中华疾病控制杂志

Follow up in cohort study

LV Jun, LI Li-ming

2019, 23(4): 373-375. doi: 10.16462/j.cnki.zhjbkz.2019.04.001

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The cohort study provides the strongest evidence of causality among observational epidemiological study design. One of the most important reasons is that cohort study more clearly indicates the temporal sequence between exposure and outcome. Effective and efficient follow-up is the fundamental necessity for research quality. This review briefly introduces the requirements for the observation period of the cohort study, the two most common ways for follow-up and their advantages and disadvantages.

Risk factors of congenital malformations and its impacts on adverse pregnancy outcomes: A prospective cohort study

ZHAO Li-juan, QIN Jia-bi, WANG Ting-ting, CHEN Le-tao, ZHENG Zan, ZHANG Sen-mao, YE Zi-wei, CHEN Li-zhang

2019, 23(4): 376-381, 396. doi: 10.16462/j.cnki.zhjbkz.2019.04.002

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Objective To explore risk factors of congenital malformations (CMs) and to evaluate its impacts on adverse pregnancy outcomes (APOs). Methods A prospective cohort study was conducted among pregnant women who received the first antenatal care from March 2013 to February 2016 in the reproductive center, obstetrics clinics, infertility clinics and ultrasound department of Hunan Provincial Maternal and Child Health Hospital. Corresponding information from pregnant women and their spouses were collected. Univariate and multivariate Logistic regression were used to screen possible risk factors of CMs and evaluate the impacts of CMs on other APOs. Results The study showed that women had history of non-standard BMI, smoking, hepatitis, pregnancy-related complications, gestational diabetes mellitus, infertility and using assisted reproductive technology before pregnancy; had no folic acid taking, active and passive smoking, drinking, uneven diet, high intensity physical activity during pregnancy increased the risk of CMs in offspring. Furthermore, the history of spouse smoking and eating betel nut also increased the risk of CMs in offspring. CMs might increase the risk of preterm birth, very preterm birth, low birth weight, very low birth weight, and perinatal mortality. Conclusions There are many risk factors of CMs. Knowing these risk factors, and giving them optimal prevention strategies and effective intervention measures are important measures in preventing the occurrence of CMs and other APOs.

Influence factors and predictive ability of a risk prediction model for carotid atherosclerosis in a follow-up population

WANG Qi, LI Juan-sheng, PU Hong-quan, BAI Ya-na, LI Hai-yan, CHENG Ning, WANG Zheng-fang, ZHANG Lei-jie, ZHU Wan-qi, YUAN Yan

2019, 23(4): 382-386. doi: 10.16462/j.cnki.zhjbkz.2019.04.003

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Objective To explore factors influencing the incidence of carotid atherosclerosis in different genders so as to provide reference for the specific prevention of the disease. Methods A nested case-control study was conducted to analyze factors influencing the incidence of carotid atherosclerosis in Jinchang cohort population who were randomly selected through stratified sampling by age and followed up. A risk prediction model was established and the goodness of fit was evaluated by the area under the receiver operator characteristic curve (ROC). Results The standardized incidence of carotid atherosclerosis in this follow-up population was 12.32%, and the incidence rate of males (13.65%) was greater than that of females (11.29%). The difference was statistically significant (χ²=4.267, P < 0.001). Age, education, elevated systolic blood pressure, and elevated low-density lipoprotein cholesterol were common risk factors for carotid atherosclerosis in both men and women. Elevated fasting plasma glucose (OR=2.556, 95% CI: 1.618-4.038) and elevated triglyceride (OR=1.535, 95% CI: 1.058-2.227) were only associated with men. Abdominal obesity (OR=1.414, 95% CI: 1.013-1.974) was only associated with women. The area under ROC of male and female prediction models was 0.835 (95% CI: 0.815-0.856) and 0.809 (95% CI: 0.788-0.831), respectively. The sensitivity was 78.0% and 78.9%, the specificity was 78.8% and 73.1%, and the diagnostic coincidence rate was 91.3% and 82.4%, respectively. Conclusions There are different risk factors for carotid atherosclerosis in males and females, and targeted prevention and control measures should be taken according to gender. The risk prediction model established by Logistic regression had certain guiding value.

Comparing the timeliness of three types of influenza surveillance data in mainland China

QIN Kang, ZHANG Ye-wu, ZHANG Peng, LI Yan-fei, MA Jia-qi

2019, 23(4): 387-391. doi: 10.16462/j.cnki.zhjbkz.2019.04.004

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Objective To evaluate the timeliness of the three sets of influenza surveillance data (influenza reported cases from Nationwide Notifiable Infectious Diseases Reporting Information System (NIDRIS), influenza-like illness consultation rate (ILI%) and influenza virus positive rate from Chinese Influenza Surveillance Information System) in mainland China. Methods The three sets of influenza surveillance data of North and South China from 2017 to 2018 were compared using peak comparison, cross correlation and Early Aberration Reporting System C3 method. Results The influenza epidemic trends reflected by the three sets of influenza surveillance weekly data from 2017 to 2018 were generally consistent and significantly correlated. However, the three sets of data had different timeliness. From 2017 to 2018, ILI% in the North was not timely at alarming the first epidemic peak, which was 6 weeks and 9 weeks later than influenza cases from NIDRIS and positive rate of influenza virus respectively. While in the South, ILI% was the most sensitive indicator, which was 4 weeks and 7 weeks earlier than influenza cases from NIDRIS and positive rate of influenza virus respectively. However, the three sets of data had little difference in the timeliness of the second epidemic peak both in the North and South. Conclusions The three sets of influenza surveillance data in mainland China could all roughly reflected the epidemic trend of influenza. After comparing the timeliness, a combination of influenza reported cases from NIDRIS together with ILI% and influenza virus positive rate could improve timeliness and accuracy for early warning of influenza.

Epidemiological survey and study of hepatitis E virus among HIV-infected population in Hubei Province

CHEN Ya-meng, YIN Ling, ZHANG Hong-wei, WANG Heng-qi, SHEN Xin, ZHAN Jian-bo, ZHENG Wu, SHU Yi-lin, ZHANG Ling

2019, 23(4): 392-396. doi: 10.16462/j.cnki.zhjbkz.2019.04.005

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Objective To determinate the seroprevalence of hepatitis E virus (HEV) exposition among HIV-infected people in Hubei Province so as to provide basic data for effective prevention and control of HIV and hepatitis E virus. Methods A total of 335 serum samples of HIV-infected people were collected from January to June 2017.Serum samples were subjected to anti-HEV IgG andanti-HEV IgM screening. Data were statistically analyzed. Results In 335 HIV-infected people, 0.89% (3/335) of serum samples were anti-HEV IgM positive and 41.49% (139/335) of them were anti-HEV IgG positive.The anti-HEV IgG positive rate was not linearly correlated with age (χ²linear=0.756, P=0.385), and there was no significant difference between the age groups (P>0.05). There was no significant difference in anti-HEV IgG positive rate between different gender(χ²=0.085, P=0.771).Anti-HEV IgG positive rate for the crowd with CD4 value ≤ 200 cell/μl was higher than that with CD4 >200 cell/μl, but showed no significant difference(χ²=1.016, P=0.314), and CD4 indexes of three positive anti-HEV IgM patients were 222, 446 and 198 in cell/μl.The anti-HEV IgG positive rate in HIV-infected population in eastern Hubei (30.77%, 32/1 041) was statistically different from that in central Hubei (47.92%, 46/96) (χ²=6.169, P=0.013), and it was also different from that in southeastern Hubei (45.79%, 49/107) (χ²=5.034, P=0.025). Conclusions There were higher HEV infection rate among HIV-infected people in Hubei Province; thus, it is essential to positively carry out double-way screening for these two diseases at the same time, and effective prevention and control of these viruses are required.

Effect of TLR gene polymorphisms on primary immune response to hepatitis B vaccine in Han children of Guangxi

LI Hai, LV Ying-nan, YANG Qing-li, JU Yu, CHEN Qin-yan, TAN Chao, DONG Bai-qing, WU Qi-jun

2019, 23(4): 397-401, 411. doi: 10.16462/j.cnki.zhjbkz.2019.04.006

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Objective To explore the association between Toll-like receptors(TLR) gene polymorphisms and the primary immune response level to Hepatitis B Vaccine in Han children in Guangxi. Methods A total of 513 Han children aged 8-9 months were collected from the department of pediatrics in the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region and Nanning Maternal and Child Health Hospital from 2014 to 2016. Peripheral venous blood of each study object was collected to detect HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc and HBV DNA. The polymorphisms of 10 sites of TLR gene were detected by SNPscanTM multiple SNP typing techniques. The association between allele, genotype of TLR gene and anti-HBs levels were analyzed by non-conditional logistic regression. Results The genetic polymorphism of TLR3 gene rs13126816 was related to immune response after primary Hepatitis B immunization in Han children in Guangxi (OR=1.79, 95% CI: 1.11-2.89, P=0.018). The anti-HBs level of children with A/A genotype[238.04(519.75) mIU/L] and G/A genotype[347.96(619.68) mIU/L] were significantly lower than those with G/G genotype[489.08(854.76) mIU/L], and the differences were statistically significant (all P < 0.05). Anti-HBs level of children carrying allele A[317.20(608.72) mIU/L] was significantly lower than those carrying allele G[457.01(852.66) mIU/L], and the difference was statistically significant (Z=-3.055, P < 0.05). The rest of the TLR genes were not related to the immune response of Hepatitis B Vaccine (all P>0.05). Conclusions The allele A of TLR3 gene rs13126816 may be the influencing factor for the low response of primary immune response to Hepatitis B Vaccine in Han children.

Comparing the antibody titers of sequential program of Sabin strain-based inactivated poliovirus vaccine followed by bivalent types 1 and 3 oral poliovirus vaccine in different dosage forms

ZHAO Zhi-mei, HUANG Teng, LI Guo-liang, YANG Xiao-lei, JIANG Rui-ju, YE Hui, ZHAO Ting, LI Jing, LIU Xiao-chang, FU Yu-ting, SHI Hong-yuan, ZHOU Hai-jun, MO Zhao-jun, CHE Yan-chun, YANG Jing-si

2019, 23(4): 402-406. doi: 10.16462/j.cnki.zhjbkz.2019.04.007

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Objective To evaluate the antibody titer distributions after primary vaccination by different sequential schedules of Sabin strain-based inactivated poliovirus vaccine(sIPV) and bivalent oral attenuated live poliomyelitis vaccine against types 1 and 3 (bOPV) in Drug Candy(DC) form or liquid dosage form. Methods Eligible infants of 2 months old selected in Liuzhou were assigned randomly in a ratio of 1:1:1:1 to 4 groups as following: sIPV+2bOPV(DC), sIPV+2bOPV(liquid), 2sIPV+bOPV(DC), 2sIPV+bOPV(liquid), and were vaccinated at 0, 28, 56 days. Polio neutralizing antibody titers against poliovirus types 1, 2 and 3 were tested prior to Dose 1 and at 28 days after Dose 3. Results The antibody titer distribution for type 1 was statistically different between sIPV+2bOPV(DC) and sIPV+2bOPV(liquid) (Z=-2.589, P=0.010) while no significant differences were detected between the two groups for type 2(Z=-0.331, P=0.741) and type 3(Z=-1.556, P=0.120). There were no significant differences between 2sIPV +bOPV(DC) and 2sIPV+bOPV(liquid) for the distributions(All P>0.05) (type 1:Z=-1.249, P=0.212; type 2:Z=-1.658, P=0.097; type 3:Z=-1.436, P=0.151). In the same dosage forms with different sequential schedules, the antibody titer distributions were significantly different between 2 doses sIPV and 1 dose sIPV groups(All P < 0.05)(sIPV+2bOPV(liquid) vs 2sIPV+bOPV(liquid): type 1:Z=-2.766, P=0.006; type 2:Z=-9.137, P < 0.001; type 3:Z=-5.529, P < 0.001. sIPV+2bOPV(DC) vs 2sIPV+bOPV(DC): type 1:Z=-3.748, P < 0.001; type 2:Z=-7.660, P < 0.001; type 3:Z=-6.030, P < 0.001). Conclusions Different dosage forms have similar immune effects, so appropriate dosage forms should be selected for vaccination according to the effectiveness, characteristics of subjects and the population density. In the case of sufficient supply of sIPV, 2 doses sIPV sequential program should be the first choice to complete the primary immunization.

Analysis on epidemic of human brucellosis in Jiangxi Province from 2011 to 2017

HUANG Yu-ping, ZONG Jun, XIONG Chang-hui, PAN Huan-hong, HU Guo-liang, LIU Xiao-qing

2019, 23(4): 407-411. doi: 10.16462/j.cnki.zhjbkz.2019.04.008

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Objective To investigate the epidemic characteristics of human brucellosis in Jiangxi province from 2011 to 2017, thereby providing reference for future prevention and control work. Methods We analyzed the case information reported in the National Notifiable Infectious Diseases Reporting Information System of Jiangxi Province during 2011-2017 by combining with the monitoring data. Results A total of 239 cases were recorded over these six years, with an average incidence rate of 0.08/100 000. Most cases and agglomerations were concentrated in the Nanchang area (48 cases/4 cases), with the case distribution ranging from 1 in 2011 to all in 2016, and the number of counties(districts) involved had increased from 1 in 2011 to 68 in 2017, which increased rapidly year by year (χ²=94.31, P < 0.001). The gender ratio was 3.12:1(181:58). Most cases were concentrated in the 40-65 age group, while farmers and herdsmen were high-risk population, accounting for 59.83% (143/239). The incidence of brucellosis peaked from May to September (May peak and September peak). In 2012-2017, 7 160 blood samples were collected from risk population, with 95 being positive for Brucella (1.33%). From 2013 to 2017, 62 strains of the Brucella, 4 were Brucella melitensis type1, 54 were Brucella melitensis type3 and 4 were Brucella suis were isolated from 193 cases. Conclusions The human brucellosis was aggravated in Jiangxi province, with the expansion of regional scope. Therefore, more efforts should be focused on regulation to prevent and control brucellosis better.

Exploration of the association between meteorological factors and incidence of hand, foot, and mouth disease based on the distributed lag non-linear model in Jiangyin

LI Jun, GU Min-hua, QIAN Cheng, YAO Jian-xiang, YAN Ya-juan, ZHOU Ju-jing, ZU Rong-qiang

2019, 23(4): 412-416. doi: 10.16462/j.cnki.zhjbkz.2019.04.009

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Objective To explore the effect of meteorological factors on the incidence of hand foot and mouth disease (HFMD) in Jiangyin City. Methods The distributed lag non-linear model (DLNM) was used to estimate the delayed and cumulative effects of meteorological factors on incidence of HFMD in Jiangyin from 2012 to 2017. Results A total of 21 791 HFMD cases were reported in Jiangyin City during 2012-2017. We observed significant correlations between the daily incidence of HFMD and daily mean temperature (r_s=0.402, P < 0.001), daily mean pressure (r_s=-0.453, P < 0.001), and daily mean relative humidity (r_s=0.075, P < 0.001), respectively. It was indicated that the maximum cumulative effect of daily mean temperature on the incidence of HFMD was 11℃ (RR=1.473, 95% CI: 1.99-1.974), and the impact on the onset of HFMD was acute and hightest at the first day (RR=1.090, 95% CI: 1.045-1.136). The cumulative effect on incidence of HFMD was highest at 85% daily relative humidity (RR=1.346, 95% CI: 1.154-1.571), and the impact on HFMD peaked on the 6th day (RR=1.023, 95% CI: 1.015-1.031); The maximum cumulative effect of daily mean pressure with the incidence of HFMD was 1010.0 hpa (RR=1.221, 95% CI: 1.020-1.463), but no lag effect was observed at this level. Conclusions Meteorological factors have significant impact on the incidence of HFMD in Jiangyin City, and the effects of temperature and humidity are lagged.

Study on epidemic factors of varicella outbreak under high varicella vaccine coverage

ZHANG Lei, WANG Yong, LIU Yuan-bao, SUN Xiang, TANG Fen-yang, ZHOU Ming-hao

2019, 23(4): 417-420, 463. doi: 10.16462/j.cnki.zhjbkz.2019.04.010

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Objective To explore the epidemic factors of varicella transmission under high varicella vacince coverage, assess the vaccine effectineness of one dose of varicella vaccine, so as to provide scientific basis for controlling the varicella outbreak and optimizing the varicella immunization strategy. Methods A 1:2 paired case-control study of a varicella outbreak was conducted in a primary school in central region of Jiangsu Province in 2018. Analysis of varicella epidemic factors was performed using conditional logistic stepwise regression. Results This outbreak lasted for 14 days. A total of 45 students were infected with varicella, of which 71.1% were breakthrough cases. The fever, rash degree and disease course of breakthrough cases were all relatively mild compared with those without immune history (all P < 0.05).The results of conditional logistic stepwise regression suggested that participating in extracurricular tutoring institutions(OR=2.6, 95% CI: 2.0-3.2), having brothers or sisters(OR=2.5, 95% CI: 2.1-4.3), without vaccination history of varicella vaccine(OR=2.7, 95% CI: 2.4-4.2), and contacting with varicella patients (OR=2.4, 95% CI: 1.1-5.3) were risks factor for varicella transmission. Time since vaccination >5 years and the initial immunization age < 15 months were potential risk factors for breakthrough cases. The overall vaccine effectiveness of one dose of varicella vaccine was 77.9%(95% CI: 53.3%-92.1%). The fever, severity of the rash and the course of the disease were all milder than those without the history of immunization (all P < 0.05). Conclusions The clinical symptoms of the breakthrough cases are relatively mild, and one dose of varicella vaccine is insufficient to control the outbreak of varicella with limited vaccine effectiveness. Two doses of varicella immunization strategy is recommended.

Study on monitoring and early warning index system for schistosomiasis in Poyang Lake eco-economic region

FAN Wen-yan, ZHAO Xin-han, WU Jin-can, HUANG Shao-xin, WANG Xiao-bo, WANG Xin

2019, 23(4): 421-425. doi: 10.16462/j.cnki.zhjbkz.2019.04.011

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Objective To establish a scientific, operational monitoring and early warning index system for schistosomiasis, so as to provide scientific evidence for promoting the scientification and standardization of early warning system in Poyang Lake Eco-economic Region. Methods Two rounds of Delphi experts' interviews were applied to construct Index system. The weight value of each indicator was determined by the Analytic Hierarchy process and improvable proportionate allocation method. Reliability, validity of index system and the rationality of index weight distribution can be evaluated in site investigation. Results The Index system included 3 first-order indicators, 9 second-order indicators, and 35 third-order indicators. The 3 first-order indicators were endemic status, environmental and social factors, control measures, with the weight value of 0.531 0, 0.101 5 and 0.367 5, respectively. For the 9 second-order indicators, the highest weight value was for Infection status of human and livestock (0.179 5)and the lowest for social factors(0.050 6). During site investigation, the Cronbach's alpha and spit half reliability of the total index system and three first-order indicators were all over 0.90, the Kendall W coefficient for the data collected in site investigation and Delphi consultation was 0.742 (P=0.018). Conclusions The Monitoring and Early Warning Index System for Schistosomiasis is suitable for the infection status of Poyang Lake Eco-economic region. The reliability and validity of index system are satisfactory, and the indicator weight distribution is rational.

Multimorbidity status of the elderly in China-research based on CHARLS data

YAN Wei, LU Yun, ZHANG Ran, CHANG Feng

2019, 23(4): 426-430. doi: 10.16462/j.cnki.zhjbkz.2019.04.012

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Objective To invistigate the prevalence of chronic diseases, the conditions and patterns of multimorbidity in elderly people of China. Methods A total of 11 698 samples aged over 60 years were selected from 2015 data of china health and retirement longitudinal study(CHARLS) for descriptive statistics analysis of chronic disease and multimorbidity status. Results The prevalence of chronic diseases was 69.13%. Top three diseases of prevalence were arthritis or rheumatism (38.50%), hypertension (26.42%), stomach or Gastrointestinal system diseases (24.53%). The prevalence of multimorbidity was 43.65%, and top three diseases of multimorbidity were arthritis or rheumatism (28.78%), hypertension (21.29%), stomach or digestive system disease (20.01%); Common dual disease combinations were gastric or digestive tract disease+arthritis or rheumatism, hypertension + arthritis or rheumatism, chronic lung disease + arthritis or rheumatism; common three disease combinations were hypertension+stomach or digestive tract disease + arthritis or rheumatism, stomach or digestive system disease + chronic lung disease + arthritis or rheumatism, hypertension+heart disease+joints inflammation or rheumatism. Conclusions The prevalence of chronic diseases and multimorbidity among elderly people are high in China and conditions of chronic diseases and multimorbidity are not optimistic. The health administrative department should raise awareness of management in chronic diseases and multimorbidity, and take actions to improve the health status of the elderly.

Study on sleep quality status and its relationship with cardiovascular disease in rural elderly in Ning'er county, Yunnan province

MA Guo-yu, CAI Le, YANG Jia-tian, CUI Wen-long, LI Xiao, WANG Xu-ming

2019, 23(4): 431-435. doi: 10.16462/j.cnki.zhjbkz.2019.04.013

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Objective To analyze the sleep quality status and its relationship with cardiovascular disease in rural elderly in Yunnan Province. Methods Multistage stratified random sampling method was used to select 1629 residents aged 60 years and over from Ning Er County in Yunnan province. Each participant received questionnaire survey and physical examination. Multivariate logistic regression analysis was used to analyze the relationship between sleep quality status and cardiovascular disease. Results Among the study population, the overall Pittsburgh Sleep Quality Index (PSQI) score was 7.48±3.89, and was 6.67±3.69 for males and 8.07±3.92 for females. The prevalence of sleep disorder, hypertension, coronary heart disease and stroke were 56.78%, 52.85%, 8.16% and 8.66%, respectively. Females had higher prevalence of sleep disorder than males (62.81% and 48.55%, P < 0.001). The elderly with lower annual average family per capital income and bad access to medical services had higher prevalence of sleep disorder than their counterparts (P < 0.001).The elderly with sleep disorder was more likely to suffer from hypertension, coronary heart disease and stroke (P < 0.05). Conclusion The prevalence of sleep disorder is high in rural elderly in Yunnan Province. Improving sleep quality among the elderly can prevent and control cardiovascular diseases to a certain degree.

Different level of fasting blood glucose and cardiovascular risk factors clustering among population of Jiangsu Province

MIAO Wei-gang, QIN Yu, SU Jian, CUI Lan, LUO Peng-fei, DU Wen-cong, ZHOU Jin-yi

2019, 23(4): 436-440. doi: 10.16462/j.cnki.zhjbkz.2019.04.014

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Objective To analyze the clustering of major cardiovascular risk factors among population with different level of fasting blood glucose (FBG) in Jiangsu provincial communities. Methods A population-based screening project was conducted during 2015-2017, with 83 522 residents aged 35-75 years from 6 areas included in the study. Prevalence and the clustering of four cardiovascular risk factors (hypertension, obesity, dyslipidemia and smoking) were analyzed. Binary Logistic regression analysis was performed to explore the relationship between FBG and cardiovascular risk factor clustering. Results The prevalence of diabetes was 18.9% among adults aged 35-75 years in Jiangsu province, and 41.4% of them were aware of their disease. Among undiagnosed population, the odd ratios (OR) of cardiovascular risk factors clustering in impaired fasting glucose (IFG) and hyperglycemia group was 1.29 (OR=1.29, 95% CI: 1.24-1.36, P < 0.001) and 1.99 (OR=1.99, 95% CI: 1.89-2.08, P < 0.001), compared with normal FBG group. The control rate of FBG was 15.5% among diagnosed cases. There was no difference in the risk clustering between diabetes patient with and without control of FBG. Conclusions Hyperglycemia and IFG increase the risk of cardiovascular risk factor clustering. Comprehensive interventions should be served as an important role to keep blood glucose at a normal level in high-risk population.

Association between uric acid and brachial-ankle pulse wave velocity among hypertensive population in rural areas of Eastern China

ZHANG Jing-ping, CAO Jing-jing, WANG Bin-yan, QIN Xian-hui, ZANG Tong-hua, XU Xi-ping

2019, 23(4): 441-444, 458. doi: 10.16462/j.cnki.zhjbkz.2019.04.015

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Objective To investigate the association between serum uric acid and brachial-ankle pulse wave velocity (baPWV) levels and to examine any possible effect modifiers among hypertensive patients in rural areas of Eastern China. Methods This cross-sectional study was conducted in Lianyungang and Anqing Cities from July to September 2013. Hypertensive patients with serum uric acid and baPWV measurements were included in this study. Multivariate linear regression was used to assess the relationship between serum uric acid levels and baPWV. Results Finally, a total of 4 278 participants were included in this study. The mean age was 65.2 (standard deviation(SD): 7.4) years and the mean value of baPWV levels were 1835.1 (SD: 383.4) cm/s. Regression analysis showed that there is a positive correlation between serum uric acid and baPWV levels (per SD increment, β=20.5 cm/s, 95% CI: 8.5-32.5, P=0.001. When uric acid was categorized in tertiles, a significantly higher baPWV level was found in participants in tertile 3 (≥ 349μmol/L)(β=51.2 cm/s, 95% CI: 23.8-78.6, P=0.001), compared with those in tertile 1(< 277 μmol/L). Furthermore, the serum uric acid-baPWV association was significantly stronger in those systolic blood pressure (SBP) ≥ 140 mm Hg (vs. < 140 mm Hg; p-interaction=0.001). Conclusion There is a positive relationship between uric acid levels and baPWV among hypertensive patients, especially in those with higher SBP levels.

Evaluation of frailty in people aged 50 years and above in Shanghai

RUAN Ye, GUO Yan-fei, SUN Shuang-yuan, HUANG Zhe-zhou, ZHENG Yang, SHI Yan, WU Fan

2019, 23(4): 445-451. doi: 10.16462/j.cnki.zhjbkz.2019.04.016

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Objective To evaluate frailty in people aged 50 years and above in Shanghai. Methods Cross-sectional data was collected from 2009 to 2010 among people aged 50 and above in Shanghai in the World Health Organization (WHO) study on global AGEing and adult health (SAGE) wave 1. A frailty index (FI) was constructed as the proportion of deficits in 40 variables. A FI of 0.2 or greater was recognized as approaching a frail state. Results A total of 8 632 participants were included, with average age of 63.3 years. The overall weighted prevalence of frailty was 7.8% (95% CI: 5.8-10.4%), the score of FI was 0.08 (95% CI: 0.07-0.09), which were both higher among women, elderly people, the divorced (separated/widowed) and individuals with lower levels of education and wealth. In addition, Ageing, insufficient intake of vegetable and fruit and low level of physical activity were significantly associated with frailty and higher FI. Conclusions Our study provides the epidemiological characteristics of frailty in people aged 50 years and older in Shanghai. It highlights the need for targeted preventive approaches and support programs to promote physical, psychological and social health in elderly people.

Status of injury death and potential losses analysis in Shaanxi Province, 2015-2017

QIU Lin, SA Ri-na, WANG Wei-hua

2019, 23(4): 452-458. doi: 10.16462/j.cnki.zhjbkz.2019.04.017

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Objective To analyze the injury death status and potential loss due to injury death in monitoring area in shaanxi province from 2015 to 2017, so as to provide a scientific basis for preventing and controlling injury. Methods Descriptive epidemiological method was used to analyze the cause of injury death data. Health economics was used to calculate the potential losses caused by injury death, calculate mortality, standardized death rate, constituent ratio, years of potential life lost(PYLL), average number of years lost(AYLL), working years of potential life lost(WPYLL), average working years of potential life lost(AWPYLL), potential economic lost(PEL). Results The average mortality of injury was 55.76 per 100 000(standardized rate was 45.83 per 100 000) in Shaanxi province from 2015 to 2017.The average injury mortality of male was higher than female, and countryside was higher than city.The leading causes of injury death were traffic accidents, falls, suicide, poisoning. Drowning and homicide were the main types of AYLL, male was higher than female and countryside was high than city.PYLL, WPYLL and PEL in traffic accident were 88 218 person-years, 56 413 person-years and 2.728 billions of Yuan, and all of them were higher in male than female, and higher in city than countryside. PYLL, WPYLL and PEL in suicide were 16 789 person-years, 10 868 person-years and 0.526 billions of Yuan, higher in female than male, and higher in countryside than city. Conclusions Injury has become a serious public health problem endangering people's life and health in Shaanxi province, and also the leading cause of death in loss of labor and potential economic loss.

The impact of parental psychological control on non-suicidal self-injury: the role of campus bullying as a mediator

ZHANG Shan-shan, ZHANG Ye

2019, 23(4): 459-463. doi: 10.16462/j.cnki.zhjbkz.2019.04.018

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Objective To explore the mediating role of campus bullying in parental psychological control and middle school students'non-suicidal self-injury. Methods Totally 1 497 students in grade 1, 2 and 3 from four middle schools in Shenyang City were selected by using stratified random cluster sampling method and surveyed with questionnaires. Results The incidence of non-suicidal self-injury was 9.9% in middle school students. Being bullied had some mediating effect between parental psychological and non-suicidal self-injury, the mediating effect accounted for 27.4% of the total effects. Bullying had some mediating effect between parental psychological and non-suicidal self-injury, the mediating effect accounted for 26.4% of the total effects. Conclusion Campus bullying (bullied and bullying) plays a multiple mediating role between parental psychological control and non-suicidal self-injury.

Prevalence of smoking status in ethnic Hui and Han adult residents in Ningxia

ZHANG Yin-e, JIN Ya-nan, MA Fang, TIAN Yuan, WANG Xiao-li, XIE Fan, LI Yuan, ZHAO Jian-hua

2019, 23(4): 464-469. doi: 10.16462/j.cnki.zhjbkz.2019.04.019

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Objective To investigate the adults smoking status of Hui and Han in Ningxia. Methods Among 6 monitoring sites in Ningxia from 2013 to 2014, multi-stage stratified cluster random sampling method was used, information about risk factors of chronic diseases by were collected questionnaire investigation, a total of 3 527 subjects were effective sample for smoking analysis among 3 540 adults aged 18 and over. After the complex weighting, the smoking status of different nationalities, sexes and age was analyzed. Results The current smoking rate was 29.42% (95% CI: 27.91%-30.92%), the current smoking rate of male(56.73%, 95% CI: 54.25%-59.20%) was higher than female (0.92%, 95% CI: 0.50%-1.34%) (P < 0.001); The current smoking rate of Han (32.04%, 95% CI: 30.24%-33.85%) was higher than Hui (23.09%, 95% CI: 20.41%-25.76%). The daily smoking rate of Han (27.98%, 95% CI: 26.25%-29.72%) was higher than that of Hui nationality (19.83%, 95% CI: 17.30%-22.36%) (P=0.001), and that of male (49.41%, 95% CI: 46.92%-51.91%) was higher than that of female (0.73%, 95% CI: 0.36%-1.11%) (P < 0.001). The average daily smoking of male (20) was higher than that of female (8) (Z=-4.448, P < 0.001). Smokers quit smoking rate was 12.54% (95% CI: 10.50%-14.57%). Adult secondhand smoke exposure rate was 54.44% (95% CI: 52.53%-56.36%). Conclusions The smoking rate of adult residents is high in Ningxia province, but the quit smoking rate is low, male smoking rate is higher than female, Han smoking rates higher than the Hui. The sample population was highly exposed to secondhand smoke. Tobacco control interventions should be taken against high-risk groups.

Analysis of multi drug resistance status of tuberculosis patients in Shaoguan from 2015 to 2017

GUO Zi-yu, LI De-chang

2019, 23(4): 470-473. doi: 10.16462/j.cnki.zhjbkz.2019.04.020

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Objective To investigate the screening status of multi drug resistant pulmonary tuberculosis(MDR-TB) in 2015-2017. Methods The clinical data of 562 patients with suspected MDR-TB were retrospectively analyzed. All patients received traditional drug susceptibility tests. The data of isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (SM), ofxofloxacin (Ofx), kanamycin (Km) resistance and MDR-TB screening results were analyzed. Results Results of traditional drug susceptibility test showed that SM had the highest drug resistance rate[19.22% (108/562)] and KM had the lowest resistance rate[4.45% (25/562)]. Traditional diagnosis of 562 patients showed that the detection rate of MDR-TB was 6.94% (39/562). There was no statistically significant difference in the detection rate of MDR-TB between different sex, age, education level. The detection rate of MDR-TB was not statistically significant between different gender, age, education level and region (all P>0.05).There was significantly different in the detection rate of MDR-TB between different patient types (P < 0.001). Conclusions The drug resistance rate of pulmonary tuberculosis patients was followed by streptomycin, isoniazid, rifampicin, ethambutol, ofloxacin and kanamycin. The single drug resistance rate and multidrug resistance rate of the patients in the retreatment group were higher than those in the initial treatment group. With the focus on the retreatment of patients, expand the scope of screening, timely cure the initial treatment of patients.

Analysis of the disease spectrum of Beijing 120 prehospital emergency patients from 2013 to 2017

ZHAO Si-yu, CAO Yu, LEI Yan-ni, LIU Fang-chao, SHAO Shi-yu, LIU Jue, NIE Dong-ni, YANG Nan-nan, LIU Min

2019, 23(4): 474-479. doi: 10.16462/j.cnki.zhjbkz.2019.04.021

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Objective To understand the disease spectrum of prehospital emergency patients in Beijing, so as to provide basis for rational allocation of prehospital emergency care resources and for improvement of prehospital emergency care. Methods Emergency dispatch database from 120 dispatching command system of Beijing Emergency Medical Center to was used study the disease spectrum of 120 prehospital emergency patients from 2013 to 2017 in Beijing, and were analyzed the differences of disease spectrum among patients of different years, genders and ages, and the time distribution of different diseases. Results From 2013 to 2017 in Beijing, 1 643 375 patients used 120 prehospital emergency care. The top 3 diseases of the disease spectrum were: injury and poisoning (29.63%), diseases of the circulatory system (18.37%), and diseases of the nervous system (15.80%). The sorting of diseases remained unchanged during the 5 years. The disease spectrums were different among different age groups and gender groups. The calls in spring, summer, autumn and winter accounted for 25.23%, 24.97%, 25.05% and 24.75% respectively. Most calls were made from 08:00 to 09:59 (12.41%), 12:00 to 13:59 (10.05%), and 14:00 to 15:59 (9.91%) during a day. The peak months and hours of different diseases were different. Conclusions The demand for prehospital emergency care has been increasing in Beijing in recent years. It is important to strengthen the prevention of injuries among all ages, especially male, and to improve the prevention and response capacity for acute attack of chronic diseases among older people. Prehospital emergency care resources should be rationally allocated according to the peak months and hours of calls.

The influence of emotional state on sleep disorder and treatment behavior among men who have sex with men with newly diagnosed HIV infection

ZHAO Ya-fang, SHENG Yu

2019, 23(4): 480-485. doi: 10.16462/j.cnki.zhjbkz.2019.04.022

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Based on the international large-scale epidemiological research results, the Joint United Nations Programme on HIV and AIDS (UNAIDS) has proposed three 90%-90%-90% strategies for AIDS prevention and control, and the major countries in the world are actively promoting it. However there is a big gap in the strategy to promote the treatment of newly diagnosed HIV-positive people because of insufficient research on the acceptance and continuum care and treatment behavior of newly diagnosed person. Domestic and foreign studies have reported that diagnose outcome may cause psychological problems under pressure. Men who have sex with men with HIV infection are more stressed than the general population for their sexual orientation and HIV infections. Depression and anxiety are common mental problems which were present in 70.7% of the population, especially among newly diagnosed MSM. Unstable emotional state and unhealthy psychological condition may effect on their sleep, seeking treatment behavior and other aspects. The bi-directional affect between sleep and emotion has been proved, while the function of emotional state impact on HIV infection MSM ignition and retention ART is still unclear yet. This paper reviews treatment behavior status of men who have sex with men with HIV diagnosis, and both the effects of emotional state and sleep disorder on their treatment behavior, also analyzes and interprets the relationship between sleep disorder and emotion. This paper may contribute to provide new ideas and basis for HIV prevention and treatment among risky population and also for the care of HIV positive people.

Analysis of nutritional status of Tibetan primary school students in Namling County, Shigatse, 2015

JINMEI Zha-ba, BASANG Pian-duo, ZHANG Gao-hui, LIANG Jing, NIMA Ci-ren

2019, 23(4): 486-488, 492. doi: 10.16462/j.cnki.zhjbkz.2019.04.023

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Objective To understand the nutrition status of primary school students in Namling County of Shigatseand so as to provide references for nutrition health intervention for students. Methods By random cluster sampling, 5 primary schools were randomly selected, and 1 class was randomly selected from each grade. A total of 1097 subjects, aged from 7 to 12 years were selected and their height and weight were measured. Results The rate of overweight was 0.46%. The rate of malnutrition was 32.27%, and boys (36.61%) were higher than girls (27.75%) (χ²=9.847, P=0.002).The rate of malnutrition was the lowest (25.00%) in the 8 years old group, and the highest (53.38%) in 12 years old group (χ²=37.808, P < 0.001). The rate of stunting was 15.86%. There was no significant difference between boys (17.14%) and girls (14.53%) (χ²=1.408, P=0.235), and the highest (31.76%) in 12 years old group and the lowest (9.66%) in 7 years old group (χ²=34.206, P < 0.001). The rate of wasting was 20.78%, boys (24.46%) was higher than girls (16.95%) (χ²=9.411, P=0.002). There was significant difference among different age groups (χ²=25.493, P < 0.001). Conclusions Malnutrition is still a serious public health problem among students and the main characteristic was high-rate of stunting and wasting. It is necessary to strengthen nutrition education to improve the nutritional status of students.

Observation on efficacy of tirofiban in patients with ischemic progressive stroke

NIU Wen-shu, LIU Yang, WANG Yu-bin, NING Qun, LI Zhi-yun

2019, 23(4): 489-492. doi: 10.16462/j.cnki.zhjbkz.2019.04.024

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Objective To observe the efficacy of tirofiban in the treatment of ischemic progressive stroke. Methods 300 patients who met the diagnostic criteria of ischemic progressive stroke were divided into the control group and tirofiban group. Patients in the control group received treatment of PA2S regiment, i.e., a combination of aspirin, clopidogrel, probucol and atorvastatin. Patients in the tirofiban group received extra tirofiban on the basis of PA2S therapy. National institute of health stroke scale (NIHSS) score was evaluated on patients in both group before the therapy and 3 days, 1 month, 6 months after the therapy respectively. Results For the control group, the average NIHSS score was 11.3±4.2, 11.5±4.4, 8.8±4.1, 6.1±4.1 before therapy and at 3 days, 1 month, 6 months after the therapy. And for the tirofiban group, the average NIHSS score was 11.4±3.9, 10.8±3.6, 7.4±3.2, 4.4±3.0 at the corresponding period respectively. There were statistical differences between the two groups in the period of 1 month and 6 months after treatment with P < 0.001. Conclusions Tirofiban hydrochloride can improve the degree of neurological deficit and outcome in patients with ischemic progressive stroke.

The Architect of American public health: Lemuel Shattuck

HU Yu-wan, FU De-ming

2019, 23(4): 493-496. doi: 10.16462/j.cnki.zhjbkz.2019.04.025

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Lemuel Shattuck (1793-1859) was a famous American public health reformer, historian and statistician in the mid-19th century. He introduced statistics into the American system of vital statistics registration and promoted the modernization of the United States demographics. In 1850, he submitted Report of a General Plan for the Promoting of Public and Personal Health to the Sanitary Commission of Massachusetts, which built a blueprint for the future development of the American public health system and laid the foundation for the widespread development of the public health movement in the late 19th century. Shattuck is not only a pioneer in the modern American census, but also a leader in public health in the United States.

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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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