中华疾病控制杂志

Strengthen sentinel surveillance of emerging infectious diseases and establish the first line of defense for major epidemics

LI Dan-dan, CAO Shi-yi, NIE Shao-fa, LU Zu-xun

2020, 24(9): 993-996. doi: 10.16462/j.cnki.zhjbkz.2020.09.001

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Sentinel surveillance is an effective method and technology for early detection of infectious diseases. It can strengthen the monitoring of emerging infectious diseases and establish the first line of defense for major epidemics, which is important for early detection of patients, shortening the transmission window period, and improving the effectiveness of prevention and control of emerging infectious diseases. This paper intends to analyze the role and significance of sentinel surveillance of emerging infectious diseases, summarize the shortcomings of sentinel surveillance work in the epidemic of coronavirus disease 2019, and propose concrete measures and suggestions to strengthen sentinel surveillance of emerging infectious disease, in order to provide reference for prevention and control work, and to provide basis for the establishment of a long-term mechanism for sentinel surveillance of emerging infectious diseases.

Prospective cohort study of the interaction between family history and obesity on the incidence of diabetes in pre-diabetics

YU Cheng, WANG Min-zhen, JIN Ya-fei, DAI Tian, XIA Miao, ZHENG Shan, CHENG Ning, HU Xiao-bin, REN Xiao-wei, BAI Ya-na

2020, 24(9): 997-1002. doi: 10.16462/j.cnki.zhjbkz.2020.09.002

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Objective To explore the effects of family history of diabetes, obesity and their interactions on the incidence of diabetes in pre-diabetic population. Methods Based on the Jinchang cohort platform, a prospective cohort study was conducted to calculate the cumulative incidence of diabetes in different groups of family history, body mass index (BMI) and waist-to-height ratio(WHtR). Cox proportional hazards regression models were used to analyze independent and joint effects of family history, BMI and WHtR on the incidence of diabetes. The interactions between family history of diabetes and BMI or WHtR were analyzed by multiplicative models. Results A total of 5 495 pre-diabetic participants were included in this study. After an average follow-up of 2.2 years, the cumulative incidence of diabetes was 15.69%. Among them, the incidence of diabetes of those with a family history (18.31%) was higher than those without a family history (15.26%)(χ²=4.664, P=0.031). With the increase of BMI/WHtR level, the incidence rate of diabetes was on the rise(χ²=91.727, P < 0.001; χ²=73.334, P < 0.001). After adjusting for confounding factors, those people with a family history of diabetes and obesity (BMI ≥ 28 kg/m² or central obesity) coexist, the risk of diabetes increased significantly (HR=4.401, 95% CI:3.026-6.401; HR=2.565, 95% CI:1.989-3.307), and there was a positive multiplication interaction. In addition, when family history, BMI ≥ 28 kg/m² and central obesity were superimposed, the risk of diabetes have reached the highest(HR=4.977, 95% CI:3.351-7.392). Conclusions The superimposition of family history of diabetes and obesity increases the risk of diabetes in the pre-diabetic population, but the independent effects of the two cannot be ignored.

Association between metabolic syndrome and its components with hyperhomocysteinemia in community population

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

2020, 24(9): 1003-1008. doi: 10.16462/j.cnki.zhjbkz.2020.09.003

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Objective To investigate the distributional features of metabolic syndrome (MS) and its components among adults in Xinqiao community Songjiang District, Shanghai City, and to explore the association between MS and its components with hyperhomocysteinemia (HHcy). Methods A community-based cross-sectional study using randomized cluster sampling was conducted among adults aged 20-74 in Xinqiao community. Distributional characteristics of MS and its components were described, and Logistic regression was used to access the association between MS and its components with HHcy. Results Among 8 201 subjects, the prevalence of MS was 18.53%, and the attack rate of HHcy was 32.59%. Among 5 components of MS, the attack rate of raised blood pressure was the highest in subjects (61.00%). Multipel Logistic regression showed that patients with MS were 1.16 times more likely to have HHcy than those without MS (OR=1.16, 95% CI:1.02-1.33, P=0.030). And HHcy was independently associated with central obesity, raised blood pressure, decreased HDL-C and raised triglyceride. The risk of HHcy increased to some extent as the number of MS components increased in individuals. Conclusions The prevalence of MS and attack rate of HHcy appeared relatively high in Xinqiao Community, and MS and its components may be risk factors of HHcy. Plasma Hcy level among high-risk population calls for attention, and it shows an urgent need for early prevention and control of MS and HHcy so as to prevent further chronic disease.

The prevalence and influencing factors of different metabolic types of obesity

HU Jing-yao, YANG Man, GUO Hai-jian, ZHU Xiao-yue, LIU Yu-xiang, XU Jin-shui, WANG Bei

2020, 24(9): 1009-1014, 1026. doi: 10.16462/j.cnki.zhjbkz.2020.09.004

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Objective To explore the prevalence and distribution of different metabolic types of obesity among adults in Jiangsu Province, so as to provide basis for the study of influencing factors, early identification and intervention. Methods We conducted a cross-sectional sampling study in Jurong City of Zhenjiang City and Yandu District of Yancheng City of Jiangsu Province from April to July 2017. Subjects were selected to complete the survey, in which information of demographic and behavioral characteristics, physical examination and clinical indicators, were collected. According to metabolic indicators of America and obesity criteria of China, the population was divided into four metabolic types of obesity status. Logistic regression was used to analyze the prevalence and influencing factors. Results A total of 5 167 subjects were investigated, among which the proportion of metabolically healthy and normal weight (MHNW) was 17.90% and the prevalence of metabolically healthy obese (MHO), metabolically unhealthy but normal weight (MUHNW) and metabolically abnormal obese (MAO) were 19.18%, 15.52% and 47.40%, respectively. In obese population, the prevalence of MAO was higher in the older and male population. Alcohol consumption was a risk factor of MAO and the difference was statistically significant. Older people and the male were more likely to suffer from MUHNW among normal weight population. Compared with the normal population, drinking was associated with MAO, and no statistical association was found with MUHNW. Conclusions The prevalence of MHO and MUHNW in Jiangsu Province is high. Emphasis should be placed on the population of MUHNW and MHO. Strengthening health education, reducing alcohol and tobacco consumption will be helpful for early intervention of obese populations to reduce the prevalence of MAO.

Relationship between egg consumption and atherosclerosis in high-cardiovascular-risk population in Jiangsu Province

ZHU Fang-yu, QIN Yu, BI Yuan, SU Jian, CUI Lan, LUO Peng-fei, DU Wen-cong, MIAO Wei-gang, WANG Jin-song, ZHOU Jin-yi

2020, 24(9): 1015-1020, 1109. doi: 10.16462/j.cnki.zhjbkz.2020.09.005

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Objective To explore the relationship between egg consumption and atherosclerosis in high-cardiovascular-risk population in Jiangsu Province. Methods Based on China patient-centered evaluative assessment of cardiac events million persons project (China PEACE MPP), we recruited 11 392 high-cardiovascular-risk participants in our cross-sectional study. We measured their egg consumption frequency and presence of carotid plaque (CP) by food frequency questionnaire, body measurements, laboratory tests, and carotid ultrasound. The relationship between egg consumption frequency and carotid plaque were assessed by binary Logistic regression and multinomial Logistic regression. Results Plaque prevalence in < 1 d/w group (2 293 people), 1-3 d/w group (4 890 people), 4-6 d/w group (2 239 people), 7 d/w group (1 970 people) were 40.7%, 33.3%, 37.7%, and 39.6%, respectively. After adjustment for demographic characteristics, cardiovascular risk factors and other dietary factors, compared with the group with the lowest frequency of egg intake (< 1 d/w), the odds ratio (OR) and 95% confidence interval (95% CI) for the risk of consuming egg of 1-3 d/w for male and female were 0.790 (0.629~0.992) and 0.772 (0.642~0.927). After grouped by the number of CP, the OR and 95% CI of multiple CPs were 0.702 (0.515~0.958) for male and 0.682 (0.517~0.901) for female when the egg consumption frequency was 1-3 d/w. Conclusions Among Chinese population with high CVD risk, low to moderate frequency of egg consumption is inversely related to carotid atherosclerosis, and the relationship is stronger among those with multiple plaques.

Value of obesity indicators on risk prediction for stroke in Jiangxi Province

ZHOU Wei, DING Cong-cong, ZHU Lin-juan, WANG Tao, BAO Hui-hui, CHENG Xiao-shu

2020, 24(9): 1021-1026. doi: 10.16462/j.cnki.zhjbkz.2020.09.006

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Objective To explore the effect of different obesity indexes on risk of stroke, so as to find the high-risk population. Methods From November 2013 to July 2014, a multi-stage stratified, random sampling method was used to select the subjects for questionnaire survey and physical measurement. Logistic regression was used to analyze the relationship between different obesity indexes body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), body fat rate (BFP), visceral fat index (VAI) and stroke, and the area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the effect of each index in predicting stroke. Results The average age of 15 172 subjects was (53.00±17.91) years old, including 226 stroke patients. Compared with non-stroke group, BMI, WC, WHtR, BRI, BFP and VAI of stroke population were higher (all P < 0.05). Multivariate analysis showed that all obesity indexes were positively correlated with stroke risk. The AUC of each obesity index from large to small was BRI and VAI combined (0.648), WHtR and VAI (0.645), WHtR (0.631), BRI (0.630), WC (0.613), VAI (0.609), BFP (0.592), and BMI (0.572). Moreover, there was no significant difference in AUC of the first four indicators (all P>0.05). Conclusions The increase of obesity index value can increase the risk of stroke. The combination of BRI and VAI, combination of WHtR and VAI, WHtR and BRI are good indicators for predicting stroke. WHtR or BRI is easier to predict stroke, while BRI and VAI, WHtR and VAI are more comprehensive in predicting stroke.

The current situation of college students' take-out food consumption and its correlation with overweight and obesity in Changsha City

ZHANG Ling-ling, XIONG Jia-hao, WANG Ji-chuan, LI Wan-yang, YANG Yi, REN Guo-feng

2020, 24(9): 1027-1031. doi: 10.16462/j.cnki.zhjbkz.2020.09.007

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Objective To understand the current situation of college students' take-out food consumption in Changsha and analyze the relationship between take-out food consumption and overweight and obesity. Methods With multi-stage stratified cluster sampling, 1 326 college students were selected and an electronic questionnaire survey was conducted. Results A total of 1 274 valid questionnaires were collected. 91.8% of college students had experience in take-out food consumption, take-out food consumption ≥ 7 times on weekdays accounted for 4.2%, take-out food consumption ≥ 2 times on weekends accounted for 35.5%. The frequencies of take-out food consumption of college students with male, urban household registration, high cost of living and food, frequent intake of smoked and baked food and sugar drinks were high. In addition, college students with frequent intake of fried foods had a high frequency of takeaways on weekdays. The most popular take out types of college students were Chinese fast food, fried rice noodles/noodles, wonton/dumpling, fried chicken/hamburger. The overall prevalence rate of overweight and obesity among college students was 12.8%. Multivariate Logistic regression analysis showed that female and rural household registration were protective factors, and take-out food consumption ≥ 7 times on weekdays was a risk factor for overweight and obesity among college students. Conclusion It is common for college students in Changsha to order meals on the Internet. Take-out food consumption is related to gender, household registration, economic factors, fried foods, smoked foods and sugary drinks. The rate of overweight and obesity is related to gender, residence location and the frequency of take-out orders on weekdays. The overweight and obesity status in college students need to be improved.

An analysis of fatty liver and related factors of middle-aged and elderly people from a HBV infection cohort in Qidong area

YU Qin, ZHANG Yong-hui, ZHU Jian, CHEN Yong-sheng, ZHAI Dong-xia, LU Jian-hua, SUN Yan, LU Ling-ling, DING Lu-lu, JIANG Xiao-ping, LING Chang-quan, CHEN Jian-guo

2020, 24(9): 1032-1036, 1078. doi: 10.16462/j.cnki.zhjbkz.2020.09.008

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Objective To investigate the related factors of chronic hepatitis B virus (HBV) infection with fatty liver disease(FLD), in order to provide a basis for prevention and treatment. Methods The HBV infection cohort in Qidong City was followed up in June 2019 to collect relevant medical history information. FLD was detected by B-ultrasound and the related factors were analyzed by multivariate Logistic regression model. Results The age of the cohort was (63.22±7.84) years old, and the prevalence of FLD was 30.18% (909/3 012). The prevalance rate of FLD was higher in female than in male (33.94%>27.25%, χ²=15.767, P < 0.001), and with statistical difference among age groups (χ²=11.614, P=0.003), being the highest in the 60-70 age group. The detection rate of fatty liver in patieuts with hepatic fibrosis was 62.50% (205/328). Multivariate Logistic regression analysis showed that history of hypertension, diabetes, hyperlipidemia, as well as tobacco or alcohol preferences and obesity were main risk factors for FLD (all P < 0.001). Conclusion The FLD prevalence of the middle-aged and elderly individuals in the HBV-infected cohort in Qidong is high, especially in women and 60-70 age group. Body weight, blood pressure, blood lipid and liver fibrosis are also the risk factors of FLD, which should be paid attention to.

Epidemiological characteristics and temporal-spatial clustering analysis of tuberculosis in Guangzhou from 2010 to 2019

HU Wen-sui, LIU Wei, HOU Jian-rong, ONG Zhi-qiang, LIU Yuan

2020, 24(9): 1037-1041. doi: 10.16462/j.cnki.zhjbkz.2020.09.009

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Objective To study the epidemiological characteristics and temporal-spatial clustering of tuberculosis in Guangzhou from 2010 to 2019, and to provide evidence for developing precise prevention and control measures. Methods The data of tuberculosis incidence was collected and described in Guangzhou from 2010 to 2019. Spatial and spatiotemporal clustering of tuberculosis incidence was analyzed in the township level. Results A total of 136 341 tuberculosis cases were reported in Guangzhou from 2010 to 2019. The average annual incidence was 103.48/100 000. The overall incidence of tuberculosis showed a downward trend form 2010 to 2019 (χ²=712.46, P < 0.001). The peak time of incidence was from March to May, and 69.59% of the reported cases were male. The annual global Moran's I of reported tuberculosis incidence ranged from 0.088 3 to 0.286 0 (all P < 0.05). The high-high area was mainly concentrated in some towns including Nansha and Huadu District located in south and northwest of Guangzhou. Two high-reported and one low-reported incidence clusters were identified by spatiotemporal scanning statistic. 5 towns including Chini and Tanbu in Huadu District was the cluster area of most highest incidence. The lowest incidence cluster areas were mainly concentrated in central urban areas such as Yuexiu and Haizhu District. Conclusion The tuberculosis incidence showed a trend of generally decreasing in Guangzhou from 2010 to 2019, and there was spatiotemporal aggregation. Some streets/towns of Huadu and Nansha District should be the keypoints of prevention and control.

HIV testing status and influencing factors of female sex workers in Anhui Province

DAI Se-ying, CHENG Xiao-li, LIU Ai-wen, SU Bin

2020, 24(9): 1042-1045, 1091. doi: 10.16462/j.cnki.zhjbkz.2020.09.010

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Objective To understand the status of taking human immunodeficiency virus (HIV) testing and their associated factors among female sex workers (FSW) in Anhui Province. Methods Cross-sectional studies were conducted among FSW in Hefei, Liu'an and Ningguo City in Anhui Province. Convenient sampling method was adopted, and eligible participant received an anonymous survey. SPSS 17.0 software was used to analyze the status of taking HIV testing and associated factors among FSW. Results A total of 1 200 FSW were investigated, and the average age of them was (30.9±8.2) years old. The rate of taking HIV testing in the recent year was only 53.3%. FSW from high-tier venues had higher rate of taking HIV testing than those from middle-tier or low-tier venues, however, the difference was not statistically significant (all P>0.05). The results of multivariate Logistic regression analysis showed that FSW who were aged 31-40 years old or more than 41 years old, had educational level of primary school and below, being knowledge about acquired immune deficiency syndrome (AIDS), received the service of condom/promotional materials distribution in the recent year, received the service of peer education in the recent year, and being from middle-tier venues were more likely to take HIV testing. Conclusion The rate of taking HIV testing among FSW needs to be further improved in Anhui Province. It should continue to strengthen the AIDS health education and targeted behavioral intervention among FSW, especially among those from low-tier venues, to improve the knowledge about AIDS and the risk perception of HIV infection, and to encourage them to take HIV testing more promptly.

Drug resistance spectrum and characteristics of multi-drug resistant Pseudomonas aeruginosa in patients with pulmonary infection

ZHOU Jun-li, ZHANG Wen-cui, WANG Ying-ying, ZHENG Hui-jie, LIU Ning, LI Ying, HE Sui-ping, GONG Zi-jun, YAO Zhen-jiang

2020, 24(9): 1046-1050, 1062. doi: 10.16462/j.cnki.zhjbkz.2020.09.011

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Objective To analyze drug resistance spectrum, production of beta-lactamases, distribution of drug-resistant genes and integrons genes in multi-drug resistant Pseudomonas aeruginosa (MDRPA) isolated from patients with pulmonary infection in Guangzhou City. Methods Antimicrobial susceptibility testing and genetic testing were performed for MDRPA isolates, which were collected from patients with pulmonary infection in five hospitals in Guangzhou from 2008 to 2012. Results Of the 248 Pseudomonas aeruginosa isolates, the prevalance of MDRPA was 58.47%. The resistance rates to antibiotics used were over 50.00%. Among 145 MDRPA strains, the detection rate of production of extended spectrum β-lactamases (ESBLs), metallo β lactamases (MBL) and class C cephalosporinases (AmpC) was 17.93%, 21.38%, 17.24%, respectively. The detection rate of encoding genes was TEM (54.48%), PER (25.52%), OXA-10 (33.79%), IMP (21.38%) and VIM (9.66%), respectively, and the lacking rate of OprD2 gene was 32.41%. The detection rate of aminoglycoside modifying enzyme genes ant(3″)-Ⅰ and aac(6')-Ⅱ was 43.45% and 40.69%, respectively, and class Ⅰ integron gene was 62.07%. Conclusion The multi-drug resistance situation of Pseudomonas aeruginosa in patients with pulmonary infection in Guangzhou is serious. Meanwhile, β-lactamase and its coding genes, class Ⅰ integron genes and a variety of drug resistance genes are widely found in MDRPA, which should be paid more attention to.

Health literacy level and influencing factors of five occupational groups in Gansu Province in 2017

PENG Meng-guo, ZHANG Zhi-zhong, LIU Xing-rong

2020, 24(9): 1051-1056. doi: 10.16462/j.cnki.zhjbkz.2020.09.012

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Objective To understand the distribution of health literacy level of five occupational groups in gansu province in 2017, and explore its influencing factors, so as to provide a basis for formulating health education intervention strategies and measures for occupational groups. Methods By using multi-stage stratified cluster random sampling method, 23 490 permanent residents aged 15-69 years in 87 counties (cities and districts) of the province were selected for investigation, including 2 154 subjects of five occupational groups. Health literacy level of residents was investigated by questionnaire. The questionnaire includes demographic data and health literacy related issues. SPSS 20.0 statistical software was used for statistical analysis, and χ² test and Logistic regression were used to analyze the influencing factors. Results In 2017, the overall level of health literacy of five types of occupational groups in Gansu Province was 25.81%. The three dimensions of health literacy level from high to low were:basic knowledge and ideas (42.90%), basic health skills (28.60%), healthy lifestyles and behaviors (23.72%); The literacy levels of 6 types of health problems ranked from high to low:safety and first aid (59.89%), scientific health concept (57.75%), health information (39.55%), chronic disease prevention (29.81%), basic medical treatment (26.00%), infectious disease prevention and control (25.58%). The results of Logistic regression analysis showed that nationality, age, education and occupation were influencing factors of health literacy level (all P < 0.05). Conclusion In 2017, the health literacy level of five types of occupational groups in Gansu Province is still low, so it is necessary to strengthen the health education and monitoring research of occupational groups, and formulate effective countermeasures and measures to improve the health literacy level.

Analysis of influencing factors of healthy self-management ability of adults over 45 years old in rural area

HU Xiao-lei, LI Gui-lin, LI Jun, WANG Hao-xiang, ZHOU Zhi-heng, WANG Jia-ji, CHEN Xiao-yu

2020, 24(9): 1057-1062. doi: 10.16462/j.cnki.zhjbkz.2020.09.013

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Objective To explore the influencing factors of adults health self-management ability in rural areas. Methods A total of 1 217 adults aged 45 years and above in Liangkou Town of Conghua District from Guangzhou City were included in this study. The influencing factors were analyzed using one-way analysis of variance, multiple linear regression models and structural equation models. Results Age, education level, occupation, whether suffering from chronic diseases and self-assessed health status were influencing factors of adults' self-management ability (all P < 0.05). After verifying the potential variables with structural equation model, the greatest impact on health self-management ability was the utilization of public health resources (path coefficient was 0.74), followed were environmental self-management (path coefficient was 0.714), diet self-management (path coefficient was 0.685), and exercise self-management (path coefficient was 0.618), health beliefs (path coefficient was 0.592), self-efficacy (path coefficient was 0.585), and disease response (path coefficient was 0.585). Conclusions The adults health self-management ability is relatively low in rural areas. We should increase the supply of basic public health services, expand the coverage of medical insurance, promote standardized management of chronic diseases and facilitate general practice teams building.

Analysis on death cause and life loss of malignant tumor in Wuhai from 2015 to 2018

XU Xiao-qian, SONG Yang, ZHU Li-ge, WANG Xue-mei, SU Xiong, ZHAO Jing, LI Hai-ling

2020, 24(9): 1063-1067. doi: 10.16462/j.cnki.zhjbkz.2020.09.014

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Objective To analyze the characteristics of malignant tumor death distribution of residents in Wuhai City, and to provide basis for formulating corresponding intervention measures. Methods According to the death data of residents in Wuhai City from 2015 to 2018, the mortality rate, the constituent ratio of death cause, the order of death causes and the indicators of life loss of malignant tumors were calculated. Results The mortality rates of male, female and total malignant tumor were 199.66/100 000, 122.99/100 000 and 163.02/100 000 respectively, and the standard mortality rates were 216.47/100 000, 142.68/100 000 and 180.45/100 000 respectively. Ratio of male to female was 1.52:1. The top three causes of death for men and women were lung cancer, stomach cancer and liver cancer. The lowest mortality rate was 2.46/100 000 in the aged 15 to 19 years, while the highest mortality rate was 3042.28/100 000 in the aged 85 years or above. The major cause of malignancy death in aged before 14 years was leukemia, and in aged after 15 years was lung cancer, stomach cancer and liver cancer. Potential years of life lost (PYLL) caused by malignancy accounted for 46.9% of all, and lung cancer was the highest among both men and women. Average years of life lost (AYLL) showed that liver cancer was the highest in men and breast cancer in women, followed by cervical cancer. Conclusions Malignant tumor has become one of the main causes of death for residents of Wuhai City. Lung cancer, stomach cancer and liver cancer are the causes of death of malignant tumors that seriously endanger the health of residents in Wuhai City. In addition, the prevention and treatment of female breast cancer and cervical cancer should also be emphasized. There should be targeted work to reduce malignant tumor mortality and improve the health of residents.

Burden of cerebrovascular diseases attributable to metabolic risks in 2011 and 2017 in Nanjing

HONG Xin, FAN Zhou-quan, YANG Hua-feng, ZHOU Hai-rong, QI Sheng-xiang, YE Qing, CHEN Xu-peng, ZHOU Jin-yi

2020, 24(9): 1068-1072. doi: 10.16462/j.cnki.zhjbkz.2020.09.015

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Objective To analyze the burden of cerebrovascular diseases attributable to metabolic risks in Nanjing population aged 25 years and older in 2011 and 2017. Methods The data were extracted from the Nanjing Chronic Disease and Risk Factor Surveillance, the Nanjing Mortality Surveillance and the 2016 Global Burden of Disease Study. Based on population attributable fractions, the deaths and life expectancy losses of cerebrovascular diseases attributable to high systolic blood pressure, high fasting plasma glucose, high total cholesterol, high body mass index and four metabolic risks combination were estimated in 2011 and 2017. Results The number of cerebrovascular diseases death attributable to four metabolic risks combination was 4 978, and resulted in a loss of life expectancy of 1.43 years in 2017. High systolic blood pressure appeared as the major cause on cerebrovascular diseases deaths (35.51%) and years of life lost due to premature mortality (YLL) (38.89%). Compared to 2011, the standardized rate of mortality and YLL on cerebrovascular diseases due to high systolic blood pressure and high body mass index in 2017 showed downward trend, while high fasting plasma glucose showed upward trend. Males appeared to have higher standardized rate of YLL on cerebrovascular diseases than females. Conclusions Metabolic exposures especially high blood pressure were important risk factors attributable to cerebrovascular diseases deaths in Nanjing. Proper management of hypertension, diabetes, dyslipidemia and obesity could remarkably reduce the pervasive burden of cerebrovascular diseases.

Association among career adaptability and depression and anxiety symptoms of freshmen in a medical college

HE Ting-ting, LIU Hai-xia, WAN Yu-hui

2020, 24(9): 1073-1078. doi: 10.16462/j.cnki.zhjbkz.2020.09.016

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Objective To analyze the association between freshmen's career adaptability and symptoms of depression and anxiety in a medical university. Methods A total of 1 302 freshmen were recruited from a medical university in Anhui Province to participate in this study. They were asked to complete an anonymous questionnaire, including college students'career adaptability questionnaire (CSCAQ), self-depression scale (SDS) and self-anxiety scale (SAS). Logistic regression models were used to investigate the relationship among career adaptability and depression and anxiety symptoms. Results After adjusting for demographic indicators, the risk of depressive symptoms in freshmen with medium and low-level career adaptability were 1.613 times (95% CI:1.165-2.234) and 5.213 times (95% CI:3.772-7.204) higher than those with high career adaptability, respectively. The risk of anxiety symptoms in freshmen with medium and low-level career adaptability were 1.583 times (95% CI:1.066-2.351) and 3.340 times (95% CI:2.292-4.866) higher than those with high career adaptability, respectively. With the decrease of career adaptability, the detection rates of depression and anxiety symptoms in freshmen were increased. Career interpersonal relations, career concern, career curiosity, career self-confidence, career control and career adjustment all had similar correlations with depression and anxiety symptoms (all P < 0.05). Conclusions Low-level career adaptability is positively correlated with the increase of depression and anxiety symptoms, suggesting that the improvement of career adaptability is related to the promotion of the mental health of freshmen in medical university.

Study on improving the awareness about flu and vaccination rate among patients with coronary atherosclerotic heart disease

SONG Xiao-zhe, SHI Chun-lei, LIU Dong-sheng

2020, 24(9): 1079-1082, 1105. doi: 10.16462/j.cnki.zhjbkz.2020.09.017

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Objective To assess the awareness about influenza and vaccines among patients with coronary heart disease(CHD), and to evaluate the effects of community-based public health interventions in increasing the influenza vaccination rate and the awareness about flu. Methods Patients with CHD in community health service centers in Gulou District were divided into two equal groups by using random cluster sampling, which were group (IG) and the control group (CG). Multi-frequency community-based public health interventions (e.g. health education) were implemented in IG, and CG was not treated. The awareness about influenza among patients with CHD was compared before and after interventions in IG, and the vaccination rate of CG was also compared after interventions. Results A total of 1 711 and 1 805 people were included in IG and CG, respectively. After the intervention, the awareness of influenza and its vaccines increased in IG (all P < 0.05), for example, the total awareness rate increased from 15.84% to 53.59%(χ²=518.734, P < 0.001).The baseline data of influenza vaccination rate in IG and CG were 4.32% and 4.76%, respectively, and there was no significant difference between them (χ²=0.391, P>0.05). After interventions, the vaccination rate increased to 7.89% in IG, which was higher than that before interventions (χ²=43.373, P < 0.001). The vaccination rate decreased to 1.88% in CG (χ²=69.258, P < 0.001), which was lower than the baseline rate (χ²=36.125, P < 0.001), and also much lower than IG after interventions (χ²=17.583, P < 0.001). Conclusions The flu vaccination rate among patients with CHD in Guolou District of Xuzhou City is not high. The community-based public health intervention is an effective means to improve the flu awareness rate and vaccination rate among patients with CHD.

Epidemiological study of Down's syndrome in Shanghai from 2011 to 2018

LI Wen-xian, DU Li, LI Min-ming, ZHU Li-ping

2020, 24(9): 1083-1086. doi: 10.16462/j.cnki.zhjbkz.2020.09.018

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Objective To analyze recent trends in Down's syndrome (DS) prevalence in Shanghai and evaluate the impact of the policy on prenatal screening and diagnosis. Methods 897 cases of DS between 2011 to 2018 were analyzed retrospectively, including live births and elective terminations with DS. Results The overall prevalence of DS was 5.36 per 10 000 births during 2011-2018, with significant differences between registered and immigrant population as well as gender groups (all P < 0.05). Prevalence of DS in terminations was 0.90 to 5.80 per 10 000, presenting an increasing trend with fluctuation since 2014 (χ²_trend=95.74, P < 0.001). While perinatal prevalence of DS was 0.80 to 5.04 per 10 000, showing a decreasing tendency since 2015 (χ²_trend=97.15, P < 0.001). The proportion of those with advanced parental age and multiparas among DS in terminations varied year by year (all P < 0.001). Conclusions The important reduction in live birth with DS suggests that the current strategies in Shanghai for prenatal screening and diagnosis of DS are effective. However, the prenatal screening network and service capacity of prenatal diagnosis need to be improved to meet the demand of prevention and control of DS under the Two-child policy.

Epidemic characteristics of hepatitis C in Lanzhou City from 2010 to 2019

MA Jing, WANG Mei, QIAO Xiao-wei, CAO Wen-pei, LI Juan-sheng, REN Xiao-wei, WANG Yu-hong, LIU Xiao-ning

2020, 24(9): 1087-1091. doi: 10.16462/j.cnki.zhjbkz.2020.09.019

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Objective To analyze the epidemiological characteristics and trend of hepatitis C in Lanzhou City, so as to provide scientific evidence for the strategy of prevention and control. Methods Data of hepatitis C virus infection reported cases in Lanzhou City from 2010 to 2019 were collected and analyzed by Excel 2016, SPSS 21.0 and Joinpoint 4.7.0.0 software. Results 22 697 cases of hepatitis C were reported in Lanzhou city from 2010 to 2019, the annual average incidence rate was 70.20/100 000. The results of Joinpoint regression models showed that the incidence of rates hepatitis C in Lanzhou City were decreased at an average annual percent changes (APC) of 7.49% (95% CI:-9.5% to -5.4%).The time distribution of onset was steady without seasonality. The three district with the highest reported incidence rates were Chengguan District (59.79/100 000), Qilihe District (59.04/100 000) and Anning District (43.36/100 000). The reported gender ratio was 1.06:1. The ages of onset were mainly from 35 to 79 years old, and the incidence of hepatitis C increased gradually with age. The occupational composition was mainly for farmers and retirees. Conclusions The number of reported cases and annual reported incidence of hepatitis C in Lanzhou show decreasing trends. It is necessary to strengthen the surveillance of key populations and areas, standardize the case report, and raise public awareness of hepatitis C virus infection.

Analysis of influence factors on congenital digestive tract malformation

HOU Guo-qiang, REN Jia-jia, CAO Wen-jun, WANG Li-hong, FANG Zi-wei, WANG Jing-ming

2020, 24(9): 1092-1095. doi: 10.16462/j.cnki.zhjbkz.2020.09.020

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Objective To explore risk factors related to congenital digestive tract malformation. Methods From March to April 2019, a self-designed questionnaire was used to investigate parental risk factors before and during pregnancy with digestive tract malformation (n=54, case group) and newborns with non-digestive tract malformation in the same department (n=60, control group) from 2015 to 2018. Results Univariate analysis showed that gender, gestational weeks, birth weight, maternal age, caffeine or multivitamin exposure during pregnancy, age of father and father smoking before 3 months of pregnancy were associated with the occurrence of congenital gastrointestinal malformations. Logistic regression analysis showed that male neonates were at high risk for digestive tract malformation (P < 0.001, OR=7.168). Multivitamin supplementation during pregnancy was a protective factor for digestive tract malformation (P=0.004, OR=0.103). Fathers smoking greater than 5/day before 3 months of pregnancy was a risk factor for digestive tract malformations (P=0.005, OR=2.833). Conclusions Male neonates, fathers smoking greater than 5/day before 3 months of pregnancy were high risk factors for digestive tract malformation and multivitamin supplementation during pregnancy was a protective factor for digestive tract malformation.

Study on the epidemiological characteristics of a large HIV-1 molecular cluster in a low epidemic county

ZENG Ya-li, MI Jia-jun, Lyu Dan, ZHUOMA La-cuo, YAN Tu, LI Ju-mei, ZHU Jun, KANG Fa-yang, LAI Wen-hong, HOU Xue-qin, LIANG Shu, SU Ling

2020, 24(9): 1096-1100. doi: 10.16462/j.cnki.zhjbkz.2020.09.021

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Objective To study the characteristics of HIV-1 molecular clusters in a low-epidemic county in Sichuan Province, so as to provide a basis for precise intervention. Methods Research subjects included HIV/AIDS patients who were newly diagnosed from January 2011 to March 2019 in a low-epidemic county in Sichuan Province, of whom the HIV-1 pol gene was sequenced, and molecular cluster analysis was performed. Epidemiological questionnaire survey was conducted among survival cases. Results Among 113 newly diagnosed cases, 49.6% (56/113) belonged to the same molecular cluster (CRF01_AE4), and the average genetic distance of this cluster was 0.006 1. The first case was found in 2011 and there was a trend of continuous rapid growth (χ²_trend=11.626, P=0.001). The cases in the cluster were mainly seniors (average age was 50.5±13.0), low-educated (42.9%), married (67.9%), male (76.8%) and only few had a going-out history (17.0%). 45.5% were infected through heterosexual commercial sexual behaviors, and the sexual transactions mainly occurred in low-cost commercial sex venues (55.0%) in local areas (87.5%), and never consistently used condoms in the sex trade. 75.0% cases who were infected through heterosexual commercial sex were mainly diagnosed since 2016. One case, who continued having high-risk sexual behaviors after being informed and refused the anti-retroviral therapy, was found connecting with multiple cases in the molecular transmission cluster. Conclusions A large-scale transmission network had continued to expand rapidly in a HIV low-endemic county and sexual transactions in local low-cost commercial sex venues were the main reason for the network expansion.

Analysis on epidemiological and clinical characteristics with fever in ever outpatient in a hospital in Anhui Province

LIU Kai, QI Jin-wei, HU Ze-ping, LIU Li-guang, LU li

2020, 24(9): 1101-1105. doi: 10.16462/j.cnki.zhjbkz.2020.09.022

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Objective To analyze the epidemiological characteristics of patients with fever during the coronavirus disease 2019 situation, so as to provide scientific basis for the prevention and treatment of the disease. Methods Patients who visited the fever clinic of the fourth affiliated hospital of Anhui medical university from January 20, 2020 to February 18 were selected. The survey included general demographic characteristics, main clinical symptoms and signs, and laboratory tests. Patients diagnosed with suspected COVID-19 were investigated for their epidemiological history. Results A total of 880 patients included in this study during the survey period. In the 880 patients, 42 were clinically diagnosed as suspected COVID-19. The ratio of male to female patients was 1.61:1, mainly young and middle-aged. There was significant difference of age between patients with suspected COVID-19 and other patients (t=4.546, P < 0.001). Most patients in the suspected COVID-19 group and the common patients group visited the doctor within 1 to 7 days, and both groups mainly had low fever. Reduced lymphocyte count was found in 32 suspected COVID-19 patients (76.2%), and elevated cevels of c-reactive protein was found in 39 suspected COVID-19 patients (92.9%). Conclusions Prediction based on the clinical characteristics of suspected COVID-19 patients, laboratory tests and other results can facilitate strict medical isolation and observation of suspected patients and may contribute to disease control and prevention.

Analysis on epidemiological characteristics of tuberculosis in Tibet Autonomous Region from 2008 to 2017

YANG Guo-feng, WANG Jian, ZHANG Bao-ying, WANG Tong-tong

2020, 24(9): 1106-1109. doi: 10.16462/j.cnki.zhjbkz.2020.09.023

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Objective To understand and analyze the epidemiological characteristics of tuberculosis in Tibet from 2008 to 2017, and to provide a reliable basis for the prevention and control of tuberculosis in Tibet. Methods Descriptive epidemiological research methods were used to analyze the tuberculosis surveillance data in Tibet from 2008 to 2017. Results From 2008 to 2017, the average reported incidence of tuberculosis in Tibet Autonomous Region was 105.70/100 000, the standard reported incidence was 10.810/100 000, and the reported incidence of tuberculosis was EAPC=-1.83% (t=3.119, P=0.014). The reported incidence of tuberculosis in Tibet declined at an average rate of 1.83% during the year; The male-to-female reported incidence of tuberculosis was 1.48:1, and the reported incidence of men was higher than that of women; The reported incidence of tuberculosis was the highest in the elderly aged 65-74 years, at 270.55/100 000; The occupations with the most reported cases of tuberculosis were farmers, followed by herders and students; Shigatse City and southern Tibet were the regions with the highest incidence of tuberculosis. Conclusions The reported incidence of tuberculosis in the Tibet Autonomous Region is declining, but the epidemic situation is still relatively serious. It is necessary to take effective measures against the epidemic-prone areas such as Shigatse City and southern Tibet, as well as populations such as farmers, herdsmen and students, to further control and reduce the tuberculosis epidemic situation in Tibet.

2020, 24(9): 1110-1112. doi: 10.16462/j.cnki.zhjbkz.2020.09.024

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A pioneer of clinical trials: James Lind

DENG Li-jun, WU Jun, YE Dong-qing

2020, 24(9): 1113-1116. doi: 10.16462/j.cnki.zhjbkz.2020.09.025

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James Lind (1716-1794) was a British Navy surgeon and one of the leaders of British hygiene. In the 18th century, human activities on the sea of Europe were ravaged by various diseases. Lind found that orange and lemon could effectively prevent and treat scurvy diseases through clinical comparative tests, and put forward a series of health measures to improve crew health, which significantly reduced the incidence and mortality of typhoid fever. Meanwhile, he linked the occurrence of diseases with the geographical environment in which he lived to promote the development of medical geography. Up to now, many of his health thoughts are still in use.

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2020 Vol. 24, No. 9

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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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