Chinese Central Government, the Ministry of Science and Technology of The People's Republic of China, and the National Natural Science Foundation of China.

Variations in cervical cancer screening rates in China have rarely been studied in depth. This study aimed to investigate cervical cancer screening rates in relation to both individual‐level and geographical measures of socioeconomic status (SES). Data were obtained from women aged 21 years or older by face‐to‐face interviews between August 2013 and July 2014 as part of the Chinese Chronic Diseases and Risk Factors Surveillance. The geographical variables were obtained from the 2010 Chinese population census. The cervical cancer screening rates and 95% confidence interval (CI) were estimated and mapped. Multilevel logistic regression models were fitted. Overall, only 21.4% (95% CI: 19.6–23.1%) of 91,816 women aged ≥21 years reported having ever been screened for cervical cancer and significant geographical variations at both province and county levels were identified (P < 0.01). The cervical cancer screening rates were the lowest among the poor [13.9% (95% CI: 12.1–15.7%)], uninsured [14.4% (95% CI: 10.3–18.4%)], less‐educated [16.0% (95% CI: 14.3–17.6%)], and agricultural employment [18.1% (95% CI: 15.8–20.4%)] women along with those residing in areas of low economic status [15.0% (95% CI: 11.8–18.2%)], of low urbanization [15.6% (95% CI: 13.4–17.7%)], and of low education status [16.0% (95% CI: 14.0–18.1%)]. The multilevel analysis also indicated that women with lower individual‐level measures of SES residing in areas with low geographical measures of SES were significantly less likely to receive cervical cancer screening (P < 0.0001). Despite the launch of an organized cancer screening program in China, cervical cancer screening rates remain alarmingly low and significant variations based on geographical regions and measures of SES still exist. It is therefore essential to adopt strategies to better direct limited available public resources to priority groups.

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Purpose: COPD prevalence has rapidly increased in China, but the geographical disparities in COPD prevalence remain largely unknown. This study aimed to assess city-level disparities in COPD prevalence and identify the relative importance of COPD related risk factors in mainland China. Patients and Methods: A nationwide cross-sectional study of COPD recruited 66,752 adults across the mainland China between 2014 and 2015. Patients with COPD were ascertained by a post-bronchodilator pulmonary function test. We estimated the cityspecific prevalence of COPD by spatial kriging interpolation method. We detected spatial clusters with a significantly higher prevalence of COPD by spatial scan statistics. We determined the relative importance of COPD associated risk factors by a nonparametric and nonlinear classification and regression tree (CART) model. Results: The three spatial clusters with the highest prevalence of COPD were located in parts of Sichuan, Gansu, and Shaanxi, etc. (relative risks (RRs)) ranging from 1.55 (95% CI 1.55-1.56) to 1.33 (95% CI 1.33-1.33)). CART showed that advanced age (≥60 years) was the most important factor associated with COPD in the overall population, followed by smoking. We estimated that there were about 28.5 million potentially avoidable cases of COPD among people aged 40 or older if they never smoked. PM 2.5 was an important associated risk factor for COPD in the north, northeast, and southwest of China. After adjusting for age and smoking, the spatial cluster with the highest prevalence shifted to most of Sichuan, Gansu, Qinghai, and Ningxia, etc. (RR 1.65 (95% CI 1.63-1.67)). Conclusion: The spatial clusters of COPD at the city level and regionally varied important risk factors for COPD would help develop tailored interventions for COPD in China. After adjusting for the main risk factors, the spatial clusters of COPD shifted, indicating that there would be other potential risk factors for the remaining clusters which call for further studies.

ObjectiveTo determine the feasibility of long-term prospective follow-up and ascertainment of cancer in offspring and mothers from the 1993–1995 Chinese Community Intervention Program that provided folic acid supplements before and during early pregnancy to reduce neural tube defects.DesignFeasibility pilot study for a prospective cohort study.SettingFamilies residing during 2012–2013 in one rural and one urban county from 21 counties in 3 provinces in China included in the Community Intervention Program campaign.ParticipantsThe feasibility study targeted 560 families, including 280 from the rural and 280 from the urban county included in the large original study; about half of mothers in each group had taken and half had not taken folic acid supplements.InterventionThe planned new study is observational.Primary and secondary outcome measuresPrimary: incidence of paediatric cancers in offspring; secondary: other chronic diseases in offspring and chronic diseases in mothersResultsOnly 3.4% of pilot study families could not be found, 3.9% had moved out of the study area and 8.8% refused to participate. Interviews were completed by 82% of mothers, 79% of fathers and 83% of offspring in the 560 families. Almost all mothers and offspring who were interviewed also participated in anthropometric measurements. We found notable urban–rural differences in sociodemographic and lifestyle characteristics of the parents, but fewer differences among the offspring. In eight catchment area hospitals, we identified a broad range of paediatric cancers diagnosed during 1994–2013, although paediatric brain tumours, lymphomas and rarer cancers were likely under-represented.ConclusionsOverall, 20 years after the original Community Intervention Program, the pilot study achieved high levels of follow-up and family member interview participation, and identified substantial numbers of paediatric malignancies during 1994–2013 in catchment area hospitals. Next steps and strategies for overcoming limitations are described.

Primary restless leg syndrome (RLS) is a common sensory-motor disorder that is characterized by an irresistible urge to move the limbs and unpleasant sensations in the legs, which affects 1.9%–4.6% adults. Pramipexole, a potent dopamine D2/3 agonist, is recommended as “effective” in the short-term and “possibly effective” in the long-term treatment of primary RLS in the European guidelines on management of RLS. In this meta-analysis, we summarized the efficacy and tolerability of pramipexole in treatment for primary RLS. Results of this meta-analysis showed a favorable effect of pramipexole versus placebo on RLS symptoms (mean change on International RLS Study Group Rating Scale [IRLS] score: mean difference [MD] = −5.96; 95% confidence interval [CI]: −7.79 to −4.41, P < 0.00001) and sleep quality (pooled standard mean difference [SMD] = −0.48, 95% CI: −0.61 to −0.35, P < 0.00001). Nausea (relative risk [RR] = 2.68, 95% CI: 1.82 to 3.95, P < 0.001) and fatigue (RR = 1.82, 95% CI: 1.14 to 2.93, P = 0.013) were the most common adverse events, but, by and large, pramipexole was well-tolerated in patients with primary RLS. Nevertheless, long-term studies and more evidence of head-to-head comparisons of pramipexole with other dopamine agonists, anticonvulsants, and levodopa are needed.

This study aims to investigate the characteristics of the phenotype and management of chronic obstructive pulmonary disease (COPD) patients in the general population in China. We analyzed spirometry-confirmed COPD patients who were identified from a population-based, nationally representative sample in China. All participants were measured with airflow limitation severity based on post-bronchodilator FEV1 percent predicted, bronchodilator responsiveness, exacerbation history, and respiratory symptoms. Among a total of 9134 COPD patients, 90.3% were non-exacerbators, 2.9% were frequent exacerbators without chronic bronchitis, 2.0% were frequent exacerbators with chronic bronchitis, and 4.8% were asthma-COPD overlap. Less than 5% of non-exacerbators ever had pulmonary function testing performed. The utilization rate of inhaled medication in non-exacerbators, exacerbators without chronic bronchitis, exacerbators with chronic bronchitis, and asthma-COPD overlap was 1.4, 23.5, 29.5, and 19.4%, respectively. A comprehensive strategy for the management of COPD patients based on phenotype in primary care is urgently needed.