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CN 34-1304/R ISSN 1674-3679

2019 Vol. 23, No. 7

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Paying a Tribute to 70 years'Development of Healthcare
Effective control and even elimination of endemic diseases in China benefits from the superior socialist system
SUN Dian-jun, GAO Yan-hui, LIU Hui
2019, 23(7): 745-748, 753. doi: 10.16462/j.cnki.zhjbkz.2019.07.001
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On the occasion of 70th anniversary of the founding of the People's Republic of China, the author reviews the historical course of endemic disease prevention and control in China in the past 70 years, combs the successful experience of endemic disease prevention and control in China and points out that the most fundamental reason for the effective control or elimination of endemic diseases in China lies in the firm leadership of the Communist Party of China, in the superior socialist system, in planning, guidance and overall consideration, in unremitting efforts of a number of researchers on endemic disease prevention and control and lies in the rapid development of China's economy and society.
Progress of the national programme and achievements of scientific researches on schistosomiasis elimination in China
ZHOU Xiao-nong, XU Jing, LV Shan, LI Shi-zhu
2019, 23(7): 749-753. doi: 10.16462/j.cnki.zhjbkz.2019.07.002
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The paper reviewed the progress of the national schistosomiasis control programme in the last 70 years in China, and summarized the achievements of both the programme and scientific researches in four different stages of the programme. In particular, on the basis of the analytic results in promotion effectiveness and gaps of control strategies in different control stages, the theoretic foundation in on-going battle actions to eliminate schistosomiasis in whole country by using the integrated strategy with emphasis of infectious sources control was analyzed. The scientific and technological achievements in the process of communication control and elimination was compared, and the practicalness of precision control of schistosomiasis was put forward at technical point of view. Finally, it was recommended how to put the precision control efforts into practice at national level in the schistosomiasis elimination stage.
The progress and achievements of tuberculosis control in China since 1949
LU Wei, ZHOU Yang, LIU Jian-jun
2019, 23(7): 754-757, 762. doi: 10.16462/j.cnki.zhjbkz.2019.07.003
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Tuberculosis is one of the major public health problems. The prevention and control faces huge challenges. This article reviewed the development of tuberculosis control since the founding of the People's Republic of China and revealed the outstanding achievements in tuberculosis control in the past 70 years, including the establishment of tuberculosis control strategy suitable for China, the perfect tuberculosis control system, the improvement of tuberculosis control capacity and the significant decline in morbidity and mortality of tuberculosis. We have summarized the experience, analyzed the challenges and the measures which should be taken to end tuberculosis.
Establishment of surveillance, investigation and health risk assessment system with Chinese characteristics in the field of environmental health
DU Peng, LI Tian-tian, SHI Xiao-ming
2019, 23(7): 758-762. doi: 10.16462/j.cnki.zhjbkz.2019.07.004
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In the past decades, serious environmental pollution problems have been caused by the extensive economic growth in China, of which adverse health effects have emerged gradually and received considerable attention. Chinese government attached great importance to these issues, and then carried out plenty of surveillance, investigation and health risk assessment work, which provide important basic data and scientific evidences for decision-making in the health effects of environmental pollution researching, related diseases control and prevention. Development, progress and future prospects of surveillance, investigation and health risk assessment system in the field of environmental health were discussed in this paper.
Original Articles
Analysis on trends in BMI among adults in Shaanxi Province from 2007 to 2015
WANG Wei-hua, FENG Liu-xin, QIU Lin, SA Ri-na, WANG Jing, LIU Rong, HU Zhi-ping, WANG Yan-ping, LIU Feng
2019, 23(7): 763-768. doi: 10.16462/j.cnki.zhjbkz.2019.07.005
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  Objective  To investigate the trend of BMI among adults in Shaanxi Province from 2007 to 2015.  Methods  Data was obtained from China Chronic Disease and Risk Factor Surveillance from 2007 to 2015, in which a multistage clustering sampling was adopted to collect a provincially representative sample of adults in Shaanxi Province. BMI percentile(P5, P25, P50, P75, P95) and the prevalence of underweight, overweight and obesity was calculated with weight in each survey. Cochran-Armitage test was used to test trends across survey periods. Changes in BMI across survey years were compared by considering the sampling weight.  Results  The results of the surveillance indicated that the prevalence of underweight decreased while overweight and obesity increased among adults in Shaanxi province (Z=-14.70, P < 0.001). We observed the highest increase in the prevalence of overweight and obesity among rural residents and residents aged from18 to 44. The mean BMI was estimated to increase 0.176(t=3.00, 95%CI: 0.055-0.298, P=0.006) per year. We found no difference in overweight and obesity (χ2=0.196, P=0.459) between 2013 and 2015.  Conclusions  We note increases in overweight or obesity and a decrease in underweight among adults in Shaanxi Province. Those living in rural areas and aged from 18 to 44 led the highest increase in overweight and obesity.
Association between 24-hour urinary sodium excretion and obesity in general population aged from 18 to 69 years old
XU Jian-wei, LIU Min, BAI Ya-min, CHEN Xiao-rong, MA Ji-xiang, WU Jing
2019, 23(7): 769-773. doi: 10.16462/j.cnki.zhjbkz.2019.07.006
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  Objective  To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old.  Methods  2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis.  Results  2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19.1%(95% CI: 17.4%-20.6%)and 24-hour urinary sodium was (166.4±71.5) mmol/d. The urinary sodium in obese, and central obesity population calculated according to waist-to-height ratio (WHtR) were higher than the normal population, respectively (All P < 0.05). Multivariate linear regression analysis showed that after adjusting for relevant factors, 24-hour urinary sodium was positively correlated with body mass index (BMI), waist circumference (WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile, population in highest quantile had an increased risk of being the obesity, abdominal obesity(calculated according to WC) and abdominal obesity(calculated according to WHtR) with OR(95% CI) of 1.61(1.18-2.20), 2.01(1.39-2.89) and 1.47(1.15-1.89), respectively, after adjusting for age, gender, education, smoking, alcohol consumption, physical activity, hypertension and diabetes.  Conclusions  High sodium is independently associated with obesity. Sodium intake is a potential and important risk factor for obesity.
Association of smoking status with incident cardiovascular disease in the middle-aged and older male populations
LEI Wen-hui, HE Shi-qi, WANG Hao, ZHOU Lue, YU Yan-qiu, LIU Kang, ZHANG Xiao-min, HE Mei-an, WU Tang-chun
2019, 23(7): 774-779. doi: 10.16462/j.cnki.zhjbkz.2019.07.007
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  Objective  To investigate the association of smoking status with incident cardiovascular disease (CVD) and its subtypes among the middle-aged and older male populations.  Methods  This study included 13 940 males from Dongfeng-Tongji (DFTJ) cohort who were free of coronary heart disease (CHD), stroke, cancer or severely abnormal electrocardiogram (ECG) at baseline. All participants completed baseline questionnaires, physical examinations, clinical biochemical tests and blood sample collection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confident intervals (CI) for the association analyses.  Results  Compared with never smokers, current smokers had significant higher risks of CVD, CHD and stroke, the adjusted HRs of current smokers who smoked for more than 40 pack-years were 1.49 (95% CI: 1.32-1.68, Ptrend=0.001), 1.40 (95% CI: 1.22-1.62, Ptrend=0.026) and 1.59 (95% CI: 1.26-2.00, Ptrend=0.029) for CVD, CHD and stroke, respectively; and the adjusted HRs of current smokers who started smoking before 20 years old were 1.29 (95% CI: 1.06-1.58, Ptrend=0.007) and 1.30 (95% CI: 1.03-1.64, Ptrend=0.010) for CVD and CHD, respectively. Former smokers who had quitted smoking for 10 or more years had significant lower risks of CVD (HR: 0.80, 95% CI: 0.71-0.91, Ptrend=0.017) and stroke (HR: 0.65, 95% CI: 0.50-0.84, Ptrend=0.207) when comparing to current smokers.  Conclusions  Smoking is significantly associated with higher risks of CVD, CHD and stroke, and greater amount of smoking and earlier age at smoking initiation are associated with a higher risk of CVD. Smoking cessation can reduce the risk of CVD.
Association of vitamin D and risk of hypertension in Henan rural population
WANG Teng, SUN Hua-lei, GE Hui-na, LIU Xin-xin, HAN Han, WANG Jun, LI Xing, LI Wen-jie
2019, 23(7): 780-784, 795. doi: 10.16462/j.cnki.zhjbkz.2019.07.008
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  Objective  The purpose of this study was to investigate the prevalence of vitamin D deficiency and hypertension in Henan rural residents, and to explore the association between vitamin D and risk of hypertension.  Methods  2 013 Henan rural participants aged 18-80 years were recruited from a cross-sectional study. Logistic regression models and restricted cubic spline model were used to evaluate odds ratios (OR), 95% confidence intervals (95% CI) and dose-response relationship between vitamin D and risk of hypertension.  Results  In total population, the prevalence of hypertension was 40.34% (30.64% after age-standard), and the mean serum 25-(OH)D was (24.50 ±16.18) ng/ml, and 53.95% of all participants were presenting vitamin D deficiency. Compared with non-hypertension, a lower level of serum 25-(OH)D was observed in people with hypertension. The prevalence of hypertension was 45.21% in vitamin D deficient group which was higher than in the vitamin D sufficient group (31.07%). Compared with the vitamin D sufficient group, the risk of hypertension was increase in the vitamin D deficient group (OR=1.59, 95% CI: 1.21-2.10), and the risk of hypertension decreased by 14% for every 10 ng/ml increase in serum 25-(OH) D levels. Moreover, an L-shaped relationship was observed between 25-(OH)D concentration and risk of hypertension.  Conclusion  Vitamin D deficiency is associated with risk of hypertension and there is an L-shaped relationship between 25-(OH)D concentration and risk of hypertension.
Guiding value of ambulatory blood pressure monitoring index in clinical prevention and treatment of elderly hypertensive population
ZHANG Yong-jun, XU Shang-yin, WU Zhu-xia, FAN Zi-qing, ZHOU Wen-jiao, YAO Ying-shui
2019, 23(7): 785-789. doi: 10.16462/j.cnki.zhjbkz.2019.07.009
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  Objective  To study the application value of dynamic monitoring of blood pressure in the prevention and treatment of elderly hypertension.  Methods  519 hypertensive patients from December 2017 to December 2018 were monitored with ambulatory blood pressure monitoring, and were divided into the elderly group (≥ 60 years old, 264 cases) and the control group (< 60 years old, 255 cases). The results of ambulatory blood pressure monitoring in two groups were analyzed, which inclued the circadian rhythm of blood pressure, blood pressure, pulse pressure, coefficient of variation of blood pressure, blood pressure load value, average heart rate and morning blood pressure surge.  Results  The incidence of abnormal circadian rhythm of ambulatory blood pressure in the elderly group was 76.5%. Compared with the control group, there were differences in the indexes of diastolic blood pressure (DBP), diastolic blood pressure load value (DBPLV), pulse pressure (PP), 24 h average heart rate (24 hAHR), systolic blood pressure coefficient of variation (SBPCV), 24 h diastolic blood pressure coefficient of variation (24 h DBPCV) and morning diastolic blood pressure surge (MDBPS) between the two groups(all P < 0.05). There were differences in 24 h systolic blood pressure (24hSBP), night systolic blood pressure (nSBP), night diastolic blood pressure (nDBP), night pulse pressure (nPP), day systolic blood pressure load value (dSBPLV), ninght systolic blood pressure load value (nSBPLV), 24 h SBPCV, 24 h dDBPCV and other indicators among different blood pressure types in the elderly group (all P < 0.05).  Conclusion  Ambulatory blood pressure monitoring indicators have important guiding value for the prevention and treatment of elderly hypertension.
Associations between sleep duration and different ischemic stroke subtypes
LI Man, WU Yao, TIAN Yao-hua, CAO Ya-ying, HUANG Zhe, HUANG Shao-ping, LIU Xiao-fen, QIN Xue-ying, TANG Xun, LI Jin, WU Tao, CHEN Da-fang, XU Bei-bei, HU Yong-hua
2019, 23(7): 790-795. doi: 10.16462/j.cnki.zhjbkz.2019.07.010
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  Objective  To explore the relationship between sleep duration and different ischemic stroke (IS) subtypes.  Methods  Participants in the study were recruited from rural communities in Beijing. The survey questionnaires, physical examination and biochemical tests were performed. Sleep duration was categorized into 5 groups, namely ≤ 5 hours/day, 6 hours/day (5.5-6.5 h/d), 7 hours/day (6.5-7.5 h/d), 8 hours/day (7.5-8.5 h/d) and ≥ 9 hours/day(≥ 8.5 h/d). Classification of ischemic stroke was based on Trial of org 10172 in acute stroke treatment(TOAST)classification. Logistic models were used to evaluate the associations between sleep duration and different IS subtypes.  Results  A total of 6 370 participants were recruited. The average age was (58.34±9.37) years old. Logistic regression analysis showed that after adjusting for age, sex, behavioral lifestyle, socioeconomic status and health status, compared to subjects with 7 hours/day, subjects with sleep duration ≤ 5 hours/day was significantly associated with increased risk of IS (OR=1.75, 95% CI: 1.42-2.15, P < 0.001), large-artery atherosclerosis (OR=1.98, 95% CI: 1.46-2.70, P < 0.001), small-artery occlusion lacunar (OR=5.73, 95% CI: 3.34-9.83, P < 0.001) and stroke of undetermined etiology (OR=4.43, 95% CI: 1.86-10.53, P=0.001). Subjects with sleep duration 8 hours/day and ≥ 9 hours/day was only found to be significantly associated with IS and large-artery atherosclerosis (P < 0.05).  Conclusions  Short sleep duration is associated with increased risk of IS, large-artery atherosclerosis, small-artery occlusion lacunar and stroke of undetermined etiology. But long sleep duration is only associated with increased risk of IS and large-artery atherosclerosis.
The prevalence and risk factors of metabolic syndrome in Chinese population based on the multi center cross-sectional survey
GUO Hai-jian, NIAN Xin, LIANG You-fang, WANG Xin-ling, LI Kai-li, WANG Qing, TU Ping, YAN Sun-jie, ZHANG Li-hui, WANG Bei, SUN Zi-lin
2019, 23(7): 796-801. doi: 10.16462/j.cnki.zhjbkz.2019.07.011
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  Objective  To understand the prevalence and risk factors of metabolic syndrome (MS) among different ethnic groups.  Methods  A multicenter cross-sectional survey was conducted. Subjects were selected by multistage stratified random sampling. Physical examination and laboratory testing were performed to collect MS related indicators, and the prevalence was standardized by the 6th general survey data. Further multivariate and logarithmic linear model methods were applied to analyze the risk factors and interaction.  Results  The overall prevalence of MS was 19.58%. The highest prevalence of MS was in Korean, followed by Han, while the lowest was in Kazakh. The rates of MS, overweight and obesity were higher in men than those in women, and increased along with age. Multivariate analysis result showed that the odds ratio (OR) of female to male was 0.556, and aging increased the risk of MS. The OR of central obesity was 2.765, and would reach to 4.259 when the waist-to-body ratio was over 0.52. The logarithmic linear model showed that the overweight/obesity, hyperglycemia, hypertension and dyslipidemia had independent effects on the risk of MS. Also, there were interactions in the four indicators.  Conclusions  The incidence of MS is high and the positive interaction between the overweight/obesity, hyperglycemia, hypertension and dyslipidemia is observed, making MS a common crisis to clinical and public health. In order to prevent and control MS, and to reduce the risk of cardiovascular and cerebrovascular diseases and diabetes, early screening of MS should be strengthened and lifestyle intervention should be carried out.
Analysis of diabetes screening in high-risk population in different communities in Shanghai from 2016 to 2017
WU Wen-jun, XU Lei, HUANG Li-mei, LI Zhi-yuan, ZHAO Qi
2019, 23(7): 802-806, 817. doi: 10.16462/j.cnki.zhjbkz.2019.07.012
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  Objective  To describe the results of screening for high-risk population of diabetes mellitus among community residents in Shanghai from 2016 to 2017 and analyze the characteristics of subjects with impaired glucose regulation or diabetes patients.  Methods  After the diabetes risk assessment for the residents aged 35 and older in Changning and Songjiang district of Shanghai, physical examination and blood glucose test were conducted for high-risk groups.  Results  A total number of 33 469 people in the two communities were screened, 4 555 patients with impaired glucose regulation and 3 412 patients with diabetes were detected. The detection rates were 13.6% and 10.2%, respectively. In high-risk population, aging was significantly correlated with the risk of diabetes(males: P < 0.001;females: P < 0.001) and impaired glucose regulation(males: P < 0.001;females: P < 0.001). The risk of diabetes in rural males was lower than that in urban males (OR=0.873, 95% CI: 0.771-0.988), while rural females had a higher risk of impaired glucose regulation than urban females (OR=1.249, 95% CI: 1.131-1.379). Self-reported history of impaired glucose regulation(males: P < 0.001;females: P < 0.001), family history of type 2 diabetes(males: P < 0.001;females: P < 0.001), hypertension(males: P < 0.001;females: P < 0.001), dyslipidemia(males: P < 0.001;females: P=0.015), overweight/obesity(males: P < 0.001;females: P < 0.001), long-term sedentary lifestyle in males (P=0.002) and a history of polycystic ovary syndrome in females (P=0.011) were related to the risk of dysglycemia. The more of the number of high-risk factors for residents, the higher the risk of impaired glucose regulation and diabetes (P < 0.001).  Conclusions  The situation of community diabetes detection and prevention in Shanghai is very serious. Therefore, it is necessary to strengthen the monitoring of high-risk groups of diabetes and take targeted intervention measures to reduce the occurrence of diabetes in high-risk population.
The spectrum of chronic diseases and influential factors of immigrants moving water source area of South-to-North Water Diversion Project
JIA Jia, LIU Bing, LV Fan-fan, JIANG Feng-bo, KE Li, KE Pan
2019, 23(7): 807-811. doi: 10.16462/j.cnki.zhjbkz.2019.07.013
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  Objective  To understand the prevalence and disease distribution of migrants within the water source area of the Middle Route Project of South-to-North Water Diversion Project and analyze the influencing factors.  Methods  By multi-stage stratified cluster sampling method, 307 immigrants and 676 immigrants were selected from Danjiangkou reservoir area, Shiyan city, Hubei Province.  Results  The prevalence of chronic diseases among in-migration was 51.8%. The prevalence rates of the top five chronic diseases were waist and leg pain, hypertension, gastritis, heart disease and diabetes. The prevalence of chronic diseases among out-migration was 65.1%. The prevalence rates of the top five chronic diseases were waist and leg pain, hypertension, gastritis, heart disease and bronchitis. The rate of chronic disease, the rate of two weeks and the rate of two weeks' visit were higher than that of emigration(all P < 0.05). The results of multivariate analysis showed that the factors influencing the chronic diseases of immigrants were 60 years old (OR=59.928, P < 0.001), unsatisfied family income (OR=0.377, P=0.002) and poor economic status (OR=0.517, P=0.028). The factors influencing the chronic diseases of immigrants were 60 years old (OR=26.190, P < 0.001), smoking (OR=1.856, P=0.004), unsatisfactory family income (OR=0.598, P=0.029) and poor economic status (OR=0.460, P < 0.001).  Conclusions  The prevalence of migrants within a high level is at a high level. Actually raising the income of immigrants is conducive to improving the health condition of immigrants.
Analysis on risk factor of chronic disease-related behaviors among adult residents in Liubei District, Liuzhou City
TAN Li-juan, LU Yan-yan, LIU Yang, LI Ming-qiang, CHEN Na-ying, WEI Liu-chun, QIN Kai
2019, 23(7): 812-817. doi: 10.16462/j.cnki.zhjbkz.2019.07.014
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  Objective  To explore the risk factor of chronic disease-related behaviors such as smoking, drinking, exercising and eating habit among residents in Liubei District, Liuzhou City.  Methods  2 487 adult residents in Liubei District were sampled by multistage sampling method and surveyed on their way of life and behavior risk factors. The content of questionnaire involved familial population information, past medical history, way of life and eating habit. EpiData 3.1 was applied to install database, SPSS 17.0 was used for data analysis, multivariate Logistic regression was used to analyze the risk factor of chronic disease-related behaviors.  Results  The rates of hypertension, diabetes, stroke, chronic obstructive pulmonary disease (COPD) were 13.63%, 4.22%, 3.62%, 0.36% and 6.84%, respectively. The rate of smoking, drinking, doing physical exercise and eat breakfast regularly were 22.92%, 5.43%, 52.87% and 93.07%. Multivariate Logistic regression analysis showed that older and smoking were risk factors of chronic disease, while physical exercise was protective factor of chronic disease.  Conclusions  Intervening measure taken in chronic disease demonstration zone were effective in the past 5 years, and health education on behavioral intervention should be carried on continuous to reduce incidence of chronic disease.
Association between sexual sensation seeking and sexual risk behaviors among men who have sex with men in Guangzhou
JIANG Hong-bo, LI Jing, TAN Zhi-min, LIN Kai-hao, CHEN Xiao-bin, CHENG Wei-bin, XU Hui-fang, YANG Yi
2019, 23(7): 818-821. doi: 10.16462/j.cnki.zhjbkz.2019.07.015
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  Objective  To evaluate the association between sexual sensation seeking (SSS) and sexual risk behaviors among men who have sex with men (MSM) in Guangzhou.  Methods  MSM aged 18 and over were recruited in Zhitong Charity from June 2017 to April 2018. Data on socio-demographic characteristics, sexual behaviors and SSS were collected using an electronic questionnaire. Logistic regression analyses were performed to evaluate the association between SSS and sexual risk behaviors.  Results  A total of 500 MSM were included in the current study. The mean age of the participants was (27.77±5.96) years old. The multiple logistic regression analyses showed that MSM with high SSS scores were more likely to engage in multiple sexual partners (OR=2.05, 95% CI: 1.40-2.30, P < 0.001), one-night stand (OR=2.11, 95% CI: 1.44-3.09, P < 0.001), and unprotected anal intercourse (OR=1.70, 95% CI: 1.16-2.50, P=0.007) than those with low SSS scores.  Conclusions  High SSS is associated with an increased risk of sexual risk behavior among MSM in Guangzhou. The behavior intervention strategy should be tailored for MSM with high SSS to improve the effectiveness to reduce sexual risk behaviors.
Effects of air pollutants on outpatient and emergency number of respiratory diseases in Yanqing District of Beijing
ZHANG Zhen-quan, WANG Shao-hua, WU Zhi-le, GUO Xiu-hua
2019, 23(7): 822-827, 834. doi: 10.16462/j.cnki.zhjbkz.2019.07.016
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  Objective  To explore the association between air pollutants and the number of outpatient and emergency visits for respiratory diseases in Yanqing District, Beijing.  Methods  Data from 2014-2017 of the number of outpatient and emergency visits for respiratory diseases was collected from secondary medical institutions in Yanqing District of Beijing, and data of meteorological monitoring and atmospheric pollution were also collected. On the basis of controlling confounding factor, a generalized additive model was used to analyze the relationship between air pollutant concentration and the number of outpatient and emergency visits for respiratory diseases, and lag effect.  Results  The results showed that, Particulate Matter 2.5 (PM2.5) increased by 10 μg/m3, the number of respiratory outpatient and emergency visits would increase 0.11% (95% CI: 0.09-0.14, P=0.001); Particulate Matter 10 (PM10) increased by 10 μg/m3, the number of respiratory outpatient and emergency visits would increase 0.17% (95% CI: 0.15-0.19, P=0.001); Nitrogen dioxide(NO2) increased by 10 μg/m3, the number of respiratory outpatient and emergency visits would increase 0.44% (95% CI: 0.37-0.50, P=0.001); carbon monoxide (CO) increased by 10 μg/m3, the number of respiratory outpatient and emergency visits would increase 3.34% (95% CI: 1.57-5.15, P=0.001), and the most effective period was on the Zeroth day. The number of respiratory outpatient and emergency visits would increase -1.69%(95% CI: -1.80--1.57, P=0.001) with sulfur ioxide (SO2) increased 10 μg/m3, and the most effective period was on the 1th day. The number of respiratory outpatient and emergency visits would increase -0.12% (95% CI: -0.15--0.10, P=0.001) with O3 increased 10 μg/m3, and the most effective period was on the 5th day. In the analysis of double pollutant model, under the influence of SO2, CO had a significant effect on the number of outpatient and emergency visits with respiratory diseases.  Conclusion  The results of this study suggest that in Yanqing District, increasing concentrations of PM2.5, PM10, NO2 and CO will cause an increase in the number of outpatient and emergency visits for respiratory diseases, and there are interactions between different pollutants.
Short-term effects of ambient air pollution and cause-specific emergency department visits in Guangzhou
HE Wei-yun, WU Yan, GUO Pi, LV Jia-yun, CHEN Yu-liang, ZHENG Mu-rui, LIU Peng-da, BU Li, FENG Wen-ru
2019, 23(7): 828-834. doi: 10.16462/j.cnki.zhjbkz.2019.07.017
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  Objective  To understand the relationship between the concentration of air pollutants and daily emergency department visits for different diseases (circulatory system disease, digestive system disease, nervous system disease and respiratory system disease) in Guangzhou, Guangdong Province.  Methods  The daily average concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2, carbon monoxide (CO) and PM2.5 and the daily maximum 8-hour concentrations of O3, the daily average temperature, the relative humidity and cause -specific emergency department visits of the four major diseases from 2015 to 2017 were collected in Guangzhou. Semi-parametric generalized additive model was used to analyze the relationship between the concentration of pollutants and daily cause-specific emergency department visits.  Results  The daily average concentrations of SO2, NO2, CO, O3 and PM2.5 during the study period were 13.24 μg/m3, 45.96 μg/m3, 0.97 mg/m3, 123.77 μg/m3 and 36.22 μg/m3, respectively. For circulatory system disease, the independently significant associations of SO2 with emergency department visits in single-pollutant models (2.91%, 95% CI: 1.00%-4.85%), and multipollutant models (4.39%, 95% CI: 1.22%-7.67%) were observed.  Conclusion  The ambient SO2 increases the risk of emergency department visits due to circulatory diseases in Guangzhou. Comprehensive prevention and control measures should be taken to reduce the emission of SO2.
Epidemiological characteristics and drug resistance surveillance of Shigella in infants and young children in Henan Province from 2013 to 2017
MU Yu-jiao, WANG Ruo-lin, ZHANG Bai-fan, ZHAO Jia-yong, LI Meng-lei, XIA Sheng-li, HUANG Xue-yong
2019, 23(7): 835-839. doi: 10.16462/j.cnki.zhjbkz.2019.07.018
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  Objective  To investigate the pathogenic characteristics of Shigella in infants from 2013 to 2017 in Henan Province.  Methods  From 2013 to 2017, 606 Shigella strains were isolated from 5 149 children with diarrhea under 5 years old in Henan Province. Serotyping, drug sensitivity test and Polymerase Chain Reaction detection of virulence gene methods were used to detect the pathogen of Shigella.  Results  The detection rate of Shigella in children with diarrhea was 11.77%, and the highest detection rate was in the 1-2 age group(24.08%). 606 Shigella strains were divided into two groups and 11 serotypes. Shigella flexneri accounted for 73.43%, and Shigella sonnei accounted for 26.57%. Resistance of 176 Shigella strains to ampicillin and naphthidine was serious (resistance rate > 90%), and the resistance rates to chloramphenicol, ciprofloxacin, norfloxacin and compound sulfamethoxamine were higher than 65%, and the sensitivity of imipenem and cephalosporin were higher. There were differences in drug resistance between Shigella flexneri and Shigella sonnei. The virulence genes of infants were mainly shET-1+, shET-2+, ipaH+ and ial+, and 5 avirulent strains were detected.  Conclusions  The bacterial dysentery of infants in Henan Province is dominated by Shigella flexneri. There are serious resistance and multidrug resistance to common antibiotics, and the dominant genes in different serotyping strains are different.
Status of childhood abuse and mental health in college students with left-behind experience
PAN Gui-xia, LI Bing, WANG Jing, ZHANG Gong-liang, MO Yin, TAO Xin-rong
2019, 23(7): 840-844. doi: 10.16462/j.cnki.zhjbkz.2019.07.019
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Abstract:
  Objective  To explore the mediating role of mental resilience between childhood abuse and mental health of college students with left-behind experience, so as to provide reference for the improvement of their mental health level of.  Methods  350 college students with left-behind experience and 297 college students who did not have such experience were recruited in some science and technology college in Anhui province and assessed with Childhood Abuse Questionnaire (CTQ-SF), the Chinese Mental Resilience Scale (CMRS) and Symptom Check List 90(SCL-90). Correlation analysis and mediation effect analysis were conducted with the collected data.  Results  The level of childhood abuse of college students with left-behind experience was higher than that of college students without left-behind experience (Z=-2.696, P=0.007), and the level of psychological resilience was lower than that of college students without left-behind experience (Z=-3.267, P=0.001).The scores of the Chinese Mental Resilience Scale, Childhood Abuse Questionnaire and Symptom Check List were negatively correlated(r=-0.279, P < 0.001, r=-0.247, P < 0.001). The scores of Childhood Abuse Questionnaire and Symptom Check List 90 were positively correlated(r=0.280, P < 0.001). The direct effect of childhood abuse on mental health problems was 0.247 and the mediation effect of resilience in total effect was 19.02%.  Conclusions  Resilience is a partial mediator between the relation of childhood abuse and mental health. Therefore, intervention activities can be carried out for the college students who have experienced left-behind childhood abuse to improve their overall mental health level.
Predictive study on school absences due to illness with seasonal exponential smoothing method
GU Rong-yan, ZHANG Ling, SONG Xiao-xiao, LI Yan, CAI Le, CUI Wen-long, LIU Wei
2019, 23(7): 845-849, 855. doi: 10.16462/j.cnki.zhjbkz.2019.07.020
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Abstract:
  Objective  To establish a suitable exponential smoothing prediction model for school absentees due to illness, to discuss its application value for predicting school absences due to illness, and to provide a basis for early warning of absence due to illness.  Methods  Numbers of schools absences by year and month due to illness in 30 primary schools from November 2015 to June 2017 were collected from symptom monitoring system of border county, southern Yunnan and Simple seasonal model, Winters addition model and Winters multiplication model were used to build simulation. The data of July 2017 to December 2017 were used for model validation. The three models were overall compared and evaluated through indicator analysis, statistical analysis and residual diagram analysis. The best model was selected to predict school absences due to illness from January 2018 to March 2018.  Results  Simple seasonal model, Winters addition model and Winters multiplication model were used to fit the variation trend of number of school absences due to illness in time series. The root mean square error (RMSE) of three models were 445.11, 420.99 and 258.75; Radj2 were 0.72, 0.72 and 0.77; R2 were 0.92, 0.93 and 0.98; P values of Ljung-Box Q were 0.54, 0.43 and 0.21. As for prediction method linear trend, Alpha were 0.999, 1.000 and 0.298. The average relative error between predicted value and actual value was 9.62%, 21.90% and 7.52%.  Conclusion  Winters multiplication model has practical value to predict school absence due to illness and provide scientific basis for early identification of abnormal signals.
TNF-α rs1800629 polymorphisms in the genetic susceptibility to cervical cancer
DING Bo, SUN Wei, SHEN Yang, CAI Yun-lang, WANG Shi-zhi
2019, 23(7): 850-855. doi: 10.16462/j.cnki.zhjbkz.2019.07.021
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Abstract:
  Objective  To investigate the relationship between tumor necrosis factor α (TNF-α) rs1800629 polymorphisms and cervical cancer risk.  Methods  A case-control study was carried out including 552 patients with cervical cancer and 654 normal controls during the same period. TNF-α rs1800629 polymorphisms were examined by Taqman-Probe assay method. The association between the genotypes and cervical cancer was analyzed by Logistic regression models. Stata 11.0 was used for the Meta-analysis.  Results  Compared with the TNF-α rs1800629 GG genotype, individuals with GA, AA and GA/AA genotypes showed no significant changes in the risk of cervical cancer (all P>0.05). Further Meta-analysis on the relationship between the polymorphisms of TNF-α rs1800629 and cervical cancer also suggested that there was no significant correlation between the genetic variation and the occurrence of cervical cancer.  Conclusion  The polymorphisms of TNF-α rs1800629 may not be related to cervical cancer risk in Chinese population.
Analysis of distribution, phenotype and clinical correlation of CD163 positive macrophages in osteoarthritis
WANG Wen-ming, WANG Li, CHU Hui, ZHOU Ying-bo, SHANG Xi-fu, LI Xiao-mei
2019, 23(7): 856-860. doi: 10.16462/j.cnki.zhjbkz.2019.07.022
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Abstract:
  Objective  The aim of this study was to analyze the distribution characteristics of CD163+ macrophages in peripheral blood and synovium of patients with osteoarthritis (OA), and investigate the correlation of CD163+ macrophages, intracellular tumour necrosis factor(TNF-α), interleukin-10 (IL-10) expression with the disease duration, inflammation level and body mass index (BMI).  Methods  The percentages of CD163+ macrophages in synovium and peripheral blood and their intracellular levels of TNF-α and IL-10 were detected by flow cytometry. Meanwhile, immunofluorescence was uesed to observe the distribution of CD163+ macrophages in synovial tissue of patients with OA or fracture.  Results  (1) There were significant differences in the percentage of CD163+ macrophages in synovial and peripheral blood between OA and fracture patients(all P < 0.05). (2) The expression of TNF-α in CD163+ macrophages of synovium and blood of OA patients with disease duration below 10 years was significantly higher than that of patients with OA disease duration above 10 years (all P < 0.05). The expression of IL-10 was significantly lower than that of patients with OA disease duration above 10 years (all P < 0.05). (3) C-reactive protein (CRP) was positively correlated with BMI in patients with OA disease duration below 10 years (r=0.680, P < 0.001), while showed no correlation with BMI in patients with OA duration above 10 years(r=0.084, P=0.187). (4) Immunofluorescence confocal microscopy showed a large number of CD163+ macrophages invaded around the synovial vessel of patients with OA.  Conclusion  The distribution of CD163+ macrophages in synovium and peripheral blood of OA patients with different course of disease was different, and showed differentiated cell subtypes.
Methologs
Path analysis of health behavior improvement in chronic disease patients based on family function theory
YUN Qing-ping, JI Ying, JIANG Xue-wen, ZHU He, CHANG Chun
2019, 23(7): 861-865. doi: 10.16462/j.cnki.zhjbkz.2019.07.023
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Abstract:
  Objective  To explore the path and effect of family cohesion, family adaptability and health remind on health behavior improvement of chronic disease patients, so as to provide evidences for the family-centered chronic disease management.  Methods  Data of all 1 134 patients with chronic diseases was selected from the national sample survey database. t-test was used to compare family cohesion, family adaptability, health remind and health behavior improvement between different groups, and Pearson correlation was used to analyze the correlation between variables. In the process of path analysis, parameters were estimated by maximum likelihood.  Results  Among the 1 134 chronic diseases patients, male accounted for 41.4%, and female accounted for 58.6%. The average age of participants was (53.6±10.0) years old. The score of health behavior improvement was (1.89±1.20). Path analysis showed that family cohesion had indirect effects on behavior improvement (effect size=0.072); family adaptability had both direct and indirect effects on behavior improvement (effect size=0.156); Health remind had direct effect on behavior improvement (effect size=0.357).  Conclusions  The high-level family cohesion and adaptability can improve patients' health behavior by improving the health remind. It is suggested that family-centered health management services for chronic disease patients should emphasize the participation of family members as well as the improvement of family function.
Analysis on the associated factors of adult urolithiasis in China based on two-level Logistic regression model
LI Yu-si, ZENG Guo-hua, MAI Zan-lin, WU Wen-qi, TAO Tao, GUO Zhuo-yuan, LI Shu-xin, MA Jin-xiang
2019, 23(7): 866-870. doi: 10.16462/j.cnki.zhjbkz.2019.07.024
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Abstract:
  Objective  To investigate the risk factors of adult urolithiasis in China.  Methods  14 areas including 11 communities and 19 villages were randomly selected from 7 provinces of China by multi-stage stratified cluster sampling method during the period of May 2013 to July 2014. Individuals were investigated by a face-to-face questionnaire and a physical examination including urinary tract ultrasonographic examinations, routine blood and urine tests and blood biochemical examination ect.  Results  In total, 1 447 participants were found with the urolithiasis among 9 310 individuals and the overall prevalence was 15.5% (1 447/9 310). The prevalence of urolithiasis was significantly different among 14 areas (χ2=711.523, P < 0.001), the lowest was the village in Shanxi (0.76%) and the highest was the village in Guangdong(35.99%). The intercept-only model further indicated the reginal aggregation for the individuals of urolithiasis (t=2.48, P=0.027) and the ICC was 48.74%. The two-level Logistic regression model showed that the gender (OR=1.235, 95% CI: 1.082-1.411, P=0.005), age (OR=1.101, 95% CI: 1.047-1.158, P=0.001), diabetes mellitus (OR=1.411, 95%CI: 1.192-1.670, P=0.001), family history of urinary calculi (OR=1.867, 95% CI: 1.500-2.323, P < 0.001), LDL (OR=1.150, 95% CI: 1.050-1.260, P=0.006), drinking coffee (OR=1.352, 95% CI: 1.065-1.716, P=0.017) and drinking sodas (OR=1.547, 95% CI: 1.203-1.990, P=0.002) were the risk factors for urolithiasis. By contrast, consumed more fermented vinegar (OR=0.567, 95% CI: 0.498-0.645, P < 0.001) and had a amount of legume (OR=0.726, 95% CI: 0.628-0.839, P < 0.001) were protective factors of urolithiasis.  Conclusion  The prevalence of urolithiasis among adults reveal an aggregation in area-level, influenced by life environment and dietary habits of individual.
Review
A review of gene-gene interaction studies in rheumatoid arthritis
SUN Qing-qing, ZHANG Wei, ZHANG Li-na, WU Xiu-di, CEN Han
2019, 23(7): 871-876, 880. doi: 10.16462/j.cnki.zhjbkz.2019.07.025
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Abstract:
To date, multiple genetic susceptible genes/loci associated with rheumatoid arthritis (RA) have been identified and confirmed through large-scale genetic association studies and genome-wide association study (GWAS). However, the heritability of RA could be not fully explained by these genetic factors, and gene-gene interaction might account for part of the missing heritability. Indeed, genetic interaction study is a critical research direction in the field of genetic epidemiology of RA, and these studies have provided novel insights into the genetic basis and pathogenesis of RA. Additionally, these studies have also provided scientific reference for risk prediction and prevention of RA. This review is aimed to present a summary of recent progress in genetic interaction study of RA, thus implicate further research in this field.
Short Reports
Analysis of Salmonella contamination in food and its detection in cases of infectious diarrhea in Taizhou City from 2015 to 2017
HE Wei-jia, ZHAO Jin, LI Chen, DONG Qing-li
2019, 23(7): 877-880. doi: 10.16462/j.cnki.zhjbkz.2019.07.026
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Abstract:
  Objective  To study the distribution of Salmonella in food and diarrhea cases in Taizhou City.  Methods  339 samples of commercially available food, 201 samples of meat production process and 1 606 stool samples of diarrhea cases were collected. Salmonella was identified and serologically classified according to national food safety standards.  Results  The detection rate of Salmonella in 9 types of foods form 2015 to 2017 was 4.4% (15/339), and the detection rates of raw poultry, raw meat and raw aquatic products were 27.5%, 7.5% and 2.5%, respectively. Among the samples collected during the meat production process, the total detection rate of Salmonella was 6.5% (13/201), and the detection rates of raw materials and intermediate products were 35.7% and 28.6%, respectively. From 2015 to 2017, the average detection rate of Salmonella in stool samples collected from 3 medical institutions was 4.9% (79/1 606). The detection rate of children under 5 years old (7.3%) was higher than other age groups (χ2=20.63, P < 0.01). Among the suspected food items for diarrhea, the top three were poultry and livestock (28.6%), dairy products (25.0%) and fruits (25.0%). A total of 21 Salmonella serotypes were identified from commercially available food and patient samples.  Conclusions  There is a high pollution rate of Salmonella in commercial food and a high detection rate in diarrhea cases in Taizhou City. Food monitoring, supervision and publicity education should be strengthened.
History of Public Health
Poisson distribution and the development of probability theory: Siméon Denis Poisson
XIA Yuan-rui, WU Jun, YE Dong-qing
2019, 23(7): 881-884. doi: 10.16462/j.cnki.zhjbkz.2019.07.027
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Abstract:
Siméon Denis Poisson (1781-1840) was a famous French mathematician, physicist and founder of statistical theory. He established the Poisson distribution model through the criminal trial cases and solved many random phenomena in natural science and social science. He also introduced birth statistics, Poisson's inference theory, Laplace's theorem and error theory, law of large numbers and judgment probability and other related theories. Poisson promoted the development of probability theory in the 19th century and opened up a new trend of physics from experimental research to theoretical research.

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