BackgroundIn recent years in China, the tense physician-patient relationship has been an outstanding problem. Empathy is one of the fundamental factors enhancing the therapeutic effects of physician-patient relationships and is significantly associated with clinical and academic performance among students.MethodsThis cross-sectional study used the JSPE-S (The Student Version of the Jefferson Scale of Physician Empathy) to assess 902 medical students from 1st year to 4th year at China Medical University. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient. We performed an exploratory factor analysis to evaluate the construct validity of the JSPE-S. Group comparisons of empathy scores were conducted via the t-test and one-way ANOVA. Statistic analysis was performed by SPSS 13.0.ResultsThe Cronbach’s alpha coefficient was 0.83. The three factors emerging in the factor analysis of the JSPE-S are “perspective taking”, “compassionate care” and “ability to stand in patients’ shoes”, which accounted for 48.00%. The mean empathy score was 109.60. The empathy score of medical students had significant differences between different genders (p < 0.05) and academic year level (p < 0.05).ConclusionsThis study provided support for the validity and reliability of the Chinese translated version of the JSPE-S for medical students. Early exposure to clinical training and a curriculum for professional competencies help to enhance the empathy of medical students. We suggest that the curriculum within Chinese medical schools include more teaching on empathy and communicational skills.

BackgroundAssociations of dietary patterns in Chinese adolescents and children with later obesity have not previously been investigated. The purpose of the present study was to evaluate the associations between dietary patterns and the risk of obesity in Chinese adolescents and children by using a longitudinal design.MethodsData from the China Health and Nutrition Survey (CHNS), a nationally representative survey, were used for our analysis. 489 participants 6–14 years of age were followed from 2006 to 2011. Factor analysis was used to identify the dietary patterns in Chinese adolescents and children. Ordered logistic regression models were used to examine the association between dietary patterns and later obesity.ResultsTwo dietary patterns were revealed by factor analysis, the traditional Chinese dietary pattern (with high intake of rice, vegetables, poultry, pork and fish and the modern dietary pattern (with high intake of wheat, processed meat and fast food). Children in the highest quartile and the second-highest quartile of the traditional Chinese dietary pattern was inversely associated with later obesity compared with children in the lowest quartile over 5 years (OR = 0.19, 95%CI: 0.09, 0.40 for Q4; OR = 0.47, 95%CI: 0.33, 0.67 for Q3); Children in the highest quartile of the modern dietary pattern was positively associated with later obesity compared with children in the lowest quartile over 5 years (OR = 2.02, 95%CI: 1.17, 3.48).ConclusionsDietary patterns in Chinese adolescents and children are associated with later obesity. These findings further confirm the importance of children’s dietary patterns in later obesity and lay groundwork for dietary culture-specific interventions targeted at reducing rates of obesity in children and adolescents.

Background Maternal body mass index is linked to short- and long-term unfavorable health outcomes both for child and mother. We conducted a systematic review and meta-analysis of population-based cohort studies to evaluate maternal BMI and the risk of harmful neonatal outcomes in China. Methods Six databases identified 2454 articles; 46 met the inclusion criteria for this study. The dichotomous data on maternal BMI and harmful neonatal outcomes were extracted. Pooled statistics (odds ratios, ORs) were derived from Stata/SE, ver. 12.0. Sensitivity analyses assessed the robustness of the results. Meta-regression and subgroup meta-analyses explored heterogeneity. Results The meta-analysis revealed that compared with normal BMI, high maternal BMI is associated with fetal overgrowth, defined as macrosomia ≥4000 g ( OR 1.91, 95% CI 1.75–2.09); birth weight ≥ 90% for gestational age ( OR 1.88, 95% CI 1.64–2.15); and increased risk of premature birth ( OR 1.38, 95% CI 1.25–2.52) and neonatal asphyxia ( OR 1.74, 95% CI 1.39–2.17). Maternal underweight increased the risk of low birth weight ( OR 1.61, 95% CI 1.33–1.93) and small for gestational age ( OR 1.75, 95% CI 1.51–2.02). Conclusions Raised as well as low pre-pregnancy BMI is associated with adverse neonatal outcomes. Management of weight during pregnancy might help reduce their adverse neonatal outcomes in future intervention studies or programmes. Electronic supplementary material The online version of this article (10.1186/s12884-019-2249-z) contains supplementary material, which is available to authorized users.

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Obesity is a common chronic metabolic disease that is harmful to human health and predisposes the affected individuals to a cluster of pathologies. Insulin resistance (IR) is one of the most frequent complications of obesity. Hydroxytyrosol (HT) may reduce obesity and IR in high-fat diet (HFD)-fed mice; however, the mechanism underlying is still unknown. Systemic low-grade inflammation and intestinal dysfunction are thought to be associated with obesity and IR. In this study, we found that HFD feeding for 8 weeks altered the intestinal microbiota, injured intestinal barrier function, increased endotoxin release into the blood, enhanced the expression of inflammatory factors (TNF-α, IL-1β, IL-6) and lipid accumulation in liver, caused obesity, and aggravated IR via the JNK/IRS (Ser 307) pathway in HFD mice. We also found that HT gavage could reverse those effects and the beneficial effects of HT were transferable through fecal microbiota transplantation. Our data indicate that HT can improve obesity and IR by altering the composition of the intestinal microbiota and improving integrity of the intestinal wall. We propose that HT replenishment may be used as a dietary intervention strategy to prevent obesity and IR.

Background: Sepsis is a deadly disease worldwide. Effective treatment strategy of sepsis remains limited. There still was a controversial about association between preadmission metformin use and mortality in sepsis patients with diabetes. We aimed to assess sepsis-related mortality in patients with type 2 diabetes (T2DM) who were preadmission metformin and non-metformin users.Methods: The patients with sepsis and T2DM were included from Medical Information Mart for Intensive Care -III database. Outcome was 30-day mortality. We used multivariable Cox regression analyses to calculate adjusted hazard ratio (HR) with 95% CI.Results: We included 2,383 sepsis patients with T2DM (476 and 1,907 patients were preadmission metformin and non-metformin uses) between 2001 and 2012. The overall 30-day mortality was 20.1% (480/2,383); it was 21.9% (418/1,907), and 13.0% (62/476) for non-metformin and metformin users, respectively. After adjusted for potential confounders, we found that preadmission metformin use was associated with 39% lower of 30-day mortality (HR = 0.61, 95% CI: 0.46–0.81, p = 0.007). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable.Conclusions: Preadmission metformin use may be associated with reduced risk-adjusted mortality in patients with sepsis and T2DM. It is worthy to further investigate this association.

Although adherence to healthy dietary guidelines has been associated with a reduced risk of several health outcomes, including cardiovascular diseases, type 2 diabetes, and some cancers, little is known about the role of dietary patterns in the development of hepatocellular carcinoma (HCC). We prospectively assessed the associations of three key commonly used a priori dietary patterns—the Alternative Healthy Eating Index‐2010 (AHEI‐2010), Alternate Mediterranean Diet (AMED), and Dietary Approaches to Stop Hypertension (DASH)—with risk of incident HCC in the Health Professionals Follow‐Up Study (HPFS) and the Nurses’ Health Study (NHS), two large prospective cohort studies. Diet was assessed almost every 4 years using validated food frequency questionnaires (FFQs). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. During up to 32 years of follow‐up, 160 incident HCC cases were identified. After adjustment for most HCC risk factors, participants in the highest tertile of Alternative Healthy Eating Index‐2010 (AHEI‐2010) had a multivariable HR of 0.61 (95% CI, 0.39‐0.95; Ptrend = 0.03), compared with those in the lowest tertile. There was a suggestive, but nonsignificant, inverse association for Alternate Mediterranean Diet (AMED; HR = 0.75; 95% CI, 0.49‐1.15; Ptrend = 0.18) and a null association for Dietary Approaches to Stop Hypertension (DASH; HR = 0.90; 95% CI, 0.59‐1.36; Ptrend = 0.61) in relation to the risk of HCC development. Conclusion: Our findings suggest that better adherence to the AHEI‐2010 may decrease the risk of developing HCC among U.S. adults. Future studies are needed to replicate our results, examine these associations in other populations, and elucidate the underlying mechanisms.

BackgroundPrevious studies have shown a positive association between type 2 diabetes (T2D) and colorectal cancer (CRC) risk. However, it is uncertain whether this association differs by duration of T2D or sex. We thus investigated the associations of T2D and its duration with the risk of incident CRC.MethodsWe followed 87,523 women from the Nurses’ Health Study (1980–2012) and 47,240 men from the Health Professionals Follow-up Study (1986–2012). Data on physician-diagnosed T2D was collected at baseline with a questionnaire and updated biennially. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsWe documented 3000 CRC cases during up to 32 years of follow-up. Among men, T2D was associated with increased risk of CRC compared to those without T2D (HR: 1.42; 95% CI: 1.12–1.81). This positive association persisted in sensitivity analyses by excluding CRC identified within 1 year of diabetes diagnosis and patients with T2D who used hypoglycaemic medications. Among women, T2D was positively, but not statistically significantly, associated with CRC risk (HR: 1.17; 95% CI: 0.98–1.39).ConclusionsOur findings support that T2D was associated with a moderately higher risk of developing CRC in men; a weaker, nonsignificant positive association was observed in women.