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CN 34-1304/R ISSN 1674-3679

2019 Vol. 23, No. 2

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Literature Review
Representativeness issues in epidemiological studies (Ⅱ)
PAN Xiong-fei, WANG Yi, YE Yi, PAN An
2019, 23(2): 125-128. doi: 10.16462/j.cnki.zhjbkz.2019.02.001
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Abstract:
The review clarifies the relation of representativeness to multicenter intervention design, heterogeneity, response rate, and loss to follow-up. In addition, the implications of representativeness in the era of precision medicine and big data-based epidemiological studies are further discussed. In summary, population health researchers should have a fair understanding of the function and role of representativeness in epidemiology in order to conduct scientifically plausible studies to generate the best evidence for practice.
Original Articles
Analysis of influencing factors for liver cancer by gender in Shunde region
ZHOU Xin-feng, WEI Zhi-mei, ZHOU Cheng-yu, ZHONG Xuan, LIU Qing, LIU Gui-yan, GAO Yan-hui, YU Xin-fa, CHEN Si-dong, LIU Li
2019, 23(2): 129-133, 139. doi: 10.16462/j.cnki.zhjbkz.2019.002
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  Objective  To investigate the influencing factors for liver cancer by gender in Shunde region, and to explore the potential interactions among influencing factors for liver cancer in males.  Methods  The relative excess risk of interaction (RERI) and other indices were used to evaluate the pair-wise interaction, and the classification and regression tree (CART) model was applied to explore the potential multi-factors interaction.  Results  This study included 1 037 male cases and 1 069 controls, together with 166 female cases and 185 controls. Chronic hepatitis B virus infection (CHB) and family history of liver cancer were significantly associated with increased risk of liver cancer both in males and females (both P<0.001). In males, positive additive interactions were observed between CHB and smoking or alcohol drinking, as well as between smoking and drinking. The RERI for CHB and smoking was 121.90(95% CI: 52.85%-190.95%). Negative additive interactions were observed between exercise and CHB or smoking. Further, the CART analysis suggested that the CHB males who smoked and drank alcohol had the highest risk of liver cancer.  Conclusions  CHB and family history of liver cancer are important risk factors for liver cancer in both males and females. CHB, smoking, and alcohol drinking synergistically promote the incidence of liver cancer for males. Exercise can antagonize the hepatocarcinogenic effect of CHB and smoking.
Prognostic values of preoperative serum CA199 and NSE on esophageal squamous cell carcinoma patients
XIANG Zhi-sheng, LIN Zheng, LIU Shuang, YANG Hui-min, WANG Hang, HUANG Li-ping, CHEN Yuan-mei, HU Zhi-jian
2019, 23(2): 134-139. doi: 10.16462/j.cnki.zhjbkz.2019.02.003
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  Objective  To explore the effects of preoperative serum cancer antigen 19-9 (CA19-9) and neuron-specific enolase (NSE) on the prognosis of patients with esophageal squamous cell carcinoma (ESCC).  Methods  This prospective study enrolled 176 patients with ESCC. χ2 test was used to analyze the relationship between CA19-9, NSE and general clinical features. Survival curves were estimated using Kaplan-Meier method and comparisons were performed using the log-rank test. The Cox proportional hazards model was performed for multivariate analyses of overall survival (OS) and disease free survival (DFS).  Results  The patients with both high CA19-9 and NSE had the poor prognosis compared with those had both low CA19-9 and NSE (OS: HR=2.310, 95% CI: 1.208-4.418; DFS: HR=2.354, 95% CI: 1.265-4.381). Compared to the separate detection of the two markers, the combined detection of CA19-9 and NSE was more accurate in the prognosis prediction of patients with ESCC (OS: C-index=0.686; DFS: C-index=0.684).  Conclusions  Preoperative serum CA19-9 and NSE were risk factors for the prognosis of patients with ESCC. Combined detection had higher accuracy of prediction of prognosis in patients with ESCC.
Analysis on influencing factors of the frailty of the elderly
ZHANG Yan, LIANG Ya-ping, SUN Ming-wei, HUANG Ling-feng, LIAN Ting-yu, HUANG Jing-xiao, YIN Ming-juan, NI Jin-dong
2019, 23(2): 140-145. doi: 10.16462/j.cnki.zhjbkz.2019.02.004
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  Objective  To explore influencing factors of the elderly's frailty.  Methods  Eight communities were randomly selected from Dalang Town, Dongguan City, and all the eligible elderly people were investigated using the self-developed frailty index. Univariate analysis was performed using the χ2 test, and multivariate analysis was performed by ordinal multi-class Logistic regression.  Results  Univariate analysis showed that there were significant differences in the distribution of frailty conditions among different demographic characteristics, family relationships, economic situation and lifestyle (all P<0.05). Multivariate analysis showed that younger age (OR=0.13, P<0.001), male (OR=0.65, P=0.012), and daily exercise (OR=0.76, P=0.049) were protective factors for frailty of the elderly. Illiterate (OR=2.42, P<0.001), fewer times to see children per month (OR=1.82, P=0.035), pension funds as the main economic source (OR=1.59, P<0.001), low level of physical activity (OR=2.18, P<0.001) and none social participation (OR=1.41, P=0.004) were risk factors of frailty.  Conclusion  Age, gender, education level, times to see children per month, economic source, exercise frequency, physical activity level and social participation are the influencing factors of frailty of the elderly.
Comparison of four different metabolic syndrome diagnostic criteria among the elderly in Nanjing
CAI Rui-xue, CHAO Jian-qian, KONG Ling-yan, WANG Ying-peng
2019, 23(2): 146-149, 161. doi: 10.16462/j.cnki.zhjbkz.2019.02.005
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  Objective  To compare the application of the 2013 Chinese Diabetes Society (CDS 2013) criteria, the 2009 joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention(JIS)criteria, the 2005 International Diabetes Federation(IDF)criteria and the 2005 US National Cholesterol Education Program Adult Treatment PanelⅢ (ATPⅢ) criteria among the elderly in Nanjing.  Methods  A total of 1 832 elderly (≥ 60 years old) were recruited in Nanjing using cluster random sampling and were surveyed with questionnaires, physical examination, and laboratory test between March and December 2013. The different prevalence under CDS 2013, JIS, IDF and ATPⅢ criteria were calculated respectively. SPSS 19.0 was used to conduct t test, chi-square test and kappa test to compare the prevalence of metabolic syndrome and the consistency of four diagnostic criteria in the elderly.  Results  According to CDS 2013, JIS, IDF, and ATPⅢ, prevalence of MS in the elderly in Nanjing was 39.9%, 58.2%, 46.5%, and 54.5%, respectively. The highest value of kappa was 0.920 between JIS and ATPⅢ, with a compliance rate of 96.1%.The value of kappa was 0.841 between ATPⅢ and IDF, with a compliance rate of 92.0%.  Conclusions  The prevalence of metabolic syndrome among the elderly in Nanjing is relatively high under different criteria. The higher detection rate of MS by the JIS standard and ATPⅢ standard can help to find MS earlier and reduce the cardiovascular damage.
The association of overweight and obesity with hypertension among residents aged 35 years or older in Yuhuan county
XIE Hong-yan, CHEN Yun, SU Mei-fang, LI Song-tao, YING Xu-hua, JIANG Qing-wu, FU Chao-wei
2019, 23(2): 150-155. doi: 10.16462/j.cnki.zhjbkz.2019.02.006
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  Objective  To assess the prevalence of overweight and obesity among residents aged 35 years or older in Yuhuan county of Zhejiang Province and explore the associations of overweight and obesity with hypertension.  Methods  A cross-sectional study was conducted among 124 693 permanent residents aged 35 years or older, who were randomly selected using cluster sampling method from Yuhuan county.  Results  The prevalence of overweight and obesity was 34.53% and 10.18% among subjects, respectively. The overweight prevalence for male (35.56%) was higher than that for female (33.66%), whereas the obesity prevalence for female (11.26%) was higher than that for male (8.90%) (all P<0.05). The multivariate analysis showed that age, education, occupation, regular physical exercise, smoking, drinking and high-salt diet were possible factors for overweight and obesity (all P<0.05). After adjustment for covariates, compared to participants with normal weight, the multivariate logistic regression indicated that the adjusted odds ratio (OR) and their 95% confidential interval of overweight and obesity were 2.02 (95% CI: 1.93-2.11) and 3.83 (95% CI: 3.57-4.10) for hypertension in men, and were 1.94(95% CI: 1.86-2.02)and 3.56(95% CI: 3.35-3.77) in women, respectively.  Conclusions  The prevalence of overweight and obesity was high among residents aged 35 years or older in Yuhuan county, and they may relate to the increasing risk of hypertension.
Prevalence of gestational diabetes mellitus and its related risk factors among 34 637 pregnant women in Tongzhou district of Beijing from 2013 to 2017
HAN Na, LIU Jue, JIN Chu-yao, LIU Zheng, Lin Li-zi, Wang Hai-Jun
2019, 23(2): 156-161. doi: 10.16462/j.cnki.zhjbkz.2019.02.007
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  Objective  The study aims to investigate the prevalence of gestational diabetes mellitus (GDM) among pregnant women in Tongzhou district of Beijing and its related risk factors.  Methods  Information of 34 637 singleton pregnancies delivered in a maternal and child health care hospital in Tongzhou district of Beijing were collected from January 1, 2013 to December 31, 2017. GDM prevalence of pregnant women were calculated. Multivariable logistic regression analysis was used to analyze the association between GDM and its related factors.  Results  The prevalence of GDM in 34 637 singleton pregnant women in Tongzhou district of Beijing was 23.2% (8 034/34 637). Multivariate analysis showed that advanced maternal age(aOR=1.87, 95% CI: 1.71-2.05), high level of education(aOR=1.19-1.23), delivering during 2016-2017(aOR=1.46, 95% CI: 1.38-1.55), macrosomia(aOR=1.27, 95% CI: 1.02-1.59), history of cesarean section(aOR=1.18, 95% CI: 1.08-1.30), history of spontaneous abortion(aOR=1.23, 95% CI: 1.10-1.37), history of induced abortion(aOR=1.08, 95% CI: 1.01-1.14), family history of diabetes(aOR=1.51, 95% CI: 1.26-1.83), multipara(aOR=1.24, 95% CI: 1.15-1.34), pre-pregnancy overweight(aOR=2.02, 95% CI: 1.89-2.15), pre-pregnancy obesity(aOR=3.11, 95% CI: 2.81-3.43)and conceived by assisted reproductive technology(aOR=1.47, 95% CI: 1.03-2.10)were the independent risk factors for GDM.  Conclusions  Prevalence of GDM is high in pregnant women in Tongzhou district of Beijing. Health education before and during pregnancy should be carried out to monitor and prevent the occurrence of GDM in time to ensure maternal and child health.
The comparison of hypertension prevalence among children based on different references of hypertension
Tang Nu, Chen Ya-jun, Tan Wei-qing, Deng Lu, Lu Shao-min, Tan Min-yi, Zeng Xia, Cai Li
2019, 23(2): 162-167. doi: 10.16462/j.cnki.zhjbkz.2019.02.008
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  Objective  To compare the differences in the hypertension prevalence among children aged 7-12 in Guangzhou based on different references of hypertension.  Methods  A total of 7698 children aged 7-12 years old in Guangzhou were recruited by stratified cluster random sampling method. Demographic information such as gender and age was collected by questionnaire. Children's height, weight, and blood pressure were objectively measured. There were five references for diagnosing children's hypertension: Mi 2010, Mi 2017, Ma 2017, America 2004, and America 2017 reference.  Results  Based on the references above, the prevalence of hypertension for children aged 7-12 in Guangzhou reached a very high level. The prevalence of hypertension, high systolic blood pressure (SBP) and high diastolic blood pressure (DBP) based on Mi 2017 reference were all higher than those based on Mi 2010 reference, but both of them were distinctly higher than Ma 2017 reference. Compared with Mi 2010 reference, the agreement of diagnosis of high SBP and high DBP were both higher for Mi 2017 than those for Ma 2017. The agreement of high SBP was higher between Mi 2017 and America 2017 than that between Ma 2017 and America 2017 (Kappa: 0.846 vs. 0.727).  Conclusion  The prevalence of hypertension in children aged 7-12 in Guangzhou reachs a very high level. The prevalence of hypertension based on Mi 2017 reference is the highest and follows with America 2017 reference, and the agreement between them is excellent. Compared with Mi 2010 or America 2017 reference, the agreement for Ma 2017 is lower than that for Mi 2017 reference, respectively.
Imapct of home environment on emotional and behavioral problems in preschool children
ZHANG Jing-li, CHEN Rui-mei, CHEN Qiu, ZUO Xiao-yu, YU Wei-ping, TAO Fang-biao, SU Ting-juan
2019, 23(2): 168-171. doi: 10.16462/j.cnki.zhjbkz.2019.02.009
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  Objective  To investigate the status of mental health in preschool children of Yangzhou city, and to explore the effect of home environment.  Methods  A total of 2 531 children from 7 kindergartens were selected by random cluster sampling. Questionnaire (including SDQ tests) was used to analyse the status and characteristics of mental health.  Results  The rate of children with mental disorder was 6.4%, the most prominent problem was peer relationship difficulty (17.8%), followed by hyperactivity/inattention (13.7%), prosocial behavior (9.4%), conduct problems (7.0%) and emotional problems (5.7%). Except for emotional symptoms, the detection rates of all other investigated problems among boys were higher than those among girls. Logistic regression analysis showed that the low level of mother's education (OR=1.85, 95%CI: 1.04-3.29) and the joint family (OR=1.81, 95%CI: 1.19-2.75) were risk factors, and gender of girl was protective factor (OR=0.71, 95%CI: 0.51-0.98).  Conclusions  The rate of mental disorder is low, but hyperactivity in boys and emotional problems in girls are quite popular, especially in children who have mother with low level of education or live in the joint family.
Evaluation of an item-specific physical activity scale for Chinese children and adolescents(I-PASCA)
LI Chao, XU Fei, YE Qing, CHU Wen-jie, QING Zhen-zhen, WANG Zhi-yong, SHEN Hong-bing
2019, 23(2): 172-175. doi: 10.16462/j.cnki.zhjbkz.2019.02.010
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  Objective  To evaluate the validity and reliability of an item-specific physical activity scale for Chinese children and adolescents(I-PASCA).  Methods  Students from Grade 4-12 in Nanjing were randomly selected using a multi-stage sampling approach, 7-days physical activity (PA) level was recorded by self-reported I-PASCA and PA log and were objectively measured with accelerometers. The total moderate and vigorous PA (MVPA) time was calculated. Cronbach α was calculated to estimate the reliability of I-PASCA. Pearson correlation coefficient and Bland-Altman were used to examine I-PASCA's validity.  Results  There were 815 students recruited in 2013 to evaluate the reliability and validity of I-PASCA using PA log. Cronbach α for I-PASCA was 0.73 regarding moderate and vigorous PA (MVPA). The Spearman correlation coefficients of the values of PA recorded by I-PASCA and PA log were 0.59 for MVPA, and the Bland-Altman coefficient was 95.8% for MVPA. 624 students were involved to examine the reliability and validity of I-PASCA using accelerometers. Cronbach α for I-PASCA was 0.72 regarding MVPA. The Spearman correlation coefficient was 0.36 for MVPA, while the Bland-Altman coefficient was 95.5% for MVPA.  Conclusions  The I-PASCA, the first physical activity questionnaire specific to Chinese children and adolescents, shows acceptable reliability and validity and can be used to evaluate Chinese students' physical activity level in population-based studies.
Mortality analysis on children under 5 years old in Yuyao County from 2013 to 2017
HU Bo-bo, FU Ke-ben, HU Bi-bo
2019, 23(2): 176-179, 184. doi: 10.16462/j.cnki.zhjbkz.2019.02.011
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  Objective  To understand the status and main causes of death among children under five years old in Yuyao County from 2013 to 2017, and to provide scientific basis to formulate relevant intervention measures.  Methods  Data monitoring deaths among children under five years old from 2013 to 2017 in Yuyao were collected. Trend of death, death rank, regional difference and utilization of pre-death health care services for children under 5 years old were retrospectively analysed using SPSS 18.0.  Results  From 2013 to 2017, the mortality rate in newborns, infants, 1-4 years old children and children under 5 years old (U5MR) decreased in Yuyao county(P=0.016, 0.002, 0.038, <0.001). Based on monitored 263 cases of deaths, the majority of deaths of children under 5 years old occurred in infants, accounting for 68.82% (181/263). Congenital malformation and unintentional injury were the main causes of death for children under 5 years old. The deaths of children under 5 years old mainly occurred in medical institutions, and 93.54% of the children were treated before death. The mortality rate of boys under 5 years old was 10.50‰, which was 1.54 times of the mortality of girls (χ2=11.693, P<0.001). The trend Chi-square test showed that the U5MR in local residents had no obvious downward trend in the past 5 years (χtrend2=0.195, P=0.658), while the U5MR in floating population significantly decreased with fluctuation (χtrend2=17.706, P<0.001).  Conclusion  The key to reduce U5MR in Yuyao is to reduce infant mortality, and the key content of death intervention is to prevent congenital malformations and unintentional injuries. Improving maternal and child health care and developing safety education for migrant children are two effective measures to reduce U5MR.
Analysis and forecasting of the epidemiological characteristics of mumps in Zaozhuang City between 2010 and 2017
SUN Xi-wang, Yu Juan-juan, Zhang Hong, Hu Xiao, Li Fu-guo
2019, 23(2): 180-184. doi: 10.16462/j.cnki.zhjbkz.2019.02.012
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  Objective  To analyze the epidemiological characteristics of mumps in Zaozhuang city from 2010 to 2017, and establish a predictive model to predict prevalence trend, so as to provide scientific basis for the prevention and control of mumps.  Methods  Mumps cases between 2010 and 2017 screened from Infectious Diseases Report Information Management System of Chinese Information System of Disease Prevention and Control were analyzed by the descriptive epidemiologic method. The time series analysis method was applied to model and predict the trend of disease.  Results  A total of 6 353 mumps cases were reported in Zaozhuang city from 2010 to 2017. The average annual incidence was 19.75/100 000. The incidence of men was higher than that of women. The seasonal indices for December to next January and April to July were all above 1. The incidence rates of Shizhong and Yicheng were higher than in other areas. The incidences aged from 3 to 14 accounted for 76.85% of the total number of cases, while students, scattered children and childcare accounted for 86.11%. The established time series model was ARIMA (1, 0, 0) * (0, 0, 0)12. The mean absolute percentage error of the predictive values based on the model was 39.99% and the number of cases predicted by the model in 2018 was 471. The predictive incidence rate was 11.13/100 000.  Conclusions  Primary and secondary school students and scattered children are the main population for the prevention and control of mumps. The model obtains better forecasting results and can be used for short-term prediction and dynamic analysis of mumps.
Epidemiological characteristics and trend prediction of mumps in Jiamusi city from 2004 to 2017
CHEN Xin, WU Xiao-min, BAO Ming-jia, LI Ming-chun, WANG Yan-xu, WANG Lei, XUE Xiao-feng, WANG Peng, WANG Kai-yan, FENG Li-ying
2019, 23(2): 185-190. doi: 10.16462/j.cnki.zhjbkz.2019.02.013
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  Objective  To analyze the epidemiological characteristics of mumps in Jiamusi city, and predict the incidence trend, so as to provide evidence for taking targeted prevention and control measures in the cold areas in Heilongjiang Province.  Methods  The mumps cases were collected from China Information System for Disease Control and Prevention in Jiamusi city from 2004 to 2017.Descriptive epidemiologic method was used for analyzing the epidemic of mumps in Jiamusi city during 2004-2017, and the autoregressive integrated moving average (ARIMA) was used to forecast the incidence of mumps in 2018.  Results  A total of 1 586 cases of mumps were reported in Jiamusi city during 2004-2017, the average annual incidence rate was 4.52/100 000. The incidence of mumps increased year by year from 2015 to 2017.The ratio of male to female was 1.67:1, those aged from 3 to 19 years accounted for 86.32% of the total cases, the higher incidence rates were found at the age of 5-9 and 10-14 years.The incidence of mumps presented obviously seasonal characteristics.Most cases concentrated from April to July and from November to January. The incidence of urban disease was higher than that of other counties; The established finally mode was ARIMA(4, 1, 2)(2, 0, 0)12 and the predicted incidence from January 2018 to June 2018 was consistent with the actual one.From July 2018 to December 2018, predictive mumps incidence were: 0.30/100 000, 0.35/100 000, 0.38/100 000, 0.39/100 000, 0.35/100 000, 0.33/100 000.  Conclusions  ARIMA model could predict the trend of mumps in Jiamusi city.To reduce the incidence of children, it is recommended to develop a second dose of mumps vaccine at the preschool age (3-6 years) or primary school; At the same time, surveillance and control should be continually strengthened in kindergartens and schools.
Epidemiological characteristics and repeated infection analysis of scrub typhus in Anhui Province from 2008 to 2017
ZHU Meng, YAO Hui-yuan, SONG Dan-dan, MA Wan-wan, WU Jia-bing, GONG Lei
2019, 23(2): 191-195. doi: 10.16462/j.cnki.zhjbkz.2019.02.014
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  Objective  To understand the epidemiological characteristics of scrub typhus in Anhui Province from 2008 to 2017, so as to provide scientific evidence for the development of control strategies and control measures.  Methods  Descriptive epidemiological methods were used to describe and analyze the cases of scrub typhus in Anhui Province from 2008 to 2017.  Results  The overall incidence of scrub typhus in Anhui Province showed an upward trend from 2008 to 2017 (χ2=3 522.49, P<0.001). The highest incidence rate in 2016 was 3.98/100 000. The cases were concentrated from September to November. It was a typical "autumn and winter type" and peaked in October. It had the phenomenon of "high incidence in October"; the cases were mainly concentrated in the age group of 40-79 years old, accounting for 76.64% of the total reported cases. The cumulative number of cases in the 60-69 age group was the largest, and the incidence was mainly farmers.  Conclusions  In recent years, the incidence of scrub typhus in Anhui Province has shown an upward trend. It is necessary to strengthen the routine monitoring of scrub typhus in key areas and the detection of scrub typhus pathogens, and actively carry out prevention and health education of scrub typhus.
Investigation on rickettsiae natural infection in mice and vector arthropods in partial areas of Yunnan
YA Hong-xiang, WANG Jing-lin, ZHONG You-hong
2019, 23(2): 196-200. doi: 10.16462/j.cnki.zhjbkz.2019.02.015
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  Objective  To investigate rickettsiae infection from host animals and vector arthropods in some areas of Yunnan Province.  Methods  Rat clip and cage traps were used to capture mice. Chiggers from body surface of mice and ticks from body surface of farm cattle were collected. DNAs were extracted from mice spleens, chiggers and ticks. Rickettsiae groEL segment were amplified by nested-polymerase chain reaction (nPCR), sequenced to analyze the homology with other known sequences.  Results  A total of 410 samples were collected for rickettsiae groEL segment detection with nPCR and 19 samples (4.63%) showed positive for rickettsiae groEL segment. Among them, 2.68%(11/410)were positive for Orientia tsutsugamsushi (Ot) groEL segment, and 1.22%(5/410)were positive for spotted fever group rickettsia (SFGR) groEL segment, and 0.49%(2/410)were positive for rickettsia mooseri (Rm) groEL segment, and 0.24%(1/410)were positive for rickettsia endosymbiont(Re) groEL segment. When analyzed the homology with other known sequences, 11Ot strains with 93.6%-100% similarities among them in this study shared the highest similarity with other Ot strains from GenBank respectively, reached up to 96.1%-100%; The groEL segments of 5 SFGR strains with 92.1%-99.5% similarities among them in this study shared highest similarity with other SFGR strains from other GenBank respectively, reached up to 98.9%-100%; In this study groEL segments of 2 Rm strains all showed 100% similarity with Wilmington strain (GenBank No: AE017197); One groEL segment of Re showed 98.9% similarity with Re strain (GenBank No: EU435143).  Conclusion  There were kinds of rickettsiaes infection in host animals and vector arthropods in Yunnan Province, so the monitoring and prevention of the Rickettsiosis should be strengthened.
Surveillance and analysis of Haemaphysalis longicornis with SFTS virus in Tumen river basin located in the frontiers of Russia, Korea and Northeast China
LI Ji-xu, SHIN-Hyeong Cho, PIAO Wen, JIN Guang-jun, SONG Zhen-hai, QUAN Sheng-huan, PIAO Guang-ming
2019, 23(2): 201-205, 211. doi: 10.16462/j.cnki.zhjbkz.2019.02.016
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  Objective  To mastered the distribution characteristics of Haemaphysalis longicornis in the Tumen River basin along the border between Russia, Korea and Northeast China, and understand the status of Haemaphysalis longicornis carrying the virus of fever with thrombocytopenia syndrome (SFTS), then, isolate the virus and analyze its genetic characteristics.  Method  Ticks were collected from Hunchun, Tumen, Helong and Longjing cities in the Tumen River basin of Jilin Province from April to September, 2017. Haemaphysalis longicornis was selected and grouped. SFTS virus was detected by real-time quantitative polymerase chain reaction (RT-qPCR). Virus isolation was carried out in Vero cells, besides, S, M, L gene segments were amplified. The homology of S, M and L gene segments was compared, phylogenetic tree was established, and their gene characteristics were analyzed.   Result   Haemaphysalis longicornis mainly distributed in Hunchun and Tumen City in the lower reaches of Tumen River. It was the dominant species in the two counties, reaching 71.85% and 87.62% respectively. A virus named YBHC-TICK2-2017/CHINA was isolated from Haemaphysalis longicornis collected in Hunchun. The sequences of S segment (1 746 bp), M segment (3 336 bp) and L segment (6 376 bp) of the virus were 98.00%-99.00%, homologous to those of SFTS virus isolates from China and Korea recorded in National Center for Biotechnology Information (NCBI) Gen Bank. Phylogenetic tree analysis showed that the S segment gene sequence of the virus strain was divided into a cluster with Jilin strain (KT890282) in China, and M segment and L segment gene sequence with Jiangsu strain (KR230781) in China.  Conclusions  Haemaphysalis longicornis are widely distributed in the lower reaches of the Tumen river. It was the first time that SFTS virus was isolated from Haemaphysalis longicornis in this area, suggesting that this area is important for SFTS prevention.
Molecular typing and antibiotic resistance of Shigella isolated from 2011 to 2014 in Shandong Province
SHAO Kun, ZHANG Hua-ning, LI Xin-peng, HU Bin, LI Wen, LIU Jing, CHEN Yu-zhen, BI Zhen-wang, HOU Pei-bin, BI Zhen-qiang
2019, 23(2): 206-211. doi: 10.16462/j.cnki.zhjbkz.2019.02.017
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  Objective  To study the characteristics and epidemic trend of Shigella in Shandong province through the analysis of serotype, virulence genes, molecular typing and drug sensitivity.  Methods  The serotype was classified using the method of slide agglutination. Polymerase chain reaction (PCR) was used to amplify the related virulence genes. The molecular typing was carried out by pulsed field gel electrophoresis (PFGE), and the antibiotic sensitivity of the strains was determined by micro-broth dilution method.  Results  The main serogroups of 44 Shigella strains were Shigella flexneri (54.55%) and Shigella sonnei (43.18%). The carrying rates of ipaH, Set1, Sen and ial were 100%, 43.18%, 56.82% and 50.00%, respectively. By PFGE typing, the strains of Shigella flexneri were divided into 18 patterns with a low similarity. The strains of Shigella sonnei were divided into 14 patterns, and the similarity of 89.47% of the strains was more than 90%. 44 strains of Shigella had different levels of resistance to 14 of the 15 antibiotics. 93.18% of the strains were multidrug resistant.  Conclusion  The Shigella in Shandong province is dominated by serogroups of Shigella flexneri and Shigella sonnei, with high virulence gene carrying rate, clustering distribution and severe antibiotic resistance. It is necessary to strengthen the monitoring on serotype, traceability and antibiotic resistance of Shigella in Shandong province.
Molecular Epidemiological Characteristics of Staphylococcus aureus Strains Associated with Food Poisoning in Xi'an from 2013 to 2017
LUAN Yang, JIN Zi-yi, ZHANG Ye, WEI Xiao-guang, WANG Zeng-guo
2019, 23(2): 212-215, 221. doi: 10.16462/j.cnki.zhjbkz.2019.02.018
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Abstract:
  Objective  To understand the molecular epidemiological characteristics of staphylococcus aureus(S.aureus), which was isolated from food poisoning in Xian between 2013 and 2017.  Methods  A total of 26 S.aureusisolates from 8 outbreaks were analyzed by using pulsed field gel electrophoresis(PFGE), multilocus sequence typing(MLST) and spa typing. polymerase chain reaction(PCR) analysis was used to analyze the staphylococcal enterotoxin genes sea to sei.  Results  26 strains of S.aureus were divided into 7 types of A-G by PFGE; They were divided into 3 types by MSLT, ST6 accounted for 65.38% which was the main type; They were Divided into 4 types by spa typing, t701 accounted for 65.38% which is the dominant type. The sea accounted for 76.92% (20/26) in the enterotoxin gene testing; sed-seg accounted for 23.08% (6/26); other enterotoxin genes were not detected.  Conclusion  The predominant type of S.aureus isolated from food poisoning in Xi'an was ST6-t701-seaprofile from 2013 to 2017. The first detection of the new enterotoxin gene seg, PFGE, MLST and spa typing were combined to fully understand the molecular epidemic characteristics of strains.
Analysis on the epidemic status and the burden of intestinal infectious diseases in Jining city from 2009 to 2016
ZHANG Jing, LIU Wei, LIU Yan-nuo, WANG Wen-jun
2019, 23(2): 216-221. doi: 10.16462/j.cnki.zhjbkz.2019.02.019
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Abstract:
  Objective  To analyze the burden of intestinal infectious diseases in Jining city from 2009 to 2016, determine the epidemic trends and the high-risk groups in this area, so as to provide evidence for the prevention and control of intestinal infectious diseases.  Methods  The intestinal infectious diseases case information were collected from the Infectious Diseases Surveillance Information Reporting System. Based on these data, the incidence rate, the years lived with disability (YLDs) and the intensity of YLDs of intestinal infectious diseases was calculated.  Results  From 2009 to 2016, the annual incidence rate of intestinal infectious diseases in Jining city was 128.81/100 000, the annual incidence rate of subtype diseases in the descending order were other infectious diarrhea (74.74/100 000), hand-foot-and-mouth disease (49.15/100 000), bacillary dysentery (3.65/100 000), hepatitis E (0.57/100 000), acute hemorrhagic conjunctivitis (0.37/100 000) and hepatitis A (0.34/100 000). The highest incidence of intestinal infectious diseases was at May to August. The total YLDs caused by intestinal infectious diseases were 593.04 person-years, including 372.31 person-years for males and 220.73 person-years for females. The YLDs ranked in descending order were of hand-foot-mouth disease (326.88 person-years), other infectious diarrhea (235.74 person-years), hepatitis E (10.65 person-years), bacillary dysentery (10.09 person-years), hepatitis A (7.71 person-years), and acute hemorrhagic conjunctivitis (1.97 person-years), and the corresponding intensity of YLDs were 0.489, 0.353, 0.016, 0.015, 0.012, and 0.003 person-years/100 000, respectively.  Conclusions  The hand-foot-and-mouth disease and the other infectious diarrhea were the main intestinal infectious diseases subtypes prevailed in Jining city from 2009 to 2016, whose incidence was highest in the season of summer, and the preschool children and elderly people were the high-risk populations. According to its incidence characteristic, relevant government departments can take effective measures to prevent and control the intestinal infectious diseases in Jining city.
Methology
A time-series prediction and analysis on rural inpatient with cardio-cerebrovascular disease in Wugang
WU Yu-pan, WEI Liu-yi, WANG Shuang, LU Shan, HU Bo-rui, TA Fu-hui, CHEN Lei, MAO Zong-fu
2019, 23(2): 222-226. doi: 10.16462/j.cnki.zhjbkz.2019.02.020
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Abstract:
  Objective  To establish a predictive model for inpatients of cardio-cerebrovascular disease in rural areas of Wugang through time series analysis, and predict the changing trend of cardio-cerebrovascular disease, so as to offer guidance for the health care resources allocation and prevention and control of cardio-cerebrovascular disease.  Methods  The seasonal autoregressive integrated moving average model (SARIMA) was constructed based on the monthly number of cases of cardio-cerebrovascular disease in rural areas from January 2013 to December 2016 by Stata 14.0 software, and the predictive effect of the model was verified with the monthly number of inpatients of cardio-cerebrovascular disease in 2017.  Results  The final fitting model of inpatients of cardio-cerebrovascular disease was SARIMA (2, 1, 1)×(0, 1, 0)12. The residual sequence of the model was diagnosed. Results of Ljung-Box Q test showed that the residual sequence was white noise sequence (Q=11.12, P=0.68). In addition, the 2017 forecast was basically consistent with the observations, the overall relative error was around -1.2%. The results showed that the summer was the peak period of cardiovascular and cerebrovascular hospitalization.  Conclusion  SARIMA model can accurately predict the number of inpatients of cardio-cerebrovascular disease in Wugang, which can provide data support for the hospital administrator to rationally allocate medical resources in the cardiovascular according to the needs of cardio-cerebrovascular treatment in different months.
Comparing performance of C5.0 decision tree and radial basis function neural network for predicting hemorrhagic transformation in patients with acute ischemic stroke
WANG Hai-dong, ZHANG Lu, WANG Jie, LI Jing, ZHOU Ying, WANG Guo-li, WANG Ke-ke, PENG Yan-bo, WU Jian-hui
2019, 23(2): 227-232. doi: 10.16462/j.cnki.zhjbkz.2019.02.021
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Abstract:
  Objective  To compare performance of C5.0 decision tree models and radial basis function(RBF) neural network in predicting the risk of hemorrhagic transformation in acute ischemic stroke.  Methods  Patients with acute ischemic stroke admitted to hospital were enrolled. Hemorrhagic transformation group and non-hemorrhagic transformation group were divided according to whether hemorrhagic transformation occurred within 2 weeks after admission. Retrospectively collected patients' case information. C5.0 decision tree models and RBF neural network model were established with the ratio of 7:3 for training set and test set, and the prediction performance of the model was compared.  Results  A total of 460 patients' case information were collected and divided in 314 training set samples and 146 test set samples. Accuracy rates of the C5.0 decision tree model were 96.5% and 80.1%, sensitivities were 98.1% and 82.6%, specificities were 94.8% and 77.9%, Kappa index were 0.93 and 0.60, and AUC were 0.97 and 0.80. Accuracy rates of the neural network model were 72.6% and 74.7%, sensitivities were 87.6% and 88.4%, specificities were 56.9% and 62.3%, Kappa index were 0.45 and 0.50, and AUCs were 0.72 and 0.75. In the training set, the prediction performance of the C5.0 decision tree model was superior to the RBF neural network model. However, there was no statistical difference in the test set.  Conclusion  C5.0 decision tree model is better than RBF neural network model in risk prediction.
Short Reports
Analysis of infection status in severe pneumonia cases infection with influenza A virus in Nanchang from 2013 to 2018
HE Feng-lan, XIA Wen, NI Xian-sheng, SONG Wen-tang, FAN Guo-yin, TU Jun-ling, WU Jing-wen
2019, 23(2): 233-236. doi: 10.16462/j.cnki.zhjbkz.2019.02.022
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Abstract:
  Objective  To explore the distribution and disease characteristics of influenza virus A in severe pneumonia cases in Nanchang city, so as to provide evidence for clinical prevention and treatment of severe pneumonia cases.  Methods  The respiratory samples and clinical case data of severe pneumonia cases were collected and the etiology and epidemiology were analyzed in Nanchang from April 2013 to March 2018.  Results  From April 2013 to March 2018, 261 case patients of severe pneumonia from 17 medical institutions in Nanchang were enrolled. 77 cases was detected as positive for influenza A virus nucleic acid, accounting for 29.50% of the total cases, as follow: 39 cases of A (H1N1pdm) influenza, 13 A (H3), 16 H7N9 and 3 H10N8 avian influenza. Cases were mainly concentrated in winter and spring (from December to May of next year, with median age 48 of years, including 48 males and 31 females. 21 cases of human infection with H7N9/H10N8 avian influenza were reported in Nanchang during 5 years, with the fatality rate of 33.33%. 90.48% (19/21) cases were detected by unexplained pneumonia surveillance system. The median age was 69 years, most of them had underlying diseases and a clear history of poultry contact.  Conclusions  Nearly 30% of the severe pneumonia cases in Nanchang city were infected with influenza A virus, among which influenza A (H1N1pdm) virus was the main epidemic strain. All deaths were caused by avian influenza virus infection.
Trend of disease spectrum of hospitalized children in Anhui provincial children's hospital from 2013 to 2017
NI Hong, LIU Hai-peng, CUI Wei, WANG Xu, LI Xiang, LI Shan-shan, LIANG Li-ke
2019, 23(2): 237-240. doi: 10.16462/j.cnki.zhjbkz.2019.02.023
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Abstract:
  Objective  To investigate the composition of the disease spectrum of hospitalized children in Anhui Provincial Children's Hospital, so as to provide scientific basis of the strategy to refine pediatric medical resources and health care.  Methods  Totally 268809 patients from 2013 to 2017 was analyzed and compared with the 2003-2007 data.  Results  Compared to 2003-2007, the number of hospitalized children and involved diseases increased significantly in 2013-2017. The proportion of common diseases such as respiratory system (28.73% vs 26.49%), digestive system (12.68% vs 10.78%), and nervous system (6.22% vs 3.72%)) significantly decreased; while the proportion of injury and poisoning (2.13% vs 7.4%), infectious diseases, parasites (7.15% vs 10.69%), tumors (2.65% vs 4.12%), and blood immunity (1.42% vs 3.19%) increased. Respiratory diseases remain the first ranking disease in hospitalized children (26.49%), with pneumonia as the first ranking single disease among it. The top 5 hospitalized children in 2013-2017 were pneumonia, bronchitis, hernia, respiratory infections, and neonatal pneumonia.  Conclusions  The absolute number and capacity of services have been greatly improved in the hospital. While constantly improving the level of diagnosis and treatment of common diseases, we should pay more attention to the injury poisoning, mental and behavioral diseases and infectious diseases in children.
Investigation on neutralizing antibody level of Japanese encephalitis virus in adults from Guizhou Province
ZHAO Su-ye, LIU Chun-ting, WANG Yu, LIU Ming, JIANG Wei-jia, GUO Hua
2019, 23(2): 241-244. doi: 10.16462/j.cnki.zhjbkz.2019.02.024
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Abstract:
  Objective  To investigate the level of neutralizing antibodies against Japanese encephalitis (JE) virus in adults from Guizhou Province.  Methods  A multi-stage random sampling method was used to collect 360 serum of healthy adults in 6 age groups of 3 cities (states) from May to June 2017. Neutralizing antibodies against Japanese encephalitis virus of healthy adults were detected by plaque reduction neutralization test.  Results  The positive rate of neutralizing antibodies against Japanese encephalitis virus was 55.28%, and the geometric mean titer (GMT) was 1:17.52 in 360 subjects. The difference of the positive rates of neutralizing antibodies against Japanese encephalitis virus of adults in different genders (χ2=10.798, P=0.001) and in different incidence regions(χ2=6.090, P=0.048)was statistically significant(both P<0.05). The positive rate of different age groups was 45.00%-60.00% (χ2=4.236, P=0.516). The positive rate of Buyi nationality was the highest (79.17%).  Conclusions  The level of neutralizing antibodies against Japanese encephalitis virus of adults in Guizhou province is low, and there is a risk of epidemic encephalitis in adults.
History of Public Health
Establishment of voluntary notification system for tuberculosis epidemic situation: Arthur Newsholme
WANG Jun-ping, WU Jun, YE Dong-qing
2019, 23(2): 245-248. doi: 10.16462/j.cnki.zhibkz.2019.02.025
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Abstract:
Arthur Newsholme (1857-1943) was a British physician and medical health officer. He applied statistical methods to analyze the causes of disease, established voluntary reporting system of tuberculosis, revealed truth about relationship between high infant mortality and environmental health in the UK, and launched maternity and child welfare schemes, tuberculosis medical services and special service for venereal diseases. Although he grew up in religious environment, he has always used scientific methods to benefit human health, promoted and spread public health.

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