中华疾病控制杂志

HIV/AIDS prevention strategy with Chinese characteristics

WU Zun-you

2019, 23(8): 885-889. doi: 10.16462/j.cnki.zhjbkz.2019.08.001

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The article reviews major achievements in three broad areas in fighting against HIV/AIDS epidemic in China in past 35 years. Major supportive laws and regulations and policies have been developed and implemented to facilitate national HIV/AIDS programs. The specialized personnel for HIV/AIDS programs have grown up and have played significant roles in the battle against the epidemic. Remarkable achievements have been made in surveillance to monitor the HIV epidemics, in providing care and treatment for people living with HIV, and in providing effective prevention services to key populations at high risk of HIV infection. Challenges are presented and recommendations are provided.

The great contribution of vaccination to the prevention and control of communicable diseases in China

LIU Yuan-bao, JIANG Hu-da-chuan, LING Jing-xin, WU Ying, ZHU Feng-cai

2019, 23(8): 890-893, 898. doi: 10.16462/j.cnki.zhjbkz.2019.08.002

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During the past 70 years since the founding of New China, Chinese public health especially the prevention and control of infectious diseases have made remarkable achievements, which benefited from the vaccination. This study is to summarize the progress of immunization and vaccines, the achievements and contributions of vaccines including polio vaccine, hepatitis B vaccine, diphtheria, tetanus and acellular pertussis combined vaccine, measles vaccine and hepatitis A vaccine to the prevention and control of infectious diseases in China in the past 70 years and to review the research and development of innovative vaccines in China in recent years, which may provide clues for the development of the expanded programe on immunization in China in the future.

The development of military preventive medicine of PLA in the past 70 years of China

CAO Jia

2019, 23(8): 894-898. doi: 10.16462/j.cnki.zhjbkz.2019.08.003

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Since the founding of the new China, military preventive medicine and health prevention workers in army closely around the military strategic approach in the different period of time, has made an important contribution in the maintenance of military health and combat effectiveness. At the same time, as an important health and epidemic force and mobile force in China, the army has actively participated in the disposal of various major public health emergencies and major pestilences outbreaks at the national and local places, and has made great achievements and set up great achievements.

The glorious history of school health development in the 70-year of China

MA Jun

2019, 23(8): 899-903. doi: 10.16462/j.cnki.zhjbkz.2019.08.004

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Student is a special group that is in the process of receiving education and growth and living together in a school environment. School hygiene, also known as child and adolescent hygiene, is a science that protects, promotes and enhances the physical and mental health of children and adolescents and is an important part of preventive medicine. Since the founding of the People's Republic of China, the development of school hygiene/child and adolescent health in China has experienced different development stages. This paper focuses on the discipline system, student health monitoring system, school health education, school health supervision and student disease prevention and control, and summarizes the development history and brilliant achievements of school hygiene.

Spatio-temporal analysis and short-term prediction of the incidence of dysentery in China

ZHANG Meng-yuan, LV Yuan, LIU Tao-cheng, YI Shang-hui, ZHA Wen-ting

2019, 23(8): 904-910. doi: 10.16462/j.cnki.zhjbkz.2019.08.005

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Objective The aim is to analyze the spatial-temporal correlation of dysentery incidence in 31 provinces, municipalities and autonomous regions in China from 2004 to 2016, and to predict the short-term incidence of dysentery in China. Methods Data about the incidence of dysentery from 2004 to 2016 was collected. Arcgis and Geoda were used to create visualized grading maps and analyze spatial correlation. The auto-regressive integrated moving average model (ARIMA)was used to predict the incidence of dysentery in 2017 and evaluate the prediction accuracy of the model. Results The incidence of dysentery in China declined with each passing year from 2004 to 2016. The incidence of dysentery in the western region was significantly higher than the eastern region, except high incidence rate in Beijing and Tianjin. There was no significantly global correlation in the incidence rate, but there was local aggregation. Qinghai had turned from high-level aggregation to low-level accumulation. Inner Mongolia and Shanxi had changed from no local aggregation to low-high accumulation. Shaanxi has long been high-high, and the southeast coastal areas had been low-low accumulation for a long time. The optimal model ARIMA (1, 0, 0) (2, 1, 1)₁₂ was established to predict the incidence of dysentery, and the prediction results were roughly consistent with the observations. Conclusion The incidence of dysentery from 2004 to 2016 is not spatially mobile but clustered. The incidence of dysentery in Beijing, Tianjin, Shaanxi and most of the western regions is severe. The ARIMA model is suitable for forecasting the incidence of short-term dysentery. And our analysis may help prevent and control the incidence of dysentery in China.

Analysis on spatial epidemiological characteristics of human infection with avian influenza A(H7N9) virus in Fujian Province

CHEN Guang-min, ZHENG Kui-cheng, XIE Jian-feng, OU Jian-ming, ZHU Han-song

2019, 23(8): 911-915, 937. doi: 10.16462/j.cnki.zhjbkz.2019.08.006

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Objective The aim is to analyze the spatial epidemiological characteristics for human infection with avian influenza H7N9 in Fujian Province, so as to provide scientific evidence for developing and adjusting related control strategies. Methods The epidemiological data of human infection with H7N9 avian influenza in Fujian Province, from 2013 to 2017 was analyzed by SAS 9.2, ArcGIS 10.3 and SaTScan 9.4 software. Results There were a total of 108 cases and 28 deaths reported in Fujian Province, up to December 31, 2017. The case fatality rate was 25.93%.96.30% of cases were sporadic. There were more incidences in winters and springs, more incidences in rural areas. The global spatial autocorrelation and high/low clustering analysis indicated that clusters at the county level were in the shore areas (Z=3.74, P < 0.001; Z=5.26, P < 0.001). The cities of Changle, Fuqing, Jinjiang and Siming were the high-high clustered areas and local hot-points. There were two clusters, from December 2014 to March 2015, the most likely cluster regions was centered around Zhangpu County with a radius of 63.04 km (RR=4.72, LLR=11.41, P < 0.001). The secondary cluster regions was centered around Fuqing City with a radius of 81.98 km (RR=4.07, LLR=7.96, P=0.037). Conclusions Human infection with avian influenza H7N9 in Fujian Province is spatially and temporally clustered. The measures of prevention and control should be focused on high incidence seasons and key regions, and the surveillance of etiology should be strengthened.

Analysis of epidemiological characteristics of Japanese encephalitis in Sichuan Province from 2008 to 2018 and application of autoregressive integrated moving average model

LIU Li-jun, LIU Yu, ZHOU Xing-yu, ZHANG Jia-ke, LI Wei, QI Qi

2019, 23(8): 916-921. doi: 10.16462/j.cnki.zhjbkz.2019.08.007

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Objective The aim is to describe the epidemiological characteristics of Japanese encephalitis(JE) in Sichuan Province from 2008 to 2018, to build time series autoregressive integrated moving average(ARIMA) model, and to discuss the model application in the prediction of JE incidence trends. Methods Descriptive epidemiological analysis was used to analyze the epidemic situation of JE in Sichuan Province from 2008 to 2018. Monthly surveillance data of JE in Sichuan Province from January 2008 to December 2017 were used to fit ARIMA model. The number of reported cases from January to December in 2018 was used to test the model. Results The epidemic situation of JE in Sichuan Province from 2008 to 2018 showed a downward trend, and eastern and southern areas were the highly prevalent areas. The incidence peak was from July to September every year. Children were the high-risk group, but the incidence of adolescent and adult was on the rise in recent years. ARIMA(1, 0, 0)(2, 1, 0)₁₂ could appropriately fit the time series. Conclusion ARIMA model can be used for short-term prediction of the reported incidence of JE in Sichuan Province.

Epidemiologic characteristics of hepatitis C in Gansu Province from 2004 to 2018

ZHAO Ya-dong, TU Ai-xia, WANG Xiao-rui, WANG Bin

2019, 23(8): 922-926, 931. doi: 10.16462/j.cnki.zhjbkz.2019.08.008

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Objective The aim is to provide scientific evidence for the strategy of prevention and control through analyzing the epidemic characteristics and change tendency of hepatitis C virus infection in Gansu Province. Methods Data of hepatitis C virus infection reported cases in Gansu Province from 2004 to 2018 were collected and analyzed by Excel 2010, SPSS 19.0 and ArcGIS 10.5 software. Results 102 802 hepatitis cases were reported including 42 death cases in Gansu Province from 2004 to 2018. The reported incidence increased from 12.39 per 100 000 in 2004 to 33.92 per 100 000 in 2018 (χ²=9 849.90, P < 0.001).The reported incidence of hepatitis C virus infection showed a rising trends with the aging of the patients (χ²=26 784.53, P < 0.001), and the highest reported incidence was the group of over 80 years(94.09 per 100 000), and exceed 50.00 per 100 000 from the each group of over 50 years. Moreover, the proportion of farmers of the reported cases increased year by year and the proportion of farmers was 67.31% in 2018.The reported incidence rates of 14 cities (autonomous prefecture) in Gansu Province showed an increasing trend. The cities (autonomous prefecture) with the highest reported incidence rates were Wuwei (1 098.42 per 100 000), Zhangye (1 077.69 per 100 000) and Lanzhou City (692.55 per 100 000). Conclusions The epidemic situation of hepatitis C virus infection in Gansu Province is still rising. It is necessary to strengthen the surveillance of key populations and areas, enhance health education, and raise public awareness of hepatitis C virus infection.

Analysis of malaria cases in Haidian District of Beijing from 2005 to 2017

WU Fan, WEI Zhi-sheng, LAI Cai-yun, WANG Yan, GAO Jian-ji, ZHANG Gao-qiang, LI Yue-qi, ZHANG Wen-juan

2019, 23(8): 927-931. doi: 10.16462/j.cnki.zhjbkz.2019.08.009

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Objective To understand the epidemiological character of malaria in Haidian District of Beijing from 2005 to 2017. Methods The epidemiological data of malaria was collected from the infectious disease reporting system of medical institutions at various levels in Haidian District of Beijing from 2005 to 2017, and the epidemiological methods was used to analyze the distribution of malaria in population, time and region. Results From 2005 to 2017, 111 malaria cases were reported in Haidian District of Beijing, the annual average incidence rate was 0.26/100 000 and one death case was reported in 2014. Among the four reported types of falciparum malaria, vivax malaria, three-day malaria and untyped malaria, the most common falciparum malaria (54.5%, 60/111), no mixed infection; The peak incidence was concentrated in the summer and autumn of June-September (52.0%, 58/111); the cases were mainly occurred in young adults aged from 20 to 59(93.7%, 104/111), and the incidence of males was higher than that of females (χ²=52.9, P < 0.001); Cadres were the main ward population (33.3%, 33/111). Malaria cases were reported in 26 streets and towns in Haidian District. 81 cases were imported from abroad, accounting for 71.4% of the total cases, of which 74 (91.36%) were originated from Africa. Conclusions In the past 13 years, the incidence of malaria was sporadic, mainly in imported cases. The monitoring of malaria should be strengthened by entry and exit to prevent the second-generation cases of malaria.

Establishment and verification of preeclampsia risk assessment model

DU Wen-qiong, ZHAO Feng, GUO Ling-ling, SHEN Jia-xin, WANG Ke-ke, WANG Ying, ZHANG Ping, FENG Yong-liang, YANG Hai-lan, WANG Su-ping, WU Wei-wei, ZHANG Ya-wei

2019, 23(8): 981-986. doi: 10.16462/j.cnki.zhjbkz.2019.08.019

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Objective To analyze the risk factors affecting pre-eclampsia, to establish a pre-eclampsia risk assessment model, and to assess the risk of pre-eclampsia early. Methods A face-to-face questionnaire survey was conducted for all women who gave birth in the Department of Obstetrics, the First Hospital of Shanxi Medical University from March 2012 to September 2016. A total of 10 319 qualified questionnaires were collected to exclude 9 623 cases of other hypertensive diseases related to pregnancy. A total of 70% of the subjects were randomly selected as training samples to analyze the influencing factors of pre-eclampsia, and a Logistic regression model was established. The remaining 30% of the objects are used as test samples to verify the effect of the model. Results Logistic regression model was established with training samples. Logit P=-2.517-0.696×Pre-pregnancy lean +0.200×Pre-pregnancy overweight +0.944×Pre-pregnancy obesity -1.995×Residential in city -0.409×Folic acid supplemented before pregnancy +1.323×Twin and multiple pregnancy +1.708×History of previous pregnancy hypertension. Homer-Lemeshow test P=0.377. Model AUC=0.767 (95%CI: 0.747-0.786, P < 0.001). Using the test sample to verify the model, the model sensitivity was 81.68%, the specificity was 75.05%, the positive likelihood ratio was 3.27, and the negative likelihood ratio was 0.24. The test sample model AUC=0.771 (95%CI=0.763-0.790, P < 0.001). Conclusion This study establishes a simple and effective pre-eclampsia risk assessment model with controllable factors. The model has good fit and sensitivity and specificity.

Analysis on the main causes of death and years of life lost among youth aged 18-44 in Chongqing from 2011 to 2016

TAN Qiang, JIAO Yan, ZHANG Rui-yuan, TANG Ping, XIA Yin-yin, CHEN Li-shu

2019, 23(8): 987-991. doi: 10.16462/j.cnki.zhjbkz.2019.08.020

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Objective To estimate the mortality and years of life lost among youth aged 18-44 in Chongqing from 2011 to 2016, so as to provide evidence for development of intervention. Methods The death data of young people in Chongqing from 2011 to 2016 were collected. The disease classification was coded according to the international classification of diseases (ICD-10).Healthcare indexes such as crude and standardized mortality, potential year of life lost (PYLL), potential year of life lost rate (PYLLR), and average years of life lost (AYLL)were analyzed. Results The crude morality and standardized mortality among youth in Chongqing were 92.21 per 100 000 and 78.95 per 100 000, respectively. The top three cause of death were injury and poisoning, tumor and circulation system disease. The mortality rate of male and female were 124.63 per 100 000 and 57.69 per 100 000, respectively. The PYLL of total cause of death for young people was 477 134.10 years, PYLLR was 36.39‰, and AYLL was 39.48 years per person. The top three causes of PYLL and PYLLR due to diseases were the same as the cause of death. Conclusions The mortality rate of young people aged 18-44 in Chongqing shows a general decline from 2011 to 2016. Injury, poisoning and chronic non-communicable diseases are important causes of death and loss of life in young people in Chongqing.

Association analysis between genetic variants in STAT4and pathological characteristics of primary liver cancer

ZHONG Xuan, ZHOU Xin-feng, WEI Zhi-mei, LIU Gui-yan, GAO Yan-hui, YU Xin-fa, CHEN Si-dong, LIU Li

2019, 23(8): 992-997. doi: 10.16462/j.cnki.zhjbkz.2019.08.021

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Objective To investigate the effect of genetic variants in STAT4 and its interaction with exercise on the pathological characteristics of patients with liver cancer. Methods In the 601 new patients with primary liver cancer, multivariate Logistic regression model was used to analyze the genetic association with the risks of advanced stage and portal vein tumor thrombosis at first diagnosis for patients. The multiplicative interaction term and the "Delta" method were used to evaluate the multiplicative and additive interactions, respectively. Results Under the dominant model, the rs897200 variant showed a marginally statistical association with the risk of advanced liver cancer at first diagnosis for patients (adjusted OR=0.64, 95% CI: 0.41-1.01, P=0.057). Carriers of the rs1031507 CC+AC genotype had a lower risk of advanced liver cancer than those with the AA genotype (adjusted OR=0.63, 95% CI: 0.40-0.99, P=0.046). In the crossover analysis, compared with the patients who carried the rs897200 CT+CC genotype and had exercise, the TT genotype carriers being lack of exercise showed an increased risk of advanced cancer (OR=3.71, 95% CI: 1.97-6.98, P < 0.001). Similarly, the rs1031507 AA genotype and the lack of exercise jointly increased the risk of advanced cancer (OR=3.78, 95% CI: 2.01-7.13, P < 0.001). However, no statistical interactions between the genetic factors and exercise were observed for liver cancer stages. Conclusion The genetic variants in STAT4, rs897200 and rs1031507, solely or jointly with exercise, affect the clinical stage of liver cancer at patients' first diagnosis.

Prognostic significance of a long non-coding RNA signature in patients with diffuse large B-cell lymphoma

ZHANG Hui-fang, GAO Qian, WANG Tong

2019, 23(8): 998-1002. doi: 10.16462/j.cnki.zhjbkz.2019.08.022

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Objective To identify the relationship between a set of long non-coding RNA (lncRNA) signature and the prognosis of diffuse large B-cell lymphoma (DLBCL) patients, so as to evaluate their prognostic significance. Methods LncRNA expression profiles and clinical data of DLBCL patients were extracted from the gene expression omnibus (GEO) database: GSE31312 (n=424, training set) and GSE10846 (n=295, validation set). In the training set, a set of 8-lncRNA signature associated with the overall survival (OS) of DLBCL patients was established through least absolute shrinkage and selection operator (LASSO) combined with stability selection method and multivariate Cox regression analysis.Based on this 8-lncRNA signature, the patients in each data set could be classified into high-risk group and low-risk group. The survival curves of patients in both groups were compared by log-rank test. Then three Cox proportional hazard models, namely, international prognostic index (IPI), lncRNA signature and IPI+lncRNA signature model were constructed. The incident/dynamic receiver operating characteristic (ROC) curves method was applied to evaluate and compare their predict accuracy. Results A total of 8 lncRNAs related to the prognosis of DLBCL were found.In the training and validation sets, the difference of survival curves between high-risk group and low-risk group was statistically significant respectively (training set: χ²=73.1, P < 0.001, validation set: χ²=13.4, P < 0.001), the difference of C-index between IPI+lncRNA signature model and either of the other two models were also statistically significant (training set: IPI+lncRNA vs. IPI: Z=76.536, P < 0.001; IPI+lncRNA vs. lncRNA: Z=17.714, P < 0.001;validation set: IPI+lncRNA vs. IPI: Z=42.427, P < 0.001; IPI+lncRNA vs. lncRNA: Z=30.587, P < 0.001). Conclusions The 8-lncRNA signature can be used as a composite prognostic biomarker of DLBCL. Besides, lncRNA combined with IPI has better prognostic predict ability than IPI alone.

Study on iodine nutritional status and total dietary iodine conversion methods of Tianjin adults from non-water-borne high iodine areas

XIN Peng, ZHENG Wen-long, CHANG Gai, LI Jing, PAN Yi, WANG Chong, LI Chang-kun, JIANG Guo-hong

2019, 23(8): 1003-1007. doi: 10.16462/j.cnki.zhjbkz.2019.08.023

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Objective To understand the iodine nutritional status and source distribution of residents aged 18 and above in non-water-borne high iodine areas in Tianjin, and compare the methodological difference between the 3 d dietary survey method and the 24 h urine iodine method when calculate total dietary iodine. Methods According to the Chinese adult chronic disease and nutrition surveillance program, a total of 1 634 inhabitants aged 18 and above were enrolled from Hexi, Nankai, Hongqiao, Wuqing, Jinnan, Baodi and Jizhou district of Tianjin. The total dietary iodine intake was obtained with 3 d dietary recall and condiment weighing method, And the iodine nutritional status of adult residents in Tianjin and iodine contribution rate of each part were described.403 investigators were randomly selected from the 1 634 inhabitants mentioned above for 24 h urine iodine concentration detection, and the difference between 3 d dietary survey method and urine iodine conversion method when calculate total dietary iodine were compared. Results The median dietary iodine intake of adult residents in non-water-borne high iodine areas of Tianjin was 207.13 μg/standard person day, 70.3%respondents were in iodine adequate state. It was found that salt iodine is the main source of total dietary iodine (78.2%), followed by food iodine (13.2%) and water iodine (8.6%). Overall, the dietary iodine intake estimated by 3 d dietary survey method was higher about 10% compared with the result estimated by 24 h urine iodine concentration. Conclusions The adults in the non-water-borne high iodine areas in Tianjin was generally in iodine adequate state. Salt iodine is still the main source of dietary iodine, and little difference is found about the total dietary iodine intake estimated by 3 d dietary survey and 24 h urine iodine conversion method.

Analysis of structural equation modeling on influencing factors for patients with deliberated acute pesticide poisoning

FAN Luo, GUI Li, WEI Jing-yun

2019, 23(8): 1008-1012. doi: 10.16462/j.cnki.zhjbkz.2019.08.024

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Objective To explore the influencing factors of deliberated acute pesticide poisoning (APP), so as to provide prevention and health promotion for the disease. Methods The deliberated APP patients related factors questionnaire was used to investigate deliberated APP and non-deliberated APP patients. The data was analyzed with Structural Equation Modeling. Results APP was directly affected by cognitive factors, psychological factors and social environment factors. Their standardized regression coefficients were -0.831, -0.752 and -0.469 respectively. Cognitive factors had a direct effect on psychological factors and social environment factors. APP was affected indirectly by cognitive deviation, absolutization, copying manner, social support, pesticide management and negative life events. Their standardized regression coefficients were 0.757, 0.541, 0.773, 0.576, 0.824 and 0.782, respectively. Conclusions Paying attention to the influencing factors for deliberated APP patients, improving sociological influencing factors, improving coping style and provide social support and strengthen pesticide management is benefided to reduce the incidence of APP.

Prediction of brucellosis epidemic trend based on ARIMA model

ZHAO Yuan, GUO Zhong-qin, LIANG Pei-feng

2019, 23(8): 932-937. doi: 10.16462/j.cnki.zhjbkz.2019.08.010

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Objective The aims is to predict the monthly incidence of brucellosis in China, in order to understand the epidemic trend of brucellosis in China, to formulate prevention and control strategies, and to provide data support and decision-making basis. Methods The national population and health science data sharing platform was used to collect the national incidence of brucellosis from January 2004 to December 2016 by month. The data were fitted and predicted using ARIMA model with R software. Results In this study, the parameters of the product season ARIMA (2, 1, 2) (2, 1, 1)₁₂ model had statistical significance (all P < 0.001). The model fitted well the monthly incidence of brucellosis in China. The average relative error between the predicted value and the actual value was 21.77%. The monthly average incidence of brucellosis in 2017, 2018, 2019 and 2020 were predicted to be 0.399 5/100 000, 0.423 8/100 000, 0.445 6/100 000 and 0.471 2/100 000 respectively, showing a gradually increasing trend (χ²=14.244, P < 0.001), with a peak incidence from April to July. Conclusion Under natural conditions, the monthly incidence of human brucellosis in China will increase year by year, and corresponding measures should be taken to control it.

Underestimation of weight status among overweight and obese adults in China in 2013

XIA Yun-ting, WU Yan-li, WANG Li-min, ZHANG Ya-li, YAN Hui-min, LIU Shao-bo, XU Ting-ling, ZHANG Mei, HUANG Zheng-jing, ZHAO Zhen-ping, ZHANG Xiao, LI Chun, LI Jian-hong

2019, 23(8): 938-944. doi: 10.16462/j.cnki.zhjbkz.2019.08.011

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Objective The aim is to understand the underestimation of body weight status and its associated factors among overweight and obese adults in China. Methods Nationally representative data were collected in 2013 by the China Chronic Disease and Risk Factor Surveillance which used a multistage stratified cluster sampling method. A total of 87 552 overweight and obese adults aged ≥ 18 years old were included. Demographic characteristics, weight perception and disease status were obtained from in-person interviews. Height, weight and blood pressure were measured through physical examination. Venous blood samples were obtained and assayed for fasting plasma glucose, 2-hour oral glucose tolerance test, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Complex sampling was weighted and multiple logistic regression models were used for analyzing. Results Among overweight and obese adults, 74.7% (95% CI: 73.3%-76.1%) underestimated their weight status. The mild underestimation rate was 60.7% (59.6%-61.7%) while the severe was 14.0% (13.1%-14.9%). The aged, low education level, low annual income, rural area and obesity were risk factors for both weight status underestimation and severe underestimation (all P < 0.05). Awareness of having hypertension and dyslipidemia were protective factors (all P < 0.05). Conclusions Most overweight and obese adults in China underestimated their own weight status, which was affected by age, education and income level, awareness of having chronic diseases and other factors. Targeted interventions should be carried out for different characteristic groups.

A prospective study on the association between body mass index and all-cause mortality in type 2 diabetic patients

LI Ying, SU Jian, YU Hao, QIN Yu, LUO Peng-fei, PAN En-chun, ZHANG Ning, SHEN Chong, ZHOU Jin-yi, WU Ming

2019, 23(8): 945-950. doi: 10.16462/j.cnki.zhjbkz.2019.08.012

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Objective The aim is to investigate the association between body mass index (BMI) and risk of all-cause mortality among patients with type 2 diabetes. Methods A total of 17 638 patients with type 2 diabetes registered in the management of National Basic Public Health Services in two areas of southern and northern Jiangsu were recruited. Cox proportional risk regression model was used to calculate the hazard ratio(HR) value and 95% confidence interval (95% CI) of different BMI groups in the follow-up period. Results The subjects were followed up for a total of 77 451 person-years with an average duration of 4.39 years, and 1 274 patients died during the follow-up period. The number of death in low weight group (BMI < 18.5 kg/m²), normal weight group (18.5 kg/m² ≤ BMI < 24 kg/m²), overweight (24 kg/m² ≤ BMI < 28 kg/m²) and obese group (BMI ≥ 28 kg/m²) were 39, 575, 484 and 176 respectively.The corresponding mortalities were 15.6%, 9.5%, 6.2% and 5.1%, respectively. Compared to normal weight group, the adjusted HR of all-cause mortality in low weight, overweight and obese group were 1.66 (95% CI: 1.20-2.30), 0.68 (95% CI: 0.61-0.77), 0.58 (95% CI: 0.48-0.68), respectively. Conclusions Low-weight patients have the highest risk of all-cause mortality compared with normal counterparts, while both overweight and obese people have a lower risk of death. Overweight and obesity may reduce the risk of all-cause mortality in type 2 diabetic patients.

Epidemiology investigation of type 2 diabetes mellitus and its associated renal insufficiency in a community-based population in Shanghai

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

2019, 23(8): 951-955, 976. doi: 10.16462/j.cnki.zhjbkz.2019.08.013

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Objective To investigate the prevalence and related factors of type 2 diabetes mellitus(T2DM) and its associated renal insufficiency in adult residents of a community in Shanghai. Methods A total of 9 257 residents aged 20-75 years old in a community of Shanghai were selected by random cluster sampling. All participants were interviewed to complete questionnaires, physical examination, examination of blood, urine and common biochemical indicators for T2DM, renal insufficiency and other related factors. Then the SPSS 19.0 software was used for analysis. Results Of the 9 257 respondents, eligible data of 8 207 subjects were enrolled in the study. The prevalence of T2DM was 12.7% (95% CI: 12.0%-13.4%), and the prevalence of its associated renal insufficiency was 15.4% (95% CI: 12.3%-18.4%), and majority of patients (65.8%) were in the early stage. Among the T2DM patients in this survey, the prevalence of renal insufficiency in obese patients was higher than that in patient with the normal body mass index. Logistic regression analysis showed that elder (OR=1.35), central obesity (OR=1.50), hyperuricemia (OR=2.51) were independent risk factors related with renal insufficiency in T2DM patients. Conclusions Renal insufficiency has become one of the important public health problems in T2DM patients. It shows a more urgent need for early prevention and control of CKD to prevent the incidence of end-stage renal disease and related complications in T2DM patients with advanced age, obesity, and hyperuricemia.

The relationship between arterial stiffness and complex profiles of blood lipid in hypertensions

SI Xiao-bei, LIU Wei

2019, 23(8): 956-960. doi: 10.16462/j.cnki.zhjbkz.2019.08.014

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Objective To further explore the relationship between blood lipid and arterial stiffness by complex blood lipid profiles. Methods 431 subjects with hypertensions or inpatients with suspension of atherosclerosis-related diseases were included. The subjects were grouped into Group A (no history of hypertension and dyslipidemia), Group B (with history of dyslipidemia but not hypertension), Group C (with history of hypertension but not dyslipidemia) and Group D (with history of hypertension and dyslipidemia). The profiles of atherogenic index of plasma(AIP), non-high density lipoprotein-cholesterol (non-HDL-C), TC/HDL-C and atherogenic index (AI) were calculated based on lipid indexes of total cholesterol (TG), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Brachial-ankle pulse wave velocity (baPWV) as well as blood lipid profiles were analyzed with comparisons and correlation analyses among groups. Results Total TC, TG, HDL-C, AIP, AI, non-HDL-C and TC/HDL-C were different with statistical significance (all P < 0.05). Multivariate linear partial correlation analysis of hypertensions showed that TG, HDL-C, AIP, AI, TC/HDL-C (all P < 0.05), but not TC, LDL-C and non-HDL-C (all P>0.05) were correlated to baPWV. Conclusion The blood lipid profiles of AI, AIP and TC/HDL-C may be correlated to baPWV, which may better reflect the trend of blood lipid and arterial stiffness in hypertensions.

Multilevel model analysis for influencing factors of readmission in coronary heart disease patients with heart failure

HAN Qiang, TIAN Jing, YAN Jing-jing, LI Chen-hao, YANG Hong, WANG Ke, HAN Qing-hua, ZHANG Yan-bo

2019, 23(8): 961-965. doi: 10.16462/j.cnki.zhjbkz.2019.08.015

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Objective To explore the influencing factors of readmission in coronary heart disease patients with heart failure by constructing a multilevel Cox regression model. Methods A total of 1 433 coronary heart disease patients with heart failure were consecutively enrolled, from two hospitals in Shanxi Province from January, 2014 to December, 2017. Patients' medical records (including baseline data, examination and treatment) were recorded and patients were followed up. The median follow-up period was 23 months. Univariate Cox regression analysis and mutivariate Cox regression analysis were used to screen the independent variables. Two-level Cox regression model was used to analyze the influencing factors. Results Rehospitalization occurred in 436(30.4%) cases. Two-level Cox regression model showed that advanced age(HR=1.010, 95% CI: 1.001-1.019, P=0.032), male(HR=1.234, 95% CI: 1.009-1.509, P=0.040), physical labor(HR=1.458, 95% CI: 1.036-2.050, P=0.030), urban medical insurance (HR=1.513, 95% CI: 1.120-2.043, P=0.007), and prolonged QRS interval (HR=1.004, 95% CI: 1.001-1.008, P=0.018) were independent risk factors for readmission coronary heart disease patients with heart failure. High urine specific gravity(HR=0.000, 95% CI: 0.000-0.059, P=0.021) was a protective factor. Conclusions The age, gender, occupation, urban medical insurance, QRS intervall, and urine specific gravity are influencing factors of readmission in coronary heart disease patients with heart failure. Strengthening clinical nursing and monitoring and perfecting social security system can reduce the occurrence of patients' rehospitalization.

Anxiety, depresson status of adolescent females and prediction of related influencing factors in Hunan Province

WANG Ting, ZHOU Yan-hui, LUO Yang

2019, 23(8): 971-976. doi: 10.16462/j.cnki.zhjbkz.2019.08.017

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Objective To explore the prevalence and influencing factors of anxiety and depression among adolescent females. Methods Adolescent females aged 10-19 years in Hunan Province were investigated by general information questionnaire, menstrual status questionnaire, generalized anxiety scale (GAD-7) and patient health questionnaire depression scale (PHQ-9). Results A total of 2 575 adolescent females were included. The prevalence of anxiety was 9.6%, while the prevalence of depression was 16.4%. Multivariate Logistic analysis showed that among the overall adolescent females, not studying at school, no physical/mental violence, longer average sleep time, no menarche were protective factors for anxiety while higher education level was risk factor; not studying at school, no physical/mental violence, no menarche were protective factors for depression while higher education level was risk factor (all P < 0.05). Among the adolescent females with menarche, not studying at school, no physical/mental violence, longer average sleep time, no dysmenorrhea in the past six months were protective factors for anxiety/depression while higher education level and irregular menstrual cycle in the past six months were risk factors (all P < 0.05). Conclusions There is a certain degree of anxiety and depression among adolescent females in Hunan Province. It is suggested that more interventions should be strengthened for high-risk groups.

Prediction of maternal and child health care indicators in China based on GM(1, 1) model

ZHU Li-ling, MENG Fan-jun, YANG Di

2019, 23(8): 977-980, 1007. doi: 10.16462/j.cnki.zhjbkz.2019.08.018

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Objective To study the predictive effect of model[GM(1, 1)] in China's maternal and child health indicators, and to predict the future maternal and child health indicators in a short-term, and provide a scientific basis for the gradual improvement of maternal and child health care services in China. Methods The maternal mortality rate (MMR), neonatal mortality rate (NMR), infant mortality rate (IMR) and under-five mortality rate (U5MR) were collected from 2008 to 2017 in China. Models were established and MATLAB 2018b software was used for predictive analysis. Results The prediction models of maternal mortality rate, neonatal mortality rate, infant mortality rate and under-five mortality rate were as follows: ${\rm{\hat x}}\left( {{\rm{k}} + 1} \right) = - 476.08{{\rm{e}}^{ - 0.09{\rm{k}}}} + 510.28({C_1} = 0.165,{P_1} = 1.000)$, ${\rm{\hat x}}\left( {{\rm{k}} + 1} \right) = - 108.43{{\rm{e}}^{{\rm{ - 0}}{\rm{.09k}}}} + 118.63({C_2} = 0.043,{P_2} = 1.000)$, ${\rm{\hat x}}\left( {{\rm{k}} + 1} \right) = - 160.60{{\rm{e}}^{ - 0.09{\rm{k}}}} + 175.50({C_3} = 0.085,{P_3} = 1.000)$, ${\rm{\hat x}}\left( {{\rm{k}} + 1} \right) = - 224.37{{\rm{e}}^{ - 0.08{\rm{k}}}} + 242.87({C_4} = 0.124,{P_4} = {\rm{ }}1.000)$, the average relative errors were as follows: 3.46%, 0.67%, 1.75% and 2.36%。 Conclusions The GM (1, 1) is suitable for the prediction of maternal and child health indicators in China, and the fitting accuracy is high. It is predicted that the indicators will continue to decline year by year in the next three years, and relevant departments should strengthen the management work in a targeted manner.

The influencing factors of depression status of the disabled elderly in rural areas of China

LIU Hao, LI Qiang, XUE Xing-li

2019, 23(8): 966-970. doi: 10.16462/j.cnki.zhjbkz.2019.08.016

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Objective To underst and the depression status of disabled elderly in rural areas and to explore its influencing factors. Methods Based on the data of China health and retirement longitudinal study (China health and retirement longitudinal study, CHARLS) in 2015, 836 respondents were enrolled. Order logit model was used to analyze the influencing factors of depression status of disabled elderly in rural areas of China and the heterogeneity of the sample was estimated by the degree of disability. Results 55.74% of the disabled elderly in rural areas had mental sub-health, of which 35.05% were in general depression status and 20.69% were in poor depression status.The basic characteristics, living conditions, health status, socio-economic characteristics and intergenerational support affected the depression status of rural disabled elderly in varying degrees. There was no statistically difference in the influence of the number of children on the depression status in the total sample, but the number of daughters (OR=1.416, 95% CI: 1.055-1.901, P=0.020) and sons (OR=2.012, 95% CI: 1.579-2.564, P=0.043) had negative effect on the depression status of moderate and severe rural disabled elderly respectively. Same village with grandchildren (OR=0.732, 95% CI: 0.554-0.966, P=0.028) had statistically difference in the influence on the depression status of rural disabled elderly, it had positive effect on the depression status of severe rural disabled elderly (OR=0.527, 95% CI: 0.341-0.813, P=0.034). Conclusion The depression status of the disabled elderly in rural areas is affected by multiple factors. The phenomena of "raising children and preventing old age" and "more children and more happiness" are gradually disappearing. The phenomenon of "next generation relatives" still exists.

Epidemiological characteristics of mumps in Hefei City from 2011 to 2016

JIANG Chun-xiao, YOU En-qing, LIU Zhen-wu, CHEN Li-li, WU Hua-bing, HUANG Fen

2019, 23(8): 1013-1016. doi: 10.16462/j.cnki.zhjbkz.2019.08.025

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Objective To analyze the epidemiological characteristics of mumps in Hefei City from 2011 to 2016, in order to provide a basis for effective prevention of mumps. Methods The data of mumps in Hefei City from 2011 to 2016 was analyzed by descriptive epidemiology. Results There were a total of 9 678 cases of mumps in Hefei City from 2011 to 2016. The average annual incidence was 22.7/100 000, with the highest in 2013 being 40.56/100 000. Mumps had obvious seasonality with high incidence in spring. Mumps cases increased in winter but the peak was not distinct. The group with the largest number of cases was mainly students, accounting for 64.5% of the total number of cases, followed by childcare and residentially-scattered children. The average annual morbidity of nine counties existed differences(χ²=256.845, P < 0.001). Conclusions There was a high incidence of mumps in Hefei City from 2011 to 2016. More effective measures should be taken to prevent the incidence of mumps and reduce the spread of mumps virus.

Comparison on local dengue fever outbreaks in public place in Shenzhen and Hong Kong in 2018

LI Xue-mei, GU Li-si, SUN Yu-shan, XU Zhen-dong, YU Hai-hang, LUO Shi-li

2019, 23(8): 1017-1020. doi: 10.16462/j.cnki.zhjbkz.2019.08.026

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Objective To compare epidemiology characteristics and control measures of dengue fever (DF) outbreaks in public places in Shenzhen and Hong Kong and integrate the advantages for better response to DF outbreaks. Methods Data of DF cases and mosquito vector surveillance in Shenzhen and Hong Kong were collected for descriptive epidemiological analysis and measures of mosquito control were compared. Results A total of 19DF cases were recorded in 13 d among six districts of Hong Kong, the male: female ratio was 1:0.9. In Shenzhen, 20 cases were recorded in 33 d, the cases were distributed in three sub-districts, the Male: female ratio was 1:0.82; Age difference between Shenzhen and Hong Kong was statistically significant (Z=-2.855, P=0.004). The time interval between date of onset and laboratory confirmation ranging from 5.5 to 8.5 d (median: 7d) in Hong Kong, and ranged from 1.5 to 5.4 d (median: 2 d) in Shenzhen, the difference was statistically significant (Z=-3.818, P < 0.001). On the 4th day of the outbreak, Hong Kong declared 30 d closure for anti-mosquito operations with a range of 500 m, and monthly area ovitrap index (AOI) was used to monitor the territory-wide situation of Aedes albopictus. On the 2nd day of the outbreak, Shenzhen declared source closure for mosquito control with a range of 400 m and emergency vector surveillance was conducted, using Breteau Index (BI) and Human-baited double net trap(HDN) every 3 d. Conclusions The nature, scale, time and place of the two local DF outbreaks in Shenzhen and Hong Kong are similar. The prevention and control system is more sensitive and prompt, the ability of early detection is stronger, mosquito vector surveillance program is more comprehensive and the frequency is higher in Shenzhen. The epidemic information dissemination and risk communication with media is more active, mosquito management and control is more professional in Hong Kong.

Practice with erudition, patriotism with sincerity: in memory of Wu Lien Teh, a plague fighter and pioneer of public health in China

MAO Yan-mei, WU Jun, PAN Hai-feng, YE Dong-qing

2019, 23(8): 1021-1024. doi: 10.16462/j.cnki.zhjbkz.2019.08.027

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Wu Lien Teh (1879-1960), a world-renowned health and epidemic prevention expert, was a pioneer in public health and medical education in China. With his scientific ideas and methods, he extinguished the plague epidemic in northeast China which shocked the world at the beginning of the 20th century. He proposed and enriched the theory of pneumonic plague, and his work marked a milestone in the world's plague prevention and treatment. He established a scientific health and epidemic prevention system in China, promoted the reform of medical education, established modern medical institutes and hospitals, founded the Chinese Medical Association, helped reclaim the right of port quarantine, strengthened the anti-opium campaign, and promoted cultural exchanges between Chinese and western medicine. He was knowledgeable and far-sighted, and committed to the practice and research of infectious disease prevention and treatment, promoting the development of China's public health, which has a far-reaching impact on China and the world.

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2019 Vol. 23, No. 8

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Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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