中华疾病控制杂志

Progress in cancer epidemiology research in China in 2019

CHEN Hong-da, ZHENG Rong-shou, WANG Le, LU: Zhang-yan, DU Ling-bin, WEI Wen-qiang, DAI Min

2020, 24(4): 373-379. doi: 10.16462/j.cnki.zhjbkz.2020.04.001

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Cancer is the leading cause of death in China. In recent years, Chinese government has advocated tremendous efforts in advancing research on cancer prevention and control, and has made great advancement. In this review, we briefly summarized the current research progress on cancer epidemiology in China, including the aspects of cancer burden, cancer-related risk factors and its intervention, screening and early detection, implementation plan of cancer prevention and control(2019-2022), in order to provide technical support and theoretical evidence in implementing effective cancer prevention and control in China in the future.

Association between total cholesterol and type 2 diabetes:a prospective cohort study

LU Yuan, LIU Huan-le, MA Yun-tao, DAI Xiao-yu, WANG Zhi-heng, LIU Yan-xun

2020, 24(4): 380-383. doi: 10.16462/j.cnki.zhjbkz.2020.04.002

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Objective To explore the association between total cholesterol and type 2 diabetes(T2 DM). Methods Non-diabetic people who aged 20 to 90 years at the baseline and who had physical examination more than 2 times were screened. Comparisons of the baseline characteristics were conducted with Student-t test or Pearson chi-square test. Generalized estimating equation(GEE) was used to analyze the effect of total cholesterol of quantiles groups(2.10-mmol/L, 4.16-mmol/L, 4.76-mmol/L and 5.42-13.29 mmol/L) to type 2 diabetes. Results The cohort with an average age of 3.53 years per person included 12 928 subjects and 45 626 person-years. During the follow-up, 447 cases of new-onset diabetes occurred and the incidence density was 9.80‰. The high incidence of type 2 diabetes increased with the increase of total cholesterol. After adjusting the factors including age, high density lipoprotein, hypertension and obesity, based on the 2.10-mmol/L group, the relative risk(RR) of the 4.16-mmol/L, 4.76-mmol/L and 5.42-13.29 mmol/L group were 1.24(95% CI:0.83-1.86), 1.75(95% CI:1.19-2.56)and 3.60(95% CI:2.51-5.17), respectively. Conclusions Total cholesterol is associated with type 2 diabetes, and as the total cholesterol increases, the risk of developing type 2 diabetes increases.

Association between physical activity and glucose metabolism in pregnant women

WU Yan-juan, WU Wei-jia, CHEN Qian, LAI Li-juan, CHEN Ya, WANG Wen-jing, WANG Dong-yu, JING Jin, CHEN Ya-jun, CAI Li

2020, 24(4): 384-388. doi: 10.16462/j.cnki.zhjbkz.2020.04.003

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Objective To investigate the association between physical activity and glucose metabolism during the second trimester of pregnancy. Methods A cross-sectional study was conducted from March 2017 to November 2018. 1 083 pregnant women at 20-28 weeks of gestation in Guangzhou, China were recruited into this study. A standardized questionnaire was used to collect demographics and lifestyles. Physical activity was assessed by the international physical activity questionnaire. The participants underwent an oral glucose tolerance test. Multiple linear regression was used to analyze the association between physical activity and blood glucose. Logistic regression analysis model was used to analyze the association between physical activity and gestational diabetes mellitus(GDM). Results Only 36.57% of pregnant women met the recommended level of total physical activity. There was a negative correlation(β=-0.104, P=0.017) between total physical activity and postprandial 2 h blood glucose. Results from different types of physical activities showed that the recreation, sport, and leisure-time physical activity were negatively associated with postprandial 1 h blood glucose(β=-0.114, P=0.042). No significant association was found between either various types of physical activities or sedentary time and GDM. Conclusions Physical activity during mid-pregnancy is inadequate in pregnant women in Guangzhou, China. Higher total physical activity and recreation, sport, and leisure-time physical activity in the second trimester of pregnancy are associated with lower postprandial blood glucose.

Study on the effect of histone deacetylase gene polymorphism and environmental factors on type 2 diabetes mellitus

CHENG Qiu-ting, LIAO Ri-fang, YU Yong-ji, YANG Meng, ZHENG Ying-ying, CHEN Deng-zhou, MA Shu-li, CENG Zhuan-ping

2020, 24(4): 389-393. doi: 10.16462/j.cnki.zhjbkz.2020.04.004

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Objective To examine whether polymorphisms of histone deacetylase(HDACs) and environment factors can be implicated in type 2 diabetes mellitus(T2 DM), and to provide evidence for the prevention and treatment of T2 DM. Methods In 2017, T2 DM patients and controls were selected from 17 villages in Huadu District, Guangzhou. According the Diagnostic criteria for T2 DM, the case group of T2 DM was matched with control group from the population diagnosed as normal by gender, age no more than 5 years old, and from the same natural village. Conditional logistic regression model was used to analyze the effect of gene and environment and their interaction on T2 DM. Results The average age of 499 cases group were(61.53±13.08) years old, and the average age of 499 controls group were(61.48±13.09) years old. There were no statistic difference between two groups. Furthermore, the two groups were gender-balanced too. In conditional logistic regression model, we found that glycerin trilaurate(TG) abnormalities(OR=2.410, 95% CI: 1.755-3.310, P < 0.001) and cholesterol total(TC) abnormalities(OR=1.436, 95% CI: 1.046-1.972, P=0.025) were risk factors for T2 DM. The subjects carries rs72792338 TC+TT genotype(OR=0.526, 95% CI: 0.349-0.793, P=0.002) had lower the risk to develop T2 DM. Conclusions Abnormal TG and TC are risk factors for T2 DM. Rs72792338 TT and TC genotype carryings decrease the risk of T2 DM.

Correlation between CTRP3 and serum uric acid levels in patients with newly diagnosed type 2 diabetes

XU Jin-xiu, ZHANG Jun-xia, XIANG Guang-da, ZHANG Bi-lin, LIN Xue

2020, 24(4): 394-398. doi: 10.16462/j.cnki.zhjbkz.2020.04.005

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Objective To investigate the correlation between serum complement C1 q/tumor necrosis factor-related protein-3(CTRP3) and serum uric acid levels in patients with newly diagnosed type 2 diabetes mellitus(T2 DM). Methods A total of 152 patients with newly diagnosed T2 DM from Central Theater Command General Hospital were enrolled. Based on the visceral fat area(VFA), the subjects were divided into non-abdominal obesity group [AO(-) group](n=79) and abdominal obesity group [AO(+) group](n=73). Spearman correlation analysis was used to analyze the correlation between serum CTRP3 and uric acid as well as other parameters.Multiple stepwise regression analysis model was used to analyze the independent effect of CTRP3 on serum uric acid levels in patients with newly diagnosed T2 DM. Results When compared with AO(-) group, patients in AO(+) group had higher levels of serum uric acid(P=0.029) and lower CTRP3(P < 0.001). Spearman correlation analysis showed that CTRP3 was negatively correlated with serum uric acid in the whole subjects and AO(+) group(r=-0.180, r=-0.518, all P < 0.05). However, there was no correlation between CTRP3 and uric acid as well as other parameters in AO(-) group(allP > 0.05). Multiple stepwise regression analysis demonstrated that CTRP3 was an independent contributor to serum uric acid levels in AO(+) group(β=-0.290, P=0.005), while not in AO(-) group. Conclusions Serum CTRP3 was an independent influencing factor and negatively correlated with serum uric acid levels in patients with newly diagnosed T2 DM, in an obesity-dependent manner.

Social engagement and depression among Chinese aged 50 years and older

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

2020, 24(4): 399-403. doi: 10.16462/j.cnki.zhjbkz.2020.04.006

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Objective To investigate the association between social engagement and depression among Chinese aged 50 and over. Methods Cross-sectional data was collected from the World Health Organization(WHO) study on global ageing and adult health(SAGE) wave 1 in China. The International Classification of Diseases 10 th revision depression scale(ICD-10) was used to evaluate the depression status of the respondents and the score of social engagement originating the frequency of social activities of the research population. All models were stratified by age groups, gender and residence. The Logistic regression analyses model were performed to identify the association between social engagement and depression. Results A total of 12 196 participants were included. The detection rate of depression was 1.72%(95% CI:1.54%-2.00%).The negative association between social engagement and depression was obtained in the multiple regression(OR=0.94, 95% CI: 0.90-0.98, P=0.006) after adjusting the factors of age, sex, residence, education level, household income, marital status, physical activity level, smoking and drinking status. In stratified analysis, the association was only statistically significant in urban, female, and 50-60 age groups(all P < 0.05). Conclusion This study found significant association between social engagement and depression, indicating that pertinence measures may help prevent depression in elderly population by enhancing social engagement.

Correlation between circadian disruption and depressive symptom in male undergraduates in Chongqing

HOU Gui-zhong, LIU Kun, ZHANG Ai-hua, CHEN Qing, CAO Jia

2020, 24(4): 404-408. doi: 10.16462/j.cnki.zhjbkz.2020.04.007

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Objective To analyze the association between circadian disruption and depressive symptoms in Chongqing young males. Methods Among 587 male college students in Chongqing, the Chinese version of the Munich chronotype questionnaire(MCTQ) was used to measure social jetlag(an indicator of circadian disruption), mean sleep duration and chronotype, which reflected individual biological clock. Depression symptom was measured using standard score of the Self-rating Depression Scale(SDS). Results The subjects' social jetlag was 0.9(0.5 to 1.3) h. There was a strong correlation between social jetlag and chronotype indicator(correlation coefficient = 0.58, P < 0.001).The social jetlag was positively correlated with the SDS standard score. For every 0.5 hour increase in the social jetlag, the SDS standard score increased by 2.1%(95%CI: 0.5%-3.5%, P= 0.011). Conclusion There is a correlation between social jetlag and SDS standard score, suggesting that circadian disruption may be related to depressive symptom.

Association of leukocyte telomere length in peripheral blood and the risk of mild cognitive impairment in elderly subjects:a case-control study

YANG Tong, WANG Hua-lou, CHEN Chong, ZHAO Hui-chao, XIONG Ying, JIA Jing-ya, ZHANG Mei-lin, MA Fei

2020, 24(4): 409-412. doi: 10.16462/j.cnki.zhjbkz.2020.04.008

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Objective To explore the relationship between leukocyte telomere length(LTL)in peripheral blood and the risk of mild cognitive impairment(MCI)in elderly subjects. Methods This was a case-control study. Healthy controls and subjects with MCI were recruited from five communities in Wangdingdi Street, Nankai District, Tianjin from October 2017 to December 2017. Questionnaires were conducted and venous blood samples were collected from each subject. LTL was assessed using real-time quantitative polymerase chain reaction assay(qPCR). Multiple logistic regression model was performed to analyze the relationship between LTL for each level group and the risk of MCI. Results A total of 183 participants was enrolled for each group. The level of serum LTL was 1.44±0.23 in the MCI group, which was lower than 1.66±0.23 in the control group(Z=-8.94, P < 0.001). There was a significant correlation between lower levels of LTL and the risk for MCI after adjusting variables for age, gender, education, smoking, alcohol consumption, diabetes, hypertension, and heart disease(allP < 0.05). Compared with the first level group of LTL, the adjusted odds ratio(OR) and 95% confidence interval(95% CI) for the risk of MCI were 0.262(0.130-0.531) for the second level group, 0.088(0.043-0.180) for the third level group, and 0.083(0.040-0.169) for the fourth level group. Conclusions Short leukocyte telomere length in peripheral blood appears to be an independent risk factor for the incidence of MCI. And with the decrease of LTL, the risk of MCI increased.

Study on the moderating effect of social class on the relationship between residents'environment knowledge and environment protection behavior

HE Hong, TAN Tian, WANG He-shu-qi

2020, 24(4): 413-418. doi: 10.16462/j.cnki.zhjbkz.2020.04.009

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Objective To study the influence of environment knowledge on environment protection behavior, and analyze moderating effect of social class on the relationship between environment knowledge and environment protection behavior. Methods Based on Chinese general social survey(CGSS) 2013, 5 746 residents aged from 18 to 60 were selected as subjects. Moderating effect model was used to explore social class' s moderation on the relationship between environment knowledge and protection behavior. Results Residents' environment protection behaviors were divided into private environment protection behaviors and public environment protection behaviors. Multiple linear regression results showed that residents' environment knowledge influenced private environment protection behaviors(β=0.18, P < 0.001), and public environment protection behaviors(β=0.02, P=0.028). Moderating effect analysis showed that self-reported social rank had a negative moderating effect between residents' environment knowledge and public environment protection behavior(β=-0.01, P=0.020), but had no moderating effect on private environment protection behavior. There were also negative moderating effects of education level. Conclusion Environment education policy should focus on residents with relatively low social classes, so as to maximize policy effectiveness.

The effect of passive smoking during pregnancy on pregnancy complications and outcomes

WANG Xue-yin, ZHANG Xiao-song, ZHOU Min, JUAN Juan, WANG Xu

2020, 24(4): 419-423. doi: 10.16462/j.cnki.zhjbkz.2020.04.010

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Objective To assess the prevalence of passive smoking during pregnancy, and toexplore the effect of passive smoking during pregnancy on pregnancy complications and outcomes. Methods A total of 8 926 postpartum women who delivered live singletons between April, 2012 to March, 2013 in 15 hospitals were enrolled. A self-made questionnaire was used to collect general information, occurrence of passive smoking during pregnancy, pregnancy complications and outcomes. Logistic regression models were used to analyze the effect of passive smoking during pregnancy on pregnancy complications and outcomes. Results A total of 1 801 women had experienced passive smoking during pregnancy. After adjusting for covariates, women who experienced passive smoking during pregnancy had an increased risk of gestational diabetes mellitus(OR=1.359, 95% CI:1.146-1.612, P < 0.001), premature rupture of membranes(OR=1.290, 95% CI:1.095-1.520, P=0.002), preterm birth(OR=1.367, 95% CI:1.155-1.619, P < 0.001), and delivering low birth weight infants(OR=1.341, 95% CI:1.079-1.668, P=0.008). Compared to those who did not experience passive smoking, women experienced passive smoking≥4 days/week had an increased risk of premature rupture of membranes(OR=1.402, 95% CI:1.104-1.780, P=0.006), preterm birth(OR=1.690, 95% CI:1.339-2.132, P < 0.001), and low birth weight(OR=1.584, 95% CI:1.172-2.141, P=0.023). Conclusions In this study, passive smoking during pregnancy is prevalent, and passive smoking during pregnancy may increase the risk of pregnancy outcomes like gestational diabetes mellitus, premature rupture of membranes, preterm birth and low birth weight.

Environmental and health literacy of medical students in minority areas of Gansu Province

TANG Li-li, ZHU Ting, NIU Jing-ping, JIANG Tian-yuan, LIU Shi-he, RUAN Ye

2020, 24(4): 424-428. doi: 10.16462/j.cnki.zhjbkz.2020.04.011

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Objective To understand the environmental and health literacy of medical students in minority areas of Gansu province, so as to provide scientific basis for improving the environmental and health literacy of this population. Methods Questionnaire was designed based on the "core questions of citizen environmental and health literacy assessment" in the "technical guide for citizen environmental and health literacy assessment(trial)" issued by the Ministry of Ecology and Environment of the People's Republic of China. Stratified cluster random sampling was used to select 1 620 medical students in the minority areas of Gansu Province for questionnaire survey. Results The proportion of medical students with environmental and health literacy in minority areas of Gansu Province was only 3.9%. In the first level classification literacy, the basic skills literacy level was the highest(39.0%), and the basic knowledge literacy level was the lowest(1.3%). Among the sub-categories, the cognitive skills were the highest(83.9%), and the scientific knowledge was the lowest(1.3%). The results of univariate analysis showed that there were statistical differences in owning rates of environmental and health literacy among medical students of different grades and nationalities. Multivariate logistic regression analysis showed that ethnicity, grade, and age were influencing factors of environmental and health literacy. Conclusions The environmental and health literacy level of medical students in minority areas of Gansu Province is very low, especially in terms of basic knowledge. Environmental and health education should carry out in these schools to improve students' environmental health literacy.

The correlation between health literacy and health lifestyle of military college students from the perspective of new media

ZHANG Ling, SONG Qiu-yue, RONG Hong-hui, ZHENG Chuan-fen, LU Lu, CHEN Ji-an

2020, 24(4): 429-433. doi: 10.16462/j.cnki.zhjbkz.2020.04.012

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Objective To understand the correlation between health literacy and health lifestyle of military college students from the perspective of new media, so as to provide scientific basis for a comprehensive health education to improve health literacy and healthy lifestyle. Methods One thousand and forty three military college students were selected by cluster random sampling to participate in a questionnaire survey. Results The overall health literacy score was(46.74±10.76). In terms of three aspects of health literacy, the score of basic health concept and knowledge was(22.26±5.00), the score of healthy lifestyle and behaviors was(13.38±3.56), and the score of health-related skill was(11.11±3.31). The scores of awareness, trust and utilization of new media were(14.22±4.00), (20.49±4.05) and(30.59±7.28), respectively. The scores of healthy lifestyle, including exercise behavior, life behavior eating behavior, health risk behavior and health responsibility behavior were(19.33±3.84), (16.24±2.91), (13.51±2.67), (16.42±3.70) and(25.7±4.11), respectively. Fitting degree of this structural equation model was good(root mean square error of approximation, RMSEA=0.06;goodness of fit index, GFI=0.95; normed fit index, NFI=0.93).The total effect coefficient of receiving health information from new media on healthy lifestyle was 0.439, of which the direct effect was 0.380 and the indirect effect was 0.059. The direct effect of new media on health literacy was 0.164, while the direct effect of health literacy on healthy lifestyle was 0.360. Conclusions The effect of new media on healthy lifestyle is higher than that on health literacy, but health literacy has the highest correlation with healthy lifestyle.The dissemination of health information by new media should be strengthened to improve students' health literacy and lifestyle.

Correlation analysis between brucellosis and natural environmental factors in Ningxia Hui autonomous region from 2012 to 2016

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

2020, 24(4): 434-437. doi: 10.16462/j.cnki.zhjbkz.2020.04.013

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Objective To explore the correlation between brucellosis and natural environmental factors in Ningxia from 2012 to 2016, so as to provide reference for early prevention and control measures. Methods The epidemic situation of human brucellosis in the statutory report infectious disease database of Ningxia center for disease control and prevention were collected from 2012 to 2016, and the correlation between brucellosis and natural environmental factors was analyzed by Spearman correlation. Meanwhile, ArcGIS 10.6 software was used to intuitively express the correlation between brucellosis and various influencing factors. Results From 2012 to 2016, the incidence of brucellosis in Ningxia increased from 449 cases to 2 160 cases. In the correlation analysis, it was found that there was a positive correlation between brucellosis incidence and wind speed, cultivated land area and grassland area(all P < 0.05). The graphics drawn by ArcGIS 10.6 software more intuitively expressed the same results as spearman's. Conclusions Human brucellosis is related to wind speed, cultivated land area and grassland area. Therefore, understanding the correlation between human brucellosis and related factors, and mastering the change trend of the corresponding natural environmental factors are conducive to the prediction of the future occurrence and development of the disease, which has certain significance for the early warning of brucellosis.

Analysis on epidemiological characteristics and spatial clusters of scarlet fever in Shandong Province from 2011 to 2018

LIU Wei-liang, KOU Zeng-qiang, BI Zhen-wang, DOU Wei-jie, FANG Ming

2020, 24(4): 438-443. doi: 10.16462/j.cnki.zhjbkz.2020.04.014

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Objective To analyze the epidemiological and spatial cluster of scarlet fever in Shandong Province from 2011 to 2018, and to provide scientific evidence for the prevention and control of scarlet fever. Methods Data of scarlet fever reported cases in Shandong province from 2011 to 2018 were collected and analyzed by the descriptive epidemiological method and spatial autocorrelation method. Results A total of 45 936 scarlet fever cases were reported in Shandong province from 2011 to 2018. The average annual incidence was 5.84/100 000 and showed an increasing trend(χ_趋势²= 5 317.16, P < 0.001). There were more cases concentrated from April to June and from November to January.The ratio of male to female was 1.62:1, with the higher prevalence(88.94%) among the total cases aged 3 to 9 years. The majority of scarlet fever cases were preschool children(42.42%), students(36.94%) and scattered children(19.50%), respectively.The global spatial autocorrelation analysis showed that the Moran's I indexes for the incidence were 0.374, 0.452, 0.411, 0.439, 0.437, 0.418, 0.478 and 0.465(all P < 0.001)respectively, suggesting that the incidence of scarlet fever had spatial clustering features in Shandong Province from 2011 to 2018. The local spatial auto correlation analysis showed that high-high clustering areas were mainly distributed in main urban districts of Jinan city and Qingdao city. Areas that located in the southwestern and northwestern parts of Shandong presented the low-low relation. Conclusions The epidemic and spatial clustering of scarlet fever existed in Shandong Province during 2011-2018. The surveillance and management on scarlet fever should be strengthened and the targeted prevention and control efforts should be focused on high incidence seasons, high risk populations and high clustering areas, so as to control the spread of scarlet fever.

Spatiotemporal characteristics of HIV/AIDS epidemic in Dehong Dai and Jingpo Autonomous Prefecture

YANG Shi-jiang, YANG Guo-long, YANG Yue-cheng, YE Run-hua, TANG Ren-hai, CAO Yan-fen, LI Lin, WANG Ji-bao, YAO Shi-tang, HE Na, DUAN Song

2020, 24(4): 444-450. doi: 10.16462/j.cnki.zhjbkz.2020.04.015

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Objective To understand the spatial and temporal distribution of human immunodeficiency virus(HIV) and acquired immunodeficiency syndrome(AIDS) in Dehong Dai and Jingpo Autonomous Prefecture(hereinafter referred to as "Dehong Prefecture") from 1989 to 2018. Methods Descriptive analysis and visualization was conducted based on annual reported HIV/AIDS cases from all 50 townships Dehong. ArcGIS 10.2 software was used. Results HIV/AIDS had spread through all 50 towns in Dehong by year 2003. 15 752 HIV/AIDS cases were reported in Dehong Prefecture from 1989 to 2018. However, the number of newly reported HIV/AIDS cases tend to decline, with 2 252, 813, 456, 393 and 297 cases reported in the year 2004, 2010, 2014, 2015 and 2018, respectively. Additionally, analysis suggested a decrease in mortality among HIV-infected patients, and a total of 8 848 cases were still living with HIV by the end of 2018. Conclusions Analysis reveals spatial variation in HIV/AIDS epidemics at township level, and indicates the serious HIV epidemic first spread through the areas bordering Myanmar. The efforts to put HIV epidemic under control are paying off in the past five years.

Epidemiological characteristics and trends of hepatitis C in Hubei Province from 2004 to 2018

WU Jing-tao, YU Chuan-hua, WANG Lei, HU Ying

2020, 24(4): 451-455. doi: 10.16462/j.cnki.zhjbkz.2020.04.016

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Objective This study aims to know the incidence of hepatitis C and provide scientific opinions and suggestions for prevention and control of hepatitis C through analyzing the characteristics of hepatitis C in Hubei Province from 2004 to 2018. Methods Data of hepatitis C reported cases in the infectious disease report information management system were collected, analyzed and predicted by time series model. Results The incidence of hepatitis C continued to increase, from 1.82/10⁵ in 2004 to 18.51/10⁵ in 2018, with an average annual growth rate of 18.01%. The incidence of hepatitis C in all age groups increased from 2004 to 2018. In the same year, the incidence rate increased initially and then decreased with the elder age group. The peak was in 60-70 age group. Among the new diagnosed patients with hepatitis C, the top three occupations were farmers, housework and unemployed, retired people, accounting for more than 80% of the total. According to the prediction of time series model, the incidence of hepatitis C could exceed 24.88/10⁵ after 5 years if no effective control measures were taken. Conclusions The incidence of hepatitis C is still rising, and it has significant population and spatial distribution pattern. It is necessary to pay attention and take effective measures to reduce the incidence of new infections and diseases onset.

Molecular characteristic of the two surface glycoproteins of highly pathogenic avian influenza A H5N6 viruses from human, 2014-2018, China

GU Hong-wei, QI Xian, CHEN Lei-yao, BAO Chang-jun

2020, 24(4): 456-461. doi: 10.16462/j.cnki.zhjbkz.2020.04.017

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Objective To analyze the molecular characteristic of hemagglutinin(HA) and neuraminidase(NA)proteins of highly pathogenic avian influenza H5 N6 viruses from 19 human cases. Methods Whole-genome sequences of original specimen and virus isolates were obtained by next-generation sequencing technology. Reference sequence information was collected from national center for biotechnology information(NCBI) and global initiative on sharing avian influenza data(GISAID) database. Pairwise sequence alignments and phylogenetic analysis were performed by Blasts, Clustal X 2.1 and Mega 6.1 softwares. Results A total of 23 cases of human infection with H5 N6 avian influenza virus occurred in China from 2014 to 2018. The HA and NA genes of H5 N6 virus from 19 cases were analyzed. HA evolutionary analysis showed that viruses belonged to Clade 2.3.4.4, of which 17 cases belonged to Group C; the first H5 N6 strain(A/Sichuan/26221/2014) belonged to Group D; and a Fujian case strain(A/Fujian-Sanyuan/21099/2017) belonged to Group B. The cleavage sites of HA protein of 29 strains of viruses in all 19 cases contained multiple basic amino acids. The 226-228 amino acids at the receptor binding sites of HA proteins of all viruses were QS(R) G(amino acids are sequenced according to the HA sequence of H3 subtype). In addition to one case in Guangzhou in 2014, the HA protein of 18 isolates mutated in T160 A, resulting in loss of glycosylation at 158 N site. In addition to A/Sichuan/26221/2014, 10 amino acids were deleted in 58-68 sites of NA proteins of strains from 18 cases. E627 K mutation occurred in 17 strains of virus PB2 protein from 9 cases. Conclusions From 2014 to 2018, the evolution of H5 N6 virus infection in China is active, and there is obvious genetic diversity. It is necessary to strengthen the monitoring of the evolution of H5 N6 viruses in China.

Research status on relationship between sense of coherence and mental health among older adults from prospective of salutogenesis

CHEN Hao, FU Hua

2020, 24(4): 462-466. doi: 10.16462/j.cnki.zhjbkz.2020.04.018

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With the increase of average life expectancy, it is significant to improve the well-being and mental health of the elderly. Among the theories of mental health promotion, the emerging theory of salutogenesis has attracted academic attention. It explains the development process of health and disease from the perspective of individuals' ability to cope with stress and stimulation, and emphasizes how to use resources to enhance the coping ability. We integrated domestic and overseas quantitative research literatures regarding the relationship between core components of salutogenesis(sense of coherence, generalized resistant resources) and mental health to summarize associations among sense of coherence, generalized resistant resources and mental health. This study would provide research basis for mental health development mechanism research and intervention strategies in aged population.

Prediction and analysis of road traffic injury death trend based on ARIMA model

XUN Lu-ning, ZHANG Fan, SUN Ji-xin, CAO Ya-jing, SUN Zhen, SHI Wei-wei, LI Mei, CUI Ze

2020, 24(4): 467-472. doi: 10.16462/j.cnki.zhjbkz.2020.04.019

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Objective To analyze the death trend of road traffic injury in Hebei province from 2014 to 2018, and to discuss the feasibility of autoregressive integrated moving average model(ARIMA) in the prediction of road traffic injury deaths trend. Methods Descriptive epidemiological method was used to analyze the general situation of road traffic injury deaths in Hebei province from 2014 to 2018. R 3.5.3 was used to establish the ARIMA prediction model for the monthly death cases of road traffic injury in Hebei province from January 2014 to June 2018. The overall regression was used to observe the fitting effect, the predicted value and the real value were compared from July to December in 2018 to evaluate the prediction effect. Results A total of 13 147 road traffic injury deaths from 2014 to 2018 were reported by Hebei province. The number of road traffic injury deaths was 10 071 males and 3 076 females, with an annual mortality rate of 17.79/100 000, showing a downward trend overall. The best prediction model is ARIMA(0, 1, 1)(0, 1, 1)₁₂. Akaike information criterion(AIC) is 390.64, Schwarz Bayesian criterion(SBC) is 395.78, the residual sequence is white noise sequence(P > 0.05), and the parameters of the model are significantly non-zero(P < 0.05). The actual values of the prediction results all fall within the 95% confidence interval of the predicted values, and the relative error between the predicted values and the actual values is between 1.15% and 11.85%. The root mean square error(RMSE) is 13.65, the mean absolute error(MAE) is 10.88, and the mean average percentage error(MAPE) is 4.80%. The prediction performance of the model is good. Conclusions The overall road traffic injury deaths in Hebei province show a downward trend year by year. ARIMA model can be used to predict the short-term trend of road traffic injury deaths.

Construction and comparative analysis of prognostic scoring system in patients with atrial fibrillation

HUANG Jia-qi, ZHONG Li, ZHANG Zhi-hui, WU Na, WU Long, XIANG Ying, LI Cheng-ying, LI Ya-fei

2020, 24(4): 473-479. doi: 10.16462/j.cnki.zhjbkz.2020.04.020

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Objective To construct a score system for predicting the prognosis of atrial fibrillation(AF) in China, and to compare its predictive ability. Methods A total of 275 patients with new-onset AF were continuously enrolled in the study. The outcome events of follow-up included stroke and all-cause mortality. Prognostic-related epidemiological and clinical information were collected. The blood concentration of N-terminal B-type natriuretic peptide(NT-proBNP), high-sensitivity troponin T(hs-cTnT) and growth differentiation factor(GDF)-15 were detected. A Cox proportional hazards regression model was used to develop novel risk scoring system. C-statistics and calibration plots were used to estimate and compare the predictive ability of risk scores. Results Multivariate Cox regression analysis showed that history of diabetes, history of transient ischemic attack, history of stroke and plasma level of NT-proBNP were independently associated with the risk of stroke. Age, history of heart failure, plasma level of hs-cTnT and GDF-15 were independent risk factors of all-cause mortality. The C-statistic of the stroke-risk score was similar to that of the CHA2 DS2-VASc score and ABC(age, biomarker, clinical history)-stroke score; the C-statistic of the death-risk score was similar to that of ABC-death score and significantly higher than that of the CHA2 DS2-VASc score. Conclusions The stroke and death risk scoring system of atrial fibrillation patients constructed in this study showed a good predictive performance. The nomograms of these scoring systems are expected to be auxiliary tools for clinical decision-making.

Epidemiologic characteristics of fall related-injuries and related factors among elderly population in Wuhan, 2018

LIU Su, YAN Ya-qiong, LI Fang, LI Zhang-feng, LI Wei-ping, GONG Jie

2020, 24(4): 480-484. doi: 10.16462/j.cnki.zhjbkz.2020.04.021

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Abstract:
Objective To investigate the status and impact factors of fall among elderly people in Wuhan Province, so as to provide scientific basis for preventing falls among elderly. Methods A total of 387 476 elders were collected by questionnaire survey and medical examination from health status census on all elder people aged over 65 in Wuhan. SAS 9.4 was used for descriptive analysis, chi-square test and multivariate Logistic regression analysis. Results The report rate of falls among elderly people in 2018 was 3.44%. The rate in urban area(4.42%) was higher than that in rural area(2.39%)and the rate in female(4.22%) was higher than that in male(2.47%). 46.48% falls occurred at home. Sprains/strains(accounted for 31.07%) was the mainly fall injury. Logistic regression analysis showed that female, slightly or moderate dependent self-care ability, hands cannot put behind the head, could not pick up things on the floor, osteoarticular diseases, eye disease and stroke were the main risk factors of falls in elderly people. Conclusions The report rate of fall in elderly people is 3.44%. In this study, weakened self-care ability, diminished exercise ability, osteoarticular diseases, eye disease, stroke are the major risk factors for falls in the elderly people.

Assessment of the lifestyle risk factors of cognitive impairment among community-dwelling older adults using decision tree and random forest model

DING Gong-wu, LIU Shu-juan, LI Jin-lei

2020, 24(4): 485-488. doi: 10.16462/j.cnki.zhjbkz.2020.04.022

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Objective To investigate the associations between lifestyle factors and social network and cognitive impairment among the elderly in three communities in China using decision tree and random forest. Methods 1 200 elderly individuals were selected from three communities in Beijing, Hefei, and Lanzhou by using a random cluster sampling method. Data was collected on lifestyle, social network and cognition. Decision tree and random forest analysis were conducted to identify the associations between lifestyle and cognitive impairment. Results A total 1 115 participants(92.9%) were administered questionnaires. The prevalence of cognitive impairment was 25.7%(n=287). Females exhibited a higher risk compared to males(P < 0.001), and there is a positive association between the risk of cognitive impairment and age(P=0.002). In the decision tree and random forest models, age, sex, activities, and sleep were associated with cognitive impairment, while the associations of smoking, alcohol and tea consumption were not significant in this study. The areas under the ROC curves were 0.64 for the decision tree, and 0.94 for the random forest model. Conclusions Classification models can help identify associations between cognitive impairment and lifestyle risk factors. Identification and intervention of risk factors are crucial in delay and prevention of cognitive impairment and in the improvement of quality of life among the elderly.

Study on the effect of trace elements such as copper, zinc, nickel, iron and manganese in serum on the missed abortion

XIE Li-ao, YAO Jian-ling, ZHU Tian-yuan, AI Shi-wei, DANG Yu-hui, LI Zhi-lan

2020, 24(4): 489-492. doi: 10.16462/j.cnki.zhjbkz.2020.04.023

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Objective To investigate the effects of levels of mercury, manganese, nickel, copper, zinc, arsenic, cadmium, and lead in serum during early pregnancy on missed abortion, and to provide clues for the study of the cause of missed abortion. Methods Twenty-one pairs of aborted patients of the same age, with the same gestational age, and normal early pregnancy were selected, and the levels of serum mercury, manganese, nickel, copper, zinc, arsenic, cadmium, and lead in the two groups of pregnant women were detected. Multivariate Logistic regression was used to analyze the possible influencing factors of missed abortion. Results Compared with the normal early pregnancy group, the serum levels of nickel(t=3.57, P=0.002), copper(t=7.94, P < 0.001), zinc(t=3.60, P=0.002), cadmium(t=4.74, P < 0.001), arsenic(t=2.82, P=0.011), and lead(t=3.46, P=0.002) were higher in the missed abortion group, and the serum manganese levels were lower(t=-8.24, P < 0.001). The binary multivariate logistic regression showed that theOR values of high blood nickel and high blood cadmium were 7.83(95% CI: 1.03-59.68, P =0.037), 3.51(95% CI:2.53-4.87, P =0.004) and 0.68(95% CI:0.47-0.97, P =0.034). Conclusion The levels of Ni, Cd and Mn in pregnant women's serum have a certain effect on the occurrence of missed abortion, and its mechanism needs further study.

The pioneer of utilitarianism and modern public health reform in Britain:Jeremy Bentham

XIA Yuan-rui, WU Jun, YE Dong-qing

2020, 24(4): 493-496. doi: 10.16462/j.cnki.zhjbkz.2020.04.024

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Jeremy Bentham(1748-1832) was a famous British philosopher, jurist, political theorist and social reformer. He became a pioneer of British public health legislation and judicial reform by putting forward utilitarian ideas and applying them to social reforms. In addition, he paid attention to the development of basic medical theories and practical applications, which had profound effects on the establishment of future preventive medicine organizational structure, the acquisition of scientific research funding, and the internationalization of pharmacopoeia standards.

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2020 Vol. 24, No. 4

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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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