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CN 34-1304/R ISSN 1674-3679

2020 Vol. 24, No. 11

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Literature Review
The designs for outbreak investigation: an example of acute hepatitis E outbreak
ZHU Yi-min, LI Ya-xin, MU Yu-tong, KAN Hui, ZHANG Miao, FAN Wei, LI Yi-jie, ZHENG Ying-jie
2020, 24(11): 1241-1245,1347. doi: 10.16462/j.cnki.zhjbkz.2020.11.001
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Once a disease outbreak is established, it means that disease outcome (and its cause or suspected exposure) has already occurred. Outbreak is one of the indicators for the epidemic intensity of a disease. Although it does not have any design elements, there are many design options for its investigation. This article uses a single hepatitis E outbreak example to investigate on the students and obtain three answers to students' judgments on the design type: cross-sectional design, case-control design and historical cohort design. With the help of causal thinking and causal diagrams, this article finds the example do not meet the designs above: only the cases for outbreak confirmation were known and can possibly be measured twice, the exposure is unknown before the investigation, and two measured temporal sequences between measured exposure and outcome existed. Based on the representativeness of the survey population and the two-time identifying characteristics of the outbreak cases, this example could be considered as a cross-sectional cohort study which is a cross-sectional study of the current population based on a hypothetical historical population. For the outcome (and the exposure) has already occurred, the accuracy of causal inference depends on the accuracy of their reconstruction history. These results imply that we should strength our understanding of such research based on reconstruction history.
Original Articles
Effects of environmental exposure during pregnancy on preterm birth and low birth weight: a cohort study
YUE He-xin, FENG Ya-hui, ZHAN Yong-le, SHI Ying-jie, CHEN Yun-li, WANG Ya-wen, WU San-san, CAI Shu-ya, MA Hai-hui, JIANG Yu
2020, 24(11): 1246-1251. doi: 10.16462/j.cnki.zhjbkz.2020.11.002
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  Objective  To investigate the relationship between maternal environmental exposure during pregnancy and neonatal preterm delivery and low birth weight.  Methods  A self-designed questionnaire of environmental exposure during pregnancy was used, including factors such as passive smoking, ventilation, decoration, gutter, garbage station, chemical plant, high temperature, radiation, noise, dust and others. A questionnaire survey was conducted among pregnant women in the Chinese Maternal Pregnant Women Cohort Study, and the birth status of newborns was collected. Correlation analysis was carried out by logistic liner regression model.  Results  A total of 6 189 pregnant women recruited were in our study, including 283 cases of premature birth (4.57%) and 202 cases of low birth weight (3.26%). After adjusting for age, nationality, registered residence, education, occupation, annual family income, pre-pregnancy body mass index (BMI) and parity other factors, logistic liner regression model showed that pregnant women exposed to noise during pregnancy were more likely to have preterm delivery than those who were not exposed to noise during pregnancy (OR=1.668, 95% CI: 1.197-2.323). Pregnant women who were exposed to high temperatures at work or at home during pregnancy were more likely to have preterm labor than those who were not (OR=2.237, 95% CI: 1.171-4.274). For other environmental exposure factors, no association were found with preterm delivery and low birth weight.  Conclusions  Exposure to noise and high temperature during pregnancy may be the risk factors of preterm delivery. Actively carry out health education to reduce the noise and high temperature exposure of pregnant women in the working and living environment, may help to reduce the risk of preterm delivery.
The immune response to hepatitis B vaccine and its influencing factors of infants born to HBsAg positive mothers
HU Ni, LI Fang, XU Jing-ning, ZHANG Ying, YAN Min, LIU Cun, ZHANG Lei
2020, 24(11): 1252-1256. doi: 10.16462/j.cnki.zhjbkz.2020.11.003
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  Objective  To obtain the probability of no/weak immune response to the hepatitis B vaccine of infants born to HBsAg-positive parturients, so as to analyze its influencing factors.  Methods  A study of 284 pairs of HBsAg-positive pregnant women and their infants who gave birth at the Northwest Women and Childre's Hospital of Shaanxi Province from January 2016 to April 2017 was carried out to follow up of infant hepatitis B vaccination and the production of serological markers.  Results  The rate of immune deficiency and weak response in high-risk children was 10.57%. The rate of immune deficiency and weak response in pregnant women with "HBsAg+, HBeAg+, HBcAb+" infection pattern was 19.64%, which was significantly higher than that of pregnant women in "HBsAg+, HBeAb+, HBcAb+" mode, which was 9.89% (RR=1.99, 95% CI: 1.01-3.92, P < 0.001). The risk of HBsAg-positive mothers with puncture history during pregnancy was 6.72 times higher than that of children with no puncture history (RR=6.72, 95% CI: 2.79-16.19, P=0.049). The liver function albumin (ALB) of the mothers who had immune deficiency and weak response to hepatitis B vaccine in young children was significantly lower than that in the strong response group (t=2.518, P=0.013). The liver function-to-white ratio (A/G) of the mothers who had immune deficiency and weak response to hepatitis B vaccine was significantly higher than that of the strong response group (t=-5.559, P < 0.001).  Conclusions  Children born to HBsAg positive mothers are at high risk of immune deficiency and weak response to Hepatitis B vaccine and intrauterine transmission of hepatitis B. Therefore, we should focus on monitoring the HBsAb production of these people. Invasive testing during pregnancy may increase the risk of immune deficiency and weak response to Hepatitis B vaccine in young children. Children have a higher hepatitis B vaccine deficiency and weak response rate when their mother's serological testing remains "HBsAg+, HBeAb+, HBcAb+" mode.
Study on association between lipid levels and HCV infection in remunerated blood donation
WANG Yan, HUANG Peng, YE Xiang-yu, NI Ze-yang, WANG Qiu-wei, HOU Yu-qing, YU Rong-bin
2020, 24(11): 1257-1262. doi: 10.16462/j.cnki.zhjbkz.2020.11.004
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  Objective  To explore the correlation between hepatitis C virus (HCV) infection and lipid, and determine the influencing factors of dyslipidemia in remunerated blood donation.  Methods  From March to May 2015, a cross-sectional study was conducted among people over 50 years old in Jiangsu Province. We obtained demographic data and related measurements through questionnaire surveys and blood test. We compared the lipid levels of different HCV infection groups. The influencing factors of dyslipidemia were explored by univariate and multivariate Logistic regression analysis.  Results  Of a total of 1 537 participants were included, of which 1 234 (80.3%) were uninfected HCV, 117 (7.6%) were HCV spontaneous clearance, and 186 (12.1%) were HCV persistent infection clients. Differences in serum TG and TC levels among the three groups after PSM were statistically significan (all P < 0.05), and those were lower in the participants with persistent infection than the other groups. Dyslipidemia occurred in 286 participants and the prevalence was 18.6%. Multivariate Logistic regression analysis showed that sex (OR=1.41, 95%CI: 1.06-1.87, P=0.018), higher fasting plasma glucose (OR=2.54, 95% CI: 1.75-3.68, P < 0.001) and HCV persistent infection (OR=0.22, 95% CI: 0.12-0.41, P < 0.001) were independent influencing factors for dyslipidemia.  Conclusions  The serum levels of TG and TC are lower in patients with persistent infection than those uninfected or with spontaneous clearance in remunerated blood donation. HCV infection, sex and fasting plasma glucose are related with dyslipidemia.
Epidemiological characteristics and trend prediction of pertussis in Hunan Province from 2009 to 2018
TAN Hui-yi, LI Chun-ying, XIAO Lan, LIU Fu-qiang, WU Cheng-qiu
2020, 24(11): 1263-1268, 1281. doi: 10.16462/j.cnki.zhjbkz.2020.11.005
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  Objective  Analyzing the epidemiological characteristics of pertussis in Hunan Pro-vince from 2009 to 2018, and establishing an autoregressive moving average model, to provide scientific basis for the prevention and control of pertussis.  Methods  The surveillance data of pertussis in Hunan Pro-vince during 2009-2019 were collected from the infectious disease reporting information management system, and the epidemiological characteristics of pertussis were analyzed. A prediction model was established based on the monthly incidence date fron January 2009 to December 2018, and the pertussis incidence of 2020 was predicted.  Results  2 530 pertussis cases were reported in Hunan Province from 2009 to 2018 with an average annual incidence of 0.371/100 000. The incidence of pertussis was relatively higher between May and September, which was lower between October and April of the next year. The incidence was higher in Loudi, Yiyang, Changsha and Chenzhou. The incidence of pertussis in male was higher than that in female, and the reported cases were mainly composed of scattered children, preschool children and students. ARIMA (0, 1, 1) × (0, 1, 0)12 was the optimal prediction model, and the incidence of pertussis in 2019 was basically consistent with that predicted by the model. The incidence of pertussis predicted by ARIMA in 2020 was 7.642/100 000, which was higher than that in 2019.  Conclusions  Pertussis began to break out in Hunan Province in 2018, and the incidence continued increasing. The phenomenon of "pertussis recurrence" may exist in Hunan Province. ARIMA model was effective in predicting the short-term incidence trend of pertussis, and it was predicted that the incidence level will continue increasing in 2020, so the epidemic prevention and control strategy of pertussis should be adjusted according to the epidemiological characteristics and specific situations in Hunan Province.
Analysis of spatial clustering and influencing factors of hand, foot, and mouth disease in Nanning based on Nuclear Density and Geodetector
PAN Meng-hua, HUANG Bing, LI Yan-ning
2020, 24(11): 1269-1274, 1331. doi: 10.16462/j.cnki.zhjbkz.2020.11.006
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  Objective  To analyze the spatial clustering and influencing factors of hand, foot and mouth disease (HFMD) in Nanning during the period from 2008 to 2015, so as to provide reference for HFMD prevention and control in Nanning.  Methods  The information about HFMD in Nanning from 2008 to 2015 was collected, spatial clustering was analyzed by nuclear density, and the effects of meteorological factors and socioeconomic factors on HFMD incidence was analyzed by Geodetector.  Results  A total of 326 785 HFMD cases were reported from 2008 to 2015 in Nanning. The average annual incidence was 505.24/100 000 with the peak incidence concentrating from April to July. The nuclear density analysis showed that there was obvious spatial clustering of HFMD. The areas of clustering in all eight years were the junction of five districts: Xingning District, Qingxiu District, Jiangnan District, Liangqing District and Xixiangtang District, and the parts of Mashan County. The Geodetector analysis revealed that meteorological factors had stronger impact on HFMD than socioeconomic factors, and the interactive effects between factors were stronger than their individual effects. Both the individual and interactive effects of temperature and relative humidity were the strongest, with interactions up to a maximum q value of 0.71 (P < 0.001).  Conclusions  The meteorological factors could have stronger effects on the HFMD incidence in Nanning from 2008 to 2015, the effects of socioeconomic factors may be bi-directional, urban areas and some grassroots areas should be concerned for prevention and control.
Effect of temperature on hand, foot and mouth disease incidence in QuJing: a distributed lag non-linear model analysis
SHEN Xiu-lian, ZHENG Er-da, HUANG Tian, PENG Xia, HE Ji-bo
2020, 24(11): 1275-1281. doi: 10.16462/j.cnki.zhjbkz.2020.11.007
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  Objective  To explore the impact of meteorological factors on the incidence of hand-foot-mouth disease (HFMD) in Qujing and its lag effect.  Methods  The distributed lag non-linear model (DLNM) was used to analyze the delayed and cumulative effects of meteorological factors on incidence of HFMD in Qujing from 2017 to 2019.  Results  A total of 25 902 HFMD cases were reported in Qujing from 2017 to 2019. The daily number of HFMD cases was positively correlated with daily average temperature and rainfall, but negatively correlated with sunshine duration. Temperature was the most significant effect on the incidence of HFMD (r=0.51); The daily average temperature of about 20 ℃ had the greatest impact on HFMD (RR=1.408, 95% CI: 1.064-1.864, P=0.017); The daily average temperature without delay had the greatest influence on HFMD, and then gradually decreased until disappeared.  Conclusions  Temperature is an important influencing factor of HFMD in Qujing, and its influence has obvious lag effect. The lag effect of different temperature on different population is obviously different, and the effect of high temperature is more significant.
Epidemiological characteristics and spatiotemporal clusters of mumps at the stage of expanding immunization program in Henan Province
XIAO Zhan-pei, LU Ming-xia, WANG Chang-shuang, WANG Yan, MA Ya-ting, ZHANG Ming-yu, ZHANG Yan-yang
2020, 24(11): 1282-1286. doi: 10.16462/j.cnki.zhjbkz.2020.11.008
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  Objective  To analyze the spatiotemporal distribution and clustering of incidence on mumps in Henan Province during 2008-2019, so as to provide suggestions for control and prevention of mumps.  Methods  A database was established in the Infection Disease Reporting Information System in China. Descriptive methods were used to analyze the distribution characteristics of mumps in Henan Province during 2008-2019. A spatial distribution map was drawn, with trend analysis and space-time clustering used to study the mumps, by using both ArcGIS 10.7 and SaTScan 9.4 software.  Results  A total of 223 499 mumps cases were reported in Henan Province during 2008-2019, with an average annual incidence of 19.68/100 000. The majority of patients were from 5 to 10 years old, accounting for 50.61%. The peak of mumps was from March to July and from November to next January.  Results  from the trend surface analysis showed that the incidence of mumps increased gradually from the southern to northern parts, with incidence slightly higher in the eastern than in the western regions. County-level temporal-spatial clusters of mumps were detected in 6 areas. Areas with most clusters of mumps appeared in Anyang District, including 4 counties, during 2008 to 2013.  Conclusions  The overall incidence rate of the mumps was in a stable fluctuation trend and showing obvious characteristics on season. The majority of patients were from 5 to 10 years old. Mumps showed temporal-spatial clustering in Henan Province during 2008-2019. The main clusters dynamically changed. Areas with clusters of mumps appeared in southeast regions in recent two years, suggesting that the prevention and control measures should be further strengthened in these areas.
Analysis of surveillance results of febrile respiratory syndrome in sentinel hospitals in Gansu Province
YUAN Yan, LIU Xin-feng, WANG Li-juan, JIANG Xiao-juan, ZHOU Jian-hui, LI Juan-sheng, MENG Lei
2020, 24(11): 1287-1291. doi: 10.16462/j.cnki.zhjbkz.2020.11.009
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  Objective  To understand the etiological surveillance of febrile respiratory syndrome (FRS) in Gansu Province, and evaluate the monitoring results, so as to provide reference basis for improving its monitoring ability.  Methods  The cases of FRS surveillance in 17 sentinel hospitals were collected in Gansu Province from 2009 to 2019. The method of observational epidemiological study was used to analyze the status of pathogen surveillance and evaluate the surveillance results.  Results  The total testing rate of FRS pathogens was 89.00% in Gansu Province during 2009-2019, and the total detection rate was 31.43%. The detection ability of all pathogens (virus / bacteria) was higher than that of any pathogen (virus/bacteria) (P < 0.001), in which the detection rate of any virus was higher than that of any bacteria (P < 0.05). For all bacteria, the testing rate was lower than that of all viruses (χ2=2 876.656, P < 0.001), but the detection rate was higher than that of all viruses (χ2=84.237, P < 0.001). As for the types of pathogen detection, the testing rate of human influenza virus was the highest (99.93%), and that of rhinovirus was the lowest (53.77%). The bacteria were mostly simultaneous test for Mycoplasma pneumoniae and Chlamydia pneumoniae, but the detection rate was low (4.15%). The clinical symptoms were mainly fever, cough and expectoration, the cases with negative pathogens were prone to fever, chest pain, fatigue and dyspnea. The evaluation of surveillance results showed that the balance of case types and the continuity of sampling time needed to be improved.  Conclusions  The level of FRS pathogen testing is relatively high in Gansu Province. It is recommended that the detection capability of pathogens should be improved by reasonably adjusting the species of pathogen testing, collecting matched specimen types, and repeatedly testing negative cases to improve the monitoring platform and the monitoring system.
Relationship between dietary inflammatory index and overweight/obesity in people aged 35 - 74 years in Yili Prefecture, Xinjiang
FU Wen-hui, LUO Tao, PEI Hua-lian, TIAN Tian, WANG Lu, GULISIYA Hai-li-li, DAI Jiang-hong
2020, 24(11): 1292-1296. doi: 10.16462/j.cnki.zhjbkz.2020.11.010
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  Objective  To analyze the association between dietary inflammation index (DⅡ) and overweight/obesity, and to provide scientific basis for studying the inflammatory mechanism of obesity.  Methods  From January to May 2019, the subjects were all adults aged 35-74 years old in the baseline participating in the Xinjiang multi-ethnic natural population cohort construction and health follow-up study. The general demographic characteristics and behavior patterns of the subjects were collected by using an unified questionnaire. The DⅡ score was calculated from a diet intake assessed by 127 food frequency questionnaires (FFQ).  Results  Among the 2 241 participants, the detection rate of overweight and obesity was 38.51% and 32.04%. Log-binomial regression analyses were used to estimate the prevalence ratios (PRs) and 95% confidence intervals (95% CIs) of DⅡ in relation to overweight/obesity. After adjusting for potential confounders, compared with the 1st quintile group, subjects from the 4th quintile group had a higher risk of overweight/obesity (PR = 1.32, 95% CI: 1.10-1.57, P=0.015). The association between DⅡ and overweight was only found between the 1st quintile group and the 4th quintile group (PR=1.26, 95% CI:1.09-1.47, P=0.002), but compared with the 1st quintile group, subjects from other groups all had higher risk of obesity.  Conclusions  There was a correlation between the dietary inflammatory index and overweight/obesity, the obesity effect of diet could be analyzed from the perspective of inflammation.
Epidemiological characteristics and influencing factors of high risk population of cardiovascular disease in Jilin Province
FU Yao, LIU Si-jie, LIU Ting, HOU Zhu-lin, LI Lu, JIA Yu-yuan
2020, 24(11): 1297-1301. doi: 10.16462/j.cnki.zhjbkz.2020.11.011
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  Objective  To understand the epidemiological characteristics of high-risk population of cardiovascular disease in Jilin Province, and analyze the related influencing factors of cardiovascular disease, so as to provide reference for the prevention and control strategy of cardiovascular disease in Jilin Province.  Methods  Cardiovascular disease is a group of chronic non-communicable diseases involving the circulatory system, including hypertension, stroke, myocardial infarction and other diseases. In this study, 6 project areas in Jilin Province were selected by multi-stage stratified cluster sampling method from 2017 to 2018, and the screening was carried out in communities or villages.Univariate and multivariate Logistic regression analysis was used to analyze the related influencing factors of cardiovascular disease. The regression method was used for the entry method, and the effect value was expressed by OR and 95% CI.  Results  From 2017 to 2018, the high-risk detection rate of cardiovascular diseases in Jilin Province was 24.3%, and the high-risk detection rate after standardization was 21.6%. Among them, urban residents had a higher risk of cardiovascular disease than rural residents (OR=1.16, 95% CI:1.029-1.306, P=0.015); the risk of high-risk detection in 55- year-old group was 3.237 times higher than that in 35-year-old group (95% CI: 2.760-3.797, P < 0.001); those with high school education, technical secondary school education, college education or above were more likely to become high-risk groups of cardiovascular disease (OR=1.499, 95% CI:1.283-1.753, P < 0.001; OR=1.539, 95% CI:1.240-1.910, P < 0.001); the administrative staff were less likely to develop into high-risk groups of cardiovascular disease than farmers (OR=0.656, 95% CI:0.502-0.858, P=0.002); those with annual family income of 10 000~, 25 000~ yuan were more likely to become the high risk group of cardiovascular disease than those with income level of less than 10 000 yuan; the risk of cardiovascular disease in smokers and drinkers was 1.822 and 1.303 times higher than that in non-smokers and non drinkers (OR=1.822, 95% CI: 1.617-2.053, P < 0.001; OR=1.303, 95% CI: 1.090~1.559, P=0.004); with the increase of BMI, the risk of cardiovascular disease detection increased.  Conclusions  We should focus on city residents, senior age group, high education level, middle and low income persons, smokers, drinkers, overweight and obese people. We should focus on primary prevention and secondary prevention of cardiovascular diseases, reduce the incidence rate of cardiovascular diseases and the burden of disease.
Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection
DONG Lin, WANG De-bin, LEI Zu-bao, ZHAO Lei, XU Ping, YANG Wan-chun
2020, 24(11): 1302-1307，1314. doi: 10.16462/j.cnki.zhjbkz.2020.11.012
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  Objective  To analyze the risk factors and pathogen characteristics of adult type 2 diabetes mellitus (T2DM) patients with community-onset bloodstream infection (COBSI) risk, so as to provide theoretical basis for early diagnosis and treatment.  Methods  A total of 293 T2DM inpatients who were admitted to the Second People's Hospital of Hefei from the adult community during 2017/01-2020/03 were retrospectively analyzed, which were divided into bloodstream infection (BSI) group and control group according to the blood results within 48 hours. Based on the analysis of the risk factors, prediction model and test model were constructed. The characteristics of pathogenic bacteria was analyzed on community acquired bloodstream infection (CABSI) group and health care-associated community acquired bloodstream infection (HCABSI) group.  Results  The prediction model was established. P=1/(1+e-y), y=-45.137+0.751×peak body temperature outside the hospital or within 48 h of admission+0.033×neutrophil percentage+0.027×plasma osmotic pressure+0.009×blood C-reactive protein+1.144×kidney failure+1.740×diabetic ketoacidosis. The area under a curve (AUC) of the model was 0.800, 95% CI was from 0.747 to 0.853, and the optimal cutoff value was 0.208 and the sensitivity was 0.90, specificity was 0.56. Hosmer-lemeshow test was performed for the calibration degree of the model, χ2=12.285, P=0.139. There were statistically significant differences (all P < 0.05) between CABSI and HCABSI groups in Gram-negative bacteria (G-), extended-spectrum β-lactamases-producing Escherichia coli, Escherichia coli, Gram-positive bacteria (G+) and Staphylococcus aureus.  Conclusions  Peak body temperature outside the hospital or within 48 hours of admission, neutrophil percentage, plasma osmotic pressure, serum C-reactive protein, kidney failure, and diabetic ketoacidosis are risk factors for COBSI in adult T2DM patients. The prediction model has good sensitivity, and there are differences in pathogenic bacteria between CABSI and HCABSI groups, which has clinical guiding significance for early diagnosis and treatment.
The mediating effect of self-compassion between alexithymia and depressive symptoms in depression patients
LI Qian-qian, DONG Yi, ZHANG Yi-Yin, WANG Kai
2020, 24(11): 1308-1314. doi: 10.16462/j.cnki.zhjbkz.2020.11.013
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  Objective  To assess the self-compassion, alexithymia and depressive symptoms in patients with depression, and to explore the mediating effects of self-compassion between alexithymia and depressive symptoms.  Methods  117 depression patients and 106 healthy subjects were measured using the Chinese version of revised self-compassion scale (SCS-C), the Chinese version of Toronto alexithymia scale (TAS-20). The patients were also assessed with the Chinese version of Beck depression rating scale (BDI), Linear regression analysis model was used to analyze the relationship between self-compassion, alexithymia, depressive symptoms and its dimensions. The mediating effect was tested with AOMS 23.0 software.  Results  Compared with the healthy controls, depressive patients had significantly lower SCS-C total score and the scores of three factors (all P < 0.05). Patients had significantly higher TAS-20 total score and the scores of three factors Compared to healthy controls (all P < 0.05). Correlation analysis model showed in the patients' group, there were significant correlation between SCS-C total score and three subscale score, the total score of TAS-20 and three subscale score and the score of depression symptoms. Regression analysis model showed that alexithymia and the three factors had negative predictive effect on self-compassion; self-compassion and the three factors had negative predictive effect on depressive symptoms; alexithymia and the three factors had positive predictive effect on depressive symptoms. Part of mediator effect of self-compassion was significant between alexithymia and depressive symptoms level.  Conclusions  Depression patients have impairments of self-compassion and alexithymia, and self-compassion is a part of mediator by which alexithymia influence depressive symptoms. Improving the depression patient's level of self-compassion may be one of the interventions to improve depressive symptoms in clinical practice.
Cross-sectional study of patients with severe mental disorders from Bao'an District in Shenzhen
CHEN Qing, LIU Cheng-feng, HAN Ming-hui, QING Li, LU Chu-hong, CHENG Juan, HU Fu-lan, ZHANG Ming, HU Dong-sheng, GUO Yan-fang
2020, 24(11): 1315-1320. doi: 10.16462/j.cnki.zhjbkz.2020.11.014
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  Objective  To understand the prevalence and epidemiological features of six severe mental disorders in Bao'an District, Shenzhen City, so as to provide scientific evidence for developing severe mental disorders prevention and control strategy.  Methods  The patients who were included in the mental health information management system in Bao'an District before 30 June 2019 were selected to analyze their demographic characteristics.  Results  A total of 7 835 patients with severe mental disorders were registered in Bao'an District, 6 408 of whom live in this district. The reported prevalence of six severe mental disorders was 1.97‰, with the highest in Xi'xiang street (2.95‰) and the lowest in Xin'qiao street (0.83‰). Among the six categories of severe mental disorders, schizophrenia was the most common disease (60.82%), followed by bipolar disorder (17.03%) and mental retardation accompanied by mental disorder (15.48%). Patients with severe mental disorders were mainly in age of 18 to 44 years old (61.01%), which had a low level of education and most of them were unmarried. In addition, the prevalence rates of hypertension and diabetes among patients were 1.44% and 1.46%, respectively. The case management rate of severe mental disorders for patients was 3.17%. The annual number of registered cases and reported incidence both showed a bimodal trend from 2010 to 2018.  Conclusions  Schizophrenia is the key disease for prevention and treatment in Bao'an District of Shenzhen City. Patients with different severe mental disorders types have different demographic composition, and the screening and case management of patients with chronic non-communicable diseases need to be further strengthened.
Quality assessment of the therapeutic health information of rare neurological diseases on WeChat official account
LIU Li-li, LAI Xue-feng, LIU Tan-xin, HE Bing-jie, ZHOU Jiang-jie, WANG Sheng-feng, ZHAN Si-yan
2020, 24(11): 1321-1326. doi: 10.16462/j.cnki.zhjbkz.2020.11.015
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  Objective  To assess the quality of online health information about rare neurological diseases on the WeChat official account in China.  Methods  We screened the WeChat official accounts about seven rare neurological diseases, and all existing articles in them were selected. The articles related to the treatment were then included using proportional random sampling. The quality was assessed independently by two well-trained reviewers using the DISCERN. The mean scores of the two observers were used as the final score to assess quality and to further explore the influencing factors for quality.  Results  A total of 28 WeChat official accounts and 173 articles were included for analysis. Medical groups posted most of the articles (50.29%), amyotrophic lateral sclerosis was the most frequently discussed disease (82.66%), and the treatment type of articles mainly focused on the nursing support (49.71%). The whole quality was poor, with a low average score of 30.27±7.20. Most of the articles (86.70%) were graded in the "poor" and the "worst", only 3 (1.73%) articles were in the "good", and no "excellent" articles existed. Most articles did not provide complete sponsor and citation resources, the consequence without treatment, and the co-determination information.  Conclusions  For rare neurological diseases, the quality of health information on the WeChat official account in China was poor based on the credibility and circumstantiality. Future work should strengthen the quality management of key information, such as citation resources and the comparison information between advantages and disadvantages of different treatments, to further ensure the accuracy of therapeutic health information.
Review
Risk factors and prevention of Nipah virus infection
FANG Yi-rong, MA Yan, YE Dong-qing
2020, 24(11): 1327-1331. doi: 10.16462/j.cnki.zhjbkz.2020.11.016
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Nipah virus (NIV) emerged in Malaysia in 1998 and subsequently occurred in Bang-ladesh and India since 2001. In the Malaysia-Singapore outbreak, transmission occurred primarily through contacting with pigs, whereas in Bangladesh and India, it was associated with ingestion of contaminated date palm sap and human-to-human transmission. Risk factors of NIV infection mainly included close contacting with ill pigs, consuming raw date palm sap, and contacting with Nipah cases. At present, no vaccines or antiviral drugs are available for NIV disease and the treatment is just supportive. Nipah virus infections can be prevented by avoiding direct contact with infected patients and host organisms, avoiding of ingestion of date palm sap, frequent hand washing and sanitization while caring for NIV patients. Surveillance for NIV in humans and reservoir animals should be done in affected areas, which helps in detecting early signs of NIV outbreak.
Advances on the relationship between trans fatty acids and chronic diseases
LI Yan-ru, WU Ya, FENG Yue-mei, YIN Jian-zhong
2020, 24(11): 1332-1337. doi: 10.16462/j.cnki.zhjbkz.2020.11.017
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With the change of dietary patterns, dietary trans fatty acids (TFA), which mainly presents in processed foods, accumulates slowly in the body through dietary intake. Scholars have studied the types, sources, structures, and effects of TFA on diseases very early in foreign countries, but the harm of TFA to diseases in China has not attracted enough attention. This article discusses the harm and mechanism of TFA in recent years on obesity, cardiovascular disease, diabetes, non-alcoholic fatty liver, cancer and other chronic diseases, and provides reference for disease prevention and treatment, nutrition and diet guidance, as well as industrial production optimization.
Short Reports
Analysis of COVID-19 epidemic characteristics based on network data
HUANG Jing, ZHAO Qiu-ling, XU Kang, DING Zhu-qing, GUAN An-chen, HUANG Dan-dan, CHEN Yi-heng, LIANG Xiao-hui
2020, 24(11): 1338-1342. doi: 10.16462/j.cnki.zhjbkz.2020.11.018
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Abstract:
  Objective  To analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in order to provide reference for COVID-19 prevention and control.  Methods  Web-Crawler was used to crawl the information of confirmed COVID-19 cases published on "TouTiao" website for statistical analysis.  Results  From Jan 8th to Feb 16th, 2020, 6 814 cases were collected on the website. The cases in provincial capitals and municipalities accounted for 15.13%, in prefecture-level cities and counties accounted for 63.98%, and in rural cases accounted for 13.41%. The number of COVID-19 cases was increased at first and then decreased. The number of confirmed cases in males was 5.85% higher than that in females, and there are statistically significant differences in gender composition of different age groups (x2=36.466, P < 0.001). The number of females was higher than that of males. The median age of the patients was 45 years old, and the number of patients aged from 18 to 45 years was the highest (44.35%). The median incubation was 8 days, 86% of the patients were within 1-14 days. There is no significant difference in days of incubation period between males and females in different age groups (all P>0.05).  Conclusions  People are generally susceptible to COVID-19, and the incubation period is consistent with the pattern of the general virus. Due to the proper measures in China and the short transmission risk period, the epidemic has been contained. The study on the epidemiological characteristics of COVID-19 will provide reference for the strategy formulation of COVID-19 prevention and control and the resumption of work and school in China.
Investigation of family reappear cases after discharge of a COVID-19 case in Wuhan City
MA Lan, LIU Yun-hao, ZHANG Ling, XIE Shu-yun, ZHANG Xue-feng, WU Xiao-min
2020, 24(11): 1343-1347. doi: 10.16462/j.cnki.zhjbkz.2020.11.019
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Abstract:
  Objective  To analyze the epidemiological characteristics of coronavirus disease 2019 (COVID-19) in a family cluster after a patient was discharged from hospital, and to provide recommendations for prevention and control of familial aggregation of COVID-19.  Methods  On-site epidemiological investigation was conducted to collect personal information, exposure history, morbidity, and clinical information of the COVID-19 patients and close contacts. Based on the data, the source of the COVID-19 virus and transmission mode were further analyzed.  Results  There were 3 cases and 1 person tested positive for nucleic acid of the virus in the familial aggregation of COVID-19 infection. The most likely source of infection came from hospital exposure and subsequent transmission among family members. Case C, as the first case, maybe a deceptive cure when she was discharged from hospital. The time of recurrence in the family might be much earlier than the reported time of symptom onset. No evidence was found to support the spread of COVID-19 after her discharge.  Conclusions  It is recommended to strengthen epidemiological investigation, comprehensively analyze clinical and laboratory results, quarantine close contacts of COVID-19 confirmed cases for medical observation, and carry out terminal disinfection of patients' households.
Analysis on epidemiological characteristics of type A and B intestinal infectious diseases in Xinghua City from 1990 to 2019
YOU Jin-hui, WEI Ping-min, DONG Dao-gen
2020, 24(11): 1348-1351. doi: 10.16462/j.cnki.zhjbkz.2020.11.020
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Abstract:
  Objective  To explore the incidence trend and epidemic features of type A and B intestinal infectious diseases, and to provide scientific basis for prevention and control.  Methods  Data of type A and B intestinal infectious diseases reported in Xinghua from 1990 to 2019 were analyzed by descriptive epidemiology.  Results  A total of 30 282 cases with 7 categories of type A and B intestinal infectious diseases were reported in Xinghua from 1990 to 2019.The average annual incidence was 69.66 per 100 000 population. The incidence showed a decreasing trends (x2=56 574.719, P < 0.001) with 161.30 per 100 000, 21.29 per 100 000, and 18. 35 per 100 000 in the 1990-1999, 2000-2009, and 2010-2019 periods respectively.The main distribution of cases were hepatitis A and typhoid and paratyphoid in 1990-1999, unclassified hepatitis and hepatitis A in 2000-2009, and unclassified hepatitis and hepatitis E in 2010-2019. The constituent ratio was 78.58%, 65.87% and 69.81%, respectively. There were significant differences with the sex and ages between three decades. Additionally, the cases in rural and urban areas accounted for 74.35% and 25.65% while the majority of patients were farmers, students, scattered children and workers. The incidence peaked in March and July to October in 1990-1999 and 2000-2009, exhibiting a double peak distribution, while the seasonality of 2010-2019 was not obvious.  Conclusions  The effects were notable in category A and B intestinal infectious diseases control and prevention with the incidence rates have declined significantly in Xinghua City from 1990 to 2019. Therefore, it is essential to strengthen the supervision of intestinal infectious disease in rural areas as well as farmers, students, scattered children and the elderly. Combined with the characteristics of A and B intestinal infectious diseases in the new era, comprehensive prevention and control measures should be taken to reduce the incidence rate.
The relation between self-directed use of antibiotics and children's health condition among preschool children in Huangshan City
HAN Hui, CAO Lei-lei, WANG Yu-xiang, WANG Shao-jie, WU Jing, SU Pu-yu
2020, 24(11): 1352-1355. doi: 10.16462/j.cnki.zhjbkz.2020.11.021
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Abstract:
  Objective  To investigate the current status and determinants of parents' self-directed practices towards the use of antibiotics, and its possible association with the health conditions of the preschool children in Huangshan City.  Methods  Self-designed questionnaires were used to collect information regarding self-directed practice towards use of antibiotics among parents of 2 395 preschool children, who were selected through stratified random clustering sampling method. Nutritional status was assessed through physical examination.  Results  A total of 2 395 preschoolers and their parents were included in the present study, including 1 177 boys and 1 218 girls. About 37.4% (896/2 395) of parents reported self-directed practice towards use of antibiotics in the past 12 months, among whom 81.8% (733/896) had used cephalosporin. Maternal education and paternal age were associated with parents' self-directed use of antibiotics (all P < 0.05). Parents' self-directed practice towards use of antibiotics was associated with increased odds of asthma [OR (95% CI): 1.870 (1.187-2.948)], frequent episodes of illness of 1-2 times per year [3.048 (2.264-4.103)], frequent episodes of illness of ≥3 times per year [4.863 (3.606-6.558)], illness≥3 per year, intravenous medication of 1-2 times per year [1.324 (1.091-1.607)] and hospitalization of 1-2 times per year [1.339 (1.071-1.676), respectively (all P < 0.05)].  Conclusions  Majority of parents reported self-directed practice towards use of antibiotics among preschool children in Huangshan, which suggests that more educational activities to parents are needed regarding appropriate antibiotics use among young children on physician's advice.
Comparison of comprehensive evaluation poor eyesight effects of RSR, improved TOPSIS and fuzzy combination method
BAO Xin-yu, YANG Di, WANG Jia-qi, ZHU Li-ling
2020, 24(11): 1356-1360. doi: 10.16462/j.cnki.zhjbkz.2020.11.022
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Abstract:
  Objective  A comprehensive evaluation of the poor eyesight of some minority students was carried out based on rank-sum ratio (RSR), improved technique for order preference by similarity to an ideal solution (TOPSIS) and fuzzy combination method, and the comprehensive evaluation effects of three methods were compared.  Methods  RSR, improved TOPSIS and fuzzy combination method were used to comprehensively evaluate the poor eyesight of some minority students based on the data of physique and health survey reports of Chinese students in 2014.  Results  The last five of poor vision levels were Bourau, Qiang and Salar under three analytical methods, and the results were relatively stable. Under RSR method, Tu nationality was the 23th, the result of grading was the first (poor), and the results were respectively the 16th, 23rd, 21st and 19th under improved TOPSIS and fuzzy combination method of three kinds of weight. Under improved TOPSIS method, Korean was the last, that RSR method and three kinds of weight were the 17th, 19th, 22nd and 24th, respectively.  Conclusions  RSR method does not fully utilize the data, and improved TOPSIS method is susceptible to extreme values, fuzzy combination method can complement the advantages of the two methods. According to the principle of majority, the results were selected with the same overall trend. Furthermore, fuzzy combination method possesses higher sensitivity and thereby is more suitable to evaluate the distribution of poor eyesight.
History of Public Health
The founder of modern health care: Max Joseph von Pettenkofer
ZHOU Hao-yue, HE Hang, YI Fen, LI Jia-lu, CAO Liu-liu, LI Bao-zhu, WU Jun, YE Dong-qing
2020, 24(11): 1361-1364. doi: 10.16462/j.cnki.zhjbkz.2020.11.023
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Abstract:
Max Joseph von Pettenkofer (1818-1901) was an outstanding German chemist and hygienist in the 19th century, who was mainly engaged in the study of environmental medicine and infectious diseases. He was an opponent of the germ theory of disease and believed that the disorder of the external environment was the main cause of the occurrence and prevalence of disease. He developed the cholera theory by studying the relationship between environmental factors and cholera. In addition, he founded the world's first Department of Hygiene and put forward many methods to prevent infectious diseases. He made great contributions to the prevention of infectious diseases and was one of the pioneers of modern hygiene science. He is regarded as the founder of modern hygiene.

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