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Symptom-based surveys suggest that the prevalence of gastrointestinal diseases is lower in China than in Western countries. The aim of this study was to validate a methodology for the epidemiological investigation of gastrointestinal symptoms and endoscopic findings in China.
A randomized, stratified, multi-stage sampling methodology was used to se...
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AIM
To assess the efficacy and safety of a Chinese herbal medicine (CHM), Xiangsha Liujunzi granules, in the treatment of patients with functional dyspepsia (FD).
METHODS
We performed a randomized, double-blind, placebo-controlled trial with patients from three centers. Two hundred and sixteen subjects diagnosed with FD according to ROME III crite...
Citations
... 19 A surveying methodology for the systematic investigation of gastrointestinal disorders has also been proposed. 20 Taking all this context into account, the proposed pilot scheme is also advantageous for multiple testing, since it helps in the making of unequivocal diagnosis by altering the posterior probabilities in a predictable fashion, that is, parallel testing results with decreased false negative rate, while serial testing leads to decreased false positive rate. Moreover, there is less unnecessary anticipated discomfort, lowering the delays and increasing compliance. ...
Background:
Employing colonoscopy, the gold standard in colorectal cancer (CRC) diagnosis testing, for CRC screening presents a significant risk of complications. Alternative methods with a lower invasive-level and fewer risks are proposed in combination, though each with lower diagnosis performance when applied separately. The main objective of this cross-sectional pilot study was to evaluate the feasibility of a CRC screening program using combined flexible sigmoidoscopy and fecal-immunochemical test (FIT).
Methods:
The patient population consisted of 2,201 consecutive-case symptomatic patients attending the gastroenterology outpatient clinic with mild complaints between 2012 and 2014. They were referred for FIT. A sample of 252 individuals underwent a subsequent colonoscopy, blind to FIT results, and theoretical sigmoidoscopy was simulated. On a subsample of 57 patients, real sigmoidoscopy was additionally performed. Prior probabilities in terms of patients’ compliance and CRC prevalence were estimated, together with predictive ability of FIT and sigmoidoscopy in screening population. We assessed the merit of a screening strategy employing two-stage serial multiple testing: a) first stage by combining two parallel tests, that is, flexible sigmoidoscopy and FIT and b) colonoscopy as the second diagnosis test. The scheme was validated using the actual predictive values derived from the study population.
Results:
Colonoscopy found 75 (29.76%) individuals with advanced neoplasia. FIT was positive in 30.3% of advanced neoplasia cases, while between 23.73% and 28.28% met the theoretical sigmoidoscopy simulation criteria, with good concordance between real and theoretical sigmoidoscopy. The colonoscopy referral compliance rate was 52% among FIT-positives. Sensitivity and specificity of the first-stage test combination were better than sigmoidoscopy alone (McNemar test: P<0.001). Negative predictive values for low prevalence levels were between 81.5% and 90.12%.
Conclusion:
Combining less resource challenging and less invasive testing procedures is worthwhile in colorectal neoplasia detection, improving sensitivity and specificity of either test alone, and leading to better posterior probabilities in usual screening scenarios. Keywords: colorectal cancer, test combination, predicted values, screening
... We conducted a nationwide population-based cross-sectional study in China with the primary aim of evaluating the epidemiology of gastrointestinal (GI) symptoms, which has been described in detail elsewhere [26]. In brief, 18,000 adults aged 18-80 years were randomly selected from Shanghai, Beijing, Xi'an, Wuhan, and Guangzhou, using a stratified, multistage sampling methodology. ...
... The main strength of this study is that it is a large truly population-based study on the relationship between BMI and gastroesophageal reflux symptoms in China that used validated questionnaires. The population sampling and survey administration methods achieved a high response rate (89.4 %) that minimized the potential selection bias and generated representative adult population samples [26]. More importantly, the ZIP regression model was used to analyze the relationships between BMI and gastroesophageal reflux symptoms in this study, which is more suitable to analyze the data with excess zeros in this study and can predict the probability of gastroesophageal reflux symptom occurrence and the frequency in participants. ...
... First, this study is based on the Chinese population and one should be cautious of generalizing of these results. In addition, language barriers and cultural differences are inevitable study limitations, although many efforts had been made to overcome these through the survey administration techniques and the linguistic validation of the questionnaires [26]. Another potential limitation is the cross-sectional study design, which does not enable the directionality of relationships between BMI and gastroesophageal reflux symptoms to be assessed. ...
Background and aim:
That obesity leads to gastroesophageal reflux is a widespread notion. However, scientific evidence for this association is limited, with no rigorous epidemiological approach conducted to address this question. This study examined the relationship between body mass index (BMI) and gastroesophageal reflux symptoms in a large population-representative sample from China.
Methods:
We performed a cross-sectional study in an age- and gender-stratified random sample of the population of five central regions in China. Participants aged 18-80 years completed a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire. The zero-inflated Poisson regression model estimated the relationship between body mass index and gastroesophageal reflux symptoms.
Results:
Overall, 16,091 (89.4 %) of the 18,000 eligible participants responded. 638 (3.97 %) and 1738 (10.81 %) experienced at least weekly heartburn and weekly acid regurgitation, respectively. After adjusting for potential risk factors in the zero-inflated part, the frequency [odds ratio (OR) 0.66, 95 % confidence interval (95 % CI) 0.50-0.86, p = 0.002] and severity (OR 0.66, 95 % CI 0.50-088, p = 0.004) of heartburn in obese participants were statistically significant compared to those in normal participants. In the Poisson part, the frequency of acid regurgitation, overweight (OR 1.10, 95 % CI 1.01-1.21, p = 0.038) and obesity (OR 1.19, 95 % CI 1.04-1.37, p = 0.013) were statistically significant. BMI was strongly and positively related to the frequency and severity of gastroesophageal reflux symptoms. Additionally, gender exerted strong specific effects on the relationship between BMI and gastroesophageal reflux symptoms.
Conclusions:
The severity and frequency of heartburn were positively correlated with obesity. This relationship was presented distinct in male participants only.
... The study was part of a recent population-based epidemiology survey. The details of the design were published by Yan et al. [16], and were briefly described here. We used a randomized stratified multiple-stage sampling method to select a representative sample of adults in Shanghai. ...
... We used a randomized stratified multiple-stage sampling method to select a representative sample of adults in Shanghai. Because approximately half of the residents lived in rural areas (54.2%) [16], at the first sampling stage, one district in urban areas (Hongkou District) and one district in rural stratum (Baoshan District) were randomly selected. Then following the sequence of block/town-residential area/village, 13 residential areas from two blocks in Hongkou District and four villages from two towns in Baoshan District were sampled, a total of 3600 residents aged from 18 to 80 years were sampled from these residential areas/villages, stratified by age and sex according to the data of the Fifth Population Census in Shanghai, 2000 [17]. ...
In this study, we aimed to investigate the prevalence, awareness, treatment, and control of diabetes in Shanghai, China. A sample of 3600 residents aged from 18 to 80 years selected by a randomized stratified multiple-stage sampling method in Shanghai was investigated, with blood samples collected. Diabetes was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, or glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol), or previous diagnosis by a physician. Adequate control of diabetes was taken as a level of HbA1c < 7.0% (53 mmol/mol) among people with treated diabetes. Multivariable regression analysis was used to explore associated factors for diabetes and prediabetes. In the 3136 participants suitable for analysis, the prevalences of diabetes, prediabetes, and previously diagnosed diabetes were 15.91%, 37.37%, and 4.46%, respectively. Among those with diabetes, only 28.06% were aware of their condition, 25.85% were currently undergoing medication treatment, and 12.42% achieved glycaemic control. Logistic regression showed that old age, preobesity, obesity, elevated triglyceride (TG), elevated C-reactive protein (CRP), and lower education level were associated with an increased risk of diabetes; old age, obesity, elevated TG, and elevated low-density lipoprotein (LDL) were associated with an increased risk of prediabetes, while male sex and rural residence were associated with a decreased risk of prediabetes. In summary, the state of diabetes in China is alarming; the rates of awareness, treatment, and control were relatively low. More efforts should be made to promote the prevention and control of diabetes in china.
... The questionnaire includes eight subscales: physical functioning (PF), role limitations due to physical health problems, bodily pain (BP), general health perceptions, vitality (VT), social functioning (SF), role limitations due to emotional problems and MH [19]. The Chinese version of the SF-36 has good reliability and validity [20,21]. ...
Objective
Depression is one of the most common mental illnesses. The reliability and the validity of the Patient Health Questionnaire (PHQ)-9, a depression screening tool, have not been examined in the general population in China. Thus, this study evaluated the reliability and the validity of the Chinese version of the PHQ-9 in detecting major depression in residents of a Chinese community.
Methods
A total of 1,045 participants from a Shanghai community were enrolled in our study. Participants completed the Chinese versions of the PHQ-9, the Self-rating Depression Scale (SDS), the 36-Item Short Form Health Survey (SF-36), and the Mini International Neuropsychiatric Interview (MINI). One hundred participants were randomly selected to complete the PHQ-9 again two weeks after the initial assessment. The reliability, the validity, and the receiver operating characteristic (ROC) curve of the PHQ-9 were analyzed.
Results
Cronbach’s alpha for the internal consistency reliability of the Chinese version of the PHQ-9 was 0.86 for the entire scale. The correlation coefficient for the 2-week test-retest of the total score was 0.86. The PHQ-9 scale correlated positively with the SDS (r = 0.29, p < 0.001) and correlated negatively with all subscale scores of the SF-36 (correlation coefficients ranged from -0.11 to -0.47, p < 0.001). The area under the curve (AUC) of the ROC was 0.92 (95%CI: 0.86-0.97). A cut-off score of 7 or higher on the PHQ-9 had a sensitivity of 0.86 and a specificity of 0.86.
Conclusions
In the general Chinese population, the Chinese version of the PHQ-9 is a valid and efficient tool for screening depression, with a recommended cut-off score of 7 or more.
... As a part of the large survey of the Systematic Investigation of Gastrointestinal Diseases in China (SILC), the main methods have been described in detail elsewhere, [13] and are summarized here. ...
... Its reliability and validity have been tested. [13,15] Data collection and response rate ...
... Those data excluded from the analysis were because of the logical errors or insufficient completion of questionnaire. [13,16] ...
Background
The epidemiology of Functional abdominal bloating (FAB) and its impact on health-related quality of life (HRQoL) in Chinese people remains unclear.
Methods
Randomised, stratified, multi-stage sampling methodology was used to select a representative sample of the general population from five cities in China (n = 16,078). All respondents completed the modified Rome II questionnaire; 20% were asked to complete the 36-item Short Form (SF-36). The associated factors of FAB were analyzed. The effects of FAB on HRQoL were estimated with gender stratification using propensity score techniques in 20% subsample.
Results
Overall, 643 individuals (4.00%) had FAB and it was more prevalent in males than in females (4.87% vs. 3.04%, P<0.001). For males, self-reported history of dyspepsia was most strongly associated with FAB (OR = 2.78; 95% CI: 1.59, 4.72). However, the most strongly associated factor was self-reported health status for females (moderate health vs. good health: OR = 2.06, 95% CI: 1.07, 3.96. P = 0.030; poor health vs. good health: OR = 5.71, 95% CI: 2.06, 15.09). Concerning HRQoL, FAB was found to be related to two domains: role limitation due to physical problems (P = 0.030) and bodily pain (P<0.001) in females. While, in males, there were significant differences in multiple domains between those with and without FAB.
Conclusion
The prevalence of FAB in China was lower than previous reports. Males who had ever been diagnosed with dyspepsia and females who were in a poor self-reported health status were correlated with a higher prevalence of FAB. FAB affected only physical health in females, but impaired both physical and mental health in males.
... The data for this study were derived from our previous epidemiology survey on gastrointestinal diseases in 5 Chinese cities, including Shanghai, Beijing, Wuhan, Xian, and Guangzhou. A detailed description of the study population and the methods of the survey have been previously published [17]. Briefly, the survey was conducted among 3,600 residents aged 18-80 years from April 2007 to January 2008. ...
Background
This study aimed to investigate the prevalence of abdominal obesity and its association with the health-related quality of life (HRQOL) in a randomly selected Chinese sample.
Methods
A population-based sample of 3,600 residents aged 18–80 years was selected randomly from 5 Chinese cities. Demographic information, and waist and hip circumference measurements were obtained. The Mandarin version of the Short Form 36 Health Survey questionnaire (SF-36) was used to assess the HRQOL. Waist circumference (WC) and waist-to-hip ratio (WHR) were used as measures of abdominal obesity, and the prevalence of abdominal obesity and its association with HRQOL were analysed.
Results
Among the 3,184 participants included in the analysis, the prevalence of abdominal obesity was about 45% in both women and men as evaluated by WC, and about 40% in women and 33% in men as evaluated by WHR. The prevalence varied by city, region, age, marital status, education level, family income, smoking, and the presence of chronic diseases. Both WC and WHR increased with age, and men had larger WC and WHR than women in most age groups. In women, abdominal obesity, as determined by both WC and WHR, was associated with meaningful impairments in 4 physical health scales and 2 mental health scales. In men, abdominal obesity, as determined by WC, was associated with 1 physical health scale and 1 mental health scale, and it was associated with 2 physical health scales based on WHR.
Conclusions
Physical health, but not mental health, was more vulnerable to impairment with abdominal obesity, and the impairments varied between genders. Public health agencies should emphasize that abdominal obesity impairs physical health.
... We used a part of the data from our previous epidemiological survey on gastrointestinal diseases in five cities of China. The details of the methodology of the survey have been published elsewhere [19], and are briefly described here. The survey was administered to 18,000 residents aged 18-80 years (3,600 in each city) from April 2007 to January 2008. ...
Background
Self-rated health (SRH), a subjective assessment of health status, is extensively used in the public health field. However, whether SRH can reflect the objective health status is still debatable. We aim to reveal the relationship between SRH and objective health status in the general population.
Methods
We assessed the relationship between SRH and objective health status by examining the prevalence of diseases, laboratory parameters, and some health-related factors in different SRH groups. Data were collected from 18,000 residents randomly sampled from the general population in five cities of China (3,600 in each city). SRH was assessed by a single-item health measure with five options: “very good,” “good,” “fair,” “bad,” and “very bad.” The differences in prevalence of diseases, laboratory parameters, and health-related factors between the “healthy” (very good plus good), “relatively healthy” (fair), and “unhealthy” (bad plus very bad) groups were examined. The odds ratios (ORs) referenced by the healthy group were calculated using logistic regression analysis.
Results
The prevalence of all diseases was associated with poorer SRH. The tendency was more prominent in cardio-cerebral vascular diseases, visual impairment, and mental illnesses with larger ORs. Residents with abnormalities in laboratory parameters tended to have poorer SRH, with ORs ranging from 1.62 (for triglyceride) to 3.48 (for hemoglobin among men) in a comparison of the unhealthy and healthy groups. Most of the health-related factors regarded as risks were associated with poorer SRH. Among them, life and work pressure, poor spiritual status, and poor quality of interpersonal relationships were the most significant factors.
Conclusions
SRH is consistent with objective health status and can serve as a global measure of health status in the general population.
... This study was part of a countrywide survey, and the details of the methodology of this survey were published elsewhere [25]. From April 2007 to January 2008, a population-based sample of 3600 individuals aged 18 to 80 years was selected randomly in five cities of China— Shanghai, Beijng, Xi'an, Wuhan, and Guangzhou—using a multiple-stage sampling method with stratification according to the proportion of the population in a particular town of a particular age and sex, as reported by the local government. ...
... Respondents with chronic diseases had more missing data (p < 0.01). Missing data among different sociodemographic variables are shown inTable 2. The demographic characteristics of the survey respondents have been described in detail elsewhere [25]. Among the 3214 respondents, 52.21% were female and 47.79% were male. ...
Background
Excessive daytime sleepiness (EDS) is a common condition worldwide that has many negative effects on people who were afflicted with it, especially on their health-related quality of life (HRQOL). The Epworth Sleepiness Scale (ESS) is a commonly used method for evaluating EDS in English-speaking countries. This paper reported the prevalence of subjective EDS in China as assessed by the Mandarin version of the ESS; tested the scale’s response rate, reliability and validity; and investigated the relationship between ESS scores and HRQOL.
Methods
A population-based sample of 3600 residents was selected randomly in five cities in China. The demographic information was collected, subjective EDS was assessed by the Mandarin version of the ESS (ESS scores >10), and HRQOL was evaluated by the Mandarin version of the 36-item Short Form Health Survey (SF-36).
Results
The Mandarin version of ESS had very few missing responses, and the average response rate of its eight items was 97.92%. The split-half reliability coefficient and Cronbach’s α coefficient were 0.81 and 0.80, respectively. One factor was identified by factor analysis with an eigenvalue of 2.78. The ESS scores showed positive skewness in the selected sample, with a median (Q1, Q3) of 6 (3, 0). 644 (22.16%) respondents reported subjective EDS, and all of the scores of the eight dimensions of the SF-36 were negatively correlated with ESS scores.
Conclusions
The Mandarin version of ESS is an acceptable, reliable, and valid tool for measuring EDS. In addition, subjective EDS is common in China, based on the ESS results, and impairs HRQOL.
... As part of the large survey of the Systematic Investigation of Gastrointestinal Diseases in China (SILC), the main methods have been described in detail elsewhere[12], and are summarized here. ...
... In addition, a random subsample of 20% of the total sample from each region was asked to complete the Chinese version of the 36-item Short Form health survey (SF-36), which measures healthrelated quality of life. Its reliability and validity have been tested[12,15]. ...
... The SF-36 and ESS questionnaires were completed by 3219 respondents (a response rate of 89.4%) and data from 3214 respondents were suitable for analysis. The demographics and lifestyle characteristics of the respondents have been described previously[12]. ...
The epidemiology of functional diarrhea and its impacts on Chinese remain unclear, and there are no data on the comparative epidemiology of functional diarrhea and diarrhea-predominant irritable bowel syndrome (IBS-D). This study was to explore the epidemiology of functional diarrhea and its impacts, and to identify its distinction from IBS-D.
A cross-sectional survey was conducted in 16078 respondents, who were interviewed under a randomized stratified multi-stage sampling design in five cities of China. All respondents completed the modified Rome II questionnaire, and the 36-item Short Form health survey (SF-36) was used for assessing health-related quality of life in 20% of the sample. Overall, 248 respondents (1.54%) had functional diarrhea and 277 (1.72%) had IBS-D. Functional diarrhea was positively associated with increasing age and body mass index (trend test P<0.05). The three most common symptoms for at least 3 weeks in the past months were loose, mushy or watery stools (n = 203, 81.85%), more than three bowel movements a day (n = 100, 40.32%) and having to rush to the toilet to have a bowel movement (n = 72, 29.03%). Meaningful impairment was observed in 5 of the 8 SF-36 domains in respondents with functional diarrhea. The demographics are mostly similar between the respondents with functional diarrhea and IBS-D; however, respondents with IBS-D had more frequent symptoms of diarrhea and even lower scores in SF-36 domains than those with functional diarrhea.
The prevalence of functional diarrhea in China is substantially lower than that in Western countries and relatively higher than that in other Asian countries. It impaired health-related quality of life, and respondents with IBS-D have even worse quality of life. Further population-based studies are needed to investigate the epidemiology of functional diarrhea and the differences between functional diarrhea and IBS-D.
... Participants and study design Randomised, stratified, multi-stage sampling methodology was used to select a representative sample of the general population from Shanghai, Beijing, Xi'an, Wuhan, and Guangzhou in China. 11 By this approach, 3600 subjects aged 18-80 years were selected from each region (18 000 adults in total) after stratification by the overall age and sex distribution for that region. Rural and urban populations were sampled equally (n = 1800 from each stratum in each region). ...
... Each individual selected was asked to complete: (i) a general information questionnaire, (ii) the Chinese version of the Reflux Disease Questionnaire (RDQ), 11,12 and (iii) the Chinese version of the modified Rome II questionnaire. 13,14 The general information questionnaire included information on age, height, weight, sex, education, total monthly family income, occupation, lifestyle habits (including smoking status, alcohol consumption and frequency of recreational exercise) and family history of gastrointestinal diseases. ...
... The RDQ was used to diagnose symptom-defined gastro-oesophageal reflux disease (GERD) and has been validated and described elsewhere. 11 The validated Chinese version of the Rome II questionnaire was used to determine the presence of FC, IBS-C and other functional gastrointestinal disorders. The modified Rome II questionnaire used in our study included gastroduodenal, bowel and biliary items only. ...
The epidemiology and effects of functional constipation (FC) on Chinese people remain unclear.
To investigate the epidemiology of FC and its distinction from constipation-predominant irritable bowel syndrome (IBS-C) in China.
A cross-sectional survey was conducted in a representative adult Chinese population (n = 16,078), which was selected from five regions using randomised, stratified, multistage sampling methodology. All respondents completed the modified Rome II questionnaire; 20% were asked to complete the 36-item Short Form (SF-36) and the Epworth Sleepiness Scale (ESS).
Overall, 948 respondents (6%) had FC and FC was more prevalent in women than in men (8% vs. 4%, P < 0.001). Straining and hard stools were the two most frequent symptoms. FC was associated significantly with dyspepsia and abdominal bloating. All SF-36 domain scores were lower for respondents with FC than for those without. The prevalence of clinically meaningful daytime sleepiness was significantly higher in respondents with FC than in those without (22% vs. 14%, P = 0.003). Respondents with FC were more likely to strain, but less likely to have a feeling of incomplete emptying after a bowel movement than those with IBS-C. Respondents with IBS-C experienced similar demographics, quality of life and daytime sleepiness to those with FC.
The prevalence of FC in China is substantially lower than that in Western countries. FC has negative effects on quality of life and daytime sleepiness. The demographics and burden of illness are similar between FC and IBS-C, although the clinical symptoms are somewhat different.
