中华疾病控制杂志

Assessment on the effect of malaria control in China-Myanmar border areas

WANG Ru-bo, ZHANG Qing-feng, FENG Jun, XIA Zhi-gui

2016, 20(9): 863-866. doi: 10.16462/j.cnki.zhjbkz.2016.09.001

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Objective To assess the effect of malaria control activities in China-Myanmar border areas and provide references for the following related work. Methods Data on the epidemic situation and malaria control activities was collected from 12 counties along China-Myanmar border, Yunnan Province during 2007 to 2013. And then the effect of prevention was evaluated. Results There were 915 270 febrile patients indentified through microscopy examination in twelve counties along China-Myanmar border, Yunnan Province, 13 146 malaria cases were treated, 121 894 cases were cured in the resting phase, and 292 720 received preventive medication. Meanwhile, 1 408 573 were protected by indoor residual spraying and 1 114 360 were protected by insecticide-treated nets. Malaria incidence decreased from 11.35/10 000 in 2007 to 0.88/10 000 in 2013, with a reduction rate of 92.24%. The total number of malaria cases decreased from 6 108 in 2007 to 290 in 2013, with a reduction rate of 95.25%. The total number of indigenous infection cases decreased from 3 546 in 2007 to 32 in 2013, with a reduction rate of 99.10%. The imported malaria cases proportion in total cases increased from 41.95% in 2007 to 88.97% in 2013. And they were mostly came from Myanmar. Conclusions The malaria burden in the China-Myanmar border area was dramatically reduced from 2007 to 2013. However, the surveillance on the transmission risk bought from imported malaria still needs to be reinforced. The mechanism for malaria joint prevention and control should be improved in the China-Myanmar border areas for continuous maintenance of malaria elimination.

Study on the difference of social norms and risk behaviors and depression among people living with HIV/AIDS

SUN Yi-peng, GUO Zi-han, CAI Wei-ping, ZHOU Qian, ZHU Ya-jing, GUO Yan

2016, 20(9): 867-871. doi: 10.16462/j.cnki.zhjbkz.2016.09.002

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Objective To explore the relationship between depression and the difference of social norms and risk behaviors among people living with HIV/AIDS. Methods Convenient sampling method and self-designed questionnaire were adopted. We utilized the Center for Epidemiologic Studies Depression Scale (CES-D) to assess the depression status of the 450 HIV/AIDS patients. The score of CES-D greater than 19 was regarded as depression. Multiple stepwise regression was used for multivariate logistic regression. Results The average score of depression of the 406 HIV/AIDS patients was 16.1±11.5, and 36.9% of the respondents were in the depressive status. The multivariate logistic regression indicated that Guangzhou household registration (OR=2.260, 95% CI: 1.177-4.340), low level of social support (OR=0.985, 95% CI: 0.974-0.996), low level of resilience (OR=0.897, 95% CI: 0.862-0.933) and high level of stigma (OR=1.089, 95% CI: 1.052-1.128) were the risk factors of depression. The difference between social norms and his own condom use behavior was a protective factor of depression (OR=0.290, 95% CI: 0.094-0.894). Conclusion The difference between social norms and risk behaviors is an influencing factor of depression.

Study on association of plasma trace elements concentration with HCV infection and liver function

XIE Chao-nan, WU Meng-ping, HUANG Peng, YUE Ming, PENG Zhi-hang, YU Rong-bin, WANG Jie, ZHANG Yun

2016, 20(9): 872-875. doi: 10.16462/j.cnki.zhjbkz.2016.09.003

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Objective To explore the association of plasma microelements (Cu, Fe and Zn) concentration with hepatitis C virus (HCV) infection and liver function in hepatitis C patients. Methods In a case-control study, 281 participants, including 90 patients with chronic hepatitis C, 92 HCV natural clearance subjects and 99 healthy controls, were investigated. The subjects' plasma trace elements concentration was detected by inductively coupled plasma mass spectrometry (ICP-MS). And partial correlation analysis and multivariable logistic regression analysis were used to explore the relationship of microelements concentration and HCV viral load in patients with chronic HCV infection. Results Compared with healthy controls, the level of zinc was decreased, however, the level of iron was increased in patients with chronic HCV infection (all P<0.05). After controlling for age, sex and BMI, the HCV viral load was negatively correlated with plasma iron concentration (r=-0.263, P=0.016). The Logistic regression showed that iron was independently associated with ALT values in patients with persistent HCV infection (OR=1.001,95% CI:1.000-1.002,P=0.030). Conclusions Trace elements (Cu, Fe and Zn) may be associated with HCV infection outcomes. Especially, iron level is an independent risk factors of chronic HCV infection.

Study on HBV infection and related factors among drug users in compulsory detoxification centers in Shanxi Province

WANG Jun, LI Chun-xia, PAN Ming-hu, CHENG Yan-peng, SU Tong, FENG Yong-liang, WANG Su-ping

2016, 20(9): 876-879,884. doi: 10.16462/j.cnki.zhjbkz.2016.09.004

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Objective To understand the seroepidemiological status of hepatitis B virus (HBV) and its vaccination coverage, and to preliminarily explore the influencing factors of HBV infection among drug users in Shanxi province, China. Methods 1 176 drug users in three compulsory detoxification centers were included in the study, from June to December 2014.Information on the general demographic characteristics, the related factors of HBV infection and history of hepatitis B vaccination were collected through questionnaires at face-to-face interviews. Anticoagulant venous blood samples of 5 ml were also collected for HBsAg and anti-HBs testing, using the enzyme linked immunosorbent assay (ELISA) method. Unconditional logistic regression model was used to analyze the influencing factors of HBV infection. Results A total number of 1 176 drug users were included in the study, including 1 118 males and 58 females, with a mean age of (37.91±8.58) years. According to the laboratory results, HBsAg positive was defined as the case group (55), and HBsAg negative was defined as the control group (1 121).Age and gender differences between the two groups had no statistically significant differences. The positive rate of HBsAg and anti-HBs were 4.68% (55/1 176)and 34.69 %(408/1 176), respectively. 717 subjects (60.97%) were negative for both markers. The coverage rate of hepatitis B vaccination was low, only 22.62%(266/1 176) of the drug users had a clear history of hepatitis B vaccination. The logistic regression analysis showed that family history of HBV infection (OR=6.654, 95% CI:2.550-17.364), having pedicure(OR=1.955, 95% CI:1.086-3.518) and history of hepatitis C infection(OR=7.935,95% CI:1.496-42.098)were associated with HBsAg positive. Anti-HBs positive was a protective factor of HBsAg positive. Additive interaction and multiplication interaction were not found between pedicure history and family history of HBV infection(all P>0.05). Conclusions Drug users in compulsory detoxification centers were high-risk group of HBV infection, and their prior hepatitis B vaccination coverage rate and anti-HBs positive rate were low. Having family history of HBV infection, pedicure experiences and history of hepatitis C infection were risk factors of HBsAg positive. All above suggest the necessity and importance of the hepatitis B vaccination. Thus, the intervention of hepatitis B vaccination could reduce the risk of HBV infection among compulsory detoxification drug users.

Risk factors of chronic hepatitis B and liver cirrhosis: a cross-sectional study based on Qidong hepatitis B intervention study

YAO Hong-yu, CHEN Tao-yang, QU Chun-feng, FAN Jian, LU Jian-quan, FAN Chun-sun, LU Ling-ling, HUANG Fei, LU Jian-hua, NI Zheng-ping, WANG Yu-ting, ZHANG Ya-wei

2016, 20(9): 880-884. doi: 10.16462/j.cnki.zhjbkz.2016.09.005

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Objective To explore the risk factors of chronic hepatitis B and liver cirrhosis in the participants from Qidong Hepatitis B intervention Study. Methods From January to October, 2013, by using a cross-sectional study design, all the participants from Qidong Hepatitis B intervention Study were sampled by a stratified random method. Questionnaire survey was conducted to gain their sociodemographic information and family history of liver cancer. Blood tests for Alanine aminotransferase (ALT), hepatitis B virus surface antigen (HBsAg), anti-HBs, anti-HBc, hepatitis B virus e antigen (HBeAg), anti-HBe, and ultrasonic examination of liver were implemented in every sampled subject. Multivariate Logistic regression analyses were conducted to explore the risk factors of chronic hepatitis B and liver cirrhosis. Results The prevalence rate of chronic hepatitis B and liver cirrhosis of vaccination group was significantly lower than that of control group. Multivariate Logistic regression showed that male, liver cancer family history, no neonatal vaccination and born before 1986 in patients with chronic hepatitis B, the adjusted OR (95% CI) were 3.60(2.04-6.34), 2.47(1.25-4.88), 2.68(1.57-4.56), 1.72(1.02-2.89), respectively. Male factors in patients with liver cirrhosis, the adjusted OR (95% CI) was 6.89(2.02-23.43). Conclusions Neonatal hepatitis B vaccination could protect inoculated population from chronic liver diseases. Male, liver cancer family history, no neonatal vaccination, born before 1986 were risk factors of chronic hepatitis B and male was also a risk factor of liver cirrhosis.

Effects of the hepatitis B immune globulin on the antenatal interruption of pregnant women infected with hepatitis B virus

LI Dong-liang, TANG Ren-shu, LIU Zhen-wu, LIU Xu-xiang, WANG Bei, WANG Xiao-ping

2016, 20(9): 885-887,892. doi: 10.16462/j.cnki.zhjbkz.2016.09.006

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Objective To analyze the results of the mother-to-infant transmission interrupting of hepatitis B virus (HBV) in Hefei and evaluate the validity of current antenatal interruption method, so as to provide reasonable basis for the interrupting. Methods This study was established on the monitoring system of the pregnant women infected with HBV in Hefei. The pregnant women infected with HBV were grouped according to the risk of HBV-DNA titers and condition of antenatal injection of hepatitis B immune globulin (HBIg). All their infants were investigated five makers of hepatitis B at one year old. And if the hepatitis B surface antigen (HBsAg) was positive, it came that the interrupting failed. The HBV-DNA titers of the pregnant women injected with HBIg were monitored both before and after injection, so as to study the effect of HBIg on the mother-to-infant transmission antenatal interruption. Results The total cases of pregnant women with HBV were 395 from 2009 to 2013. The positive rate of control group was 2.74% and the treatment group was 3.88%. The difference between two rates was not statistically significant by Chi-square test and also the titer change between before and after injection. Conclusions Effect of HBIg on the antenatal interruption of pregnant women infected with HBV should be further studied.

Detection of ccc DNA and HBV DNA in peripheral blood mononuclear cells of patients with HBV infection by in situ hybridization

LIU Chang, ZHONG Yan-wei, XU Yuan-yong, DI Feng-lin, WU Yi-chen, LIU Hong-bo, LI Hao, JIANG Qi-yu, WANG Zhi-jie

2016, 20(9): 888-892. doi: 10.16462/j.cnki.zhjbkz.2016.09.007

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Objective To investigate whether hepatitis B virus (HBV) can infect and copy in the peripheral blood mononuclear cell (PBMC) in patients with chronic hepatitis B. Methods 137 inpatient attenders' peripheral blood was selected;mononuclear cells were isolated from peripheral blood;cells were fixed using cell rejection slice method; HBV DNA and cccDNA were detected with Real-time Quantitative polymerouse chain rection(QPCR) and rolling circle amplification combined with in situ cross gap PCR immunohistochemical staining method was used to detect HBV DNA and HBV cccDNA expression in PBMC. Results In 137 cases of specimen, after immunohistochemical staining, 68.6% (94/137) cases were detected the expression of HBV DNA, 83.9% (115/137) cases were deteced of HBV cccDNA positive signal by in situ hybridization and rolling circle amplification PCR; the positive rate of HBV cccDNA in PBMC of patients with serum HBV DNA concentration with higher than 106 copies/ml was 95.1%, the positive rate of less than 106 copies/ml was 51.4%. Conclusions HBV can infect the peripheral blood mononuclear cells and replicate in it, this study lays the foundation for further study of the PBMC infection leading to intrauterine infection of HBV.

Study on the relationship between ALT, AST, GGT disorders and lipid metabolic parameters in Anti-HBs positive population of Jinchang cohort: a cross-sectional study

JI Xiao-hong, BAI Ya-na, WANG Xu-tian, LI Juan-sheng, DING Jiao, CHENG Ning, HU Xiao-bin, LIU Yan-qing, PENG Zheng

2016, 20(9): 893-896. doi: 10.16462/j.cnki.zhjbkz.2016.09.008

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Objective To analyze the relationship between alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) disorders and lipid metabolic parameters in Anti-HBs positive population of Jinchang cohort. Methods A Cross-sectional study was conducted, and a total of 14 467 Anti-HBs positive study subjects without any kinds of hepatitis history were selected from Jinchang cohort during June 2011 to December 2013 by cluster sampling. Lipid metabolic parameters and ALT, AST, GGT were detected by laboratory serology method. Results The detection rates of ALT, AST,GGT disorders were 21.35%, 17.45%, 15.01% respectively, and the detection rates for males was higher than that for females(all P<0.001). Along with triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), body mass index (BMI) increasing, there were higher detection rates of ALT, AST, GGT disorders(all P<0.001).While with the high density lipoprotein cholesterol (HDL-C) increasing, the detection rates of ALT, AST, GGT disorders was gradually decreased (all P<0.001), showing a dose-response relationship. In addition, the detection rates of ALT, AST, GGT disorders of Uric acid (UA) abnormal group were higher than that of normal group (all P<0.001). Conclusions The detection rates of ALT, AST, GGT disorders were high in Anti-HBs positive population of Jinchang cohort, and male should be paid to the major prevention and control. Dose-response relationship was observed between detection rates of ALT, AST, GGT disorders and BMI, TG, TC, LDL-C, HDL-C.

Association between CYP3A5*3/CYP3A4*18-B gene polymorphisms and liver injury induced by anti-tuberculosis drugs

GUO Tong-jun, LI Yu-hong, ZHU Ling-yan, WANG Yue, TIAN Shen-qian, NIU Chen, LI Yan-hui, REN Qi, HAN Tie-sheng, Feng Fu-min

2016, 20(9): 897-900,909. doi: 10.16462/j.cnki.zhjbkz.2016.09.009

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Objective To explore the association between the gene polymorphisms of cytochrome CYP3A5*3,CYP3A4*18B and anti-tuberculosis drug-induced liver injury. Methods A case-control study was conducted. 175 Chinese patients with ADLI were selected from the patients who received the anti-tuberculosis therapy as the ADLI group and 185 patients who had not have a hepatic injury were selected as controls. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to identify the genotypes of CYP3A5*3 gene and CYP3A4*18B gene. Results The frequency of A/G of CYP3A5*3-6986 and the frequency of G/A of CYP3A4*18B-20232G were 4.5%,38.9%,56.6% and 42.3%,46.9%,10.8% respectively in cases and 16.7%,41.1%,42.2% and 58.9%, 34.1%, 7.0% in controls. There were differences of genetic polymorphisms between CYP3A5*3 and CYP3A4*18B in the two groups(all P< 0.05). The frequency of the combination of CYP3A5*3(G)/CYP3A4*18B(G)and CYP3A5*3(G)/CYP3A4*18B(A)between the case group and the control group had statistically difference(all P<0.05)when compared with CYP3A5*3(A)/CYP3A4*18B(G). The frequency of the combination of CYP3A5*3(A)/CYP3A4*18B(A)between the case group and the control group had no statistically difference(χ²=0.002,P=0.964)when compared with CYP3A5*3(A)/CYP3A4*18B(G). Conclusions The CYP3A5*3 and CYP3A4*18B genetic polymorphisms will raise the risk of liver injury induced by anti-tuberculosis drugs,and the variation combination of CYP3A5*3 and CYP3A4*18B will add to the risk to ADLI. The variation combination of CYP3A5*3(G)/CYP3A4*18B(G) will raise the risk of ADLI compared with CYP3A5*3(A)/CYP3A4*18B(G).

Epidemiology characteristic of influenza in Jiangsu Province, 2010-2014

DENG Fei, ZI Hai-rong, YU Hui-yan, WANG Shen-jiao, QI Xian, DAI Qi-gang, BAO Chang-jun, TANG Fen-Yang

2016, 20(9): 901-904. doi: 10.16462/j.cnki.zhjbkz.2016.09.010

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Objective To analyze the epidemiology characteristic of influenza by cases from 13 sentinel sites for hospital-based influenza surveillance in Jiangsu province during 2010-2014 and to explore influenza prevention and control. Methods According to the requirements by “National Influenza (swine flu) Monitoring Plan”, influenza-like cases (ILI) from the sentinel hospitals were collected. The pharyngeal swab specimen were collected for influenza virus RNA detection and virus isolation. Clinical cases were entered into the national influenza network monitoring system. Excel 2007 and PASW(Predictive Analytics Software) 18.0 were used for data analysis. Results Total 123 330 ILI cases were reported in five years. 14 238 influenza virus strain were isolated with a positive rate of 11.54%. Kindergarten and scattered children was the dominant group in all occupations. 0- age group contributed the largest population by age distribution. Conclusions There are two epidemic peaks of influenza each year in Jiangsu province, from January to March and July to October, respectively. In the years of 2010 to 2012, the epidemic flu strains were seasonal A/H3N2 and type B. The main epidemic flu strain switched to seasonal A/H3N2 and A/H1N1 (09pdm) between 2013 and 2014.

Epidemiological characteristics of live poultry markets and poultry related workers in Nanchang

XIE Wen-jing, HU Mao-hong, SONG Wen-tao, WU Jing-wen, XIA Wen, CHEN Sheng-en, CHEN Hai-ying, LIU Ming-bin

2016, 20(9): 905-909. doi: 10.16462/j.cnki.zhjbkz.2016.09.011

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Objective To understand epidemiological characteristics of live poultry markets (LPMs) and related workers, and the contamination status of LPMs in Nanchang. Methods LPMs and poultry related workers were randomly selected as study subjects by using Probability-Proportional-to-Size Sampling. Self-designed questionnaires were used to collect information of LPMs and poultry related workers. Sewage, poultry fresh feces and smears of poultry cage samples were collected to detect subtypes of avian influenza viruses using real-time RT-PCR. Results A total of 76 LPMs and 390 poultry workers were investigated. Of total LPMs, 55.26% (42/76) were cleaned every day, 76.32% (58/76) were sterilized at least one time per week, only two rested for one day per month, 97.37% (74/76) slaughtered poultry and 69.74% (53/76) kept live poultry overnight in markets. The median cumulative time of poultry workers' exposure to live poultry was 13.00 years (inter-quartile range: 6.12 to 20.00 years). Of the 390 poultry workers, 72.56% reported their exposure to live poultry through slaughtering and 55.90% through sale, and 11.79% reported having direct contact with sick or dead poultry recently. 474 environment samples were collected from LPMs. Of these, 75 were positive for influenza A virus, with an overall positive rate of 15.82%. Among these 75 positive samples, 44, 16, 11 and 2 were positive for H9, H5, H7 and H10, respectively. Conclusions The avian influenza control measures were insufficient in LPMs, which were heavily contaminated in Nanchang. Further management of the LPMs should be employed to reduce the infection risk of avian influenza virus for live poultry workers and customers visiting LPMs.

Human infection with avian influenza A (H5N6) virus in Jiangxi Province: first fatal case report

LIU Xiao-qing, LIAO Yong, XIE Chun-yan, FU Wei-jie, ZENG Zhi-li, YUAN Hui

2016, 20(9): 910-912,917. doi: 10.16462/j.cnki.zhjbkz.2016.09.012

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Objective To analyze epidemiological characteristic of the first fatal H5N6 case in Jiangxi Province and provide scientific evidences for the disease control and prevention. Methods Epidemiological and clinical information of the case and close contacts were collected and analyzed by descriptive epidemiologic method. Field epidemiological investigation including biological and environmental samples collecting were conducted, and then used for laboratory tests to figure out the infection source. Results This case was confirmed as human infection with avian influenza A (H5N6) virus and died from respiratory failure. There was no secondary case among the individuals' close contacts. There was a clear history of avian exposure for this case and H5 subtype nucleic acid was positive. Conclusions The first fatal H5N6 case in Jiangxi Province was not local infection and there was no evidence suggesting human-to-human transmission. The source of infection may relate to contact with poultry in live poultry market.

Study of epidemiological characteristics of injuries among minority undergraduates in Jiangsu Province

DU Guo-ping, GUO Yan, LI Xiao-shan, LI Wei, ZHANG Xu-jun, WEI Ping-min

2016, 20(9): 913-917. doi: 10.16462/j.cnki.zhjbkz.2016.09.013

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Objective To examine the epidemiological features and relative risk factors of injuries among minority undergraduates. Methods A total of 4 233 undergraduates were selected by stratified random cluster sampling from nine colleges under jurisdiction of Jiangsu Province and 236 among them were minority. A self-designed questionnaire was administered to investigate the status of injuries and injuries related knowledge-attitude-practice (KAP) theory the differences between minority and the Han nationality undergraduates was analyzed, meanwhile the influencing factors of injuries was explored. Results The total incidence, person-time incidence and repeated incidence of injuries in minority undergraduates were 25.0%, 33.9% and 3.4% respectively, which were higher than those in the Han nationality undergraduates (all P<0.05). Compared with the Han nationality undergraduates, minority undergraduates had a higher proportion of intentional injury (χ²=4.896, P=0.027), a lower recovery proportion (χ²=12.760, P<0.001), a longer off days (Z=2.244, P=0.025) and a longer hospitalization days because of injury (Z=4.359, P<0.001). Among minority undergraduates, male (OR=1.94), the knowledge scored lower (OR=3.31) and the behavior scored lower (OR=2.24) were identified as high-risk factors while using female, the knowledge scored higher and the behavior scored higher as references respectively. Conclusions This survey showed that minority undergraduates are the high risk population of injuries. Variety of health education about injuries should be established according to the characteristics of injuries among minority undergraduates, so as to reduce the incidence of injuries.

Analysis on trend and disease burden of injury deaths in Guangxi zhuang auonomous region in 2014

QIN Qiu-lan, MAO Wei, TENG You-ming, XU Jing-jing, CAI Jian-feng

2016, 20(9): 918-920,925. doi: 10.16462/j.cnki.zhjbkz.2016.09.014

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Objective To analyze the trend and disease burden of injury deaths in Guangxi zhuang auonomous region in 2014 and to provide scientific basis for making policy strategies on injury death prevention. Methods Data of injury deaths were analyzed with mortality,standardized mortality and years of potential life lost(YPLL). Results The mortality of injury was 45.58 per 100 000,and standardized mortality was 46.45 per 100 000.Injury mortality of male was 2.36 times higher than that of female.The top five causes of injury deaths were traffic accidents, accidental falls, other unintentional injuries, drowning, suicide and sequelae. The leading cause of injury deaths for 0-14 age group was drowning, for 15-64 age group was traffic accidents and for age group 65 and above was accidental falls. The top five causes of YPLL were traffic accident, drowning, other unintentional injuries, accidental falls and accidental poisoning. YPLL caused by injury deaths was 269 651.9 person-years and 28.59 years in average. Conclusions Injury has become a major health concern in Guangxi. The injury deaths distribution is varied by gender and region. It is necessary to take effective measures and make strategies to prevent and control injury according to local situations.

Analysis of two-week prevalence of diseases among residents and prevalence rate of chronic diseases within six-month period among residents aged 15 years and over in Hunan, 2013

PENG Man-hua, ZHANG Lin, HUANG De-jian, ZHANG Wei, TAN Wei, TIAN Dan-ping, LI Li, DENG Xin, DENG Jing, HU Guo-qing

2016, 20(9): 921-925. doi: 10.16462/j.cnki.zhjbkz.2016.09.015

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Objective To investigate two-week prevalence of disease among residents in Hunan and prevalence rate of chronic disease within previous six months among Hunan residents aged 15 years and over in the year of 2013. Methods Totally, 24 282 individuals were selected using multi-stage random sampling. Rao-scott adjusted chi-square test was used to test differences in prevalence rates. In addition, the proportions of top 10 diseases were estimated. Results The two-week prevalence rate was similar between urban residents and rural residents for all age groups in Hunan Province (23.03% vs 22.75%), but the two-week prevalence was much higher in rural residents than in urban residents for 15- years (5.52% vs 2.18%) and 35- years (14.96% vs 9.40%), with significant difference(all P<0.05). Acute respiratory infectious diseases and injuries were the most common diseases of two-week prevalence for residents aged less than 5years, 5- years and 15- years in both urban and rural residents. While chronic diseases accounted for the major of two-week prevalence in residents with aged ≥35 years. The prevalence of chronic diseases within previous six months was slightly higher for residents aged ≥15 years in urban areas than that in rural areas (32.97% vs 27.68%), but no significant difference (χ²=1.34,P=0.247). Hypertension, diabetes and intervertebral disc disorders were major causes of chronic disease prevalence in residents aged ≥35 years. Conclusions Acute respiratory infectious diseases and injuries were common cause of two-week prevalence in residents aged <35 years. For residents aged ≥35 years, the proportion of chronic diseases increased with of age. The prevalence of chronic diseases in the prior six months was up to 28.92% in residents aged ≥15 years. Hypertension, diabetes and intervertebral disc disorders were common causes of chronic disease prevalence in residents aged ≥35 years in Hunan.

Analysis of economic burden of four major chronic diseases in rural Yunnan Province

LI Qing, CAI Le, WANG Wen-li, LI Shao-mei, CUI Wen-long, YOU Ding-yun

2016, 20(9): 926-928,944. doi: 10.16462/j.cnki.zhjbkz.2016.09.016

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Objective To estimate the economic burden of four major chronic diseases (hypertension, diabetes, coronary heart disease and stroke) in rural Yunnan Province. Methods Multistage stratified random sampling method was used to select representative samples of 4 979 rural residents aged 35 years and over in Yunnan Province during the period of January to August of 2015. Human capital approach combined with disability adjusted life years (DALY) were applied to measure economic burden of the four chronic diseases. Results In the study region, the prevalence of hypertension, diabetes, coronary heart disease(CHD)and stroke was 35.3%, 9.9%, 3.8% and 1.7%, respectively, and the DALY per 1 000 population due to hypertension, diabetes, CHD and stroke was 2.4, 5.2, 23.5 and 21.1, respectively. Mean unit economic burden of the four chronic diseases was 6 667.4 Yuan, 9 126.1 Yuan, 9 270.0 Yuan and 16 187.2 Yuan, respectively. Mean unit economic burden of the four chronic diseases was 7 093.8 Yuan, 9 510.4 Yuan, 12 060.9 Yuan and 19 262.4 Yuan for male, whereas 6 250.7 Yuan, 8 554.9 Yuan, 4 849.4 Yuan and 9 030.6 Yuan for female, respectively. The total economic burden of the four chronic diseases was 108 185.2 million Yuan, 41 529.5 million Yuan, 16 192.0 million Yuan and 12 649.0 million Yuan, respectively. Males had higher mean unit economic burden for each of the four diseases than those for females (all P<0.05). Conclusions Hypertension, diabetes, coronary heart disease and stroke cause significant economic impacts on society in rural Yunnan Province. Effective measures are needed to reduce the economic burden of the four diseases.

Study on the anxiety and its associated factors among elderly living alone in one rural area of Anhui Province

FENG Fang, QIAN Zhen-zhong, HU Cai-yun, GONG Feng-feng, LU Shan-shan, ZHAO Yuan-yuan, HUANG Yu-jun, SUN Ye-huan

2016, 20(9): 929-931,970. doi: 10.16462/j.cnki.zhjbkz.2016.09.017

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Objective To explore the level and the associated factors of anxiety among the elderly living alone in one rural area of Anhui province, and providing evidence for improving the level of physical and psychological health of the elderly living alone. Methods The residents aged 60 years or over and lived one year or more in rural areas were selected as participants, with cluster sampling in Anhui province. The statistical software SPSS (version 16.0) was used for data analysis. Results Among 695 elderly living alone, there were 153(22.0%) people with anxiety, slight, moderate and severe attack were 123(17.7%), 29(4.2%), 1(0.1%) respectively. Binary Logistic regression analysis showed that marital status, self-rating economic status, quantity of chronic disease, being taken care when being sick, and physical self-maintenance scale (PSMS) were factors influencing the prevalence of anxiety among the rural elderly living alone. Conclusions Among the rural elderly living alone, the prevalence of anxiety was high, marital status, chronic disease, PSMS, etc. were associated with anxiety. Early and effective measures aiming to these identified risk and protective factors should be provided for promoting the physical and psychological health of elderly living alone.

A retrospective study of hepatic carcinoma in Guangxi Long'an County:from 2006 to 2014

FANG Kong-xiong, NONG Qiu-feng, LU Xue-ming, HUANG Jian-yun, TAN Chao, CHEN Qin-yan, WANG Fu-zhen, FANG Zhong-liao, BI Sheng-li, SHEN Li-ping, WANG Feng, LI Hai

2016, 20(9): 932-935. doi: 10.16462/j.cnki.zhjbkz.2016.09.018

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Objective To investigate epidemiological characteristics and risk factors of primary hepatic carcinoma (PHC) in Guangxi Long'an County. Methods 2 170 PHC cases in Long'an County were retrospectively investigated by looking up to report forms on paper, medical record, and cancer direct report system. Information of basic demographic, diagnosis and report, infection of hepatitis B virus and hepatitis C virus, and status of immunization were collected and analyzed. Results Most of the study subjects were men over the age of 35. The mean age was 57.22±14.61 years. Male-female sex ratio was 3.50:1. Among the 2 170 study objects, 457 (21.06%) cases were HBsAg positive; 10 (0.46%) cases were anti-HCV IgG positive; 3 cases were both HBsAg and anti-HCV IgG positive. Most of the patients were Zhuang. Infection rates of HBV and HCV were 65.76% (457/695) and 1.79% (10/558) respectively. Except twenty four study subjects with unknown history of hepatitis B vaccination, there was no history of hepatitis B vaccination in other cases. Crude incidence rate during 2006-2014 was 60.50 per 100 000. Population of China standardized morbidity was 32.11 per 100 000. World population standardized morbidity was 43.60 per 100 000. Morbidity in 2012-2014 demonstrated a trend of rising year by year. Conclusions Long'an County is a PHC high incidence region and the incidence rate increased considerably in recent years. HBV infection is one of the major PHC risk factors in Long'an County.

An analysis of risk factors of liver metastases from non-small cell lung cancer and a comparison of different treatments for it

WANG Sen, WEI Yuan-dong, ZHAO Zhi-yi, WANG Sheng-jun, PENG Wei, DING Qiang, HAO Ji-qing

2016, 20(9): 936-939. doi: 10.16462/j.cnki.zhjbkz.2016.09.019

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Objective To explore the risk factors of liver metastases from non-small cell lung cancer (NSCLC) and to compare the advantages and limits of surgery, chemotherapy and chemotherapy combined with transcatheter arterial chemoembolization (TACE) in treating the liver metastases from NSCLC. Methods We reviewed literature to find potential risk factors that could affect liver metastases from NSCLC. Next, they were investigated using the chi-square test and logistic regression analysis. Also, Kplan-Meier survival curve analysis was used to compare the three kinds of treatments. Results Chi-square test and logistic regression analysis suggested that no history of hepatitis B (P<0.001), adenocarcinoma (P=0.004) and stage Ⅲ (P<0.001) were independent prognostic factors. The efficiency rate was 100% for surgery, 31.0% for chemotherapy and 65.0% for chemotherapy combined with TACE (CCT), respectively (χ²=10.037, P=0.002). The median PFS was 6.3 months for surgery, 5.9 months for chemotherapy and 7.9 months for CCIT, respectively (surgery vs chemotherapy: χ²=0.540, P=0.462; CCT vs chemotherapy: χ²=2.561, P=0.001; CCT vs surgery: χ²=3.762, P=0.007). Conclusions No history of hepatitis B, adenocarcinoma and stage III are risk factors of liver metastases from NSCLC. CCT may bring more PFS benefits compared with surgery and chemotherapy for patients with liver metastases from NSCLC.

A study on possible mechanism of leptin in improving glucose and lipids metabolism in type 2 diabetic ob/ob mice

YANG Cheng-wei, WANG Qu-nan, CHEN Ke-yang

2016, 20(9): 940-944. doi: 10.16462/j.cnki.zhjbkz.2016.09.020

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Objective To investigate the improvement of leptin on liver function, glucose and lipids metabolism and explore possible mechanism from oxidative stress, endoplasmic reticulum stress and insulin resistance. Methods Choosing leptin-deficient ob/ob mice as animal model of type 2 diabetes mellitus and dealt with or without leptin respectively (1 mg/(kg·d), intraperitoneal injection), C57BL/6J wild-type mice were chonse as control group. Roche ACCU-CHEK was used to measure serum triglyceride (TG) and total cholesterol (TC) which reflected lipids metabolism, and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) which reflected liver function, the serum level test of insulin with enzyme linked immunosorbent assay, detecting the protein expression level with western blot including oxidative stress indicator-NOX4, anti-oxidative enzyme indicator-CAT, endoplasmic reticulum stress symbol indicator-GRP78, AKT activation in the classical pathway of glucose and lipids metabolism regulated by insulin. Results Compared with wild-type mice, the blood glucose, serum TG and TC, serum ALT and AST activity, and serum insulin level of ob/ob mice increased significantly (all P<0.05); compared with ob/ob mice without leptin, the blood glucose, serum TG and TC, serum ALT and AST activity, and serum insulin level of ob/ob mice dealt with leptin decreased significantly (all P<0.05). Compared with wild-type mice, there were significant increas in NOX4 and GRP78 expression level (all P<0.05), CAT and p-AKT expression level in ob/ob mice decreased significantly (all P<0.05). There were significant decrease in NOX4 and GRP78 expression level compared with ob/ob mice (all P<0.05), CAT and p-AKT expression level of ob/ob mice dealed with leptin increased significantly (all P<0.05). Conclusions Leptin could improve the glucose and lipids metabolism and liver function of type 2 diabetic mice significantly, which might related to the mechanism of leptin reducing liver oxidative stress and endoplasmic reticulum stress, and restoring the sensitivity to insulin.

Human Resources Allocation Equity in Centers for Disease Control and Prevention in China

LI Wen-xian, ZHANG Xiang-feng, MIAO Mao-yun, ZHANG Chun-xi, ZHANG Ye-wu, SHI Xiao-ting, WANG Xiao-feng, ZHANG Ying-jie

2016, 20(9): 945-947. doi: 10.16462/j.cnki.zhjbkz.2016.09.021

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Objective To analyze and evaluate the human resources allocation of Centers for Disease Control and Prevention in east, middle and west areas, so as to provide foundation for making scientific manpower plans. Methods The manpower data was drawn from Chinese Center for Disease Control and Prevention basic information system and the population data was from infectious disease network reporting system. The CDC's staff number was described, as well as structure of age, degree and title, in different levels (province, city and county) and different areas (east, middle and west), in China. And manpower allocation equity against population was analyzed by Gini coefficient. Results In East Areas, the staffs under age of 35 years comprised 31.54%. Those with degree accounted 39.13%. The proportion of employees with senior and vice-senior title were 12.83%,which were all higher than those in the Middle and West Areas. The demographic Gini index was 0.117 0, which was lower than those in the other two areas. Conclusions The human resources for health is distributed equally in Centers for Disease Control and Prevention, in China. However, not only the overall quality was higher, but also HRH configuration was more balanced in CDCs in east areas. More attention is needed to reduce HRH maldistribution in CDCs in middle and west areas.

Survey on health service needs and influence factors among residents of daga Xiang Lhasa

Ci Ren Yang Zong, DE Ji, Zha Xi Da Wa, Da Wa Pu Chi, Ou Zhu Luo Bu

2016, 20(9): 948-952. doi: 10.16462/j.cnki.zhjbkz.2016.09.022

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Objective To investigate the health service needs and influencing factors among the resident aged 15 years and above, so as to provide the clues for establishing the health policy. Methods 665 residents were recruited through multistage cluster random sampling method and questionnaire survey were conducted. Results The two-week prevalence rate and the chronic disease prevalence rate of residents aged 15 years and above were respectively 25.3% and 21.5%, by multiple factors analysis,the main influencing factors were sex, age, family economic status and population.Both two-week prevalence rate and chronic disease prevalence rate of female were higher than that of male with odds ratio of 2.725 (95% CI:1.756-4.225)and 1.887 ( 95% CI:1.178-3.017) respectively. Both two-week prevalence rate and chronic disease prevalence rate of residents were increasing with age. And both prevalence rates were highest among the residents aged 55 to 64 years. Comparing to the residents aged 15 to 24 years, the two-week prevalence rate and the chronic disease rate of the residents aged 55 to 64 years were 8.547 times(95% CI:3.228-22.470)and 25.641 times (95% CI: 8.153-80.450) of them respectively. The two-week prevalence rate of residents with high income was 0.604 times (95% CI:0.376-0.971)of that of residents with low income. The chronic disease prevalence rate was the lowest among the residents with middle income (OR=0.536,95% CI:0.292-0.987). The two-week prevalence rate was decreased among the residents with family population four and above. The chronic disease prevalence rate was descended in the residents with family population seven and above(OR=0.264,95% CI:0.078-0.886). Conclusions The demands of health services among residents of Daga Xiang were high, the main influencing factors were demographic characteristic and status of family recourses.

Calculation of C statistics for the Cox proportional hazards regression models and its implementation in SAS

YAN Ruo-hua, LI Wei, GU Hong-qiu, WANG Yang

2016, 20(9): 953-956,961. doi: 10.16462/j.cnki.zhjbkz.2016.09.023

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Objective C statistics is one of the most widely-used indexes in accessing the discrimination of the Cox proportional hazards regression models. However, the calculation methods for C statistics have been controversial. Our study aims to investigate the calculation of C statistics and its implementation in SAS. Methods To calculate C statistics and its 95% confidence interval (CI), we used PROC PHREG to predict the survival function, and decided whether the predicted survival probabilities was consistent with the actual survival times. Taking a registry study as an example, we evaluated the discrimination of a Cox regression model which predicted the 30-day mortality after discharge in patients with acute heart failure. Results A total of 2 836 patients were included in the final analysis. Older age (Unit: years; hazard ratio (HR): 1.029; 95% CI: 1.022-1.037), lower systolic blood pressure (Unit: mmHg; HR: 0.992; 95% CI: 0.989-0.995) and increased pulse rate (Unit: beats/min; HR: 1.011; 95% CI: 1.007-1.014) were all statistically significant predictors for 30-day post-discharge death. The C statistics of the model was 0.638 (95% CI: 0.570-0.704), indicating a certain degree of discrimination. Conclusions C statistics is a good index for accessing the discrimination of Cox regression models, and it can be calculated by SAS programs.

Application of a transition-specific Cox model in alzheimer's disease progression

XU Xiao-meng, SUN Qian-qian, YANG Bei, MA Cai-yun, YU Hong-mei

2016, 20(9): 957-961. doi: 10.16462/j.cnki.zhjbkz.2016.09.024

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Objective To apply the transition-specific Cox model in Alzheimer's disease(AD) progression among the elders and to explore factors influencing each transition during different AD progression stages. Methods Data were collected from nine follow-up visits in three communities in Taiyuan City from October 2010 to October 2014. Based on the five state structures in AD progression, including mild cognitive impairment(MCI), AD, loss to follow up, die of AD(DEATH) and die of other else causes, the transition-specific Cox model was fitted to identify influencing factors for every possible transition in AD progression. Results At the significance level of 0.05, age (HR=0.68, 95% CI:0.52-0.90), sex(HR=2.13, 95% CI:1.32-3.43), smoking(HR=1.93,95% CI:1.25-2.98), hypertension(HR=2.51,95% CI:1.55-4.08), high cholesterol(HR=2.03,95% CI:1.25-3.30), and diabetes(HR=1.71,95% CI:1.10-2.67) were statistically significant for transition from MCI to AD; relatives with dementia (HR=4.11, 95% CI: 1.33-12.69)was statistically significant for transition from MCI to DEATH;relatives with dementia (HR=5.88, 95% CI: 1.91-18.06)and hypertension(HR=7.06, 95% CI:1.60-31.26) were statistically significant for transition from AD to DEATH. Conclusions Prevention measures should be taken based on the main factors of each transition in AD progression to delay the disease deterioration.

The detection rate and the epidemiological characteristics of the breast cancer among middle-aged women in several communities of Nanchang

WANG Yi-li, XIONG Qiu-yun, CAO Ya-li, LI Pin, ZENG Ni

2016, 20(9): 962-964,968. doi: 10.16462/j.cnki.zhjbkz.2016.09.025

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Study on direct economic cost of five kinds of nosocomial infection in a 3A-grade hospital in Anhui Province

ZHANG Lin, LIU Xian-ling, WU Jin-feng, WANG Wen-yi, ZOU Qiong, XU Ying-fang, CHENG Gui-e

2016, 20(9): 965-966. doi: 10.16462/j.cnki.zhjbkz.2016.09.026

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2016, 20(9): 967-968. doi: 10.16462/j.cnki.zhjbkz.2016.09.027

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2016, 20(9): 969-970. doi: 10.16462/j.cnki.zhjbkz.2016.09.028

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

Assistant editor