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CN 34-1304/R ISSN 1674-3679

2019 Vol. 23, No. 1

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Literature Review
Representativeness issues in epidemiological studies
PAN Xiong-fei, WANG Yi, YE Yi, PAN An
2019, 23(1): 1-4. doi: 10.16462/j.cnki.zhjbkz.2019.01.001
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Representativeness has long been a contentious topic in epidemiology. The review starts with defining representativeness in epidemiology and describing fundamental epidemiological concepts including study population, source population, target population, internal validity, and external validity. In addition, it elaborates the role and practicality of representativeness in four major epidemiological study designs including cross-sectional, cohort, case-control, and intervention studies. In summary, representativeness is an important consideration in cross-sectional studies of investigating disease or health status in the target population, but cannot be overstated in epidemiological studies for causal inferences regarding exposure-outcome relationships or intervention effects.
Original Articles
Mortality of acute myocardial infarction in China from 2002 to 2016
YU Qi, WANG Bin, WANG Yan, DAI Cui-lian
2019, 23(1): 5-9, 28. doi: 10.16462/j.cnki.zhjbkz.2019.01.002
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  Objective  To analyze epidemical features and time trend of acute myocardial infarction (AMI) deaths in China from 2002 to 2016.  Methods  AMI mortality data for Chinese residents from 2002 to 2016 were collected and the Joinpoint model was used to analyze the time trends in AMI mortality of various populations and different age groups.  Results  In the past 15 years, the age standardized mortality rate of AMI in China increased rapidly. In 2002-2007, AMI mortality of urban population were higher than that in the rural, and rural rates exceeding urban rates after 2007.The age standardized rates of AMI in urban males, urban females, rural males, and rural females increased from 2002 to 2016. The average annual percentage change (AAPC) was 5.6%, 6.1%, 9.4%, and 9.9%, respectively. The age-specific mortality rates increased rapidly among young middle-aged male and elder female.  Conclusions  The mortality rate of AMI increased from 2002 to 2016, among which the AMI mortality rate in rural residents was increasing rapidly. The death of AMI in urban and rural areas among young middle-aged male and elder female showed a significant growth trend.
Analysis of the incidence and mortality trend of breast cancer in Chinese women from 2005 to 2013
HE Ming-yan, ZHU Bi-qi, ZHONG Yuan, WANG Lei, YANG Liu, LIAO Xian-zhen, RANG Wei-qing
2019, 23(1): 10-14. doi: 10.16462/j.cnki.zhjbkz.2019.01.003
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  Objective  To Analyze the change trend of the incidence and mortality of breast cancer in Chinese women from 2005 to 2013 in the Chinese Cancer Registry Annual Report in order to provide references for the implement of the prophylaxis and treatment of breast cancer.  Methods  Extracted all the records of the incidence and mortality of breast cancer in Chinese women from 2005 to 2013, applied the Joinpoint regression model to analyze the change trend of the incidence and mortality of breast cancer in Chinese women.  Results  The incidence levels of breast cancer among urban women in China was higher than that in rural from 2005 to 2013, the change trend of urban incidence was stable(t=-0.2, P=0.828), the rural incidence showed an increasing trend(t=7.8, P<0.001). The peaks of urban and rural incidence were in the age group of 50-and the age group of 45-respectively.The mortality of breast cancer among urban women in China was higher than that in rural from 2005 to 2013, the change trend of urban mortality was stable(t=0.8, P=0.458), and the rising trend of rural mortality was obvious(t=3.3, P=0.014). The mortality of urban women began to rise after the age of 30, accelerating to rise after the age of 75, the mortality of rural women began to rise after the age of 30, the change tended to be stable at the age of 55-69, and began to rise after the age of 70 again.  Conclusions  The incidence and mortality of breast cancer among urban women in China were all higher than that in rural from 2005 to 2013, the rising trend of the incidence and mortality of breast cancer among rural women was obvious, so the prophylaxis and treatment measures of breast cancer should be actively formulated and perfected.
A prospective cohort study on the risk of HBV infection in preschool children without immune response to hepatitis B vaccine
HUANG Hui-sen, WEI Na, LAN Mei-dan, CEN Zuo-jie, MENG Xing-xing, JIANG Jin-tai, YANG Lu, XIE Zhi-chun
2019, 23(1): 15-18. doi: 10.16462/j.cnki.zhjbkz.2019.01.004
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  Objective  To evaluate the risk of hepatitis B virus(HBV) infection among preschool children who were the non-responders to hepatitis B vaccine in future.  Methods  A prospective cohort study was conducted. Children aged 2 to 5 years were selected from 64 kindergartens.These children were inoculated three doses of hepatitis b vaccine at 0, 1 and 6 months after birth. Hepatitis B surface antigen (HBsAg) and Hepatitis B surface antibody (anti-HBs) were detected during the period from March to May 2015. The children who were HBsAg negative were enrolled in the study. The subjects were divided into exposure group (anti-HBs negative) and control group (anti-HBs positive). The follow-up began on June 1, 2015 and ended on June 1, 2016. Serum HBsAg of children in the cohort was then collected and detected from June 1 to 30, 2016. At the end of the study, the HBsAg positive rates between two groups were compared.  Results  83 children who received hepatitis B vaccine again during the follow-up period were excluded from 1 907 non-responders. The actual number in non-responders group was 1 824. 151 children were lost at the end of the study. The actual number of follow-up was 1 673 and 5 children were found to be positive for HBsAg and the infection rate was 0.30% (5/1673). In the respondent goup, 2 054 were enrolled and followed. Finally, 140 children were lost and none of the remaining 1 914 people were HBsAg positive at the end of the study. HBsAg positive rate was higher in the non-responder group than in the responder group (P=0.023).  Conclusion  There is a risk of HBV infection in the children who are non-responders to hepatitis B vaccine in future.
Risk factors of high birth weight in rural areas of Shanxi Province
LIN Shi-qi, WU Ji-lei, WANG Ni, ZHANG Yuan, LI Jia-jia, PEI Li-jun
2019, 23(1): 19-23, 49. doi: 10.16462/j.cnki.zhjbkz.2019.01.005
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  Objective  To estimate the association between the risk of high birth weight(HBW) and maternal environmental and behavioral factors exposure during pregnancy in rural areas.  Methods  Data were collected from the surveillance system of birth population and adverse pregnancy outcome in Pingding County, Shanxi Province during 2007 and 2012, where we followed up 204 controls with normal birth weight, 125 cases with HBW ≥ 4 200 g and 171 cases with HBW 4 000-4 200 g. Case control study was performed to explore the potential risk factors of HBW.  Results  The total number of births was 18 749, including 1 177 cases of high birth weight, with an incidence rate of 6.28% between 2007 and 2012. Concerning the case control study on HBW<4 200 g, after adjusting parental reproductive age and parity, the risk of HBW was 3.10 (95% CI: 1.67-5.76) times higher among women with gestational weeks ≥ 42 than that of women with gestational weeks < 42. The risk of HBW in boys was 2.30 (95% CI: 1.46-3.63) times higher than that in girls. No significant association was observed between maternal BMI before pregnancy and the risk of HBW; Regarding the case control study on HBW ≥ 4200 g, after adjusting maternal reproductive age and parity, the risk of HBW was 3.01(95% CI: 1.49-6.08) times higher among women with gestational weeks ≥ 42 than that of those with gestational weeks <42. The risk of HBW was 1.91 (95% CI: 1.15-3.16) times higher among women with pre-pregnancy BMI ≥ 24 than that of those with pre-pregnancy BMI< 24. The risk of HBW was 2.59 (95% CI: 1.06-6.32) times higher in women who ate soybean products ≥ 4 times a week than that of those who ate soybean products less than once a week.  Conclusion  It would be of public health significance to reduce the risk of high birth weight, which can be reduced by managing pre-pregnancy BMI, diet during pregnancy and controlling gestational week.
Analysis on potential factors of small for gestational age of Zhuang ethnicity in Wuming District of Nanning
QIN Xiao-ling, LIU Shun, GUO Xue-feng, WANG Neng, QIU Xiao-qiang, PANG Ting, LI Ke-hua, LIU Mei-liang, WU Liu-yu, ZENG Xiao-yun
2019, 23(1): 24-28. doi: 10.16462/j.cnki.zhjbkz.2019.01.006
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  Objective  To understand the prevalence of small for gestational age (SGA) in Zhuang population, and to analyze the potential factors of SGA.  Methods  A total of 3 839 live births in the Wuming District People's Hospital and Wuming Maternal and Child Health Hospital from January 2016 to January 2018 were recruited. Random Forest, χ2 test and Logistic regression model were used for statistical analyses.  Results  The incidence of SGA was 9.6% (368/3 839), and it was 6.9% (142/2 049) and 12.6% (226/1 790) for male and female infants respectively. Random Forest method showed that second-trimester intrauterine growth restriction's importance score was the highest, but gestational week's was the lowest. Also, seven important variables were selected by this method. Unconditional logistic regression analysis showed that parity <2, the height of mothers <1.55 m, insufficient gestational weight gain, second-trimester intrauterine growth restriction were risk factors for SGA, but pre-pregnancy BMI ≥ 18.5 kg/m2 and male infants were protective factors.  Conclusions  The incidence of SGA is slightly higher, among the Zhuang population in Guangxi. SGA is affected by many factors. Therefore, it is necessary to evaluate the status of intrauterine growth and adopt comprehensive measures to control and reduce the incidence of SGA.
Intrahepatic cholestasis of pregnancy and hepatitis B virus infection during pregnancy elevates the risks of small for gestational age and low birth weight infants
MAO Bao-hong, WANG Yan-xia, ZHOU Li, LI Yun-zhi, LI Jing, XU Xiao-ying, ZHOU Min, ZHAO You-hong
2019, 23(1): 29-33, 55. doi: 10.16462/j.cnki.zhjbkz.2019.01.007
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  Objective  To explore the impact of hepatitis B virus infection, intrahepatic cholestasis during pregnancy on the risk of small for gestational age (SGA) and low birth weight (LBW), and analyze the interaction effect.  Methods  The study was conducted from Jan 2017 to Apr 2018 at the Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. The peripheral blood hepatitis B surface antigen (HBsAg) and total bile acids of pregnant women were determined by chemiluminescence method, unconditional Logistic regression models were used to estimate association between hepatitis B virus infection, intrahepatic cholestasis of pregnancy and the risk of neonate outcomes.  Results  After adjusting for confounding factors, compared to normal pregnant women, HBV infection alone or ICP alone during pregnancy did not increase the risk of SGA or LBW. The increased risk of born before term SGA (OR=1.76, 95% CI: 1.16-2.65, P=0.007) and LBW infants (OR=1.85, 95%CI: 1.44-2.38, P<0.001) were observed in pregnant women with HBV infection and ICP, the additive and multiplicative interaction were also observed for before term SGA[RERI (95% CI)=6.54(0.14-12.94), AP (95% CI)=0.90%(0.68%-1.13%), S (95% CI)=7.03(1.38-42.64)] and LBW[RERI (95% CI)=5.69(0.48-10.90), AP (95% CI)=0.76%(0.55%-0.97%), S (95% CI)=8.02(1.92-33.43)].  Conclusions  Our results suggest that pregnancy HBV infection combined with ICP increase the risk of SGA and LBW infants. These two risk factors had a synergistic effect.
The estimation of influenza-related outpatient rate in children under 5 years in Suzhou from 2011 to 2017
GAO Jun-mei, CHEN Li-ling, TIAN Jian-mei, ZHU Jun, LIN Yu-zun, WANG Yin, YU Jia, SHAN Wei, SHAO Xue-jun, ZHANG Tao, ZHANG Jun, ZHAO Gen-ming
2019, 23(1): 34-38. doi: 10.13315/j.cnki.cjcep.2019.01.008
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  Objective  To estimate the outpatient rate of influenza-related influenza-like illness (ILI) for children younger than 5 years in Suzhou municipal districts.  Methods  From October 2011 to March 2017, we conducted a prospective surveillance program on ILI for children under 5 years in outpatient settings of Soochow University Affiliated Children's Hospital (SCH). The throat swabs were collected and tested for influenza viruses by RT-PCR. Based on the healthcare utilization surveys and population data, the number of visits and the outpatient rate of influenza-related ILI for children younger than 5 years in Suzhou municipal districts were estimated.  Results  During 2011-2017, in total, there were 45 930 estimated influenza-related ILI cases younger than 5 years in Suzhou municipal districts, which consisted of 7 490 influenza A/H1N1 cases, 17 843 influenza A/H3N2 cases and 20 597 influenza B cases. The estimated outpatient rate of influenza-related ILI was 6.4% in 2011-2017, which was highest in 2011-2012, 20.5%, and the lowest in 2012-2013, 2.4%.  Conclusion  The number of visits and the outpatient rate of influenza-related ILI in children younger than 5 years was high in Suzhou municipal districts.
Surveillance analysis on influenza-like illness from 2017 to 2018 in the plateau of Qinghai Province
ZHAO Jin-hua, SHI Yan, CAO Hai-lan, LI Yong-hong, LI Hong, LU Nan-nan, XU Li-li
2019, 23(1): 39-44. doi: 10.16462/j.cnki.zhjbkz.2019.01.009
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  Objective  To analyze the surveillance results of influenza-like illness (ILI) and investigate the prevalent trend of influenza from 14th week 2017 to 13th week 2018 (April 3, 2017-April 1, 2018) in Qinghai Province so as to provide the scientific basis for the development of prevention and control measures.  Methods  The epidemiological and pathogenic characteristics of influenza-like cases in qinghai province from 14th week 2017 to 13th week 2018 were collected and analyzed.  Results  ILI mainly occurred in winter and spring from 14th week 2017 to 13th week 2018, 26 086 ILI cases reported in total, accounting for 2.95% (26 086/884 529) of total number of outpatients and emergency cases; including 18 655 cases under 5 years old, accounting for 71.51%; 1 991 cases were detected with positive by real -time RT PCR with the positive rate of 17.48% (1 991/11 391), In the early stage, H3 and H1 were the predominate strains and the middle period was mixed with H3, H1 and B, and the latter was dominated by type B. Positive rates of influenza virus testing had no statistical differences in different gender (χ2=5.33, P=0.021), while with statistical differences in different age and time (χ2=108.59, P<0.001; χ2=1 629.13, P<0.001). Number of ILI cases and the percentage in the outpatients was significantly related with influenza virus positive rates (Pearson correlation coefficient was 0.896 and 0.699, respectively, P<0.001).  Conclusions  Influenza-like cases at sentinel hospital of Qinghai Province can accurately reflect actual activity level. The peak of positive detection of influenza samples in Qinghai province from 14 weeks 2017 to 13 weeks 2018 season was from mid-December to mid-January. The dominant strain of influenza viruses alternated, and the majority of the affected population is mainly in children under 5 years old. In the future, we should strengthen monitoring works in epidemic season, from October to March of next year and focus on the children under 5 years old and the fever clinic. The collection of samples of influenza-like cases in the 0-year-old group should be strengthened, and collective organizations should focus on influenza prevention and control.
Study on the influence of risk attitude to hepatitis B vaccination behavior of residents in suburban areas
LIU Cai, LI Ying, WANG Xiao-fang, ZHANG Miao
2019, 23(1): 45-49. doi: 10.16462/j.cnki.zhjbkz.2019.01.010
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  Objective  To explore the influence of risk attitude to hepatitis B vaccination behavior of residents in suburban areas, and provide evidence for improvement of health education.  Methods  A total of 1 031 adults aged 16-60 years old were selected from 6 villages in Ninghe county and Jinghai county. A questionnaire was used to investigate them.  Results  Logistic regression analysis showed that respondents' hepatitis B vaccination behavior was affected by their risk attitude when controlling other factors. The younger (OR=0.94, 95% CI: 0.93-0.96, P<0.001), unmarried (OR=8.24, 95% CI: 2.89-23.60, P<0.001), low self-rated health (OR=1.78, 95% CI: 1.53-3.49, P=0.008), the formal sector workers (OR=7.18, 95% CI: 2.29-22.54, P=0.001), covered by health insurance (OR=8.46, 95% CI: 2.31-30.86, P=0.001), risk aversion (OR=1.65, 95% CI: 1.06-2.57, P=0.026) and risk neutral (OR=1.50, 95% CI: 1.03-2.17, P=0.032) were more likely to choose hepatitis B vaccination.  Conclusions  For the risk aversion and risk neutral, health education on disease symptoms and disease economic burden should be enhanced; for the risk seeking, more knowledge on prevalence trend and transmission route need to be improved.
Seroepidemiological survey of hepatitis B virus infection among people under 60 years old in Ma'anshan City, 2017
YANG Kun, FANG Da-chun, QIN Qi-rong, XIANG Ke-xia, FAN Yin-guang
2019, 23(1): 50-55. doi: 10.16462/j.cnki.zhjbkz.2019.01.011
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  Objective  To understand the current epidemic and immunity status of hepatitis B virus in Ma'anshan City, and to compare the prevention and control effect after the adjustment of hepatitis B vaccine immunization strategy.  Methods  Multi-stage random sampling method was used to select 10 investigation points in the whole city, a random sample of 3 460 people under 60 years old was included according to urban and rural stratification. questionnaires and blood were collected from the subjects, and domestic enzyme linked immunosorbent assay (ELISA) was used for hepatitis B immunoglobulins detection.  Results  The total positive rate of hepatitis B virus surface antigen (HBsAg), hepatitis B virus surface antibody (HBsAb) and Hepatitis B virus (HBV) infection was 3.32%, 51.21% and 29.16% respectively. The positive rate of HBsAb in urban area was higher than that in rural area (χ2=28.204, P<0.001). The positive rate of HBsAb was significantly different between the medical and nursing staff and other occupational groups (χ2=22.772, P<0.001). The difference of HBsAb positive rate before and after HepB vaccine content adjustment was statistically significant (χ2=90.331, P<0.001). The rate of HepB decreased with age (χtrend2=1 984.342, P<0.001).  Conclusions  Since HepB was incorporated into the immunization program, hepatitis B prevention and control in school-age children has achieved remarkable results. More attention should be paid on the low positive rate of HBsAb in students and the low immunization rate of HepB in adults.
Relationship between genetic polymorphisms of IL-10 promoter and antituberculosis drug-induced liver injury
LI Biao, KONG Hua-wen, LI Yu-hong, DU Ying, CHONG Ying-zhi, REN Qi, ZHENG Guo-ying, FENG Fu-min
2019, 23(1): 56-59, 74. doi: 10.16462/j.cnki.zhjbkz.2019.01.012
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  Objective  To investigate the relationship between interleukin 10 (IL-10) -592 (rs1800872) and -819 (rs1800871) promoter genetic polymorphisms and the susceptibility of antituberculosis drug-induced liver injury (ADLI).  Methods  A case-control study was conducted. Epidemiology survey data and peripheral blood samples were obtained from the patients. Two IL-10 gene polymorphisms (-592 A/C and 819 C/T) were genotyped with PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) in Chinese Han ADLI subjects (n=180) and sex matched by frequency matching in control subjects (n=180).  Results  No significant differences in genotypes of IL-10 -592 site and IL-10 -819 site between ADLI group and that of the control group were noticed (all P>0.05). The mutant alleles -592 C of IL-10 gene polymorphism was significantly higher in ADLI subjects compared to controls, and in dominant model, the frequency of CC+AC genotype was 1.62 higher among the cases than controls (all P<0.05). Significant difference in allele -819 C/T between the ADLI group and the control group were not found (P=0.190). The polymorphisms at -819 C/T and -592 A/C variants of IL-10 gene were found to be good linkage disequilibrium. The CC haplotype represent genetic risk factor (OR=1.37, 95% CI: 1.02-1.85) and CA haplotype represent genetic protect factor (OR=0.49, 95% CI: 0.34-0.70) for ADLI in the subjects.  Conclusions  The polymorphisms in IL-10 gene -592 A/C and -819 C/T are associated with ADLI.
Analysis of tuberculosis medical intention and the influencing factors among middle school students with health belief model
LIU Jing-nan, LI Zheng, WANG Yan-ling, CHANG Chun
2019, 23(1): 60-64. doi: 10.16462/j.cnki.zhjbkz.2019.01.013
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  Objective  To understand the medical intention and influencing factors of middle school students with suspected tuberculosis symptoms in some areas of China and to analyze the influencing factors based on health belief model.  Methods  A total of 2 547 middle school students in six provinces of China were chosen by PPS sampling method. Logistic regression was used to analyze tuberculosis medical intention.based on health belief model.  Results  Female students, urban students, eastern students and residential students had higher degree on knowledge than other respondents in the same group, which had statistically significant difference(all P<0.05). Middle school students in the western region had a higher degree of perceived disease threat, boys and middle school students in the eastern region were more likely to be reminded and accompanied by family members and friends. The delay rate was 25.4% when students have continuous cough and expectoration more than two weeks. In terms of logistic regression analysis, gender (OR=0.809, 95% CI: 0.668-0.980), urban and rural (OR=0.692, 95% CI: 0.572-0.838), only-child (OR=0.819, 95% CI: 0.676-0.992), perceive the severity of the disease(OR=0.955, 95% CI: 0.922-0.989) and prompt factors(OR=0.514, 95% CI: 0.429-0.617) were the influencing factors of the tuberculosis medicial intention.  Conclusions  The health belief model could analyze and explain the influencing factors that affect the tuberculosis medical intention of middle school students in some way. Health education should be strengthened and health behaviors should be advocated according to the characteristics of different groups.
Structural equation model analysis of mental health influencing factors in family caregivers of schizophrenic patients
WANG Feng, ZHU Chang-cai, ZHU Ke, XU Shan-dan
2019, 23(1): 65-69. doi: 10.16462/j.cnki.zhjbkz.2019.01.014
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  Objective  The structural equation model was used to analyze the influencing factors of mental health of family caregivers with schizophrenia, so as to provide scientific basis for targeted intervention measures.  Methods  On the basis of investigating the social dysfunction of schizophrenia patients and their family function, social support and mental health status, structural equation model was used to analyze the factors affecting mental health of caregivers and their effect indexes, the main fitting parameters included compare the fitted indices (CFI), goodness of fit index (GFI), the adjusted goodness of fit index (AGFI), normed fit index (NFI) and approximate error root mean square (RMSEA).   Result   The total score of psychological self-rating scale of carers was higher than that of normal people (all P<0.05). Only 19.0% of home care providers with schizophrenia felt no or little burden, 33.0% mild burden and 48.0% heavy burden. Structural equation model fitting index for: χ2(58)=47.440, P=0.838, χ2/df=0.818, the main fitting parameters GFI=0.968、AGFI=0.943, CFI=1.000, NFI=0.973, RMSEA=0.000, model fitting effect was good. The total effects of social support, family care, patient social function and care burden on the mental health of family caregivers were -0.016, -0.197, 0.114 and 0.118, respectively.  Conclusions  The family caregivers of schizophrenia have serious mental health problems, and the burden of care is heavy. improving social support, family care and social function of patients is an effective way to improve their care burden and mental health level.
Study on the relationship between health literacy and health status among residents in Qingdao
WANG Rui, JIA Xiao-rong, LI Shan-peng, HU Ping, LIN Peng, GENG Mei-yun, WANG Ya-ni, XU Zhen-shi, QI Fei
2019, 23(1): 70-74. doi: 10.16462/j.cnki.zhjbkz.2019.01.015
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  Objective  To analyze the status of health literacy and its relationship with chronic diseases and self-reported health among residents in Qingdao, discuss the influence of health literacy on health status and provide the scientific basis for the development of health education strategies and measures.  Methods  The stratified multistage and probability proportionate to population size sampling (PPS sampling) method was adopted in this investigation. In 2017, a questionnaire survey was conducted among 16 700 permanent residents aged 15-69 from 10 districts in Qingdao.  Results  The overall level of health literacy status was 15.92%, the prevalence rate of chronic diseases was 19.31%, the self-reported health proportion of good, fair and poor were 81.68%, 12.12% and 1.71% among residents in Qingdao. Logistic regression analysis showed that, after adjusting for urban and rural areas, gender, age, education, income and occupation, health literacy was a protective factor for people with chronic diseases and self-evaluated health(OR=1.232, P=0.003;OR=1.159, P=0.033). Three aspects of health literacy were correlated with chronic diseases and self-reported health among people (all P<0.05).  Conclusions  Health literacy is positively correlated with the health status of residents. The improvement of health literacy is an important way to enhance the health status of residents.
Disparity in self-rated health between male and female elderly: a Fairlie decomposition analysis
KAN Chao-jie, ZHANG Xiao
2019, 23(1): 75-79. doi: 10.16462/j.cnki.zhjbkz.2019.01.016
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  Objective  To investigate the disparity and factors of self-rated health between male and female elderly so as to provide evidence for narrowing the disparity and promoting health equity.  Methods  We extracted data from China Health and Retirement Longitudinal Study in 2013. Fairlie decomposition was adopted to analyze the disparity of self-rated health between 3 744 male and female elderly who were 65 and older.  Results  The male elderly reported a significantly higher ratio of good health than the female elderly(47.1% vs 41.6%, χ2=11.74, P<0.001). Fairlie decomposition analysis revealed that lifestyle, income and educational level were significant influencing factor for self-rated health (all P<0.05), which could explain 73.98%, 17.48% and 16.70% of the overall disparity in self-rated health among the elderly.  Conclusions  There is a disparity between male and female elderly's self-rated health. The self-rated health of male elderly is better than that of female elderly. It would contribute to the equity of male and female elderly's health by promoting publicity of health education and advocating healthy lifestyle of female elderly.
Relationships between different forms of social support and suicidal ideation and gender differences analysis among medical college students in Anhui Province
LIU Jing, GAO Rong, WAN Yu-hui
2019, 23(1): 80-84. doi: 10.16462/j.cnki.zhjbkz.2019.01.017
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  Objective  To investigate the relationship between various types of social support and suicide ideation, and whether the relationship varies by gender.  Methods  A total of 4 799 students in cluding freshmen and sophomores were recruited by stratified cluster sampling from 2 medical colleges in Anhui Province. We assessed demographic indicators, social support and suicidal ideation, etc. Logistic regression was used to analyze their gender differences and the relationship between social support and suicidal ideation.  Results  The prevalence of suicidal ideation was 6.2%, and no gender difference was found (χ2=1.224, P=0.269). The rate of suicidal ideation was higher with the decreasing of social support. Low levels of social support had independent effects on suicidal ideation among total samples and females respectively after controlling for confounding factors (all P<0.05), while low levels of social support, subjective social support and support availability increased the risk of suicidal ideation among males (P value was 0.049, 0.002, 0.031, respectively). In adolescents with low levels of social support, objective social support and various sources of social support, females versus males had higher risk to have suicidal ideation.  Conclusions  Low level of social support increased the risk of suicidal ideation among students in medical college, especially for girls. Groups at highest risk of suicidal ideation in relation to certain types of social support should be targeted with interventions accordingly.
Relationship between the expression of DcR3 and high-risk human papilloma virus infection in cervical carcinoma
HAN Jing, MIAO Hui, FENG Xiang-xian
2019, 23(1): 85-89. doi: 10.16462/j.cnki.zhjbkz.2019.01.018
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Abstract:
  Objective  To explore the relationship between the expression of decoy receptor 3 (DcR3) and high-risk human papilloma virus(HR-HPV) infection in cervical carcinoma.  Methods  Immunohistochemistry and hybird capture Ⅱ assay were used to detect the expression of DcR3 and HR-HPV in 35 cases of normal cervical tissues(NCE), 39 cases of cervical intraepithelial neoplasm(CIN) and 44 cases of cervical squamous epithelial carcinoma(CSES). Specific HR-HPV16 E7 siRNA and nonspecific HR-HPV16 E7 siRNA were synthesized and transfected to SiHa cells by Lipofectamine. The expression of DcR3 at mRNA and protein levels was examined by real-time polymerase chain reaction and western blot. The growth inhibition was examined by MTT assay.  Results  In NCE, CIN and CSES, the positive expression rates of DcR3 were 8.6%(3/35), 48.7%(19/39) and 77.3%(34/44), respectively, and the expression intensity was increasing(χ2=36.942, P<0.001). In NCE, CIN and CSES, the infection rates of HR-HPV were 5.7%(2/35), 56.4%(22/39) and 93.2%(41/44), respectively(χ2=60.322, P<0.001). The protein expression of DcR3 was positively correlated with the infection of HR-HPV in CSES(r=0.893, P=0.004).  Conclusions  DcR3 was highly expressed in cervical cancer. Its expression was positively correlated with HR-HPV infection, which may contribute to the occurrence and development of cervical cancer. HR-HPV silencing inhibited cellular growth and proliferation by down-regulating the expression of DcR3.
Methology
Application and comparison of residual autoregressive model and Holt's two-parameter exponential smoothing model in infant mortality prediction in some countries along the Belt and Road Initiative
LI Gang-gang, ZHOU Xiu-fang, BAI Ya-na, ZHOU Li, HAN Xiao-li, REN Xiao-wei
2019, 23(1): 90-94, 100. doi: 10.16462/j.cnki.zhjbkz.2019.01.019
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Abstract:
  Objective  To explore the application of residual autoregressive model and Holt's two-parameter exponential model in the prediction of infant mortality rate in some countries along the "Belt and Road" (China-Indo-China Peninsula Economic Corridor).  Methods  The time series data of infant mortality rate in Vietnam, Laos, Cambodia, Myanmar, Thailand, Singapore, Malaysia, and China for 1978-2013 were used as training set to fit residual autoregressive model and Holt's two-parameter exponential model. The 2014-2016 data was used as the validation set to compare the performance of model prediction.  Results  The akaike information criterion (AIC) value of the residual autoregressive model was superior to Holt's two-parameter exponential model. Both prediction models showed high accuracy, and most evaluation indicators (absolute error and relative error) of residual autoregressive prediction model were smaller than Holt's two-parameter exponential model. The residual autoregressive models of Laos, Myanmar and Cambodia were better than the Holt's two-parameter exponential model for the infant mortality rate(IMR) prediction in different years.  Conclusions  The residual autoregressive model and Holt's two-parameter exponential model performed well in infant mortality rate prediction in some countries along the China-Indo-china Peninsula Economic Corridor. The residual autoregressive model has better fitting effect. The residual autoregressive model for infant mortality prediction is superior to the Holt two-parameter exponential model in most countries in most years.
Application of Lee-Carter model in the prediction of mortality risk in digestive tract cancer in Suzhou
JIANG Yun, FENG Yue-yi, WANG Lin-chi, LU Yan, SHU Xiao-chen
2019, 23(1): 95-100. doi: 10.16462/j.cnki.zhjbkz.2019.01.020
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Abstract:
  Objective  A Lee-Carter model was used to predict the risk and trend of mortality in the digestive tract cancer in Suzhou from 2002 to 2016.  Methods  The crude and standardized mortality rates were calculated based on deaths of digestive tract cancer which was identified from Suzhou chronic disease surveillance system.We used Lee-Carter model to predict the trend of mortality in digestive tract cancer.  Results  The effectiveness of the results forecasted by Lee-Carter model was validated in the data of digestive tract cancer mortality from 2012 to 2016 in Suzhou. The mean absolute percentage error (MAPE) values for the model were 2.48% and 4.13% for the age and year respectively, which indicated a well accepted prediction value. The mortality index was on the down trend in overall digestive tract cancer from 2002 to 2016, among which the mortality index in upper digestive tract cancer decreased, while the mortality index in lower digestive tract cancer increased. The mortality rate of upper digestive tract cancer was 4.23 fold higher than that of lower digestive tract cancer, and mortality rate in male was 2.17 times higher than that in female.  Conclusions  Our study observed a downward mortality trend in digestive tract cancer overall. Notably, the male mortality rate of lower digestive tract cancer was on an upward trend. In recent years, Suzhou has been undergoing a rapid population aging with medical and health level was increasing as well.
Application and comparison of three models for the prediction of influenza-like illness in Jiangxi Province
FU Wei-jie, XIE Yun, ZENG Zhi-li, LIU Xiao-qing
2019, 23(1): 101-105. doi: 10.16462/j.cnki.zhjbkz.2019.01.021
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Abstract:
  Objective  To establish the optimal epidemical trend prediction model of influenza in Jiangxi Province and provide scientific guidance for influenza prevention and control.  Methods  Monthly influenza sentinel surveillance data of Jiangxi Province were derived from the "Influenza Surveillance Information System In China" from 2013 to 2017, and the different forecasting methods were used to build model, such as autoregressive (AR), exponential smoothing (ES) and autoregressive integrated moving average (ARIMA), also compared predictions with actual values in 2017.  Results  R square of the three models were 0.731, 0.751 and 0.815 respectively; the root mean square error (MRSE) were 0.253, 0.243 and 0.212, respectively; mean absolute error(MAE) were 0.189, 0.178 and 0.151, respectively; mean absolute percentage error (MAPE) were 10.092, 9.523 and 8.124 respectively; the average relative error (MRE) were 11.45%, 10.92% and 8.96%, respectively.  Conclusions  ARIMA was a good model for predicting the percentage of influenza-like illness in outpatient visits in Jiangxi Province.
Short Reports
Analysis of awareness of HIV/AIDS-related knowledge and related behavior among men who have sex with men (MSM) in Changsha
ZHENG Chan-juan, MA Lan-xin, TAN Ye-feng, XIANG Yu-han, YANG Yi-de, LI Cheng-xi
2019, 23(1): 106-109. doi: 10.16462/j.cnki.zhjbkz.2019.01.022
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Abstract:
  Objective  To understand the awareness of HIV/AIDS-related knowledge and characteristics of sexual behaviors among men who have sex with men (MSM) in Changsha City.  Methods  By a snowball sampling method, volunteers were recruited in two social public welfare organizations in Changsha (Qingcai and Zhongda Sunshine) and interviewed by anonymous electronic questionnaires. Data were analyzed using software SPSS 19.0.  Results  Among 150 MSM, the overall awareness rate of HIV/AIDS-related knowledge was 86.0% (129/150). For different demographic characteristics, higher age group, higher education level and higher income groups had significantly higher rates of awareness about HIV/AIDS related knowledge, compared with the reference groups, respectively. For the sexual behaviors, 32.7% of the investigated MSM population had their first MSM sexual intercourse at age of <18 years old, the rate of ≥ 18 years old group was significantly higher than the <18 years old group (χ2=4.315, P=0.038), 46.7% of the MSM population had more than 1 sexual partner during the past six months, the ratio of MSM used condoms in the sexual intercourse occasionally or never was 29.3% and 6.7%, respectively.  Conclusions  Young age, relatively low educational level and low income MSM in Changsha had a relative low awareness of HIV/AIDS-related knowledge. MSM in Changsha City had first MSM sexual intercourse at a very younger age. There is an urgent need to take well-targeted measures to improve the HIV/AIDS-related knowledge with special MSM population, and develop effective intervention measures for the high-risk sexual behaviors among MSM.
A study on social support and associated factors among HIV/AIDS patients in Liangshan
YIN Yao, CHEN Hong
2019, 23(1): 110-113. doi: 10.16462/j.cnki.zhjbkz.2019.01.023
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Abstract:
  Objective  To assess the social support of PLWHA in Liangshan and explore the associated factors.  Methods  A total of PLWHA 322 was selected by two-stage sampling. The questionnaire consisted of basic characteristics, simplified Chinese medical outcomes study social support survey and family concern index questionnaire.  Results  The social support score of PLWHA was 46.09(32.49, 61.59) in Liangshan, which was lower than other regions of China. Scores of four dimensions were listed as follows: tangible support 56.25(29.69, 75.00), affectionate support 50.00(33.33, 75.00), positive social interaction 46.88(31.25, 56.25), informational and emotional support 43.75(25.00, 56.25). Multiple stepwise regression analysis suggested that the older PLWHA had lower sores of the social support(β=-1.997, P=0.037); PLWHA who were living alone got lower sores of the social support(β=8.127, P=0.008); PLWHA who were more satisfied with family function was associated with higher scores of social support(β=13.809, P<0.001).  Conclusions  The status of social support among PLWHA was poor in Liangshan, which needed urgent improvement. Meanwhile, PLWHA who were older and living alone needed special attention. Health care workers should help PLWHA build a comprehensive family support system.
HIV prevalence and risk factors among premarital couples in Dehong Prefecture of Yunnan Province, 2017
GONG Yu-rong, QIAO Shi-jie, YANG Shi-jiang, YANG Yue-cheng, TANG Ren-hai, CAO Yan-fen, GAO Jie, LI Lin, YE Run-hua, WANG Ji-bao, YAO Shi-tang, DING Ying-ying, HE Na, DUAN Song
2019, 23(1): 114-117. doi: 10.16462/j.cnki.zhjbkz.2019.01.024
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Abstract:
  Objective  To understand the prevalence of HIV infection and its influencing factors in the premarital physical examination population in Dehong Prefecture, Yunnan Province, 2017.  Methods  The data of people receiving premarital medical examination was collected, the demographic characteristics was described and the related factors was analyzed by Logistic regression.  Results  There were 21 875 participants receiving premarital medical examination in Dehong. 98(0.45%) participants were confirmed positive for HIV and male infection rate was 0.47% (52/10 955) and female was 0.42% (46/10 920). Among the 98 patients, 20 patients were infected in the first time, and main route was sexual transmission accounting for 81.63% (80/98). Logistic multivariate regression analysis showed that age, ethnicity and drug use were the influencing factors for premarital couples infecting HIV. The risk of HIV infection in 31-40 and 41-50 years old group was higher than the people under 25 years old group(OR=3.78, 95% CI: 1.81-7.89, P<0.001;OR=3.95, 95% CI: 1.72-9.08, P=0.001). The infection risk of Dai and Jingpo ethnic group was higher than that of the Han ethnic(OR=1.86, 95% CI: 1.06-3.29, P=0.031;OR=3.25, 95% CI: 1.81-5.84, P<0.001). The risk of infection among drug users was much higher than non-drug users (OR=926.76, 95% CI: 271.65-3 161.71, P<0.001).  Conclusion  Age, ethnicity, and drug use are influencing factors of HIV infection among premarital couples. Targeted measures need to be taken against risk factors. HIV infection is mainly transmitted by sexual transmission. It can be effectively detected and controlled through premarital medical examination.
History of Public Health
American public health promoter: William Henry·Welch
GUO Heng-sheng, WU Jun, YE Dong-qing
2019, 23(1): 118-121. doi: 10.16462/j.cnki.zhibkz.2019.01.025
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Abstract:
William Henry·Welch (1850-1934) was a famous American pathologist, bacteriologist and medical school administrator. He introduced European exquisite experimental technology, frontier bacteriology theory and innovative scientific research thinking into American medical field, promoted American health reform, and promoted the development of public health in the United States. At the same time, Welch founded the Johns Hopkins School of Hygiene and Public Health, the first public health school in the United States, and provided a blueprint for world public health education.

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