AMH in healthy women of reproductive age in Urumqi region, and to investigate the association between AMH and risk factors associated with cardiovascular disease.

Methods

From May to July 2018, healthy women aged 19-50 years who met the criteria were selected from the natural population of a community-based epidemiological survey with four living residents area in Urumqi city by targeted sampling, and the serum AMH, fasting plasma glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglyceride (TG), serum uric acid, and thyroid stimulating hormone (TSH) levels of the survey subjects were tested. Height, body mass, abdominal circumference, hip circumference, blood pressure, and other indicators were measured to analyze the relationship between AMH and the above indicators related to cardiovascular risk factors.

Results

The median AMH among 855 healthy women of reproductive age was 1.58 (0.01, 8.78) μg/L. The reference range of AMH in healthy women of reproductive age in our region was established, that was, 0.89 to 10.94μg/L for 19-24 years old, 0.66 to 11.77 μg/L for 25-29 years old, 0.27 to 8.25μg/L for 30-34 years old, 0.01 to 6.87μg/L for 35-39 years old, 0.01 to 3.98μg/L for 40-44 years old, <0.01-1.87μg/L for 45-50 years old. Spearman correlation analysis showed that AMH was negatively correlated with age, body fat index (BMI), abdominal circumference, hip circumference, systolic blood pressure, diastolic blood pressure, TSH, TC, LDL-C (P<0.05), but not with blood glucose, TG, HDL-C, uric acid (P>0.05) .

Conclusion

In this study, the reference range of serum AMH in healthy women of reproductive age in Urumqi was established, which may provide a basis for the functional assessment of ovarian reserve in women of different ages. Low AMH levels in women of reproductive age are associated with cardiovascular risk factors such as increased age, obesity, abdominal obesity, hypertension, and hyperlipidemia.

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9. Association of Sleep Duration on the Prevalence of H-type Hypertension in Female Population
DU Shihong, HONG Xiuqin, YANG Yi, XIE Rong, ZHANG Yannan
Chinese General Practice    2023, 26 (01): 58-63.   DOI: 10.12114/j.issn.1007-9572.2022.0613
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Background

Sleep duration is strongly associated with hypertension, but its effect on H-type hypertension in female population is not well characterized.

Objective

The examine the effect of sleep duration on the prevalence of H-type hypertension in female population.

Methods

A cross-sectional study design was used. One thousand seven hundred and nine female hypertensive inpatients were selected from Department of General Medicine and Geriatric Department of Hunan Provincial People's Hospital from July 2018 to December 2020, among whom those who with serum Hcy≥10 μmol/L and the others were assigned into H-type hypertension and non-H-type hypertension groups, respectively. Binary Logistic regression was used to assess the correlation of between sleep duration and H-type hypertension across three groups with different self-reported mean daily sleep durations in the past month (<7 h, 7-8 h, and >8 h) , and to further assess the correlation between the two across by age (≤60 and >60) .

Results

The distribution of age, education level and marital status differed across three groups with different daily sleep durations (P<0.05) . 901 (52.72%) with daily sleep duration of <7 h, 697 (40.78%) with daily sleep duration of 7-8 h, and 111 (6.50%) with daily sleep duration of >8 h. The distribution of age, education level, living area (urban or rural) , marital status, BMI, exercise status, and daily sleep duration, as well as prevalence of drinking between H-type hypertension group〔973 (56.93%) 〕 and non-H-type hypertension group〔736 (43.07%) 〕 (P<0.05) . The risk of H-type hypertension in those with <7 h of daily sleep duration was 1.291 times higher than that in those with 7-8 h of daily sleep duration〔95%CI (1.032, 1.615) , P<0.05〕after adjusting for confounding factors such as age, education level, living area, marital status, BMI and exercise status. Further analysis revealed that <7 h of daily sleep duration was associated with increased risk of H-type hypertension only in those aged greater than 60 years〔OR (95%CI) =1.421 (1.021, 1.978) , P<0.05〕.

Conclusion

Less than 7 h of daily sleep duration was a risk factor for H-type hypertension in female over 60 years old. In view of this, it is suggested to put more attention to sleep health to improve blood pressure in this group.

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10. Problems and Countermeasures in the Implementation of National Cervical and Breast Screening Program for Women in Rural Areas 
HUANG Jing,YANG Xianghong,LIU Ai,ZHOU Wenjuan
Chinese General Practice    2020, 23 (13): 1680-1686.   DOI: 10.12114/j.issn.1007-9572.2019.00.509
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Cervical cancer and breast cancer are two most common malignant tumors among Chinese women,which seriously damage their health.To reduce the morbidity and mortality of cervical and breast cancer,China launched the national cervical and breast cancer screening program in 2009,and promotes the screening actively,and the screening becomes available at the national level from 2016 onwards.Based on the field survey of the implementation of the "two cancer screening" project in the rural areas of a city in Hunan Province from 2016 to 2017,this paper summarizes the problems in the implementation of the project as follows:some rural women lack knowledge and social support of "two cancer";geographical traffic factors,screening time and place arrangement,distrust of medical institutions affect women's participation in screening;some areas lack of screening atmosphere.It is proposed that in order to promote the development of this work,village doctors should take part in the launch,multiple means of repeated propaganda and stimulation,inform the screening results on the spot and timely return the follow-up results,and avoid recommending unnecessary follow-up services.
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11. Influencing Factors of Benign Breast Nodules Growth in Women 
FAN Na,GAO Ying,WEI Wei,LI Shu,TAO Fengran,JIANG Yunwen,ZHANG Qing
Chinese General Practice    2021, 24 (30): 3799-3805.   DOI: 10.12114/j.issn.1007-9572.2021.02.003
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Background The incidence of benign breast nodules is increasing in recent years,but studies about the factors affecting the growth of benign breast nodules measured by ultrasound(BI-RADS 2 or 3) are very limited. Objective To identify factors associated with the growth of benign breast nodules. Methods A total of 1 399 women with newly detected benign breast nodules by annual ultrasound screening for breast were selected from Health Management Center of Tianjin Medical University General Hospital between January 2013 and January 2019. Basic demographics,blood lipids,blood glucose,tumor markers and routine blood parameters were analyzed. Ultrasonic imaging characteristics such as the location,number,size,echo,composition,margin,morphology,calcification,blood flow,ductal dilatation,and presence of nodules in the contralateral breast were analyzed at baseline and during follow-up. Multivariate Cox proportional hazards model was used to identify the factors associated with the growth of benign breast nodules. Results The mean age of the participants was (45.7±9.3)years,and the median follow-up time was 1.08 years. Up to the study's completion time,654 cases (46.7%) showed an increase in the diameter of the nodules measured by ultrasound. Multivariate Cox proportional hazards regression analysis results revealed that,age <50 years old 〔HR=1.25,95%CI(1.05,1.50)〕,platelet count >252×109/L 〔HR=1.19,95%CI(1.01,1.40)〕,maximum diameter of nodules <8 mm 〔HR=1.62,95%CI(1.35,1.95)〕,and multiple nodules〔HR=1.23,95%CI(1.03,1.47)〕 were all independent risk factors for the growth of benign breast nodules. Conclusion Increased risk of growth of benign breast nodules in women was independently associated with younger age,elevated platelet count,smaller maximum diameter of breast nodules initially measured by ultrasound,and prevalence of multiple nodules. Therefore,clinical priority should be given to the monitoring of breast nodules and shorten the follow-up interval in female individuals with one of the above-mentioned risk factors,to achieve timely control and effective management of nodules.
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12. Risk Factors for Breast Cancer-related Lymphedema in Chinese Women:a Meta-analysis 
ZHANG Hao,LIU Ruirui,ZHU Lin,BO Dingxi,ZHONG Yizhu,LIANG Yun,GAO Jing
Chinese General Practice    2021, 24 (26): 3349-3358.   DOI: 10.12114/j.issn.1007-9572.2021.01.206
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Background Breast cancer-related lymphedema (BCRL)is the most common postoperative complication of breast cancer,which cannot be cured clinically at present. Early identification of the risk factors for BCRL may improve the outcome significantly,yet it is still controversial in existing relevant studies,and there is no relevant systematic review in China. Objective To systematically evaluate the risk factors for BCRL in Chinese women. Methods We searched the databases of CINAHL,PubMed,EMBase,Web of Science,The Cochrane Library,CNKI,CQVIP,Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria,extracted data 〔including the first author,time of publication,type of studies,sample size,measurement methods for edema,degree of edema,follow-up time,and BCRL-related factors(age,BMI,hypertension prevalence,lymph node metastasis prevalence,scope of axillary lymph node dissection,having a lymph node dissection,number of lymph nodes dissected,postoperative healing complication,chemotherapy,radiation therapy)〕,and performed risk of bias assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results 31 studies involving 2 618 subjects were included,with moderate or high methodological quality. Meta-analysis showed that older age〔OR=2.59,95%CI(1.95,3.45),P<0.000 01〕,increased BMI〔OR=2.33,95%CI(1.91,2.85),P<0.000 01〕,hypertension〔OR=4.76,95%CI(2.53,8.94),P<0.000 01〕,lymph node metastasis〔OR=1.22,95%CI(1.06,1.39),P=0.005〕,extended axillary lymph node dissection〔OR=2.30,95%CI(1.88,2.81),P<0.000 01〕,having a lymph node dissection〔OR=8.29,95%CI(2.32,29.60),P=0.001〕,number of dissected lymph nodes ≥15〔OR=1.12,95%CI(1.06,1.19),P<0.000 1〕,postoperative healing complication〔OR=4.11,95%CI(3.26,5.17),P<0.000 01〕,chemotherapy〔OR=3.17,95%CI(2.16,4.63),P<0.000 01〕,radiation therapy〔OR=2.69,95%CI(2.32,3.13),P<0.000 01〕were risk factors of BCRL. Conclusion BCRL among Chinese women may be associated with various risk factors,such as age>40,BMI≥24 kg/m2,hypertension,lymph node metastasis,extended axillary lymph node dissection,having a lymph node dissection,number of dissected axillary lymph nodes ≥15,postoperative healing complication,chemotherapy,and radiation therapy. Due to limited quality and quantity of the included studies,more large-sample prospective cohort studies are required to verify the above conclusion.
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13. Prevalence and Associated Factors of Depression among Middle-aged and Elderly Women 
YE Haichun, YAN Yajie, WANG Quan
Chinese General Practice    2021, 24 (36): 4574-4579.   DOI: 10.12114/j.issn.1007-9572.2021.02.053
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Prevalence and Associated Factors of Depression among Middle-aged and Elderly Women
YE Haichun1, YAN Yajie2,3, WANG Quan2, 3*
1.School of Nursing, Shandong Xiehe University, Jinan 250109, China
2.School of Health Sciences, Wuhan University, Wuhan 430071, China
3.Global Health Institute, Wuhan University, Wuhan 430072, China
*Corresponding author: WANG Quan, Associate professor, Master supervisor. E-mail: wangquan73@whu.edu.cn
【Abstract】Background Depression is a common mental illness threatening physical and psychological health of middle-aged and elderly people. However, there are few large-scale studies focusing on depression and its influencing factors in middle-aged and elderly Chinese women. Objective To investigate the depression prevalence and associated factors in middle-agedand elderly Chinese women, providing evidence for exploring mental health and effective interventions in this population.Methods This study was conducted from January to March 2021. Data were obtained from the China Health and RetirementLongitudinal Study (CHARLS), involving 7963 women at age 45 or over, including demographic characteristics, physicalhealth status, socio-economic features, life satisfaction, regional distribution(eastern, central or western China), and depressive prevalence assessed by the 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). The score of CES-D-10 ≥ 10 was considered as depressive symptoms. Robust OLS regression, robust Tobit regression and robust Logit regression were used to identify associated factors of depressive symptoms. Results The median CES-D-10 score of the participants was 8(4, 14)points. Except for 4490 cases(56.39%), the remaining 3473 cases (43.61%) were found with depressive symptoms, including1715(41.52%) aged 45-59 years, and 1758(45.88%) aged 60 or over. Analyses using three regression models indicated that age and age squared(OR=1.099, 0.999), education level (OR=0.897), living in rural or urban areas (OR=0.731), self-rated health (OR=1.245), physical disability (OR=1.332), chronic disease (OR=1.172), troubled with body pains(OR=1.579), BADL (activities of daily living) disability(OR=1.734), IADL(instrumental activities of daily living) disability(OR=1.967), living with spouse(partner)or not(OR=0.763), number of children(OR=1.074), using the internet or not(OR=0.773), having care support or not when needed (OR=1.509), having debt(OR=1.017), life satisfaction (OR=2.150), and regional distribution (OR=1.275) were associated with depression(P<0.05). Conclusion According to the data analysis of this study, the prevalence of depressive symptoms among middle-aged and elderly Chinese women was high, accounting for more than 40%. To control and prevent depressive symptoms to improve mental health status in this population, it is suggested to improve their education level, physical health status, family relations and life satisfaction, reduce their debt-financed consumption, and to offer them more ways to access information, and more social support, as well as to promote urbanization.
【Key words】 Depression; Middle aged; Aged; Femininity; China Health and Retirement Longitudinal Survey; Root cause analysis
Studies have shown that depression, as a common psychological disorder among middle-aged and elderly people, can contribute to a high risk of self-harm and suicide [1-2], as well as the risk of cognitive dysfunction and senile dementia [3], which not only reduces the quality of life of middle-aged and elderly people, but a big contributor to the family economic burden and national medical and health resources burden [4]. A great deal of research indicating that there is a gender gap in depression, which is more common in middle-aged and elderly women [5-7].The transition of family identity of middle-aged womenis highly consistent with the China's reform and opening up, the transition period of family and social ethics, and they are more adversely affected in life and psychology.Therefore, it is of great practical importance to understand the mental health status of middle-aged and elderly women in China, especially to explore as many influencing factors as possible.Given this, the study used the 2018 survey data of the China Health and Retirement Longitudinal Survey (CHARLS) to analyze prevalence and associated factors of depression in middle-aged and elderly Chinese women, providing evidence for exploring mental health and effective interventions in this population.
1.Objectivesand Methods
1.1. Objectives
This study was conducted from January to March 2021. Data were obtained from the fourth wave survey data of the China Health and Retirement Longitudinal Study (CHARLS, wave 4), which was released in September 2020 and involved 19816 respondents from 150 counties/districts and 450 villages/communities, with good sample representation [8]. Inclusion criteria :(1) age ≥ 45 years; (2) female; (3) respondents who clearly responded to the 10-item version of the Centre for Epidemiological Studies Depression Scale. Exclusion criteria: inability to complete the survey or refusal to participate in the survey. After removing samples with missing selected variables, a total of 7963 middle-aged and elderly women were included in the study. The CHARLS was approved by the Ethical Review Committee of Peking University. (IRB00001052-11015) andthe informed consent was signedat the time of participation with all participants.
1.2. Methods
1.2.1.The investigation content of CHARLS related to the study
The contents included demographic characteristics (age, education levels, residency), physical health status (self-reported health, physical disability, chronic disease, troubled with body pains,BADL disability, IADL disability), sociological characteristics (living with spouse/partner or not, number of family members, number of children, number of children who visit their parents at least once a month, caring for grandchildren, number of still alive parents, social activities, using the internet or not, and having care support or not when needed), economic characteristics (having jobs other than self-employed agricultural, individual income, having debt, retirement), life satisfaction, and regional distribution.For BADL, respondents were asked to answer whether they had difficulty in six activities of daily living included dressing, bathing/showering, feeding oneself,
getting in or out of bed, using the toilet, and controlling urination and defecation, while theIADL contained doing household chores, cooking, shopping, managing finances, taking medications, and using telephone calls. For both BADL and IADL, answers were categorized as: “do not have any difficulty”, “have difficulties but still can do it”, “have difficulties and help is needed”, “cannot complete it”. Those respondents who reported any difficulty in any item of BADL/IADL were defined as having BADL disability or IADL disability [9].
1.2.2.Measures of depression
The 10-item version of the Centre for Epidemiological Studies Depression Scale (CES-D-10)was used to assess depression in middle-aged and elderly women.The CES-D-10 was revised by ANDRESEN et al. [10] based on the results of item analysis to overcome the problems of long answer time, sensitive item content and high rejection rate in the original CES-D-20.The CES-D-10 scale included the following: (1) I was bothered by things that do not usually bother me. (2) I had trouble keeping my mind on what I was doing. (3) I felt depressed. (4) I felt that everything I did was an effort. (5) I felt hopeful about the future. (6) I felt fearful. (7) My sleep was restless. (8) I was happy. (9) I felt lonely. (10) I could not get “going”.By asked respondents “How often this past week did you ...” answered the above ten items, each item was scored from 0 to 3:“rarely or none of the time (less than 1 day) was scored as 0,” “some or a little of the time(1–2 days) was scored as 1,”, “occasionally or a moderate amount of the time(3–4 days) was scored as 2,” “most or all of the time (5–7 days) was scored as 3.”The responses the two positive feelings of the item 5 and the item 8 were scored as 3, 2, 1 and 0. The total CES-D 10 score ranged from 0 to 30, respondents were classified as scores 10-30 being having depression symptoms and those with scores 0-9 as being without depression symptoms. With a higher score indicating a greater severity of depressive symptoms [10]. The Cronbach’s alpha of CES-D-10 was 0.788[11].
1.3. Statistical analysis
Statistical analyses were performed using Stata version 14.1 software. The measurement data that did not conform to normal distribution were described by M (P25, P75), and counting data were described in relative numbers. Robust OLS regression, Tobit regression and Logit regression were used to analyze the influencing factors of depression in middle-aged and elderly women. Two sided P<0.05 was considered as statistically significant.
2. Results
2.1. The characteristics of the sample
Among 7963 middle-aged and elderly women, 4131 (51.88%) were aged from 45 to 59, and 3832 (48.12%) were aged 60 and above. Other demographic characteristics, physical health status, sociological characteristics, economic characteristics, life satisfaction and regional distribution are shown in Table 1.
Table 1. Characteristics of 7963 middle-aged and elderly women.


Note: BADL, basic activities of daily living; IADL, instrumental activities of daily living; The number of family members, number of children, number of children who visit their parents at least once a month, the number of still alive parents (including foster parents, father, mother, father-in-law, mother-in-law), individual income, and having debt were recorded as continuous variables and not listed in the table 1.
2.2. Prevalence of depression in middle-aged and elderly women
Among 7963 middle-aged and elderly women, the median CES-D-10 score of the participants was 8(4, 14)points. Except for 4490 cases (56.39%), the remaining 3473 cases (43.61%) were found with depressive symptoms, including 1715(41.52%) aged 45-59 years, and 1758(45.88%) aged 60 or over.
2.3. Regression analysis of the influencing factors of depression in middle-aged and elderly women
Based on the analysis of relevant literature[12-13], we selected demographic characteristics, physical health status, sociological and economic characteristics, life satisfaction and regional distribution of middle-aged and elderly women as independent variables. For age, the quadratic term of age was introduced in regression according to existing literature[14].
The CES-D-10 scoreof middle-aged and elderly women wasseen as dependent variables, and the above independent variables were included for OLS regression analysis (the assignments of variables used in the study are all shown in Table 2).The multi-collinearity test was performed first, and it was found that the maximum VIF of each variable except age and its quadratic term was 1.88, indicating that there was no multi-collinearity problem.Then,heteroscedasticity test was carried out and it was found that there was heteroscedasticity, so robust OLS regression was used. The result of the robust OLS regression analysis showed that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of family members, number of children, using the internet or not, having care support or not when needed, having jobs other than self-employed agricultural or not, individual income, having debt, life satisfaction, and regional distribution were correlated with depression in middle-aged and elderly women (P<0.05).
Table 2. Assignment of variables possibly associated with depression among middle-aged and elderly women.

Note: CES-D, Center for Epidemiologic Studies Depression Scale; BADL, basic activities of daily living; IADL, instrumental activities of daily living.
The total CES-D-10 score of 10 items ranged from 0 to 30, and does not conform to normal distribution, OLS regression may produce estimation errors, so the dependent variables and independent variables are included for further analysis in robust Tobit regression, and the results show that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of family members, number of children, using the internet or not, having care support or not when needed, having jobs other than self-employed agricultural or not, having debt, life satisfaction, and regional distribution were associated with depression in middle-aged and elderly women (P<0.05).
With or without depressive symptoms as dependent variables, the above independent variables were included for robust Logit regression. The results indicated that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of children, using the internet or not, having care support or not when needed, having debt, life satisfaction, and regional distribution have significant impact on depression in middle-aged and elderly women (P<0.05) (Table 3).
The results of the three regression models showed that age and age squared, education level, living in rural or urban areas, self-rated health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of children, using the internet or not, having care support or not when needed, having debt, life satisfaction, and regional distribution were associated with depression.
Table 3. Robust OLS regression, robust Tobit regression and robust Logit regression analyses of influencing factors possibly associated with depression among middle-aged and elderly women.

Note: BADL, basic activities of daily living; IADL, instrumental activities of daily living; a, Chi-square statistic.
3. Discussion
Previous studies have found that the rate ofdepression for women was higher than that for men,and the prevalence of depressive symptoms in middle-aged and elderly women in China was
43.2% [15].The results of this study showed that middle-aged and elderly women with depressive symptoms accounted for 43.61% (3473/7963), which was close to the above results.Demographic variables, including age, education levels and residency, can affect the depressive symptoms of middle-aged and elderly women. Among them, the influence of age on depressive symptoms was relatively complex, asthe coefficient of age’s level valuewas significantly positive and coefficient of age squaredwas significantly negative, which was in the shape of inverted U-shaped parabola, and the peak age of onset was 52 years old.This was similar to the results of relevant domestic studies, depression symptoms firstworsened and then alleviated with age, and the peak age of onset was between 50 and 60 years old[14].One study reported that higher education level reduced the correlation between social isolation and depressive symptoms in men, but not in women [16]. However, the results of this study showed that the higher level of education, the lower the risk of depression symptoms in middle-aged and elderly women, which was consistent with the results of Li J S et al. [14].The results of our study showed that compared with living in rural areas, middle-aged and elderly women living in urban areas had a lower risk of developing depressive symptoms, which was similar to the results of HE et al. [17],Kong XK et al. [18]. The improvement of the level of urbanization significantly reduced the rate of depression.
Results indicated that physical health status was related to depressive symptoms in middle-aged and elderly women, including poor self-rated health, physical disability, chronic disease,troubled with body pains, BADL disability, IADL disability, which werethe influencing factorsfor depression symptoms in those population, supported by relevant research findings [19-21].The results suggestedthat medical workers should attach great importance to the physical health of those population and minimize the negative impact of physical illness on mental health.
The results of the study showed that the number of children was associated withdepressive symptoms in middle-aged and elderly women, similar to previous literature [22]. The more the number of children, the higher the risk of depression symptoms they were.Thereasons why middle-aged and elderly females were more affected by depression symptomscould be attributed to two aspects: on the one hand, the large number of childrenincreases the cost of living, education and healthcare for middle-aged and elderly women, leading to a heavier economic burden.On the other hand, employment, marriage and other problems of multiple children may also increase the psychological burden of middle-aged and elderly women, and then lead to developing depression.In contrast, if living togetherwith a spouse or a partner, the symptoms of depression can be reduced. A spouse or a partner can take careeach other andsolve some tough problems together,especially when it comes to the children.Our study found that surfing the internet or not was also associated with depressive symptoms in middle-aged and elderly women, and the reason was that surfing the internet increased access to information and interpersonal communication. Our results also indicated thathaving care support or not when needed was related to depressive symptoms in middle-aged and older women. When they without care support from family members, relatives and friendswhen needed, depressive symptoms were evident, which may be related to the lack of relevant social support.This result pushed urgent requirements for us to concern overthe mental health status of the special groups and the government to improve the elder social security system.
The results of this study also showed that having debt was associated withdepressive symptoms in middle-aged and elderly women.Over-consumption and debt management have gradually become a common economic phenomenon, but the modern financial consciousness has
not followed up, resulting in middle-aged and elderly women have more psychological pressure for debt. Life satisfaction was correlated with depression symptoms in middle-aged and elderly women, which was confirmed in previous studies[23], indicating thatpeople who were less satisfied with their lives had more negative psychological feelings and were more prone to be depressed. Moreover,as confirmedin several studies [24-25],there was an imbalance in the regional distribution of depression symptoms in China, which may be closely related to the level of economic development among regions. Much can be doneby relevant institutions and departments to narrow the regional differences between middle-aged and elderly women, improve the level of social equity, and promote the healthy development of mental healthof this populationin different regions.
To sum up, according to the data analysis of this study, the prevalence of depressive symptoms among middle-aged and elderly Chinese women was high, accounting for more than 40%. To control and prevent depressive symptoms to improve mental health status in this population, it is suggested to improve their education level, physical health status, family relations and life satisfaction, reduce their debt-financed consumption, and to offer them more ways to access information, and more social support, as well as to promote urbanization.
Acknowledgments
The authors would like to thank the Institute of Social Science Survey of Peking University for their organizing of CHARLS, and all the participants, investigators and assistants of CHARLS.
Author Contributions
All authors have approved the final manuscript.
Declaration of Competing Interest
None.
References
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(Received: 6 June 2021; Revised: 27 August 2021)


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14.

Spatiotemporal Analysis of Cervical Cancer Prevalence in Guangdong Province20152019

XU Bixia, LIN Xiaodan, YAO Weiguang
Chinese General Practice    2022, 25 (06): 735-741.   DOI: 10.12114/j.issn.1007-9572.2021.02.084
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Background

Cervical cancer is the most common cancer threatening women's health that calls for strengthened dynamic monitoring and early warning.

Objective

To perform a spatiotemporal analysis of cervical cancer prevalence in Guangdong from 2015 to 2019, providing a decision-making basis for relevant government departments to take targeted prevention and treatment measures for cervical cancer.

Methods

In May 2021, data of 5-year (2015—2019) cervical cancer prevalence in 20-64-year-old female Guangdongers living in Guangdong's 21 cities were collected for analysis at the provincial and municipal levels. Average annual growth rate for descriptive analysis. ArcGIS 10.6 was used for spatial visualization, spatial autocorrelation analysis and hot spot analysis (Getis-Ord Gi) .

Results

During 2015—2019, cervical cancer prevalence in Guangdong declined from 50.28/100 000 to 49.84/100 000. The highest average annual growth rate of cervical cancer prevalence was in Meizhou (76.05%), and the lowest was in Chaozhou (-52.81%). In 2019, Jieyang (210.40/100 000) was found to have the highest cervical cancer prevalence, followed by Maoming (127.34/100 000) and Yangjiang (108.05/100 000). In 2018, global spatial correlation (Global Moran's I value=0.364, P<0.05) appeared in the prevalence of cervical cancer in 21 cities in Guangdong, showing the characteristic of aggregated distribution. The results of local spatial autocorrelation indicated that Guangzhou consistently showed the local characteristics of "low-value to low-value agglomeration" from 2015 to 2019, with an expanded scope with the local characteristics overall. Jieyang and Chaozhou were cervical cancer "hot spots" in 2015, 2018 and 2019.

Conclusion

From 2015 to 2019, although Guangdong saw a decrease in cervical cancer prevalence on the whole, it had a higher cervical cancer prevalence in 2019 (43.3/100 000) than the national level. Comparatively speaking, the overall cervical cancer prevalence in Pearl River Delta region was lower than that of eastern, western and northern Guangdong. And cervical cancer "hot spots" were mainly in eastern Guangdong.

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15. Characteristic of Biochemical Markers of Bone Turnover in Female Patients with Osteitis Condensans Ilii
Chenjing LIU, Hui SONG, Hongchao LI, Zhe GUO, Siliang MAN
Chinese General Practice    2022, 25 (29): 3635-3639.   DOI: 10.12114/j.issn.1007-9572.2022.0374
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Background

It is sometimes difficult to distinguish osteitis condensans ilii (OCI) from other diseases, and exploring biochemical markers of bone turnover may contribute to the differential diagnosis.

Objective

To evaluate the characteristic and significance of biochemical markers of bone turnover in patients with OCI.

Methods

Participants were retrospectively selected from Beijing Jishuitan Hospital from June 2013 to February 2022, including 61 female outpatients and inpatients with OCI {observation group: 15-50 years old〔mean age of (33.8±6.6) years〕, duration of OCI of two weeks to 15 years}, and 61 healthy female physical examinees{control group: 15-48 years old〔mean age of (35.6±7.6) years〕}. The clinical data and biochemical markers of bone turnover were compared between the two groups. The correlations of biochemical markers of bone turnover with OCI-related indices were analyzed.

Results

The serum albumin of the observation group was significantly lower than that of the control group〔 (45.4±2.9) g/L vs (46.5±2.8) g/L〕 (t=2.190, P<0.05) . In terms of biochemical markers of bone turnover, the observation group had significantly lower serum β-isomerised carboxy-terminal cross-linking telopeptide of type 1 collagen (β-CTX) 〔0.28 (0.23, 0.37) μg/L vs 0.36 (0.29, 0.48) μg/L〕, N-terminal osteocalcin (OC) 〔13.1 (11.2, 16.2) μg/L vs 15.6 (13.7, 17.3) μg/L〕, and 25- (OH) VD3 〔 (14.1±5.1) μg/L vs (17.5±6.6) μg/L〕 than the control group (Z=-2.983, -3.255, t=3.081, P<0.05) . OCI patients with a longer disease duration had significantly higher serum OC〔14.6 (12.4, 18.5) μg/L vs 11.7 (10.2, 14.0) μg/L〕 than those with a shorter duration (Z=-2.407, P<0.05) . OCI patients with two or more pregnancies had significantly lower serum β-CTX〔0.25 (0.22, 0.32) μg/L vs 0.33 (0.26, 0.44) μg/L〕 and OC〔12.2 (10.3, 15.0) μg/L vs 13.4 (12.0, 18.8) μg/L〕 than those with no or one pregnancy (Z=-2.486, -1.897, P<0.05) . Correlation analysis showed that, in OCI patients, the procollagen type 1 N-terminal propeptide (tP1NP) was negatively correlated with the number of pregnancies and deliveries (rs=-0.276, -0.298, P<0.05) . Serum OC level was negatively correlated with BMI, VAS score and the number of pregnancies (rs=-0.284, -0.374, -0.360, P<0.05) . The serum 25- (OH) VD3 level was positively correlated with BMI (rs=0.275, P<0.05) .

Conclusion

The serum levels of OC and β-CTX in female patients with OCI were significantly lowered, which could be used for distinguishing OCI and other diseases. The serum level of OC may be a predictor of the severity of OCI, which was related to the number of pregnancies. The level of tP1NP was related to the number of pregnancies and deliveries.

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16. Mediating Effect of Marital Satisfaction Level on the Relationship between Partner Phubbing and Depression in Late Pregnancy
Yun TIAN, Yuhong LI, Jingjing ZHAO, Yudong ZHANG, Liu ZHANG
Chinese General Practice    2022, 25 (20): 2541-2546.   DOI: 10.12114/j.issn.1007-9572.2022.0072
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Background

The prevention and treatment of depression is a priority among mental health issues in China, and pregnant women are a key target group. Prenatal depression is easily ignored although it is highly prevalent and harmful. To reduce its prevalence, it is crucial to identifying the interaction mechanism between psychosocial factors (such as marital satisfaction and partner support) associated with prenatal depression, and controlling the modifiable risk factors.

Objective

To explore the relationship between marital satisfaction, partner phubing and depression in late-pregnancy women, and to assess the level of mediating effect of marital satisfaction on the relationship between the latter two, providing maternal and child healthcare professionals with evidence on interventions for prenatal depression.

Methods

Convenience sampling method was used to select women in late pregnancy who underwent routine prenatal check-ups in the Obstetrics Clinic, the First Affiliated Hospital of Anhui Medical University from October 2020 to May 2021. A self-designed general information questionnaire was used to collect sociodemographic and obstetric data. The Partner Phubbing Scale (PPS) was used to assess partner phubbing prevalence. The Quality of Marriage Index (QMI) was used to measure the level of marital satisfaction. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the prenatal depression prevalence. Mplus 8.3 was used to establish a structural equation model for mediation analysis.

Results

Altogether, 300 cases were recruited. All of them were included for analysis except nine cases who returned unresponsive questionnaires, obtaining a survey response rate of 97.00%. The prenatal depression prevalence in the respondents was 40.89% (119/291) . The mean scores of PPS, QMI, and EPDS for them were (25.6±6.3) , (37.9±6.0) , and (8.0±3.5) , respectively. Correlation analysis showed that partner phubbing was negatively associated with marital satisfaction (r=-0.292, P<0.01) , and positively associated with prenatal depression (r=0.350, P<0.01) . Marital satisfaction level was negatively correlated with prenatal depression (r=-0.338, P<0.01) . Mediation analysis revealed that the size of direct effect of partner phubbing on prenatal depression was 0.214, accounting for 82.63% of the total effect. Marital satisfaction partially mediated the relationship between partner phubbing and prenatal depression, with a size of mediation effect of 0.045, accounting for 17.37% of the total effect.

Conclusion

Partner phubbing could positively predict depression in late pregnancy, and their relationship may be partially mediated by marital satisfaction. To reduce the prevalence of depression in late pregnancy, maternal and child healthcare professionals could improve the marriage of pregnant woman via providing them with interventions to decrease the prevalence of partner phubbing.

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17. Breast Cancer Prevention and Treatment Behaviors in Community-living Women: Latent Class Analysis and Influencing Factors
Jiahui MA, Guolian LIU, Lianhua ZHENG, Yaru BAI, Juanjuan MAI, Wenlian YAO
Chinese General Practice    2022, 25 (28): 3515-3522.   DOI: 10.12114/j.issn.1007-9572.2022.0477
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Background

The overall incidence of breast cancer in Chinese women is on the rise, seriously threatening their physical and mental health. Breast cancer prevention and treatment behaviors are critical to the outcomes of affected women in the community. However, these behaviors vary across individuals. And measures should be explored to improve the efficacy of such behaviors.

Objective

To perform a latent class analysis of breast cancer prevention and treatment behaviors among community-living women, and to explore the associated factors, providing evidence for individualized prevention and management of female breast cancer in the community.

Methods

A total of 1 355 community-living women were selected from in 15 towns/subdistricts of 5 counties/districts in Yinchuan and Zhongwei cities of Ningxia, China by use of convenience sampling method from November 2019 to August 2020. They were surveyed using a questionnaire consisting of baseline characteristics, and breast cancer prevention and treatment behaviors (relevant questions used are belonging to the part of breast cancer prevention and treatment in the Knowledge, Attitude and Practice of Breast and Cervical Cancer Prevention and Treatment Among Women in Ningxia) . The latent classes of breast cancer prevention and treatment behaviors were presented, and their influencing factors were identified by multivariable logistic regression analysis.

Results

The survey achieved a response rate of 97.93% (1 327/1 355) .By use of latent class analysis, breast cancer prevention and treatment behaviors of the respondents were classified into four latent classes, including positive prevention and treatment (n=522, 39.34%) , high-risk behaviors plus positive treatment (n=449, 33.83%) , high-risk behaviors plus negative treatment (n=229, 17.26%) , and general prevention and treatment (n=127, 9.57%) . The overall median score of breast cancer prevention and treatment behaviors was 9.00 (7.00, 11.00) points for all respondents. The median score of breast cancer prevention and treatment behaviors was 11.00 (11.00, 12.00) points for respondents with positive prevention and treatment behaviors, 9.00 (8.00, 10.00) points for those with high-risk behaviors plus positive treatment behaviors, 6.00 (5.00, 6.00) points for those with high-risk behaviors plus negative treatment behaviors, and 8.00 (6.00, 9.00) points for those with general prevention and treatment behaviors, with significant difference across the groups (H=1 008.493, P<0.001) . Multivariable Logistic regression analysis showed that, compared with general prevention and treatment behaviors, living in Zhongwei and having a history of childbirth were associated with increased possibility of being classified into positive prevention and treatment behaviors, having health insurance〔urban resident basic medical insurance (URBMI) , commercial health insurance, or other types〕, self-pay treatment, and a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , having a history of childbirth were associated with increased possibility of being classified into high-risk behaviors plus positive treatment behaviors, having health insurance (URBMI or commercial health insurance) , as well as a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , and primary education or below, household monthly income per person of 1 000-2 999 yuan were associated with increased possibility of being classified into high-risk behaviors plus negative treatment behaviors, and having URBMI were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) .

Conclusion

In general, breast cancer prevention and treatment behaviors in this group could be definitely classified, all being performed at a moderate level. To improve the level of breast cancer prevention and treatment behaviors of Ningxia's community-living women, focus should be on those who have high-risk behaviors and negatively seek for treatment. Moreover, the problems in positive breast cancer prevention and treatment behaviors in women with other three classes of behaviors should also be intervened and corrected to improve the outcomes of them.

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18. The Influencing Factors of Depression Symptoms in the Chinese Female Elderly Population Based on Health Ecology Models
ZHANG Ying, JIANG Xintong, WANG Pingyu
Chinese General Practice    2025, 28 (13): 1595-1600.   DOI: 10.12114/j.issn.1007-9572.2024.0297
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Background

The elderly population in our country is large and growing rapidly, and depression is a common emotional disorder and mental health problem among the elderly population. The mental health of the female elderly population is increasingly becoming a focus of social concern.

Objective

To explore the influencing factors of depression symptoms in the female elderly population from a multi-level and comprehensive perspective of health ecology, and provide theoretical basis for identifying and intervening in depression symptoms in the elderly female population in China.

Methods

In January 2024, we extracted for the 2020 survey data from the China Health and Retirement Longitudinal Survey (CHARLS), and a group of female elderly adults aged 60 years and above were selected for the study (n=4 594). Based on the health ecology model, the influencing factors were divided into five levels: personal characteristics layer, behavioural characteristics layer, interpersonal network layer, living and working conditions layer, and policy environment layer. The χ2 test and binary Logistic regression model were used to explore the influencing factors of depression symptoms and to establish a health ecology model of depression symptoms in the Chinese female elderly population.

Results

The detection rate of depression symptoms in the Chinese female elderly population was 48.06% (2 208/4 595). Logistic regression analysis showed that age of ≥80 years (OR=0.601, 95%CI=0.449-0.804), sleep duration of≥6 h (OR=0.561, 95%CI=0.493-0.639), satisfaction with life (OR=0.256, 95%CI=0.199-0.330), better self-rated physical health (OR=0.459, 95%CI=0.395-0.533), urban household registration (OR=0.717, 95%CI=0.603-0.853), satisfaction with children (OR=0.666, 95%CI=0.472-0.940), education level of junior high school and above (OR=0.712, 95%CI=0.582-0.871), family income >50 000 yuan (OR=0.822, 95%CI=0.704-0.959) and the per capita GDP of the city is 50 000 to 100 000 yuan (OR=0.841, 95%CI=0.730-0.970) were the protective factors for the development of depression symptoms in the Chinese female elderly population (P<0.05). Having become disabled (OR=1.786, 95%CI=1.556-2.050), suffering from chronic diseases (OR=1.159, 95%CI=1.014-1.324), central region (OR=1.298, 95%CI=1.107-1.522) and western region (OR=1.407, 95%CI=1.183-1.675) were the risk factors for depression symptoms in the Chinese female elderly population (P<0.05) .

Conclusion

The detection rate of depression symptoms in the Chinese female elderly population is relatively high, and there are many influencing factors, including: age in the personal characteristics layer; sleep time, satisfaction with life, self-related of physical health, disability, and chronic disease in the behavioral characteristics layer; household registration type, satisfaction with children, and geographical distribution in the interpersonal network layer; education and family income in the living and working conditions layer; the per capita GDP of the city in the policy environment layer. Effective intervention measures should be taken at all layers, targeting key populations, in order to reduce the incidence of depression symptoms among the Chinese elderly women.

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19. Interpretation of the Clinical Statement for Management of Female Cardiac Emergencies in 2024
HUANG Chuanying, LIAO Xiaoyang, YANG Rong, LI Dongze, ZHANG Peng, JIA Yu, LIU Lidi
Chinese General Practice    2025, 28 (12): 1427-1432.   DOI: 10.12114/j.issn.1007-9572.2024.0314
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Cardiac emergencies occur rapidly and pose a serious threat to the health and lives of patients. Female cardiac emergencies have been under-researched, under-diagnosed and under-treated due to gender bias and atypical symptoms for a long time. There are clear gender differences in the pathophysiological mechanisms, risk factors, management and outcomes of female cardiac emergencies. In China, the prevalence of female cardiac emergencies is notably high, and research on it has commenced relatively late. There is no authoritative guideline for female cardiac emergencies, so it is urgent to enhance the management strategies for these conditions. To standardize the management of cardiac emergencies in women and enhance health outcomes, clinicians from general medicine, cardiology and emergency medicine were convened to interpret the clinical statement titled Management of Female Cardiac Emergencies published in 2024 by the Association for Acute Cardiovascular Care and other organizations.

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20. Effect of Antibiotic Therapy on the Outcome of Frozen-thawed Embryo Retransfer Following Failed First Implantation in Women with Chronic Endometritis
Longlong WEI, Cuilian ZHANG
Chinese General Practice    2022, 25 (21): 2605-2609.   DOI: 10.12114/j.issn.1007-9572.2022.0080
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Background

Chronic endometritis (CE) refers to chronic inflammatory condition of the endometrium. Recent studies have found that CE is closely associated with infertility, recurrent miscarriage, and recurrent implantation failure. However, there are no studies on CE prevalence in patients with first implantation failure and the outcome of re-pregnancy by assisted reproductive technology in these patients after antibiotic treatment.

Objective

To investigate CE prevalence in women who used in vitro fertilization & embryo transfer (IVF-ET) to assist in achieving a pregnancy but had failed first implantation and the impact of antibiotic treatment on the outcome of the next frozen-thawed embryo transfer in this group.

Methods

Women (n=381) who received IVF-ET to assist in achieving a pregnancy but had failed first implantation were selected from Henan Provincial People's Hospital from May 2017 to May 2021. 333 patients without CE were according to hysteroscopic and endometrial histopathological findings. 37 of CE patients were found with reversed (cured) clinical condition, but the other 11 still with unreversed (uncured) condition who were received antibiotic treatment . Clinical data and the outcome of the second assisted conception were compared between cured and uncured CE patients, as well as non-CE patients.

Results

Cured and uncured CE patients and non-CE patients had no statistical differences in mean age, BMI, endometrial thickness on the day of embryo transfer, years of infertility, and number of embryos transferred, as well as the distribution of infertility type (P>0.05) . But they had statistical differences in success rates of embryo retransfer and pregnancy (P<0.05) . Cured CE patients and non-CE patients had higher success rates of embryo retransfer and pregnancy than did uncured CE patients (P<0.05) . There were no statistical differences in early abortion rates were found across cured and uncured CE patients and non-CE patients (P>0.05) .

Conclusion

CE should be treated by standard antibiotic treatment. Uncured CE may negatively influence the outcome of frozen-thawed embryo retransfer. So it is recommended that women with first implantation failure actively undergo hysteroscopy and endometrial histopathology so as to find possible causes of implantation failure.

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21. Prevalence and Influencing Factors of Osteoporosis in Postmenopausal Women: a Meta-analysis
HE Haiyang, YANG Jialing, LEI Xun
Chinese General Practice    2024, 27 (11): 1370-1379.   DOI: 10.12114/j.issn.1007-9572.2023.0688
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Background

With the aging of the population, the health threat of osteoporosis (OP) has become more prominent. The prevalence of OP in postmenopausal women will further increase to three times of that in men due to the reduction of ovarian estrogen secretion. The prevalence and risk factors of OP in postmenopausal women have been widely reported and systematically summarized, however, there are few systematic reviews of relevant studies worldwide.

Objective

To systematically review the prevalence and influencing factors of OP in postmenopausal women.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched for studies on the prevalence and influencing factors of OP in postmenopausal women from 2002-11-01 to 2022-11-01; in addition to literature tracking based on the references in the included studies. Two reviewers independently conducted literature screening and information extraction, the quality was evaluated using the risk of bias assessment criteria recommended by the Agency for Healthcare Research and Quality. A Meta-analysis on the prevalence and influencing factors of OP in postmenopausal women was performed using Stata 16.0 software.

Results

A total of 68 articles were included, with a total sample size of 112 097 cases. Meta-analysis showed that the prevalence of OP and osteopenia in postmenopausal women was 34.73% (95%CI=31.02%-38.44%) and 41.83% (95%CI=38.19%-45.47%), respectively. Subgroup analysis showed that the highest prevalence was found in the age≥80 years group (68.72%, 95%CI=59.81%-77.62%), followed by the age of 70-79 years group (57.20%, 95%CI=50.53%-63.87%) and the age of 60-69 years group (37.46%, 95%CI=28.95%-45.98%), the age of 50-59 years group (24.94%, 95%CI=15.50%-34.39%), the age of 40-49 years group (14.01%, 95%CI=6.64%-21.38%) ; the prevalence rate of <2 births (34.24%, 95%CI=24.08%-44.41%) was lower than that of ≥2 births (39.27%, 95%CI=30.10%-48.44%) ; the prevalence of age ≥10 years menopause (47.15%, 95%CI=42.27%-52.04%) was higher than that of <10 years menopause (34.18%, 95%CI=33.30%-35.06%) ; the prevalence in developing countries (35.87%, 95%CI=31.39%-40.34%) was higher than that in developed countries (30.10%, 95%CI=23.97%-36.23%). The influencing factors of OP in postmenopausal women included diabetes (OR=2.79, 95%CI=1.75-4.46, P<0.05) ; high BMI (OR=0.53, 95%CI=0.43-0.64, P<0.05) ; exercise (OR=0.43, 95%CI=0.28-0.65, P<0.05) ; number of births (OR=2.52, 95%CI=1.72-3.67, P<0.05) ; duration of menopause (OR=1.88, 95%CI=1.43-2.46, P<0.05) ; family history (OR=1.92, 95%CI=1.38-2.67, P<0.05) ; alcohol consumption (OR=1.95, 95%CI=1.54-2.47, P<0.05), menopausal hormone therapy (OR=0.34, 95%CI=0.25-0.44, P<0.05) ; non-violent fracture history (OR=3.83, 95%CI=1.88-7.98, P<0.05) ; and age (OR=1.43, 95%CI=1.29-1.59, P<0.05) .

Conclusion

The prevalence of OP and osteopenia in postmenopausal women is high, with about one third of postmenopausal women suffering from osteoporosis, and about half of postmenopausal women suffering from osteopenia. High BMI, regular exercise, and use of menopausal hormone therapy are protective factors for OP in postmenopausal women, while diabetes, high number of births, long years of menopause, family history of disease, alcohol consumption, non-violent fracture history, and advanced age are risk factors. The evaluation and intervention of OP should be strengthened in clinical practice, and it is also necessary to promote healthy lifestyle to postmenopausal women to improve their quality of life.

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22. Efficacy of Daily Self-weighing and Online Group-based Cognitive-behavioral Interventions for Weight Loss in Overweight and Obese Female Railway Workers: a Randomized Controlled Trial
Cong YIN, Wei SHENG, Yan CAO, Wenpei BAI
Chinese General Practice    2022, 25 (22): 2746-2752.   DOI: 10.12114/j.issn.1007-9572.2022.0224
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Background

Female railway workers are a high-risk group for obesity. Information technology is increasingly used in interventions for weight loss in overweight and obese populations. Daily self-weighing is a cognitive-behavioral strategy for self-monitoring of weight, but its effect on weight loss remains still controversial.

Objective

To investigate the effect of daily self-weighing plus online group interaction on weight loss and development of healthy lifestyle in overweight and obese female workers in Beijing Railway Bureau.

Methods

A prospective randomized controlled study was conducted. Participants were 72 overweight or obese female workers of Beijing Railway Bureau voluntarily recruited from June 1 to September1, 2019. They were equally randomized into an experimental group and a control group, receiving different weight loss interventions for 3 months (intervention scheme for the experimental group: individualized diet and exercise recommendations, daily self-weighing plus online group-based cognitive-behavioral therapy for weight loss, and that for the control group: individualized diet and exercise recommendations, and self-measurement of body weight with weight management counseling during the telephone or hospital follow-up once a month). Baseline and post-intervention data of both groups were collected, including composition indices (body weight, BMI, body fat percentage, fat content, waist circumference, hip circumference, waist-to-hip ratio), blood lipid indices〔total cholesterol (TC), triacylglyceride (TG), high-density liptein cholesterol (HDL-C), low-density liptein cholesterol (LDL-C) 〕and total score and dimension scores of the Health Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ). Univariate and multivariate Logistic regression was used to explore factors associated with a 5% or more weight loss from baseline.

Results

Seventy-one participants (35 cases and 36 controls) who completed the study were finally included for analysis. The each body composition index, each blood lipid index, and total score and dimension scores of the HPLP-Ⅱ were similar in both groups at baseline (P>0.05). After the intervention, the experimental group showed a significant decrease in the body composition indices (except the waist-to-hip ratio), blood lipid indices (except the HDL-C), and a significant increase in the total score and dimension scores of the HPLP-Ⅱ (P<0.05). However, no significant differences were found in each observation index in the control group before and after the intervention (P>0.05). Compared with the control group, the experimental group showed lower post-intervention body composition indices (except the waist-to-hip ratio) and blood lipid indices (except the HDL-C), and higher post-intervention total score and dimension scores of the HPLP-Ⅱ (P<0.05). A total of 22 participants (31.0%) had a weight loss of ≥5% from the baseline, including 16 cases (72.7%), and 6 controls (27.3%). Both univariate and multivariate Logistic regression analyses showed that intervention scheme and baseline nutrition status were the influencing factors of a 5% or more weight loss from baseline.

Conclusion

Daily self-weighing and online group-based cognitive-behavioral interventions contributed to weight loss, formation of a healthy lifestyle, and improvement in quality of life in overweight and obese female workers in Beijing Railway Bureau.

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23. Association of Degenerative Knee Osteoarthritis Pain with Sex Hormone and Inflammatory Cytokines in Synovial Fluids in Postmenopausal Women
Limin MOU, Wenhao ZHANG, Siping ZHANG, Qi QIN, Mingzhan HAN, Wanji CHEN, Jian RAN
Chinese General Practice    2022, 25 (29): 3652-3657.   DOI: 10.12114/j.issn.1007-9572.2022.0335
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Background

The pain induced by degenerative knee osteoarthritis (KOA) is common in postmenopausal women, but there is a lack of clinical evidence on whether it has an association with decreased sex hormone levels and inflammatory cytokines in the synovial fluid.

Objective

To assess the associations of degenerative KOA pain with sex hormones in the serum 〔estradiol (E2) , testosterone (T) , prolactin, luteinizing hormone (LH) , follicle-stimulating hormone (FSH) and progesterone (P) 〕, and inflammatory cytokines in synovial fluids 〔interleukin-1 (IL-1) , IL-6, IL-10 and tumor necrosis factor-α (TNF-α) 〕 in postmenopausal women, providing a novel basis for estrogen hormone treatment of pain induced by degenerative KOA.

Methods

Ninety postmenopausal women with pain induced by degenerative KOA were recruited from the Sixth Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2021, including 30 with mild pain (VAS score ≤ 3) , 30 with moderate pain (VAS score higher than 4 but lower than 7) , and 30 with severe pain (VAS score higher than 7 but lower than 10) . They were compared to 30 postmenopausal women with knee effusion (controls) undergoing physical examination in the hospital during the same period. The levels of serum sex hormones and inflammatory cytokines in synovial fluids were measured in all cases. All subjects were tested for sex hormones in the serum and inflammatory cytokines in synovial fluids.

Results

The BMI differed across mild, moderate, and severe pain subgroups and the controls (P<0.05) . In particular, severe pain subgroup had higher BMI than did controls and mild pain subgroup (P<0.05) . The serum levels of E2 and T differed across mild, moderate, and severe pain subgroups and the controls (P<0.05) . Specifically, the controls had higher levels of E2 and T than did moderate and severe pain subgroups (P<0.05) . The E2 level in the moderate pain subgroup was lower than that of mild pain subgroup (P<0.05) . The E2 and T levels in the severe pain subgroup were lower than those in the mild pain subgroup (P<0.05) . There were no significant differences in prolactin, LH, FSH and P between controls, and mild, moderate and severe pain subgroups (P>0.05) . The levels of IL-1, IL-6, and IL-10 as well as TNF-α varied across mild, moderate, and severe pain subgroups and the controls (P<0.05) . Compared with controls, mild pain subgroup had higher IL-1 level, and moderate and severe pain subgroups had higher IL-1, IL-6, IL-10 and TNF-α levels (P<0.05) . The levels of IL-6, IL-10 and TNF-α in severe pain subgroup were higher than those in mild pain subgroup (P<0.05) . E2 and T levels were negatively correlated with VAS score for degenerative knee pain (rs=-0.686, -0.454, P<0.05) ; IL-1, IL-6 and TNF-α levels were positively correlated with VAS score for degenerative knee pain (rs=0.517, 0.665, 0.319, P<0.05) . There was no correlation between IL-10 and VAS score for degenerative knee pain (rs=0.162, P>0.05) .

Conclusion

In postmenopausal women, VAS score for degenerative knee pain was negatively correlated with E2 and T levels. There was no significant difference in prolactin, LH, FSH and P levels among degenerative KOA patients with different pain levels. The IL-1, IL-6 and TNF-α levels in synovial fluids were positively correlated with the VAS score of degenerative knee pain. So reducing the levels of IL-1, IL-6 and TNF-α could improve the tolerance of knee pain, which may be a reference for clinical treatment of degenerative knee pain.

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24. Associations of Muscle and Adipose Tissue with Bone Mineral Density in Premenopausal and Postmenopausal Women Undergoing Physical Examination
XU Haina, AN Miaomiao, ZHU Yan, WU Chunyan, RAN Limei
Chinese General Practice    2023, 26 (21): 2626-2631.   DOI: 10.12114/j.issn.1007-9572.2022.0778
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Background

The associations of muscle and adipose tissue with bone mineral density (BMD) in perimenopausal women has been studied, but there are differences in site distribution, which lead to that the effect of muscle and adipose tissue on BMD and the site of action are still unclear.

Objective

To analyze the relationships of BMD in lumbar spine, femoral neck, total hip and adipose, muscle tissue in perimenopausal women, and provide theoretical basis for improving the quality of life of middle-aged and elderly and preventing and treatment of osteoporosis (OP) .

Methods

2 355 women aged 40-60 years who underwent medical examination in the Health Management Center, Affiliated Hospital of Guizhou Medical University from January 2018 to October 2021 were retrospectively selected and divided into pre-menopausal women (n=1 261) and post-menopausal women (n=1 094) according to whether they were menopausal or not. BMD of lumbar spine, femoral neck, and total hip were measured by Dual energy X-ray Absorptiometry (DXA) . Adipose and muscle tissue were measured by Bioelectrical Impedance Analysis (BIA) . To explore the association of adipose and muscle tissue with BMD of different site in perimenopausal women by Pearson correlation and multiple linear regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of appendicular lean mass (ALM) for postmenopausal OP.

Results

Pearson correlation analysis showed that adipose mass, total body muscle mass, trunk muscle mass and ALM were positively correlated with BMD of lumbar spine, femoral neck and total hip in premenopausal, postmenopausal and overall women (P<0.05) .Multiple linear regression analysis showed that total body muscle mass and trunk muscle mass were the influencing factors of femoral neck BMD in overall female (β=-0.051, 0.099, P<0.05) , ALM was an influencing factor of BMD of lumbar spine, femoral neck and total hip in overall female (β=0.244, 0.199, 0.199, P<0.05) ; total body muscle mass was an influencing factor for BMD of femoral neck and total hip in postmenopausal women (β=-0.125, -0.075, P<0.05) . Trunk muscle mass was an influencing factor for BMD of femoral neck in postmenopausal women (β=0.150, P<0.05) . ALM was the influencing factor for BMD of lumbar spine, femoral neck and total hip in postmenopausal women (β=0.226, 0.216, 0.188, P<0.05) . ROC curve analysis showed that the AUC of ALM for predicting OP of total hip in postmenopausal women was 0.825〔95%CI (0.742, 0.908) 〕, with 81.82% sensitivity and 76.59% specificity when the cut-off value was 16.24 kg. The AUC of ALM for predicting OP of femoral neck in postmenopausal women was 0.760〔95%CI (0.692, 0.829) 〕, with 75.61% sensitivity and 61.89% specificity when the cut-off value was 16.68 kg. The AUC of ALM for predicting OP of lumbar spine in postmenopausal women was 0.641〔95%CI (0.603, 0.679) 〕, with 60.85% sensitivity and 60.17% specificity, when the cut-off value was 17.20 kg. The best site of ALM for predicting OP in postmenopausal women was the total hip (Zfemoral neck=-9.89, P<0.05) .

Conclusion

ALM is positively correlated with BMD of lumbar spine, femoral neck and total hip in postmenopausal women. ALM can predict the occurrence of OP at different body parts of postmenopausal women, of which the optimal site of prediction for OP is the total hip.

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25. Death Status and Trends of Female Mental Disorders Patients in Pudong New Area of Shanghai, 2005-2021
SHEN Dingyi, LI Xiaopan, MENG Fanping, LU Jingjue, ZHOU Yixin, LYU Jun
Chinese General Practice    2022, 25 (32): 4072-4078.   DOI: 10.12114/j.issn.1007-9572.2022.0290-1
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Background

There are few epidemiological analyses on mental illness deaths among Chinese residents. As an economically developed region, Shanghai has more complete health information system, which can provide data support for deeper analysis of smaller categorical disease characteristics and causes of death among residents, and analysis of the circumstances and trends of deaths related to mental disorders among women in Shanghai will help to understand the local burden of mental disorders in women.

Objective

To analyze the death status and trend of mental disorders among female residents in Pudong New Area of Shanghai from 2005 to 2021.

Methods

Cause of death monitoring data of registered residents of the whole population in Pudong New Area from 2005 to 2021 were collated, and deaths of local female residents with mental disorders were analyzed by using indicators such as crude mortality rate, standardized mortality rate, years of life loss and rate of life loss, and annual percentage change (APC) and average annual percentage change (AAPC) were calculated by using Joinpont regression model for trend analysis.

Results

From 2005 to 2021, there were 1 165 female deaths from mental disorders in Pudong New Area of Shanghai, accounting for 0.32% of the total deaths in the same period. The crude mortality rate was 4.82/100 000, and the standardized mortality rate was 1.85/100 000. The crude mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend from 2005 to 2012 (APC=-13.05%, P=0.002), and an upward trend from 2012 to 2021 (APC=7.66%, P=0.012). The standardized mortality rate showed a downward trend from 2005 to 2012 (APC=-16.79%, P<0.001), and a overall downward trend from 2005 to 2021 (AAPC=-4.93%, P=0.009). The life loss rate showed a downward trend from 2005 to 2012 (APC=-13.79%, P<0.001), and an upward trend from 2012 to 2021 (APC=6.93%, P=0.011). From 2005 to 2021, the death age of female mental disorders in Pudong New Area of Shanghai was 50.8-105.8 years old, and the death age distribution was dominated by ≥80 years old (79.48%), and the death rate of female mental disorders ≥80 years old showed an overall upward trend (AAPC=0.98%, P=0.027). From 2005 to 2021, the proportion of women who died at aged 70-79 with mental disorders was 16.57%. The death rate (AAPC=-5.13%, P=0.026), crude mortality rate (AAPC=-7.20%, P=0.003) and life loss rate (AAPC=-6.89%, P=0.005) showed a downward trend as a whole.

Conclusion

From 2005 to 2021, the standardized mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend as a whole, but the death rate of female mental disorders≥80 years old showed an overall upward trend. The burden of mental disorders among elderly female residents deserves attention of local authorities. Promoting the mental health of elderly women is conducive to improving the health level of local women.

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26. The Incidence Rates of Sexual Dysfunction in Perimenopausal and Postmenopausal Women: a Meta-analysis
XIANG Feng, CAO Xuehua, HU Wanqin, JIA Yu, ZHOU Zitong, XIONG Langyu, WANG Xiaoxia
Chinese General Practice    2024, 27 (26): 3312-3313.   DOI: 10.12114/j.issn.1007-9572.2023.0684
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27. Current Status and Influencing Factors of Depression among Rural Middle-aged and Elderly Women in China
YANG Lu, ZONG Zhanhong, YI Yingying
Chinese General Practice    2023, 26 (25): 3091-3095.   DOI: 10.12114/j.issn.1007-9572.2023.0130
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Background

With the population aging, mental health of the middle-aged and elderly adults is of great concern, especially in middle-aged and elderly women. Compared with urban women, rural women are more likely to suffer from mental diseases due to their poorer health status, lower education level and backward living conditions, however, the accessibility of mental health services among them is low.

Objective

To understand the prevalence of depression among middle-aged and elderly women in rural China and analyze its influencing factors, in order to provide empirical evidence for improving the mental health of middle-aged and elderly women.

Methods

From May to July 2021, the follow-up data of the 2018 China Health and Retirement Longitudinal Study (CHARLS) was extracted, and rural women aged 45 years and above were selected as the study subjects (n=6 736) . The scores of the simplified version of the Center for Epidemiologic Studies Depression Scale (CES-D) were used to determine the depression status of rural middle-aged and elderly women. Chi-square tests and multivariate Logistic regression model were used to analyze the influencing factors of the occurence of depressive symptoms among rural middle-aged and elderly women (including individual characteristics, health behaviors, social participation and utilization of medical services utilization) .

Results

The CES-D score of 6 736 rural middle-aged and elderly women was (20.0±6.9) , 42.46% (2 860/6 736) of whom had depressive symptoms. The results of multivariate Logistic regression analysis showed that satisfication with health status〔OR (95%CI) =0.40 (0.36, 0.45) 〕, sleep duration ≥6 h〔OR (95%CI) =0.48 (0.43, 0.54) 〕, Internet use〔OR (95%CI) =0.63 (0.50, 0.80) 〕 and satisfication with life 〔OR (95%CI) =0.25 (0.21, 0.30) 〕 were correlated with lower risk of depression; hysical disability〔OR (95%CI) =1.41 (1.16, 1.71) 〕, suffering from chronic diseases〔OR (95%CI) =1.35 (1.21, 1.50) 〕, receiving outpatient services within 1 month〔OR (95%CI) =1.25 (1.09, 1.43) 〕 and hospitalization services within 1 year〔OR (95%CI) =1.31 (1.13, 1.52) 〕 were correlated with higher risk of depression.

Conclusion

Based on the results of this study, the depression status of middle-aged and elderly women in rural China is relatively severe and affected by individual characteristics, health behaviors, social participation, and the medical services utilization. It is recommended that governments and civil affairs departments at all levels pay close attention to the mental health of rural middle-aged and elderly women, especially through the intervention and prevention from multiple dimensions such as health promotion and education, medical service quality, and accessibility of information, in order to promote the construction of healthy villages and process of health aging in China.

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28. Short-term High-intensity Interval Training Reduces the Accumulation of Advanced Glycation End Products and the Risk of Cardiovascular Disease in Normal Weight Obese Female University Students: a Randomized Controlled Trial
CAI Ming, WANG Liyan, YANG Ruoyu, LIANG Leichao, YANG Yuanyuan, JIA Shihao, CHEN Ruiyi, REN Yu, LIU Qianle, HU Jingyun
Chinese General Practice    2023, 26 (12): 1472-1478.   DOI: 10.12114/j.issn.1007-9572.2022.0803
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Background

People with normal weight obesity (NWO) are prone to cardiovascular diseases in their middle and old age. High-intensity interval training (HIIT) has been demonstrated to effectively improve cardiovascular health. However, whether HIIT can decrease the risk of cardiovascular diseases in NWO population is not clear.

Objective

To explore the effects of HIIT on the advanced glycation end-products (AGEs) and the risk of cardiovascular disease in NWO female university students.

Methods

From November to December 2020, 137 female college students were recruited in Shanghai University of Medicine & Health Sciences, among whom 40 NWO cases were screened out as subjects by the Asian female NWO standard. They were equally and randomly divided into a control group (n=20) and a HIIT intervention group (n=20) to receive no interventions or weekly five-day interventions, for consecutive four weeks after one-week adaptive training. Body weight, body mass index (BMI) , body fat percentage (BF%) , visceral fat level (VFL) , visceral fat area (VFA) , waist circumference, levels of four blood lipids 〔high-density lipoprotein (HDL) , low-density lipoprotein (LDL) , triglyceride (TG) , and total cholesterol (TC) 〕, cardiovascular disease risk (assessed by the China-PAR model) , AGEs, and fasting blood glucose of two groups were observed before and after intervention. The correlation between AGEs and cardiovascular disease risk was analyzed.

Results

Except for 10 dropouts, the remaining 30 cases (13 in the control group and 17 in the HIIT intervention group) were finally included for analysis. After intervention, the average BMI, BF%, VFA, VFL, waist circumference, TC/HDL ratio, LDL/HDL ratio, TG/HDL ratio, AGEs and fasting blood glucose in HIIT intervention group were lower than those in control group (P<0.05) . Nine subjects in the HIIT intervention group were evaluated for the risk of cardiovascular and cerebrovascular diseases as the China-PAR model was applicable to subjects aged 20 years or older. The risk of cardiovascular disease was (11.82±0.47) % and (9.79±0.57) % in control group and HIIT intervention group, respectively, before intervention, and (14.13±0.97) % and (6.93±1.17) % in the two groups, respectively, after intervention. The post-intervention risk of cardiovascular disease in HIIT intervention group was lower than that in control group (P<0.05) . Spearman rank correlation analysis showed that AGEs were not correlated with cardiovascular disease risk (rs=-0.006, P=0.979) .

Conclusion

The four-week HIIT can effectively reduce the body fat, the levels of AGEs and fasting blood glucose as well as the risk of cardiovascular disease in NWO female university students.

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29. Association of Different Metabolic Obesity Phenotypes with Breast Cancer Risk in Women: a Prospective Cohort Study
ZHOU Jing, JIA Jianguo, LIN Yixin, WU Shuang, DAI Shilong, WANG Mingjun, ZHANG Qingsong
Chinese General Practice    2024, 27 (02): 150-155.   DOI: 10.12114/j.issn.1007-9572.2023.0507
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Background

Earlier studies have investigated the association between overweight/obesity and an elevated risk of breast cancer in women. However, some studies have found that it may not be scientifically accurate to solely analyze the association between overweight/obesity and breast cancer in women for overweight/obesity can be classified into different metabolic phenotypes. The current findings on the association of different metabolic phenotypes with breast cancer remain inconsistent.

Objective

To prospectively analyze the associations of different metabolic obesity phenotypes with the risk of breast cancer in women.

Methods

In this prospective cohort study, female employees (n=23 406) of Kailuan Group who participated in physical examinations for the first time in Kailuan General Hospital and its 11 affiliated hospitals from 2006 to 2008 were selected as the study subjects and received questionnaire investigation, physical examination and laboratory tests. The study subjects were divided into the four groups based on the types of metabolic syndrome and BMI, including metabolically healthy normal weight (MHNW) group (n=12 739), metabolically unhealthy normal weight (MUNW) group (n=1 060), metabolically healthy overweight/obese (MHO) group (n=6 394), and metabolically unhealthy overweight/obese (MUO) group (n=3 213). The subjects were followed up, with the first physical examination attended as the starting point, and new onset breast cancer, death, or the end of follow-up time (2020-12-31) as the endpoints. Multivariate Cox proportional hazard regression model was used to estimate the association of the four groups with the risk of breast cancer.

Results

During an average follow-up of (13.26±1.85) years, with 353 new cases of breast cancer and an incidence density of 11.38 cases per 10 000 person-years in the total population. The incidence cases in the MHNW, MUNW, MHO, and MUO groups were 154, 21, 113, and 65, respectively, with the incidence density of 9.08, 15.37, 13.27, and 15.49 per 10 000 person-years, and the cumulative incidence of 1.22%, 2.01%, 1.67%, and 1.93%, respectively. Multivariate Cox proportional hazard regression model analysis, after adjusting for confounders, showed that compared with the MHNW group, the risk of breast cancer was increased by 42% (HR=1.42, 95%CI=1.11-1.82) and 59% (HR=1.59, 95%CI=1.17-2.17) in the MHO group and MUO group, respectively. Stratified analysis by menopausal status showed that compared to the MHNW group, the MUO group was associated with a 69% increase in risk of premenopausal breast cancer (HR=1.69, 95%CI=1.01-2.83). The risk of postmenopausal breast cancer was increased by 85% (HR=1.85, 95%CI=1.09-3.14), 50% (HR=1.50, 95%CI=1.06-2.13), and 55% (HR=1.55, 95%CI=1.05-2.28) for the MUNW, MHO, and MUO groups, respectively, compared to the MHNW group.

Conclusion

Overweight/obesity is a risk factor for female breast cancer, and overweight/obesity with metabolic abnormalities further increases the risk of breast cancer. Additionally, normal weight postmenopausal women who are metabolically unhealthy may be at an increased risk of postmenopausal breast cancer.

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30. Prevalence and Characteristics of Thyroid Diseases in Peri- and Post-menopausal Women 
JIAZIREYA·Zaiyinati,XING Shuqing,RENAGULI·Aikebaier,ZHANG Kaidi,ZHANG Yuyuan,XING Bei,WANG Xinling,GUO Yanying
Chinese General Practice    2021, 24 (3): 310-315.   DOI: 10.12114/j.issn.1007-9572.2020.00.619
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Background Thyroid disease is the second most-common endocrine and metabolic system disease,with increasing incidence recently.However,there are no large-scale studies on the prevalence and characteristics of thyroid diseases in peri- and post-menopausal women.Objective To investigate the prevalence of thyroid diseases in peri- and post-menopausal women in Urumqi,and to explore the significance of thyroid function screening in this population.Methods From May to June 2017,by use of clustering random sampling,eligible women aged 40-60 years old (n=620) were recruited from two randomly selected urban communities of Urumqi.Thyroid hormones (thyroid-stimulating hormone,free thyroxine,free triiodothyronine) and thyroid autoantibodies 〔thyroid peroxidase antibody (TPOAb),anti-thyroglobulin antibody (TGAb)〕were measured and thyroid disease was screened.The levels of thyroid-stimulating hormone and thyroid autoantibodies and the prevalence of thyroid diseases were compared across groups stratified by menstrual status (regular,peri- and post-menopausal menstruation) and by age (40-44,45-49,50-54,55-60).Results Of the participants,the prevalence of regular,peri- and post-menopausal menstruation was 45.8%(284/620),18.9%(117/620),and 35.3%(219/620),respectively,and the percentages of age groups of 40-44,45-49,50-54 and 55-60 were 27.9%(173/620),29.8%(185/620),18.6%(115/620),and 23.7%(147/620),respectively.The prevalence of hypothyroidism,subclinical hypothyroidism,hyperthyroidism and subclinical hyperthyroidism were 2.7%(17/620),23.9%(148/620),0.4%(3/620) and 1.0%(6/620),respectively.The prevalence of Hashimoto thyroiditis,TGAb positivity,TPOAb positivity,and thyroid nodules was 35.0% (217/620),22.6% (140/620),27.6% (171/620),and 32.4% (201/620),respectively.The mean TPOAb level,and prevalence of thyroid nodule and TPOAb positivity differed significantly across groups of regular,peri- and post-menopausal menstruation(P<0.05).There was significant difference in the prevalence of thyroid nodules among the 4 age groups(P<0.05).There was no significant difference in the prevalence of hypothyroidism,subclinical hypothyroidism,hyperthyroidism,subclinical hyperthyroidism,Hashimoto thyroiditis or TGAb positivity in groups of regular,peri- and post-menopausal menstruation(P>0.05).There was no significant difference in the prevalence of hypothyroidism,subclinical hypothyroidism,hyperthyroidism,subclinical hyperthyroidism,Hashimoto thyroiditis,TPOAb positivity or TGAb positivity in different age groups(P>0.05).Conclusion The prevalence of subclinical hypothyroidism,Hashimoto thyroiditis or thyroid nodules in 40-60-year-old women was higher than that of general population in Urumqi,Xinjiang.The prevalence of thyroid nodules varied by menstrual status and age.The prevalence of TPOAb positivity varied by menstrual status.
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31. Influence of Daily Self-weighing Supported by Online Supervision on Body Composition and Emotions in Overweight/Obese Women with Anxiety and Depression
YIN Cong, DIAO He, SHENG Wei, CAO Yan, BAI Wenpei
Chinese General Practice    2023, 26 (24): 2992-2996.   DOI: 10.12114/j.issn.1007-9572.2023.0169
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Background Overweight/obese women are a growing population with high incidence of depression, anxiety and psychological abnormalities. Due to lack of effective responsive measures to emotions and behaviors, weight loss outcomes are often unsatisfactory in overweight/obese women with anxiety and depression. And less attention has been paid to weight loss outcomes and emotions in this group.Objective To explore the effect of daily self-weighing supported by online supervision on body composition and emotions in overweight/obese women with anxiety and depression.Methods A prospective, randomized, controlled study was conducted with 92 overweight/obese women with mild to moderate anxiety and depression voluntarily recruited from Beijing's Haidian District from October to December 2019. The subjects were randomized into an experimental group (n=46) and a control group (n=46) at a ratio of 1∶1, and treated with weight control interventions for three months: besides eating the appropriate food combinations with scientific and individualized guidance and excising rationally, the experimental group measured their body weight daily with online supervision from the special member of our research group and reported the data to the group, while the control group measured their body weight per month, which was collected by our research group through monthly telephone follow-up. Body composition measurement result, anxiety assessed using Self-Rating Anxiety Scale (SAS) and depression assessed using Self-Rating Depression Scale (SDS) were compared at baseline and three months after the intervention.Results All the participants completed the questionnaire assessment and follow-up. After the intervention, the control group had higher average body weight, BMI, body fat percentage and body fat as well as larger average visceral fat area than the experimental group (P<0.05) . Reduced body weight, BMI, body fat percentage, body fat and visceral fat area were seen in the experimental group after intervention (P<0.05) . The SAS score and SDS score in the experimental group were also lowered after intervention (P<0.05) . The average post-intervention scores of SAS and SDS in the experimental group were lower than those in the control group (P<0.05) .Conclusion In overweight/obese women with anxiety and depression, daily self-weighing with online supervision contributes to weight and fat loss and the improvement of anxiety and depression symptoms, which is a simple, effective and safe intervention measure.
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32. Characteristics of Metabolic Calorific Values Measured by Infrared Thermal Imaging in Female Adults with Hashimoto's Thyroiditis: an Exploratory Analysis
Qian YANG, Hua LU, Qianchen LIU
Chinese General Practice    2022, 25 (18): 2255-2261.   DOI: 10.12114/j.issn.1007-9572.2021.02.121
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Background

Hashimoto's thyroiditis (HT) is an autoimmune disease, and a major cause of hypothyroidism. Due to its insidious nature, non-presence of clear clinical symptoms, there is often a delay in getting a diagnosis for HT, which leads to irreversible damage. Therefore, early screening and improving diagnostic accuracy are essential to the treatment of HT. There are few studies on the application of infrared thermal imaging technology as an auxiliary diagnostic tool for HT.

Objective

To explore the features of metabolic calorific values measured by infrared thermal imaging in female adults with HT.

Methods

Participants were recruited from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from April 2019 to June 2021, including 100 adult gynecological outpatients with HT, and 100 healthy, adult female physical examinees. Both groups completed the Classification and Determination of Constitution in TCM (ZYYXH/T157-2009) for assessing the constitution in TCM. Thyroid function test was performed to understand levels of thyroid function parameters〔thyroglobulin antibody (TGAb) , thyroid peroxidase antibody (TPOAb) , thyroid-stimulating hormone (TSH) , free triiodothyronine (FT3) , free thyroxine (FT4) 〕. Full body thermography using infrared thermal imaging was implemented to examine the calorific values of the left and right lobes of the thyroid gland, the uterus, the Shenque acupoint and the Governor vessel. The aforementioned parameters were compared between HT patients and physical examinees to identify intergroup differences. The calorific values of thyroid left and right lobes, the uterus, the Shenque acupoint and the Governor vessel were compared across HT patients with 9 types of constitution in TCM, and the associations of them with thyroid function parameters were explored, then their associations with infertility in HT were evaluated using binary logistic regression analysis.

Results

The top 4 types of constitution in TCM in HT patients were yang-deficiency, qi-stagnation, damp-heat, and phlegm-dampness. The calorific values of Shenque acupoint and the Governor vessel varied significantly across HT patients by types of constitution (n=9) in TCM (P<0.05) . Compared with the control group, the levels of TGAb, TPOAb and TSH in HT group increased (P<0.05) . There was no significant difference in FT3 and FT4 levels between the two groups (P>0.05) . HT patients had higher calorific values of thyroid left and right lobes and lower calorific values of the uterus, Shenque acupoint and the Governor vessel than physical examinees (P<0.05) . In the HT group, the calorific value of the left or right lobe of the thyroid gland was positively correlated with TGAb (rs=0.260, 0.198, P<0.05) , and the calorific value of the uterus was negatively correlated with TSH (rs=-0.313, P<0.05) . The calorific values of the uterus〔OR=0.413, 95%CI (0.180, 0.945) 〕, the Governor vessel〔OR=0.270, 95%CI (0.075, 0.971) 〕, and the Shenque acupoint〔OR=0.264, 95%CI (0.073, 0.954) 〕were associated with infertility in HT (P<0.05) .

Conclusion

In adult female HT patients, the most common four types of constitution in TCM were yang-deficiency, qi-stagnation, damp-heat, and phlegm-dampness. The metabolic calorific values measured by infrared thermal imaging were featured by higher values of thyroid left and right lobes, and lower values of the uterus, Shenque acupoint and the Governor vessel, which may be new theoretical evidence obtained from clinical practice explaining infertility in HT. Furthermore, the calorific values of thyroid left and right lobes could be used as parameters for early screening or identifying HT. So infrared thermal imaging could be used as an auxiliary diagnostic tool to improve the diagnostic efficiency of HT.

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33. Novel Developments in the Relationship between Diet and Female Fertility 
QIU Jie,ZHAO Mei,DING Peipei,WANG Jieyu,TU Youhui
Chinese General Practice    2020, 23 (31): 4018-4022.   DOI: 10.12114/j.issn.1007-9572.2020.00.539
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Infertility morbidity is increasing with recent social and economic development,and has become the third most common disease after cancer and cardiovascular disease in women. Female fertility is affected by ovarian reserve function,the ability of ovarian cortical follicles to grow into fertilizable oocytes,which is associated with many factors such as heredity,immunity,environment,life style,age,disease and psychology. As a controllable factor,the positive and negative effects of different food and diet structure on female fertility have been preliminarily determined. We explored the impact of macronutrient intake on female fertility,with detailed analysis of the effects of several essential dietary macronutrients,aiming to provide healthy diet guidance for women of childbearing age to improve diet quality to protect reproductive function and prevent reproductive diseases.
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34. Inner Experience of Postpartum Depression in Women:a Qualitative Study 
LIU Yan,QI Weijing,ZHAO Lixia,ZHANG Ya,HU Jie
Chinese General Practice    2019, 22 (24): 2949-2954.   DOI: 10.12114/j.issn.1007-9572.2019.00.086
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Background Postpartum depression(PPD) is a common mental health problem in parturients,which causes pain and produces serious negative effects on parturients and their families.It has attracted wide attention at home and abroad.Objective To get a deep understanding of the inner experience of PPD in women by a survey,and analyze the causes of PPD.Methods This qualitative study was based on Edmund & Heidegger's interpretive phenomenology.Participants were 14 consecutive PPD female outpatients recruited from a tertiary grade A hospital in Shijiazhuang City during May to July,2017 by use of convenience sampling.Unstructured interviews were conducted to collect data associated with PPD.Interviews were recorded on site,transcribed,and analyzed with Colaizzi's method.Results The focus problems extracted from the interviews mainly were relationship between mother-in-law and daughter-in-law,relationship between husband and wife,family economic issues,parenting issues.And the 3 themes identified were relationship between mother-in-law and daughter-in-law,relationship between husband and wife,and lack of parenting experience.Conclusion Interpersonal relationships,especially family relationships,are the issues concerned most by women with PPD,which also are the major problems that plague their life.In addition,lack of parenting experience also trouble these women to a certain extent.
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35. Novel Advances in Estrogen Deficiency and Cognitive Impairment in Postmenopausal Women 
YANG Yanyan,ZHAO Lei,YIN Nan,DAI Congwei,LYU Peiyuan
Chinese General Practice    2018, 21 (35): 4299-4304.   DOI: 10.12114/j.issn.1007-9572.2018.00.239
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Estrogen is the main sex hormone in women.Circulating estrogen can maintain female reproduction functions,normal sexual desire and female secondary sexual characteristics,in particular,estrogen in the brain can help maintain the steady state of the central nervous system.Epidemiological data show that the lack of estrogen in postmenopausal women can cause cognitive decline in different degrees,such as impaired concentration,memory impairment and even dementia.We analyzed the effects of estrogen deficiency on the cognitive function in this population from neurobiological mechanism of estrogen affecting cognition,morphological changes of cognitive function regulation center due to estrogen deficiency,correlation between estrogen and cognitive function and estrogen hormone therapy,in order to raise the awareness of cognitive impairment due to estrogen deficiency in elderly postmenopausal women for improving the quality of life of this population and to provide a research direction for clinical workers.
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36. Correlation between Cervicovaginal Microbiota Variation and Persistent HPV Infection 
BI Qingqing,ZHU Jie,ZHANG Lei,MU Xiaofeng
Chinese General Practice    2021, 24 (9): 1102-1106.   DOI: 10.12114/j.issn.1007-9572.2020.00.642
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Background Early differentiation of persistent and transient HPV infection is important in diagnosis and treatment of cervical cancer.It will provide help for the early intervention of cervical cancer,which has important clinical significance.Changes in cervicovaginal microbiota may induce inflammatory microenvironment and persistent chronic inflammation,or may be associated with persistent HPV infection.Objective To determine the correlation between cervicovaginal microbiota variation and persistent HPV infection.Methods 16s rDNA sequencing was used to determine the cervicovaginal microbiota variation in the samples of women with persistent HPV infection(n=6),transient HPV infection(n=4) and HPV negative(n=5) selected from those undergoing gynecological examination or treatment in Qingdao Central Hospital during January to June 2018.Alpha diversity was applied in analyzing complexity of species diversity.T-test and LEfSe analysis were used to determine the variation of cervicovaginal microbiota among different groups.Results The structure of cervicovaginal microbiota of healthy and transiently infected individuals was relatively single,Firmicutes occupied the main composition.However,that of those with persistent HPV infection presented a complicated trend and the abundance of Proteobacteria and Bacteroidetes was higher.Bacteria with significant differences between persistent and transient HPV infection included Acinetobacter,Prevotella,Pseudomonas and Sphingomonas.Conclusion The reproductive tract flora of patients with persistent HPV infection is complex,and Acinetobacter,Prevotella,Pseudomonas and Sphingomonas are related to persistent HPV infection.
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37. Establishment of a Rothman-Keller-type Risk Prediction Model for Stress Urinary Incontinence in Adult Women Using Evidence-based Data 
BO Xiaojie,MA Le,YANG Sen
Chinese General Practice    2021, 24 (30): 3893-3899.   DOI: 10.12114/j.issn.1007-9572.2021.00.584
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Background As the most common type of female urinary incontinence,stress urinary incontinence(SUI) has an increasing incidence in adult women with the process of aging and lifestyle changes in recent years. Although it is not life-threatening,it seriously affects the performance of work and physical and mental health. Objective To develop a Rothman-Keller-type model for actively screening for SUI risk in adult women,so as to effectively identify and timely intervene with the high-risk groups. Methods Observational studies about SUI in adult women were searched from databases of PubMed,EMBase,SinoMed,CNKI and Wanfang Data from January 2005 to December 2020. Review Manager 5.3 software was used for meta-analysis. The establishing principles of the Rothman-Keller model were used for creating a Rothman-Keller-type model for predicting the risk of SUI in adult women,and the threshold of different risks was determined using simulation data sets. The predictive accuracy of the model was verified by using Logistic regression model. Results Finally,18 articles were included.The 12 risk factors obtained from analysis were:age(≥50 years),BMI(≥24 kg/m2),menopause,urinary system infection,vaginal delivery,and pelvic prolapse,history of pelvic surgery,number of deliveries(≥3 times),constipation,chronic respiratory disease,hypertension,and diabetes. We generated 20 000 simulated individual data based on the risk factors using binomial distribution function,and incorporated them into the Rothman-Keller-type model to plot a curve predicting the SUI risk in adult women,and chose 0.285 5 and 0.429 4 as the threshold for dividing low and intermediate risks,and intermediate and high risks,respectively,according to the curve changes. We incorporated the simulated individual data into a Logistic regression model to plot a curve predicting the SUI risk in adult women,and used 0.261 2 and 0.547 4 as the threshold for dividing low and intermediate risks,and intermediate and high risks,respectively,according to changes in the curve. Validation results of risk prediction for a 60-year-old female:she was predicted to have a high risk for SUI〔P=0.485 6(>0.429 4)〕 by the Rothman-Keller-type model,and was classified into high risk group for SUI 〔P=0.878 6(>0.547 4)〕 according to the prediction using the Logistic regression model,indicating that the predictive results of the two models were consistent. Conclusion Our model has proved to have strong accuracy and predictability. Our experience may provide ideas for the development of risk prediction models for other chronic diseases.
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38. Epidemiology of Cholecystolithiasis in Uygur,Kazakh and Han Women in the Xinjiang Uygur Autonomous Region 
LYU Fujun,DING Dandan,LIU Jiangwei,JI Feng,JIAO Dongxiao
Chinese General Practice    2019, 22 (20): 2436-2440.   DOI: 10.12114/j.issn.1007-9572.2019.00.046
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Background It is found that the prevalence of cholecystolithiasis in Xinjiang Uygur Autonomous Region is relatively high,and its prevalence in women is higher than that in men,but there is a lack of research on the prevalence of cholecystolithiasis in women in Xinjiang Uygur Autonomous Region.Objective To study the prevalence and the influential factors of cholecystolithiasis in Uygur,Kazakh and Han women in Xinjiang Uygur Autonomous Region,and to provide evidence for the prevention and treatment of cholecystolithiasis in Uygur,Kazak and Han women.Methods female residents in Xinjiang Uygur Autonomous Region were selected from June to September 2011 by using the method of typical sampling followed by multi-stage stratified random sampling.Self-made general data questionnaires were used and translated into Uygur.Abdominal ultrasound examinations of liver and gallbladder were performed on the subjects.The prevalence of cholecystolithiasis in women of different ethnic groups and different ages of menarche,irregular menstruation,the number of babies,age of childbirth in each ethnic group were compared,and the influential factors of the prevalence of cholecystolithiasis in women were analyzed by multivariate Logistic regression.Results A total of 3 508 questionnaires were distributed and 3 175 were valid,with an effective recovery rate of 90.5%.The prevalence of cholecystolithiasis in female was 16.9%(535/3 175)in Xinjiang Uygur Autonomous Region,and the prevalence of cholecystolithiasis in Uygur,Kazakhs and Han women was 24.0%(222/924),10.8%(94/873)and 15.9%(219/1 378),respectively.The prevalence of cholecystolithiasis among the three ethnic groups was statistically significant (χ2=57.913,P<0.001).Multivariate Logistic regression analysis showed that the age of menarche 〔OR=1.167,95%CI(1.007,1.353)〕,irregular menstruation 〔OR=6.486,95%CI(4.636,9.532)〕,the number of births 〔OR=1.355,95%CI(1.237,1.483)〕 were influential factors of Uygur women with cholecystolithiasis (P<0.05);the age of menarche 〔OR=1.296,95%CI(1.007,1.668)〕,the number of births 〔OR=1.240,95%CI(1.022,1.504)〕 were influential factors of Kazakh women with cholecystolithiasis (P<0.05);the number of births 〔OR=1.341,95%CI(1.214,1.482)〕,age of childbirth 〔OR=0.942,95%CI(0.892,0.996)〕 were influential factors of Han women with cholecystolithiasis (P<0.05).Conclusion In Xinjiang Uygur Autonomous Region,the prevalence of cholecystolithiasis in female is higher,and the prevalence of cholecystolithiasis in Uygur female is related to age of menarche,irregular menstruation and the number of babies.The prevalence of cholecystolithiasis in Kazakh women was related to the age of menarche and the number of babies.The prevalence of cholecystolithiasis in Han women is mainly related to the number of babies and the age of childbirth.Therefore,the clinical work should focus on women with delayed menarche,large number of babies,and young age of childbirth,especially in the Uygur population who have higher prevalence of cholecystolithiasis.
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39. Application of Internet-based Self-management Intervention in the Clinical Treatment of Middle-aged and Elderly Female Patients with Stress Urinary Incontinence: a Randomized Controlled Trial
LIANG Jing, ZHANG Kui, NIU Lichun, ZHANG Ying
Chinese General Practice    2024, 27 (36): 4575-4581.   DOI: 10.12114/j.issn.1007-9572.2023.0720
Abstract680)   HTML24)    PDF(pc) (948KB)(169)    Save
Background

Stress urinary incontinence (SUI) is one of the common diseases in middle-aged and elderly women, which seriously affects their quality of life and physical and mental health. Internet medicine has the advantages of flexibility, privacy and accessibility, which can be used as an effective approach of self-management intervention for urinary incontinence patients. However, its effectiveness on the clinical treatment of middle-aged and elderly female SUI patients is unclear.

Objective

To explore the effects of Internet-based self-management intervention on improving clinical symptoms, self-efficacy, and psychological status in middle-aged and elderly female SUI patients.

Methods

A total of 120 middle-aged and elderly female SUI patients treated in the Air Force 986 Hospital of PLA from January to December 2022 were recruited. They were randomly assigned into control group (n=60) and experimental group (n=60) by double-blind random number table method. Patients in both groups were given conventional pelvic floor muscle training (PFMT), with 20 minutes per day, once every other day for a course of 10 times of PFMT, and those in the experimental group were additionally given Internet-based self-management intervention for 6 months. Outpatient re-examination and follow-up visits were conducted before treatment and 3 and 6 months after treatment. Clinical symptoms of SUI in middle-aged and elderly female patients were evaluated by surveying the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) and 1-hour pad test, thus determining the clinical efficacy. The Broome Pelvic Muscle Self-efficacy Scale (BPMSES) was used to evaluate the self-management efficacy. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status, respectively.

Results

The ICI-Q-SF scores of experimental group at 3 months [ (6.58±3.91) points vs. (9.27±3.11) points, P<0.05] and 6 months [ (3.37±2.74) points vs. (7.41±3.55) points, P<0.001] after treatment were significantly lower than those of control group. Urinary loss in 1-hour pad test at 3 months [ (4.83±1.64) g vs. (5.29±2.34) g, P<0.05] and 6 months [ (2.16±0.88) g vs. (3.87±1.66) g, P<0.01] after treatment was significantly less in the experimental group than that of control group. The total clinical effective rate of the control group was significantly lower than that of the experimental group (78.33%, 47/60, vs. 91.67%, 55/60, χ2=6.227, P=0.044). The total scores of BPMSES in the experimental group at 3 months [ (105.70±15.68) points vs. (77.90±17.52) points, P<0.05] and 6 months [ (126.61±16.64) points vs. (108.12±15.74) points, P<0.05] after treatment were significantly higher than those of control group. The expected self-efficacy scores of the experimental group at 3 months [ (69.27±5.91) points vs. (59.08±6.84) points, P<0.05] and 6 months [ (79.71±10.41) points vs. (61.17±6.92) points, P<0.001) ] after treatment were significantly higher than those of control group. The expected efficacy scores at 3 months [ (58.17±8.69) points vs. (50.26±9.04) points, P<0.05] and 6 months [ (64.93±7.84) points vs. (50.17±8.76) points, P<0.001) after treatment were significantly higher in the experimental group than those of the control group. The SAS scores [3 months (43.29±7.71) points vs. (45.25±7.50) points, P<0.05; 6 months (39.18±8.32) points vs. (42.58±8.39) points, P<0.001] and SDS scores [3 months (46.86±10.62) points vs. (47.17±10.22) points, P<0.05; 6 months (38.68±11.24) points vs. (42.54±10.31) points, P<0.001] at 3 months and 6 months were significantly lower in the experimental group than those of the control group.

Conclusion

Internet-based self-management intervention can significantly improve the self-management efficacy of middle-aged and elderly female SUI patients and alleviate psychological states of depression and anxiety, thus enhancing the clinical efficacy of PFMT on middle-aged and elderly female SUI patients. It provides unique advantages in improving treatment compliance and relieving negative psychological factors in middle-aged and elderly female SUI patients. Serving as a safe, effective and economic friendly intervention, Internet-based self-management intervention is worthy of clinical promotion to middle-aged and elderly female SUI patients.

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40. 抗癫痫药丙戊酸镁缓释片对女性癫痫患者生殖内分泌的影响
张冬梅,孙凤英
Chinese General Practice    2015, 18 (14): 1727-1728.   DOI: 10.3969/j.issn.1007-9572.2015.14.032
Abstract678)      PDF(pc) (455KB)(748)    Save
目的  分析抗癫痫药丙戊酸镁缓释片对女性癫痫患者生殖内分泌的影响。方法  选取2010年3月-2013年3月滨州医学院附属医院收治的50例女性癫痫患者,均给予丙戊酸镁缓释片口服治疗,0.5g/d。分别于患者用药前及用药3、6个月时,抽取空腹静脉血,采用酶联免疫吸附试验检测卵泡刺激素(FSH)、黄体生成素(LH)、催乳素(PRL)、雌二醇(E2)、孕酮(P)、睾酮(T)水平。同时观察患者月经及卵巢变化情况,多囊卵巢综合征(PCOS)、高雄激素血症发生情况。结果  50例患者用药前及用药3、6个月时,FSH、LH、PRL、E2、P、T比较,差异均有统计学意义(P<0.05);其中用药3、6个月时FSH、T均高于用药前,PRL、E2、P均低于用药前(P<0.05)。用药6个月后,38例(76.0%)患者月经周期尚在参考范围内;12例(24.0%)患者月经周期出现异常。6例(12.0%)患者出现PCOS。16例(32.0%)患者为高雄激素血症。结论  丙戊酸镁缓释片可使女性癫痫患者机体PRL、P水平降低,T水平提高。
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