中华疾病控制杂志

Representativeness of the study population: choice between ideal and reality

TANG Jin-ling

2019, 23(3): 249-252. doi: 10.16462/j.cnki.zhjbkz.2019.03.001

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All scientific studies are based on samples. The representativeness of the sample is essential for generalization of research findings. The need for high representativeness of the study population depends largely on the nature of the research question. In studies of disease burdens, for example, the researcher's concern is some current specific facts about a specific population, which can be clearly defined and from which drawing a representative sample is both important and possible. In contrast, in studies of causes of disease and effectiveness of treatment, for example, the researcher is interested to find a law of nature in all relevant populations, which are an abstract entity and from which drawing a representative sample is impossible. The difficulty of obtaining representativeness is also inversely related to the variation (like interaction) of the studied phenomenon. Furthermore, overemphasis on representativeness may lead to inevitable compromises in quality control, induce biases, and eventually decrease internal validity, making the gained representativeness compromised. Therefore, research on disease causes and treatment effectiveness relies on repeatedly testing in different populations so as to approach the target population to which the findings can be applied to and which is the totality of the populations represented by the study populations in all the relevant studies. Having said all the above, it is important to note that all studies should draw their samples in a way they represent the population from which the samples are drawn. This forms the basis for the statistical inference and the validity and generalization of epidemiological findings. In addition, any studies based on big data are also sampling studies, in which unfortunately the sampling population is often unclear, which makes generalization of research findings difficult.

A dynamic model of hand foot and mouth disease in Jiangsu Province based on EV71 vaccination

JIA Si-yue, LI Jing-xin, ZHU Feng-cai

2019, 23(3): 253-258. doi: 10.16462/j.cnki.zhjbkz.2019.03.002

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Objective To establish a dynamic model of hand foot and mouth disease in Jiangsu Province, analyze the epidemic of hand foot and mouth disease in Jiangsu, predict the trend of this disease and simulate the effect of EV71 vaccination on the control of hand foot and mouth disease caused by EV71. Methods A compartmental model of hand foot and mouth disease was constructed.A group of differential equations was established. The incidence data of hand foot and mouth disease was used to fit the model and calculate the basic reproduction number of this disease in Jiangsu. Then, vaccination was added to the model and the incidence of hand foot and mouth disease under different vaccination coverage rates was simulated. Results The basic reproduction numbers of hand foot and mouth disease in Jiangsu between 2013 and 2016 were 1.31 (IQR: 0.99-1.48), 1.37 (IQR: 0.97-1.52), 1.34 (IQR: 1.00-1.61) and 1.38 (IQR: 1.00-1.76), respectively. With the increase of immunization coverage of EV71 vaccine, the cases of hand foot and mouth disease caused by EV71 decreased accordingly. When the annual immunization rate of EV71 vaccine was maintained at a high level (75%), the annual incidence of hand foot and mouth disease caused by EV71 after 5 years reduced to 10% of that in the same year when there was no vaccination. Conclusions The epidemic trend of hand foot and mouth disease in Jiangsu is stable from 2013 to 2016. Vaccination plays an important role in controlling hand foot and mouth disease caused by EV71.

Resistance of influenza virus in Henan Province to neuraminidase inhibitor from 2017 to 2018

ZHAO Sheng, SENG Ming-hua, Lv Wan-yu, YANG Jian-hui, ZHANG Xin, XU Jin

2019, 23(3): 259-262, 288. doi: 10.16462/j.cnki.zhjbkz.2019.03.003

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Objective To analyze the resistance of influenza virus to neuraminidase inhibitors (NAI) in Henan province during 2017-2018. Methods Virus were collected from the Henan Influenza Surveillance Network during 2017-2018. 36 confirmed influenza virus(with 15 H1pdm09, 6 H3N2 and 15 B) were selected to test resistance to oseltamivir and zanamivi with fluorescence(FL). The NAI sensitive reference viruses were A/California/12/2012(H1pdm09)-275H, A/Beijing Haidian/1942/2014(H3N2)-119E and B/Rochester/02/2001-198D. The NAI resistant reference viruses were A/Texas/23/2012(H1pdm9)-H275Y, A/Texas/12/2007(H3N2)-E119V and B/Rochester/02/2001-D198N. Results The half maximal inhibitory concentration(IC₅₀) of A/California/12/2012(H1pdm09)-275H, A/Beijing-Haidian/1942/2014(H3N2)-119E and B/Rochester/02/2001-198D for oseltamivir were 0.29 nmol/L (nM), 0.10 nM and 12.71 nM, and for zanamivir were 0.2 nM, 0.49 nM and 0.33 nM respectively. The IC₅₀ for oxastatin of H1pdm09 and H3N2 ranged from (0.28-1.37 nM) and (0.08-0.17 nM) respectively, the IC₅₀ for zanamivir ranged from (0.15-0.49 nM) and (0.12-0.22 nM), all was within 10 fold IC₅₀ of the reference virus(corresponding type); the IC₅₀ value of type B for oseltamivir and zanamivir ranged from (11.83-24.59 nM) and (0.48-1.25 nM), all was within 5 fold IC₅₀ of the reference virus. Conclusion All the tested influenza strains isolated in Henan province during 2017-2018 were sensitive to NAI.

Analysis on molecular epidemiological characteristics of 38 HIV-1 positive seroconcordant couples in Yunnan Province

LIU Jia-fa, LI Jian-jian, DENG Xue-mei, ZHANG Nian, YANG Bi-hui, ZHANG Mi, DONG Xing-qi

2019, 23(3): 263-267. doi: 10.16462/j.cnki.zhjbkz.2019.03.004

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Objective To analyze the molecular epidemiological characteristics of 38 HIV-1 positive seroconcordant couples in Yunnan Province. Methods The samples of HIV-1 antibody screened initially and positive confirmed in the Laboratory of Yunnan Provincial Infectious Diseases Specialist Hospital from 2014 to 2016 and laboratory data were collected. 41 samples from HIV-1 positive seroconcordant couples were selected and sequenced by RT-nested-PCR amplification. After the sequences were aligned and spliced, the qualified pol gene region sequence was used to construct phylogenetic tree and analyze subtypes, and the gene distance differences between each positive couple were calculated. Results A total of 76 pol gene regions from 38 HIV-1 positive seroconcordant couples were obtained. The major gene subtypes included CRF08_BC (45, 59.2%), CRF07_BC (18, 23.7%) and CRF01_AE (7, 9.2%), there were also C (4, 5.3%) and B (2, 2.6%). Phylogenetic tree analysis and gene distance calculation clearly showed that HIV transmission between relationship partners occurred in 9 HIV-1 positive seroconcordant couples. Conclusions As the proportion of sexual transmission of HIV has risen year by year, the transmission between husband and wife should be the focus of our attention. Late diagnosis of HIV infection is the main factor that causes the transmission between husband and wife. For special populations, monitoring and testing should be strengthened as soon as possible, so as to reduce the occurrence of transmission between AIDS couples.

Analysis on AIDS related knowledge, high-risk behaviors and STDs infection status of whoremasters in Kaiyuan City, Yunnan Province

WANG Yue-hui, ZHOU Yun-hua, CEN ping, CHEN Xiang-fan, LI Ying, LI Shi-yue, WANG Ning, YAN Hong

2019, 23(3): 268-272. doi: 10.16462/j.cnki.zhjbkz.2019.03.005

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Objective To understand the awareness of AIDS related knowledge, high risk behaviors, the infection status of HIV, syphilis and HSV-2, and to explore the associated factors with HSV-2 infection among whoremasters in Kaiyuan City, so as to provide scientific evidence for targeted intervention to prevent and control HIV and other STDs. Methods A self-designed questionnaire survey was conducted among whoremasters recruited through outreach activities and snowball sampling. The blood and urine were also collected for corresponding laboratory examination. Results Among the whoremasters, 98.22% had a high awareness of AIDS related knowledge, 9.33% once used drugs, and 14.67% did not use a condom during the latest commercial sex. 62.22% of the whoremasters ever had non-marital sex partners, and of those who had sex with non-marital sex partners in the past year, 59.55% reported using condoms inconsistently. The total infection rate of HIV/syphilis/HSV-2 was 18.22% and the infection rates of HIV, syphilis and HSV-2 were 3.11%, 1.33% and 16.44%, respectively. The older whoremasters were more likely to have a higher HSV-2 infection rate[AOR=1.044, 95%CI: 1.016-1.073, P=0.002], and those whoremasters not using a condom during the latest commercial sex were more likely to have a higher HSV-2 infection rate[AOR=3.125, 95%CI: 1.229-7.945, P=0.017]. Conclusions Though whoremasters in Kaiyuan City had a high awareness of AIDS related knowledge, they had high-risk behaviors and relatively high HIV and other STDs infection rates. Targeted interventions are needed to improve the risk awareness of STDs infection to promote consistent condom use in both commercial and non-marital sexual behaviors among whoremasters.

Spatial epidemiological analysis of measles in Taizhou from 2009 to 2017

WANG Chao, ZHANG Xiang, ZHU Zhong-kui, XIE Yan, XIAO Hui, TANG Wan-qin

2019, 23(3): 273-277. doi: 10.16462/j.cnki.zhjbkz.2019.03.006

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Objective To analyze the spatial epidemiological characteristics of measles in Taizhou from 2009 to 2017, so as to provide theoretical basis for measles prevention and control. Methods The spatial autocorrelation analysis and trend surface analysis of measles epidemics data from 2009 to 2017 in Taizhou were performed using ArcGIS 10.0 software. The dynamic characteristics of measles epidemics in Taizhou were analyzed. Results Among 2009-2017 years, the incidences of measles in Taizhou ranged from 0.83/1 million to 65.43/1 million. The results of global autocorrelation analysis showed that there were spatial correlations of the incidence of measles among 2012, 2013, 2015, and 2016 in Taizhou with a high-value clustering distribution. Local autocorrelation analysis indicated that the hot spots of measles incidence in Taizhou from 2009 to 2017 were mainly concentrated in the central towns of Taizhou. Trend surface analysis suggested that the measles incidence in the south towns of Taizhou was higher than that in the north in 2010, and the incidence in the central region was higher than those in other regions in 2013 and 2015. Conclusions According to the spatial analysis, autocorrelation was observed for the spatial distribution of measles incidence in Taizhou from 2009 to 2017, and there are hot spots in the central township. Targeted preventive measures should be taken based on these characteristics.

Relationship between hyperuricemia and chronic kidney disease in adult residents of communities in the Songjiang district, Shanghai

ZHOU Xiao-yan, ZHAO Qi, WANG Na, WANG Rui-ping, ZHANG Yue, YU Yu-ting, JIANG Yong-gen, ZHAO Gen-ming

2019, 23(3): 278-282, 293. doi: 10.16462/j.cnki.zhjbkz.2019.03.007

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Objective To explore the relationships between hyperuricemia (HUA), serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of communities. Methods A cross-sectional study was conducted in Xinqiao town of Songjiang district, Shanghai and a total of 9 527 residents aged 20-75 years were selected by random cluster sampling. Logistic regression models were used to evaluate the association between SUA and CKD. Results Subjects were divided into five groups according to the gender-specific quintiles of SUA. The CKD prevalence in serum uric acid quintiles of male were 4.9%, 5.7%, 6.0%, 8.0% and 13.8% respectively, while of female were 12.8%, 12.7%, 11.9%, 13.3% and 18.2% respectively, increasing along with the increase of SUA among both sexes (all P<0.05). Compared to the serum uric acid first quintile, the multivariate-adjusted odds for CKD in male of the fourth and fifth quintiles were 2.12 (95% CI: 1.32-3.39) and 3.84 (95% CI: 2.45-6.02), and the multivariate-adjusted odds for CKD in female of the fifth quintile was 1.38 (95% CI: 1.05-1.80). Hyperuricemia was defined by SUA>420 μmol/L(male) or >360 μmol/L(female). In the unadjusted model, HUA was significantly associated with CKD of all subjects (OR=2.03, 95% CI: 1.69-2.44, P<0.001), and the association was still significant (OR=2.04, 95% CI: 1.68-2.49, P<0.001) after adjustment for the potential confounders. The multivariate-adjusted odds of CKD associated with HUA was 2.89 (95% CI: 2.12-3.94, ) and 1.98 (95% CI: 1.51-2.60) for male and female, respectively. Conclusion Hyperuricemia was independently associated with the increased prevalence of CKD among community-based population living in the Songjiang district, Shanghai.

Analysis of sleep patterns and their relationship with diabetes among adults under health examination in Guangzhou

ZHANG Guan-rong, LIN Ai-hua, FU Li, HE Wen-ting, XIAN Yu-fei, YANG Yang

2019, 23(3): 283-288. doi: 10.16462/j.cnki.zhjbkz.2019.03.008

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Objective To investigate the characteristics of sleep patterns and their effects on the risk of diabetes mellitus (DM) among adults in Guangzhou. Methods A retrospective study was conducted using data collected by the lifestyle survey and health outcomes of 5 666 employees from Guangzhou who underwent physical examination between November 2012 and October 2013 at Guangdong Provincial People's Hospital. Sleep patterns and their distribution profiles were analysed using latent class analysis (LCA). Multiple logistic regression models were performed to investigate the association between sleep patterns and DM. Results LCA identified five sleep patterns: "very short sleep duration with insomnia" (class 1, 5.6%), "sleep insufficiency with mild daytime dysfunction" (class 2, 20.4%), "normal sleep" (class 3, 47.7%), "sleep insufficiency with daytime functioning complaints" (class 4, 4.7%) and "sleep insufficiency with poor nocturnal sleep" (class 5, 21.6%). After adjustment for the confounding factors, subjects of class 1 (OR=2.28, 95% CI: 1.51-3.43, <0.001), class 4 (OR=2.48, 95% CI: 1.54-4.00, P<0.001) and class 5 (OR=1.31, 95% CI: 1.01-1.71, P=0.045) had a higher risk of DM when compared with those of class 3. Conclusions There were significant associations between various sleep-related factors, leading to distinct sleep behavioral patterns among adults. Poor sleep patterns could increase the risk of DM.

Association between obesity and blood pressure in preschool children in urban areas

ZHANG Meng-han, WANG Wen-yuan, ZHANG Ting-ting, ZHAO Gui-lan

2019, 23(3): 289-293. doi: 10.16462/j.cnki.zhjbkz.2019.03.009

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Objective To investigate the blood pressure status of preschool children in urban areas of Qingdao, and to determine the relationship between obesity and blood pressure in preschool children. Methods A stratified cluster sampling method was used to select a total of 13 kindergartens in urban districts of Qingdao. Height, weight, waist circumference, hip circumference and blood pressure of children in three classes were measured. Body mass index (BMI), waist to hip ratio and waist to height ratio were calculated and the relationship between obesity and blood pressure was analyzed. Results The mean values of systolic and diastolic blood pressure in preschool children in urban areas of Qingdao were (95.52±7.66) and (62.78±6.52) mmHg, respectively.The detection rate of hypertension in preschool children was 13.50%. The SBP and DBP were positively correlated with BMI, waist circumference, hip circumference and waist to height ratio. There was a linear regression relationship between body mass index and age and blood pressure. The risk of hypertension in overweight and obese children was 5.191 and 2.824 times of normal body weight, respectively. Conclusions The prevalence of hypertension in preschool children in Qingdao urban areas is high.Overweight and obesity are risk factors for elevated blood pressure.Therefore, while preventing preschool children from obesity, preschool children's blood pressure monitoring and blood pressure monitoring and early intervention of hypertension of preschool children should be implemented.

Investigation on the epidemic characteristics of injuries among left-behind children in rural areas in Qingyuan city, Guangdong Province

ZHU Xu-hao, LIN Shun-wei, PAN Min-yi, ZHOU Shu-dong, MENG Rui-lin, LI Xing-ru, LI Jing-hua

2019, 23(3): 294-298, 323. doi: 10.16462/j.cnki.zhjbkz.2019.03.010

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Objective To investigate the epidemic character of injuries among rural left-behind children, so as to provide evidence for strategies and processes on preventing injuries. Methods Using stratified cluster sampling, a town was randomly selected from each of the two layers with different economic development levels in Qingxin district, Qingyuan city, Guangdong Province. The local left-behind children of 3-9 grades from 3 elementary schools and 3 middle schools were randomly selected from the local area. The student self-administered questionnaire was used to investigate the occurrence of injuries, personal circumstances, family environment and school situation in the past year. Data of injury situation, personal situation, family situation and school situation during last year were analysed by Chi-square and multiple logistic analysis. Results Injuries were reported to occur in 440 left-behind children, with an injury rate of 17.5%. Significant difference of injury rate was observed between groups divided by grades, being only-child in family, health conditions, anxiety, getting along with other students, teacher's attitude to students, emphasizing security by teachers, knowledge level about injury, and injury-relative behaviors (all P<0.05). Multivariate logistic regression model results suggested that middle school, physical health, behavioral level, and relationship with classmates are protective factors, anxiety is a risk factor (OR=1.262, 95%CI: 1.009~1.577, P=0.041). Conclusions We have to take some comprehensive methods to prevent injuries that are influenced by all kinds of factors. While constructing an advantage circumstance to left-behind children, their awareness of security should also be improved to reduce the occurrence of injuries.

Analysis of injury epidemiological characteristics in children aged 0-14 years in Suzhou

DAI Ning-bin, WANG Jing, GONG Tian, HUANG Qiao-liang

2019, 23(3): 299-303. doi: 10.16462/j.cnki.zhjbkz.2019.03.011

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Objective To investigate the epidemiologic features of injuries in children aged 0-14 years in Suzhou, so as to provide targeted education and prevention guidance for parents and schools. Methods Complex sampling was used to choose 4 989 children aged 0-14 years in Gusu and Wujiang districts in Suzhou. The primary caregivers filled out an injury occurrence questionnaire to analyze the distributions of injury numbers, occurrence time and locations. Results In the past 12 months, the overall incidence of children injuries was 7.7%, with 95% confidence interval (CI) was 6.9%-8.4%. The incidence tended to decrease with age (χ²=5.06, P=0.025), however, increase with monthly increase (χ²=28.51, P<00.001).Of all types of children injuries, the incidence of fall was highest (65.5%). Head and face injuries were the most common (45.3%). Most of injuries occurred at home (59.5%) and during leisure play (32.2%). 81.3% of the injuries were slight, and 45.4% of the injuries were dealt with infirmaries. 9.7% of the injured children recovered with aesthetics impact. Young children were more likely to experience head fall or burn injuries during leisure play. Young girls were more likely to experience injuries at home. However, older children were more likely to have lower limb injuries during sports and housework. Older boys were more likely to be harmed at school. Conclusions Different age and gender children had different injury epidemiological characteristics. Specific preventive measures should be taken according to their characteristics.

Study on the status and influence factors of self injurious behavior of college students

WANG Jun, WANG Yan-qiu, ZHANG Ye, CHEN Yan, JIN Yue-long, YAO Ying-shui

2019, 23(3): 304-307. doi: 10.16462/j.cnki.zhjbkz.2019.03.012

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Objective To explore the current situation and influencing factors of College Students' self-injury behavior. Method By stratified cluster sampling, 4 363 college students from three universities in southern and Northern Anhui were investigated by questionnaire, and the influencing factors of College Students' self-injury behavior were analyzed. Results The detection rate of self injury was 42.52%. Multivariate logistic regression analysis showed that female college students' self-injury behavior was lower than male college students' self-injury behavior (OR=0.508, 95% CI: 0.411-0.627, P<0.001); non-medical colleges and universities higher than medical colleges and universities (OR=1.612, 95% CI: 1.445-1.779, P<0.001). College students with discordant relationships with their fathers (OR=1.514, 95% CI: 1.168-1.961, P=0.002), mothers (OR=1.593, 95% CI: 1.188-2.135, P=0.002) were more likely to suffer from self-injuries.The burden of learning was a risk factor for self-injury of college students (OR=1.277, 95% CI: 1.061-1.538, P=0.010); high requirements for self, good academic performance, and good relationship with classmates were protective factors for self-injury behavior of college students (all P<0.05). Conclusions Men are more likely to have self-injury behaviors. Positive communication between students, observation of the psychological situation in men, and timely intervention measures should be strengthened. Parents need to pay close attention to the psychological status of children, increase the communication with their children, and create a good family atmosphere to reduce the incidence of College Students' self injurious behavior.

Mental health status and its influencing factors of the elderly

WANG Jin-song, LIU Xiao-jun, HOU Yi-tan, HE Mei-kun, WU Yu-pan, TAN An-ran, ZHANG Fang-jie, MAO Zong-fu

2019, 23(3): 308-312. doi: 10.16462/j.cnki.zhjbkz.2019.03.013

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Objective To assess the current status and factors associated with the mental health condition of older adults. Methods A convenience sampling survey was conducted using symptom check list 90 (SCL-90) among the Chinese older adults aged 60 or above from January to March, 2018. The older adults aged 80 or above were selected for this study. Chi-square test and binary logistic regression model were used to analyze the influencing factors. Results The total participants were 485. The SCL-90 positive detection rate was 20.21%. The symptoms of the four highest detection rates were somatization (39.38%), others (25.15%), obsessive-compulsive symptoms (24.33%) and depression (22.68%). The older adults with normal BMI (OR=0.537, 95% CI: 0.250-0.857, P=0.027) and lived in county town (OR=0.224, 95% CI: 0.075-0.667, P=0.007) showed lower SCL-90 positive detection rate. These who had been educated for 1-5 years (OR=11.092, 95% CI: 4.446-27.671, P<0.001), 6-8 years (OR=9.800, 95% CI: 3.464-27.721, P<0.001), 9~11 years (OR=19.279, 95% CI: 6.722-55.297, P<0.001), 12 years and above (OR=24.321, 95% CI: 7.894-74.929, P<0.001) had higher SCL-90 positive detection rate compared with those who were uneducated. Conclusion The mental health condition of Chinese older adults is mainly influenced by residence place, education level, family income self-evaluation and BMI status.

Study on prevalence of and influencing factors of mild cognitive impairment among elderly people in communities of Nanning

JIANG Hu, WANG Xiao-min, HUANG Kai-yong, ZUO Yu-kun, WU Xiang-min, GAO Yong-fen, S Abdullah, YANG Li

2019, 23(3): 313-317. doi: 10.16462/j.cnki.zhjbkz.2019.03.014

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Objective To investigate the prevalence and influencing factors of mild cognitive impairment (MCI) among elderly people in communities of Nanning, so as to provide scientific basis for the formulation of MCI early intervention measures. Methods A total of sample of 3 000 elderly people aged 60 or above living in Nanning area were sampled out using the method of cluster random sampling from three communities in Nanning. The Beijing version of the montreal cognitive assessment (MOCA-BJ) was administered by face to face interview. Results 833 MCI patients were detected. The standardized prevalence rate of MCI was 27.27% by the age composition of the population in Nanning in 2010. Single factor analysis showed that there were significant differences(all P<0.05)in the prevalence of MCI in different groups by age, education, occupation, exercise time, sleep time, number of reading, community activities and housework. Multivariate analysis showed that old age, primary education level, occupation of farmer/migrant worker and enterprise personnel/worker were the risk factors of MCI, adequate sleep time, moderate exercise time and reading times were the protective factors of MCI (all P<0.05). Conclusions The prevalence rate of MCI is high among the elderly in Nanning. The elderly with advanced age, primary school education, occupation as farmer/peasant-worker and enterprise personnel/workerare at high risk of developing MCI. Effective measures should be taken as soon as possible to prevent the occurrence and development of MCI.

Intervention effect of family support services in Changning district of Shanghai on family members of patients with severe mental disorders

ZHANG Qiong-ting, JU Kang, TAO Hua, CHEN Hao, CUI Jia, CAO Guang-wen

2019, 23(3): 318-323. doi: 10.16462/j.cnki.zhjbkz.2019.03.015

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Objective To explore the effect of family support service intervention on improving the rehabilitation of patients with severe mental disorders in community and the mental health status and family burden of family members. Methods Using multi-stage random sampling method, 100 patients who met the diagnostic criteria of severe mental disorders were randomly selected from two communities, and then 100 patients who met the diagnostic criteria of severe mental disorders were randomly matched according to gender, age and diagnosis in other communities into the control group. The control group and intervention group were set up strictly according to the inclusion criteria of patients and their families. Results The average age of the 200 groups was (48.27±12.67) years, and the average age of the family members was (63.61±13.19) years. After intervention, the activity dailyliving scale (ADL) scores of the control group were higher than those of the intervention group at all time points (all P<0.05). After intervention, the social disability screening schedule (SDSS) scores of the control group were higher than those of the intervention group at all time points (all P<0.05). After intervention, there was no significant difference in the morningside rehabilitation status scale (MRSS) score between the intervention group and the control group at all time points (all P>0.05). After intervention, the SCL-90(self-reporting inventory) scores of the mental health of the family members in the control group were higher than those in the intervention group at all times (all P<0.05). After intervention, the family burden scale of diseases (FBS) scores of the control group were higher than those of the intervention group at all time points (all P<0.05). Conclusions The intervention measures did improve the rehabilitation effect of severe mental disorder patients in community and the psychological and family burden of family members. A professional family support service team should be established.

Situation analysis of mental disorders in females with systemic lupus erythematosus

YUAN Fei-fei, WANG Hong, DAI Zi-wei, WANG Zhi-hui, DONG Yuan-yuan, GU Ming-ming, Li Xiang-pei, Ye Dong-qing, Wang Bin

2019, 23(3): 324-327, 350. doi: 10.16462/j.cnki.zhjbkz.2019.03.016

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Objective To study the influences of mental disorders on female systemic lupus erythematosus(SLE)and analyze the factors. Methods We used symptom check list -90 (SCL-90) as a basis for judging mental disorders disease activity. Disease activity, social support and depreciation - discrimination were used as possible influencing factors. Social support and discomfort - discrimination were possible influencing factors. Multivariate unconditional logistic regression model was used to analyze the influencing factors of mental disorders. Results The total score of SCL-90 of patients with female SLE was significantly higher than that of norm models[(136.39±48.66) vs (129.96±38.76)] (P<0.05), in 289 SLE patients, the number of patients with mental disorders was 128 (44.3%). High monthly income(OR=0.770, 95% CI: 0.604-0.981, P=0.034) was a protective factor for mental disorders. High disease activity (OR=1.792, 95% CI: 1.023-3.138, P=0.042)and high discomfort-discrimination (OR=1.100, 95% CI: 1.035-1.169, P=0.002)were risk factors for mental disorders. Conclusions Female SLE patients have a higher risk of mental disorders than the general population. And eliminating self-depreciation, reducing social discrimination, active employment, increasing monthly income, standardizing treatment and reducing disease activity may effectively alleviate mental disorders in SLE patients.

Correlation between anxiety among public hospital medical personnel and social support, perceived social support and coping styles

HE Yun-juan, LU Man-man, CHEN Gui-mei, WANG Meng-jie, CHEN Ming-zhuang, SHE Yu-ting, YAO An-qi

2019, 23(3): 328-331. doi: 10.16462/j.cnki.zhjbkz.2019.03.017

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Objective This research aimed to explore the mental status of public hospital medical personnel and social support for them, social support they perceive, and their coping styles. This study was designed to investigate on the relationship between their anxiety and social support, perceived social support and their coping styles. Methods A questionnaire was adopted to collect data, including participants' background, measurement of anxiety, as well as social support, perceived social support and their coping styles. Results (1) The anxiety level of medical personnel was significantly higher than that of domestic norm 37.23±12.59(t=14.370, P<0.001);(2)Anxiety levels appeared to be significantly different in occupation, educational background and working years; (3)Results shown in the three scales were different among participants with different levels of anxiety in perspectives of every dimension in the scales; (4) With the help of Spearman correlation analysis, it showed that anxiety levels of medical personnel was negatively correlated with objective support (r=-0.098, P=0.051), subjective support (r=-0.189, P<0.001), utilization of social support (r=-0.164, P=0.001), friend support (r=-0.356, P<0.001), family support (r=-0.330, P<0.001), other support (r=-0.238, P<0.001) and positive response (r=-0.282, P<0.001), and positively correlated with negative response (r=0.385, P<0.001). Conclusions Mental health of medical personnel should be noticed and enhanced, and social support for public hospital medical personnel should be strengthened. Thus, the performance of the medical team can be developed in order to support further public medical service construction.

Rationality evaluation of predisone dosage in the treatement of SLE with different clinical scoring systems

FENG Dan-dan, GENG Jing-jing, XU Liang, YUAN Hui

2019, 23(3): 332-335. doi: 10.16462/j.cnki.zhjbkz.2019.03.018

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Objective To evaluate the rationality of predisone dosage in the treatement of SLE with different clinical scoring systems. Methods The clinical data of 51 newly diagnosed patients with systemic lupus erythematosus(SLE) were collected, and disease activity was assessed by SLEDAI- 2000, BILAG- 2004 and SLAM-R scoring systems. The correlations between SLEDAI- 2000, BILAG- 2004, SLAM-R scores and prednisone dosage were analyzed. Results BILAG-2004 score showed the best correlation with the dosage of prednision (r=0.827, P<0.001).SLAM score showed the worst correlation with the dosage of prednision (r=0.512, P<0.001). Different treatment choice was associated with different organ/system involvement. Conclusions BILAG- 2004, SLEDAI- 2000 and SLAM-R scoring systems all can be used as references for the prednisone dosage slection.It is suggested that the BILAG- 2004 scoring system is more reliable and comprehensive in clinical practice.

Analysis on drug resistance characteristics and risk factors for extensively drug resistant tuberculosis patients

JIA Fang, SONG Qing-shan, HUANG Hai-rong

2019, 23(3): 336-340. doi: 10.16462/j.cnki.zhjbkz.2019.03.019

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Objective To analyze the drug resistance profile and risk factors for extensively drug resistant tuberculosis (XDR-TB) patients. Methods XDR-TB cases were identified by sixteen anti-TB drug susceptibility kits among inpatients with a diagnosis of laboratory-confirmed mycobacterium tuberculosis. Single-factor and Logistic analysis were used to analyze the risk factors for drug resistant of the first and second-line anti-TB drugs in XDR-TB patients. Results Resistant rate of rifampin, isoniazid and rifampicin were 100%, Resistant rate of streptomycin, rifampicin and dean, b sulfur isoniazid, levofloxacin and capreomycin were from 90% to 100%, resistant rate of kanamycin and amino salicylic acid were from 70% to 80%, resistant rate of amikacin from 60% to 70%, resistant rate of sulfur isoniazid was from 50% to 60%, resistant rate of ethambutol and moxifloxacin were from 40% to 50%, resistant rate of clarithromycin was from 10% to 20%, resistant rate of clofazimine 5.2%. 92.1% of XDR-TB patients were resistant to more than 10 anti-TB drugs, and the least of the patients were resistant to 6 anti-TB drugs.Logistic regression analysis showed the risk factors for XDR-TB first-and second-line anti-tb drugs included age[20-40 year (OR=6.318, 95% CI: 1.204-33.15, P=0.029;40-60 year (OR=4.772, 95% CI: 0.973-23.392, P=0.054); 60 year (OR=41.366, 95% CI: 2.909-588.265, P=0.006)] and anti-TB treatment history was retreatment(OR=28.013, 95% CI: 3.357-233.766, P=0.002). Conclusions XDR-TB patients have serious drug resistance, but there were some drug treatable drug resistance types, and the risk factors mainly come from age and anti-TB treatment history.

Analysis of the indicators of frequent exacerbation of chronic obstructive pulmonary disease

CHEN Jie, SUN Geng-yun

2019, 23(3): 341-344. doi: 10.16462/j.cnki.zhjbkz.2019.03.020

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Objective To investigate the relationship between multiple blood indexes and frequent exacerbation of chronic obstructive pulmonary disease (COPD). Methods 102 patients with COPD were selected and divided into frequent exacerbation group (≥ 2 times/year, 55 patients) and infrequent exacerbation group (< 2 times/year, 47patients), according to the frequency of acute exacerbation in one year. The relationship between multiple indicators in blood routine and blood gas analysis and frequent exacerbation of COPD was explored by independent sample t test, χ² test, and multiple Logistic regression analysis. A retrospective study was conducted. Results Neutrophils count (NEU), neutrophils ratio (Neut%), and neutrophil-to-lymphocyte ratio (NLR) of frequent exacerbation group were significantly higher than those of infrequent exacerbation group, while lymphocytes (LY), lymphocytes ratio (LY%) were lower (All P<0.05). OR(95% CI) of NLR was 3.483(1.170-10.373), and OR(95% CI) of partial pressure of carbon dioxide in artery (PaCO₂) was 1.124(1.053-1.201).NLR and PaCO₂ were risk factors for frequent exacerbation of COPD. Increase of NLR and PaCO₂ led to an increasing risk of frequent exacerbation of COPD (All P<0.05). Conclusions The levels of NLR and PaCO₂ in COPD patients with frequent exacerbation are higher than those in patients with infrequent exacerbation. As a consequent, NLR and PaCO₂ could be considered risk factors for frequent exacerbation of COPD.

Investigation and risk assessment for water quality hygiene in self-supply well water in four northern provinces of China

ZHANG Xi-yao, ZHANG Can, SHI Yun, QI Hong-juan, BAI Miao, AN Dai-zhi, WANG Li-li, HU Xiao-feng, LIU Xue-lin, ZHANG Chuan-fu

2019, 23(3): 345-350. doi: 10.16462/j.cnki.zhjbkz.2019.03.021

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Objective To understand the water quality of self-supply wells in four provinces of northern China (Heilongjiang, Beijing, Inner Mongolia and Tibet), so as to provide a reference for supervision and management of self-supply wells. Methods Water were sampled from 233 self-supply wells in four northern provinces of China according to standard examination methods for drinking water (GB/T 5750-2006). In total, The samples were tested for 27 kinds of water quality parameters involving sensory properties, chemistry, bacteriology and toxicology, and then evaluated. Results The total unqualified rate of water quality in self-supply well water in four northern provinces of China was 52.36%. The water quality varied greatly among provinces. As for Heilongjiang, the main unqualified indicators of self-supply wells water involved turbidity, visible to the naked eye, manganese, arsenic and nitrate. In relation to Beijing, these referred to the nitrate and microorganism. In case of Inner Mongolia province, these included sulfate and fluoride. With reference to Tibet, these were zinc and chloride. Conclusions To ensure the safety of drinking water for residents, the management, disinfection and purifying measures of self-supply wells should be strengthened basing on their regional differences and water quality characteristics.

Application of directed acyclic graphs in identification and control of selection bias in causal inference

LIU Zi-yan, WU Xiao-li, XIE Mei-qiu, WANG Zhi-peng, LIU Ai-zhong

2019, 23(3): 351-355. doi: 10.16462/j.cnki.zhjbkz.2019.03.022

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In the etiology study of epidemiology, selection bias will lead to the fact that the research sample cannot represent the general population, the association between exposure and outcome among those selected for analysis differs from the association among those eligible, and the true causal association cannot be inferred. Directed acyclic graphs (DAGs) could visualize complex causality, introduce the Collider-stratification bias using simple graphics language, provide a simple and intuitive way to identify Selection bias, different types of selection bias are verified by the graphic structure of the Collider-stratification bias. In practical studies, there may be multiple biases at the same time, improper adjustment of the collider will lead to Collider-stratification bias, open a backdoor path, even change the size and direction of the confounding bias. In order to obtain an unbiased estimate of the exposure to the outcome, it is necessary to identify the collider and avoid the adjustment to prevent the occurrence of Collider-stratification bias by using DAGs.

Epidemiologic characteristics and pathogen surveillance of hand, foot and mouth disease in Hebei province from 2008 to 2017

ZHU Bao-zeng, ZHAO Wen-na, LIU Ying-ying, YU Qiu-li, SU Tong, XIE Yun, LI Qi

2019, 23(3): 356-359. doi: 10.16462/j.cnki.zhjbkz.2019.03.023

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Objective To analyze the epidemiological and pathogenic characteristics of hand-foot-mouth disease (HFMD) in Hebei Province from 2008 to 2017, so as to provide scientific evidence for prevention and control of HFMD. Methods The epidemic data and laboratory detection data of HFMD from 2008 to 2017 were collected and analyzed by descriptive epidemiology. Results From 2008 to 2017, a total of 690 368 cases of hand, foot and mouth disease, including 4 939 severe cases and 208 deaths were reported in Hebei Province, with an average annual incidence of 95.53/100 000. The largest number of reported light cases were 2009, while severe cases and deaths were in 2010. The number of reported cases increased every other year but decreased in general. In 2008, 2009 and 2012, the main peak of the onset of spring and summer was formed from April to June. In 2010, 2011 and 2013-2017, the main peak of the onset of spring and summer was from May to July. Main peak value in spring and summer showed a backward delayed trend. The sex ratio between men and women was 1.59:1.The majority of deaths case were scattered children and preschool case. Other enteroviruses, human enterovirus 71, (EV-A71) and coxasckievirus A16, (CV-A16) alternately became the main pathogens of common cases. The pathogenic composition of different cases was different and the difference was statistically significant (χ²=2274.17, P<0.001). Conclusion The number of reported deaths and severe cases has decreased significantly. It is necessary to adjust the focus of prevention and control, pay more attention to the mild cases of FHMD, and further strengthen the monitoring of other enteroviruses pathogenic spectrum.

Quality of life and its influencing factors of hepatitis B positive in pregnant women in Jianyang

YANG Dan-dan, XU Yao-ming, ZHAO Jian-wei, ZHANG Wen-qiang, MA Xin-ya, XIAO Jun, LUAN Rong-sheng

2019, 23(3): 360-364. doi: 10.16462/j.cnki.zhjbkz.2019.03.024

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Objective To evaluate the quality of life in pregnant women with hepatitis B positive and to explore its influencing factors. Methods Eighty pregnant women with positive hepatitis B were randomly selected from Jan. to Apr. 2018 in Jianyang Maternal and Child Health Hospital as the case group, and 323 normal pregnant women were selected as the control group. A face-to-face survey was conducted using the Concise Health Survey Scale SF-36. t test, ANOVA and multiple linear regression were used for statistical analysis. Results The scores of PF and RP in the case group were lower than those in the control group, and the scores of GH in the case group were higher than those in the control group. Analysis of the factors affecting the quality of life of the case group found that the more severe the early pregnancy reaction, the lower the quality of life score. Conclusions The PF and RP of pregnant women with hepatitis B positive in Jianyang City are worse than those of normal pregnant women. Comprehensive measures should be taken to improve their quality of life.

Epidemiological and clinical characteristics of acute upper respiratory infection of patients in peace-keeping operations area in Mali from 2014 to 2017

TANG Jing, FU Qiang, CUI Yun-liang

2019, 23(3): 365-368. doi: 10.16462/j.cnki.zhjbkz.2019.03.025

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Objective To analyze the epidemiological and clinical characteristics of acute upper respiratory infection of patients in peace-keeping operations area in Mali, so as to provide experiences for prevention and control of acute upper respiratory infection. Methods A retrospective analysis was made on the case history of upper respiratory tract infection from January 2014 to December 2017. The clinical data of the patients were recorded and the collected data were analyzed by descriptive epidemiological method. Results A total of 484 patients met the inclusion criteria. According to the time distribution, most patients with upper respiratory tract infections were concentrated in May, August, September and December. WBC in fever group were higher than those in normal temperature group (t=3.41, P=0.008), Gran in fever group were higher than those in normal temperature group (t=3.92, P<0.001).while Lymph was lower than that in normal temperature group (t=2.23, P=0.027). There was no significant difference in HGB, PLT, ALT, AST and TBIL values (all P>0.05). The electrolyte K, Ca, Na and Cl values in fever group were lower than those in normal temperature group (all P<0.05). Conclusions In terms of time distribution, under the circumstances of rotation and handover of peacekeeping forces, seasonal change, large temperature difference between day and night, etc, the peacekeeping forces should take precautions to reduce the incidence of upper respiratory tract infections and avoid non-combat attrition of peacekeepers. From the analysis of clinical characteristics of upper respiratory tract infection, fever alone is not an indication of antibiotic use, but must be combined with symptoms, signs and laboratory examinations of patients. At the same time, patients with fever are prone to electrolyte disorders, which should be paid great attention by medical staff.

A Promoter of the Metropolitan Health Bill: Stephen Smith

DENG Li-jun, WU Jun, YE Dong-qing

2019, 23(3): 369-372. doi: 10.16462/j.cnki.zhjbkz.2019.03.026

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Stephen Smith (1823-1922) was an American surgeon, an editor of the New York Journal of Medicine and outstanding public health leader. He founded the American Public Health Association, and used the American Medical Times as a position to alert people to efforts and improve the living environment. His unremitting efforts contributed greatly to the enactment of the Metropolitan Health Bill in USA. He has made significant contributions to public health legislation and improving public health in USA. He is also synonymous with longevity, using his 99-year-old to demonstrate the importance of preventing disease for longevity.

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2019 Vol. 23, No. 3

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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