中华疾病控制杂志

Advocating reasonable lifestyles during gestation and preventing pregnancy complications

JIANG Yu

2021, 25(2): 125-127, 226. doi: 10.16462/j.cnki.zhjbkz.2021.02.001

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With the implement of the two-child policy, topics on maternal and child health are getting more concerns in China. As an important part of early life, gestational period has great impacts on pregnancy outcomes and offspring's growth. However, there are high prevalence, complicated etiology and various factors regarding pregnancy complications. How to prevent their occurrence is the key to ensure maternal and child health. Papers in this issue "Maternal and Child Health" showed the results of the Chinese Pregnant Women Cohort Study (CPWCS) project, including status of maternal and child cohort research, influencing factors of pregnancy complications, as well as relationship between environmental factors, lifestyles and maternal and child health. This issue aims to provide more comprehensive basis and guidance for maternal and infant related services, and to promote the scientific implement of the maternal and child health promotion campaign.

Cohort study on the impact of nutrient supplement use during pregnancy on anemia in pregnant women

JING Ao, WU Hong-guo, ZHAN Yong-le, CHEN Yun-li, SHI Ying-jie, YUE He-xin, LIU Xuan, LYU Tian-chen, MENG Yao-han, QU Yi-min, MA Liang-kun, HUANG Ping, JIANG Yu

2021, 25(2): 128-132. doi: 10.16462/j.cnki.zhjbkz.2021.02.002

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Objective To investigate the relationship between the use of nutrient supplements and anemia in pregnant women in China. Methods A self-designed questionnaire on the use of nutrient supplements during pregnancy was used on pregnant women in the Chinese Pregnant Women Cohort Study. The use of nutrient supplements and the diagnosis of anemia during pregnancy were followed up and the data were analyzed by Logistic liner regression model. Results A total of 3 321 subjects were included in the study. The incidence of anemia with pregnancy was 14.0%. The results of Logistic liner regression model showed that compared with the women who used folic acid throughout pregnancy, those who did not use folic acid throughout pregnancy were more likely to have anemia (OR=1.362, 95% CI: 1.096-1.691, P=0.005). Conclusions Failure in continuous use of folic acid throughout pregnancy is a risk factor for anemia in pregnancy. Pregnant women should be encouraged to use folic acid throughout pregnancy to reduce the risk of anemia.

The relationship between fetal umbilical cord entanglement and environmental exposure factors

YUE He-xin, LI Xiao-xiu, ZHAN Yong-le, CHEN Yun-li, SHI Ying-jie, LIU Xuan, JING Ao, MENG Yao-han, LYU Tian-chen, QU Yi-min, MA Liang-kun, MAN Dong-mei, JIANG Yu

2021, 25(2): 133-137. doi: 10.16462/j.cnki.zhjbkz.2021.02.003

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Objective To understand the incidence of fetal umbilical cord entanglement in China and its correlation with environmental exposure factors, so as to provide scientific guidance for prevention and intervention of umbilical cord entanglement. Methods The pregnant women of the Chinese Pregnant Women Cohort Study were selected as the research subjects. The general demographic information and environmental exposure information of pregnant women were collected in the early pregnancy, and the related outcomes of umbilical cord entanglement were obtained by follow-up. Multivariate unconditional Logistic regression analysis model was used to analyze the influencing factors of fetal umbilical cord entanglement. Results The incidence of fetal umbilical cord entanglement was 9.00%. The results of Logistic regression analysis showed that after adjusting for confounding factors, pregnant women exposed to passive smoking (OR=1.199, 95% CI: 1.010-1.423, P=0.038) or noise (OR=1.242, 95% CI: 1.002-1.541, P=0.048) had a higher risk of umbilical cord entanglement than those who were not exposed to passive smoking or noise during pregnancy. Conclusions Passive smoking and exposure to noise during pregnancy can affect fetal umbilical cord entanglement. Education during pregnancy should be strengthened to reduce passive smoking and noise exposure during pregnancy.

Association and dose-response relationship of physical activity and sedentary behavior with risk of premature rupture of membranes

ZHAN Yong-le, WU Hong-guo, CHEN Yun-li, SHI Ying-jie, LIU Xuan, YUE He-xin, JING Ao, MENG Yao-han, LYU Tian-chen, QU Yi-min, MA Liang-kun, MA Hai-hui, JIANG Yu

2021, 25(2): 138-142, 148. doi: 10.16462/j.cnki.zhjbkz.2021.02.004

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Objective To investigate the association and dose-response relationship of physical activity (PA) and sedentary behavior with premature rupture of membranes (PROM). Methods Data were collected from the Chinese Pregnant Women Cohort Study. The International Physical Activity Questionnaire-Short Form was used to assess the frequency of PA and sedentary time (ST), and diagnosis of PROM was collected in the follow-up period. Logistic regression analysis model and restricted cubic spline (RCS) model were used for data analyses. The odds ratio (OR) with its 95% confidence interval (CI) was calculated. Results A total of 6 848 participants were included in this study. The incidence of PROM was 13.79% among pregnant women. Compared with low frequency group, women with high frequencies of moderate-intensity PA (OR=1.50, 95% CI: 1.01-2.23) and light-intensity PA (OR=1.19, 95% CI: 1.04-1.37) had higher risks of PROM respectively. The risk of PROM increased 13% (OR=1.13, 95% CI: 1.03-1.24) per 1 d/week increase of vigorous-intensity PA, while the risk increased 2% (OR=1.02, 95% CI: 1.01-1.04) per 1 h/d increase of ST. The RCS model showed that the risk for PROM was significant with frequencies of over 2 d/week of vigorous-intensity PA, over 5 d/week of moderate-intensity PA or over 5 d/week of light-intensity PA (all ORs with corresponding 95% CIs>1). Conclusions High frequency of physical activity and sedentary behavior are risk factors for PROM. Pregnant women are supposed to conduct physical activity with proper frequency and moderate intensity as well as decreasing sedentary time, so as to prevent the risk of PROM during pregnancy.

Influencing factors of preterm birth: a prospective cohort study

SHI Ying-jie, ZHAN Yong-le, CHEN Yun-li, JIANG Yu, MA Liang-kun

2021, 25(2): 143-148. doi: 10.16462/j.cnki.zhjbkz.2021.02.005

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Objective To analyze the prevalence and risk factors of preterm birth in China and to provide reference for the prevention of preterm birth. Methods Data was from the Chinese Pregnant Women Cohort study (CPWCS). The basic information and delivery outcomes of pregnant women were collected through questionnaire surveys and hospital information system. The chi-square test and multivariate logistic regression analysis were conducted by SPSS 26.0 software. Results The prevalence of preterm birth among 5 671 pregnant women was 5.2%, and there was no significant difference in the prevalence of preterm birth among different regions (χ² =0.591, P=0.771). The results of multivariate logistic regression analysis showed that advanced age, history of diabetes, history of premature birth, placental abruption, premature rupture of membranes, fetal distress, hypertension during pregnancy, and twins were risk factors for preterm birth (all P < 0.05), while among pregnant women who give birth naturally, advanced age (OR=2.90, 95% CI: 1.67-5.06, P < 0.001), premature rupture of membranes (OR=6.17, 95% CI: 4.21-9.06, P < 0.001), and twins (OR=17.72, 95% CI: 3.23-97.25, P < 0.001) were risk factors for preterm birth. Conclusions There are many influencing factors of preterm birth. Accurately identifying risk factors and providing pregnant women with scientific and reasonable health education and individualized prevention and control measures are important means to prevent preterm birth.

The status and influencing factors of physical activity among Chinese pregnant women during different pregnancies

CHEN Yun-li, MA Hai-hui, SHI Ying-jie, ZHAN Yong-le, MA Liang-kun, JIANG Yu

2021, 25(2): 149-154. doi: 10.16462/j.cnki.zhjbkz.2021.02.006

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Objective To study the physical activity level of Chinese pregnant women in different trimesters, and analyze the influencing factors of constant physical inactivity. Methods The study objects were from Chinese Pregnant Women Cohort Study (CPWCS) who were followed-up in the first, second and third trimester. The general information of pregnant women was obtained through baseline survey, and the physical activity in each trimester was assessed through International Physical Activity Questionnaire (IPAQ) Short Form. Multivariable logistic regression was used to analyze the influencing factors of constant physical inactivity during pregnancy. Results A total of 2 920 pregnant women were included in the study, of which only 1 057 (36.2%) were physically active all through the pregnancy, and 267 (9.14%) were constant physical inactivity. Logistic regression analysis results showed that prepregnancy obesity (OR=1.985, 95% CI: 1.078-3.654, P=0.028), having more than 2 family members (OR=1.544, 95% CI: 1.122-2.123, P=0.008), and smoking before pregnancy (OR=2.395, 95% CI: 1.309-4.382, P=0.005) were risk factors of constant physical inactivity. Conclusions The physical activity of Chinese pregnant women was insufficient. To help pregnant women carry out physical activities safely and effectively during pregnancy, and promote the health status of pregnant women and fetuses, we should provide personalized physical activity guidance, and family members should take actions to support pregnant women to carry out physical activities.

A bibliometric analysis on cohort study of maternal and child health in China

LIU Xuan, HUANG Ping, ZHAN Yong-le, CHEN Yun-li, SHI Ying-jie, YUE He-xin, JING Ao, MENG Yao-han, LYU Tian-chen, ZHANG Yi-fang, QU Yi-min, LI Xiao-xiu, JIANG Yu

2021, 25(2): 155-159. doi: 10.16462/j.cnki.zhjbkz.2021.02.007

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Objective To retrospectively analyze the application trend of cohort study in the field of maternal and child health and to look forward to its future development trend. Methods Chinese and English papers reporting the cohort studies of maternal and child health conducted in the mainland of China were included. The literature management software was used to analyze the publication time, institution, type and objective of the studies and the follow-up performance. Statistical analysis was carried out by using SPSS 22.0. Results The number and quality of the papers reporting maternal and child health-related cohort studies increased significantly in the past 30 years and a core Chinese and English journal group of this field has been formed. The average annual growth rates of Chinese and English papers published were 12.2% and 23.2% respectively. About 54.4% of the Chinese papers and 79.3% of the English papers were published in the past five years with high quality. The number of Chinese papers published on Chinese core journals accounted for 56.9% while English papers published on SCI periodicals (IF>3) accounted for 54.3%. For the study objective, those published on the domestic and SCI journals mainly focused on etiologic research (90.8% and 91.3% respectively), being the most of which were large-scale studies. High-quality SCI papers were more interested in the studies of etiologic researches, and regression analysis was the common statistical method to be used. Conclusions The application of cohort study in the field of maternal and child health gradually increased in China. Large-scale study and regression analysis were conducted commonly. However, it is necessary to further improve the researchers' understanding of cohort study, improve the follow-up quality, and increase the application of scientific evaluation methods, such as Cox regression analysis, for the better solving of practical problem.

The study of periconception folic acid supplementation and its relationship with pregnancy outcome

CHEN Gan-ne, JIANG Min, HUANG Wei-wen, ZHAO Xin-jie, LIU Yun-hui, HUANG Wan-ping

2021, 25(2): 160-164. doi: 10.16462/j.cnki.zhjbkz.2021.02.008

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Objective This study aimed to investigate the situation and dosage of penconception folic acid supplementation and to explore the association between periconception folic acid supplementation and pregnancy outcome. Methods A total of 6 526 pregnant women were recruited from October 2017 to June 2019 in Huadu District of Guangzhou. R retrospective surveys before or after delivery were conducted to collect information about general demographic characteristics, periconception folic acid supplementationand pregnancy outcomes. Results There were 1 345 pregnant women (20.18%) taken folic acid for more than one month at half a year before pregnancy. 764(11.69%) pregnant women took normal daily dosage of folic acid during periconception. Preconception folic acid supplementation was associated with 74.68 g higher birth weight and the first-trimester supplementation increased 55.05 g (P < 0.05), compared to no folic acid supplementation. After adjusted maternal age, educational level, pre-gestational body mass index (BMI), passive smoking time, periconception folic acid supplementation could reduced the risk of small for gestational age (SGA) infants (aOR=0.66; 95% CI: 0.46-0.95). Low birth weight (LBW) and spontaneous preterm delivery were not related to the type of folic acid supplementation. High-dose folic acid during periconception may increased the risk of spontaneous preterm (aOR=1.75; 95% CI: 1.02-3.01). SGA and LBW were not related to folic acid dose. Conclusions Periconception folic acid supplementation was positively associated with fetal growth resulting in birth weight, and decreased risks of SGA.

Association between maternal dietary intake during postpartum period and infant eczema

ZENG Jing-jing, WU Wei-jia, TANG Nu, PAN Wen-ting, JING jin, CAI Li

2021, 25(2): 165-170. doi: 10.16462/j.cnki.zhjbkz.2021.02.009

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Objective To explore the association between maternal food group intakes in breastfeeding women during postpartum period and the risk of infant eczema. Methods Participants were from a prospective cohort study in Guangzhou, China. Mothers were recruited in the second trimester and followed up at 6-8 weeks after delivery by a face-to-face interview. Trained investigators collected dietary information of breastfeeding mothers during first month after delivery using a validated food frequency questionnaire, and collected infant eczema information. Food items were aggregated into 10 food groups according to the 2016 Chinese Dietary Guidelines, and the intake of each food group was calculated. The association between maternal dietary intake during postpartum period and infant eczema was tested using multivariate Logistic regression models. Results A total of 468 mother-infant pairs were enrolled. The cumulative incidence of infant eczema at 6-8 weeks postpartum was 47.44%. No statistical differences were observed in maternal intakes of cereals and tubers, vegetables, fruits, red meat, poultry, fish, eggs, dairy, soybean, and nuts and seeds between eczema group and control group. The results of multivariate Logistic regression analysis model showed that the risk of infant eczema increased by 26.4% with the increase of one standard deviation of fish intake during puerperium (OR=1.264, 95% CI: 1.015-1.574, P=0.037). The risk of infant eczema increased by 27.2% for each standard deviation increase of freshwater fish intake (OR=1.272, 95% CI: 1.019-1.588, P=0.034), while no such association was observed for deep-sea fish. Conclusions Maternal higher intake of freshwater fish during postpartum period was associated with an increased risk of infant eczema.

Correlation analysis on trimethylamine N-oxide and its metabolites in early pregnancy with overweight

CAO Shu, LENG Jun-hong, LI Wei-qin, FANG Zhong-ze, YANG Xi-lin, HUO Xiao-xu

2021, 25(2): 171-175. doi: 10.16462/j.cnki.zhjbkz.2021.02.010

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Objective To explore the differences in the distribution of trimethylamine N-oxide (TMAO) and its metabolites in pregnant women under different weight status in early pregnancy, and analyze the relationship between TMAO and its metabolites and overweight. Methods A pregnancy cohort of 22 302 pregnant women was established in Tianjin from October 1 2010 to August 31 2012, and then gestational diabetes mellitus (GDM) was selected as the target disease. The nested case-control study included 243 pregnant women who developed GDM between 24 and 28 weeks of pregnancy. At the same time, a 1:1 match was made according to (age ±1) year. The final analysis included 486 subjects. The serum TMAO and its metabolites were determined by liquid chromatography-tandem mass spectrometry. Subjects were divided into overweight group and non-overweight group according to BMI≥24.0 kg/m² and BMI < 24.0 kg/m², TMAO and its metabolites were divided into high and low levels by percentile method, and binary logistic regression analysis was performed. Results The level of overweight group trimethylamine (TMA) was significantly higher than that of non-overweight group, the difference was statistically significant (Z=-2.747, P=0.006). Logistic regression analysis showed that when the confounding factors were not adjusted, compared with pregnant women with low TMA, the OR value of overweight at TMA≥264.5 nmol/mL was 1.771 (95% CI: 1.193-2.629, P=0.005); After adjusting for confounding factors, the OR value of overweight at TMA≥264.5 nmol/mL was 1.734 (95% CI: 1.063-2.827, P=0.027). Conclusions The level of TMA in early pregnancy is significantly related to the overweight of pregnant women. By adjusting the level of TMAO and its metabolites, it may provide new ideas for the control and treatment of metabolic syndromes such as obesity and diabetes.

Study on the sleep quality of perinatal women and the influencing factors of postpartum sleep

YANG Huai-jie, YANG Hong, XIAN Wen-ying, LI Yan, WANG Tao

2021, 25(2): 176-179, 239. doi: 10.16462/j.cnki.zhjbkz.2021.02.011

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Objective To survey the sleep quality of perinatal women, and to explore the influence factors for postpartum sleep quality so as to provide basis for the formulation of intervention measures. Methods The research was conducted from April 2018 to July 2019. A repeated questionnaire method was used. The first survey was completed during the pregnancy check-up, and a questionnaire survey again 3-7 days after delivery was conducted. Pittsburgh sleep quality index was used to measure the sleep quality of the participants. At the same time, the general information, obstetric data, depression during pregnancy and pregnancy, and confidence in breastfeeding were collected. The predictors of postpartum sleep quality were analyzed by multiple linear regression analysis. Results A total of 367 pregnant women completed questionnaire twice. Subjective sleep quality, sleep latency and sleep disorders were three aspects of poor maternal sleep quality. The proportion of sleep disorder in pregnant women was 26.5%, and 23.7% in maternal women. Postpartum sleep quality was moderately related to sleep quality during pregnancy. Multiple linear regression analysis showed that the factors influencing sleep quality of postpartum women included sleep quality during pregnancy, postpartum depression, and maternal breastfeeding efficacy. These factors explained 34.5% of the total variance of postpartum sleep quality. Conclusions The incidence of sleep disorders in perinatal women is high. It is recommended to carry out health education and guidance to promote sleep from pregnancy. Reducing postpartum depression and improving breastfeeding efficiency can improve maternal sleep quality.

Correlation analysis of 0-6 years old children's disability and mother's health conditions before and during pregnancy

YANG Na, CAO Yong-wen, GE Xiao-jie, YE Jia-xin, WU Yang-haotian, LIU Qian-qian, YAN Huan, HAN Xue-mei

2021, 25(2): 180-185. doi: 10.16462/j.cnki.zhjbkz.2021.02.012

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Objective To understand the prevalence of six types of disabilities in children aged 0-6 in Gansu Province, including vision, hearing, limbs, intelligence, autism, and multiple disabilities, and to analyze the correlation between maternal health status before and during pregnancy and child disability. Methods Data were from the disability screening project for children aged 0-6 years in Gansu Province. After obtaining the data, the data was cleaned first, and finally logistic regression model was applied to analyze the data. Results A total of 203 (6.64‰) children in the project were diagnosed with the disability. The prevalence rate among boys and girls was 7.2‰ (128) and 5.86‰ (75), respectively. The results of Logistic regressive model analysis showed that there were 12 factors related to children's disability. The most important factors were premature delivery and self-delivery, previous birth defects, taking ovulation-promoting drugs 6 months before pregnancy, chronic respiratory diseases with a history of illness during pregnancy, surrounded by chemical plants and mines that discharge environmental pollutants, eating pickled sun-dried foods >350 g/week, and people often smoking indoors (all P < 0.05). Conclusions Physical disability, intellectual disability, and visual disability are the key types of disability preventions. A mother's health status and habits before pregnancy and during pregnancy will affect her child's disability. It is suggested that women should pay attention to their health and eating habits during pregnancy to prevent the occurrence of child disability.

Serotype distribution and antimicrobial susceptibility of streptococcus pneumoniae isolated from children in Suzhou from 2017 to 2019

FENG Shuang, TIAN Jian-mei, TAO Yun-zhen, ZHANG Wan-qing, DAI Zi-rui, ZHANG You-yi, SHAO Xue-jun, ZHAO Gen-ming, ZHANG Tao

2021, 25(2): 186-191. doi: 10.16462/j.cnki.zhjbkz.2021.02.013

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Objective To investigate the serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae (S. pneumoniae) isolated from children with respiratory infectious diseases in Soochow University Affiliated Children's Hospital, so as to provide evidences for treatment and vaccination strategies of pneumococcal disease. Methods S. pneumoniae strains were serotyped by latex agglutination and quellung reactions, and were detected the susceptibility of multiple antibiotics with E-test method. Results From Jan 2017 to Jul 2019, a total of 3 652 pneumococci were collected. The strains were mainly isolated from 6-month to 2-year old children, with a male to female ratio of 1.5:1. The common serotypes were 19F, 6B, 23F, 19A and 6A, and the coverage of serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13)was 73.1% (95% CI: 71.6%-74.5%). The penicillin resistance rate was 1.9%. Among the penicillin non-susceptible (PNSP) strains, the rates of resistant to amoxicillin, erythromycin and azithromycin were higher than those of the penicillin susceptible S. pneumoniae (PSSP) strains. The antibiotics resistance rate of strains included in PCV13 serotype was higher than that of the strains not covered by PCV13 vaccine serotype. Conclusions The coverage of PCV13 vaccine serotypes was high among the S. pneumoniae isolated from children in Suzhou, and most of the penicillin non-susceptible strains were covered by the PCV13 vaccine serotypes.

Effectiveness of Haemophilus influenzae type b conjugate vaccine on hospitalized pneumonia among children in Suzhou: an observational study

DAI Zi-rui, LUAN Lin, TIAN Jian-mei, XU Xin-xin, LIN Yu-zun, ZHENG Ben-feng, FENG Shuang, LIU Chang-peng, ZHANG Jun, ZHANG Tao, ZHAO Gen-ming

2021, 25(2): 192-197. doi: 10.16462/j.cnki.zhjbkz.2021.02.014

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Objective To evaluate the vaccine effectiveness (VE) of different doses of Haemophilus influenzae type b (Hib) conjugate vaccine on hospitalized pneumonia among children. Methods A retrospective cohort study was conducted among local children born in 2018 and admitted to Suzhou University Affiliated Children's Hospital. Hospital records were collected by using Hospital Information System and vaccination information were identified through Suzhou CDC's electronic vaccine registry database before Jun 30, 2019. The incidence rates of hospitalized pneumonia among vaccinated and children with different doses unvaccinated children were compared and VE was calculated. Results Hib vaccination coverage of ≥1-dose was 18.8%(10 080/53 753)among children in Suzhou between Jan 1, 2018 to Jun 30, 2019. The incidence rates of hospitalized pneumonia decreased with the increase of doses of Hib vaccine (χ²=-4.31, P < 0.001), and the protective effects of 1-dose and 2-doses Hib vaccine were not found, but 2-doses Hib vaccine showed a trend of protection. The incidence rate of hospitalized pneumonia among children who received ≥3-doses Hib vaccine was lower than unvaccinated children (RR=0.72, 95% CI: 0.59-0.89, P < 0.001), and the incidence rate of vaccine-preventable hospitalized pneumonia was 1 514.8 per 10⁵ person-years, and VE of ≥3- doses was 28% (95% CI: 11%-41%). Conclusions Incidence rate of hospitalized pneumonia among children in Suzhou can be reduced by ≥3- doses Hib vaccination. It is suggested that Hib vaccination should be further promoted in children to increase the Hib vaccination coverage.

Dynamic response analysis of economic development and infant mortality rate in China from 1991 to 2018

FAN Qiao-rong, ZHOU Peng-fen, TONG Si, ZHANG Yan, WANG Yan, HUANG Juan, HUANG Nan, LI Chen-lu, YANG Xiao-long, LIU Jian-zheng

2021, 25(2): 198-203. doi: 10.16462/j.cnki.zhjbkz.2021.02.015

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Objective To explore the interactional relationship between economic development and infant mortality in China, and to predict the changing trend of infant mortality in China. Methods Based on gross domestic product (GDP), total expenditure on health (TEH) and infant mortality rate (IMR) data of China from 1991 to 2018, a vector autoregressive model was constructed to predict the infant mortality level of China in 2030. Results The results of VAR (4) model showed that R²=0.86, AIC=-20.37 and SBC=-18.44. The Granger cause of IMR decrease and TEH increase was GDP (χ²=20.97, P < 0.001). The Granger causes of TEH increase were IMR and GDP (χ²=18.07, P < 0.001). The impact of innovations in GDP and TEH had a positive medium-to-long-term response to infant health, and the contribution to IMR changes at 12 periods were 11.04% and 69.49 %, respectively. GDP was positively affected by the impact of IMR and TEH innovation. It was expected that IMR of China would drop to 2.13 ‰ (95% CI: 0.93 ‰-4.90‰) by 2030. Conclusions The increase of economic development and health investment has effectively reduced infant mortality in China. accordingly, the decline in infant mortality and increase in health investment have also promoted the economic development of China.

Establishment and validation of a predictive model for new onset atrial fibrillation in patients with acute coronary syndrome during hospitalization

LI Jun-zheng, XU Xiang, ZHANG Zhi-hui, WU Na, YUAN Zhi-quan, JIA Xiao-yue, LI Cheng-ying, WU Long, XIANG Ying, ZHONG Li, LI Ya-fei

2021, 25(2): 204-210. doi: 10.16462/j.cnki.zhjbkz.2021.02.016

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Objective To establish a predictive model of new onset atrial fibrillation in patients with acute coronary syndrome (ACS) during admission, so as to provide scientific basis for early detection of high-risk patients and timely intervention measures. Methods A retrospective cohort study was conducted among 1 915 patients with ACS who were admitted to the Department of Cardiology of a large general hospital between January 2010 and December 2019. Patients were randomly divided into two groups: model group and validation group. In the model group, a multivariate Logistic regression analysis model was used to screen the independent factors associated with new onset atrial fibrillation. Regression prediction model and nomogram were established, and validated in the validation group. Area under curve (AUC) of receiver operating characteristic curve (ROC) and Hosmer-lemoshow test were used to evaluate the discrimination and calibration of the model, respectively. Results There were 958 cases in the model group comprising 62 new onset atrial fibrillation cases, and 957 cases in the validation group comprising 65 new onset atrial fibrillation cases. In the model group, seven indicators were independently associated with atrial fibrillation, including age, heart rate at admission, Killip classification of heart failure, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left atrial diameter, right atrial diameter and neutrophil count. In the modeling group, the AUC was 0.91 (95% CI: 0.88-0.94) in model group and 0.86 (95% CI: 0.81-0.91) in validation group. Calibration plot and goodness of fit test (in modeling group and validation group, P>0.05) indicated that the prediction model had a good calibration ability. Conclusions In this study, the prediction model of new onset atrial fibrillation in patients with acute coronary syndrome was successfully constructed, which has a good discrimination and calibration, the nomogram could conveniently be used and intuitively predict the risk of atrial fibrillation, thus provides foundation for early intervention and improvement of prognosis in clinical practice.

SUN Qian-nan, QIAN Yi-ning, LI Xin-yu, FEI Gao-qiangc, ZHANG Xu-jun

2021, 25(2): 211-215. doi: 10.16462/j.cnki.zhjbkz.2021.02.017

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Objective To explore the risk factors affecting alcohol abuse among Chinese medical students and to provide scientific basis for reducing harmful use of alcohol. Methods Cases and controls were all selected from the investigation of alcohol abuse among medical students in Jiangsu Province. The 319 respondents reporting perpetrating alcohol abuse behaviors were enrolled to the case group. Two controls were selected for each case from those participants who did not abuse alcohol. Matching was based on gender, major and grade. Univariate conditional Logistic regression analysis and multivariate conditional Logistic regression analysis were carried out using SPSS 22.0. Results Drinking rate of medical students in Jiangsu Province was 44.59%, and the incidence of alcohol abuse was 8.25%. Multi-conditional Logistic regression analysis indicated that minorities (OR=4.800, 95% CI: 2.487-9.262), the per capita monthly income of less than 2 000 yuan (OR=4.660, 95% CI: 2.600-8.350), the per capita monthly income of 2 000-6 000 yuan (OR=1.764, 95% CI: 1.142-2.725), the per capita monthly income of more than 10 000 yuan (OR=2.395, 95% CI: 1.456-3.941), drinking is necessary to adapt to society (OR=1.768, 95% CI: 1.071-2.920), drinking may not be necessary to adapt to society (OR=1.948, 95% CI: 1.311-2.894), extroverted personality (OR=1.651, 95% CI: 1.126-2.423), having some emotional stress (OR=1.812, 95% CI: 1.283-2.558), having great emotional stress (OR=7.207, 95% CI: 3.970-13.085), smoking behavior (OR=5.352, 95% CI: 3.325-8.612) were related factors of alcohol abuse among medical students. Conclusions The situation of alcohol abuse among medical students is related to their ethnicity, personality, smoking, emotional stress, attitudes about whether drinking is necessary to adapt to society, and monthly household income per capita. Preventive intervention measures should be taken to reduce the incidence of alcohol abuse.

A systematic review of the effect of immune strategy switching on poliovirus monitoring in the environment

SHI Hong-yuan, SHI Hao-yu, YANG Jing-si

2021, 25(2): 216-221. doi: 10.16462/j.cnki.zhjbkz.2021.02.018

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We completed a systematic review to evaluate the impact of polio immunization strategy transformation on the design, detection and type of poliovirus in environmental surveillance, so as to provide reference for countries undergoing polio conversion. We searched PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wan-fang database by using the terms "environmental monitoring", "sewage" and "poliovirus". Then we screened and extracted the information for systematic evaluation. A total of 10 articles on immune strategy transformation during environmental surveillance of poliovirus were included. According to the climate and population immune status of different countries, the detection rate and final detection time of poliovirus in sewage were different. There were also differences in the design of environmental monitoring during the transformation period of immunization strategies. Poliovirus types Ⅱ and Ⅲ were major strains. Before the change of immunization strategy, there were more polio vaccine-related strains in the environment, which had more than 99% homology with Sabin vaccine strains. In the final phase of polio eradication, especially in countries undergoing a shift in immunization strategies, environmental monitoring should be strengthened to provide evidence for confirmation of polio eradication.

Analysis of myopia and its influencing factors among students in Liaoning Province

GAO Qing, LIU Yi-qing, YE Qian-wen, WANG Hong-wei, XU Pin-liang, WU Ming

2021, 25(2): 222-226. doi: 10.16462/j.cnki.zhjbkz.2021.02.019

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Objective To investigate the myopia of students in Liaoning Province in 2019 and analyze its influencing factors, so as to provide scientific basis for further formulating the strategy and the measure of preventing and curing the myopic students. Methods Students from 14 cities in Liaoning Province were selected by multi-stage stratified random cluster sampling, and their long-range vision, refractive examination and questionnaire survey were conducted. Logistic regression analysis was conducted to explore the influencing factors of myopic students. Results The myopic rate of students in Liaoning Province was 53.17%. Multiple Logistic regression analysis showed that the main factors affecting myopic rate were economic classification, urban and rural division, gender, school type, whether living in school, seat exchange, eye exercise, whether outdoor activities meeting the standard and whether existing excessive video-time (all P < 0.05). Among them, the reduction of myopic rate was related to the good economic level (OR=0.802, 95% CI: 0.751-0.855), gender (OR=0.663, 95% CI: 0.635-0.692), senior grade (junior high school OR=0.337, 95% CI: 0.358-0.398; high school OR=0.182, 95% CI: 0.170-0.196; vocational high school OR=0.392, 95% CI: 0.351-0.438), not living in school (OR=0.771, 95% CI: 0.716-0.830), changing seats at least once a month (OR=0.801, 95% CI: 0.739-0.868) and doing eye exercises at least twice a day (OR=0.922, 95% CI: 0.850-0.998), but the medium economic level (OR=1.215, 95% CI: 1.115-1.323), the suburb county area (OR=1.134, 95% CI: 1.083-1.187), substandard outdoor activities (OR=1.069, 95% CI: 1.014-1.128) and too much screen time (OR=1.221, 95% CI: 1.166-1.280) were related to the myopic rate increase. Conclusions The incidence of myopia among students in Liaoning Province was relatively high and the situation of prevention and control was severe. We should take effective measures such as changing students' habit of using eyes, strengthening physical exercise and so on, multi-ways joint prevention and control means to diminish the occurrence of students' myopia.

Cyberbullying and suicidal ideas among primary and middle school students: a moderated mediation model

YU Shi-wei, WU Chun-lei, WANG Bo, QUAN Ju-qing, YUE Wen-juan, GUO Wei-wei, MA Jing, SUN Chang-qing

2021, 25(2): 227-230. doi: 10.16462/j.cnki.zhjbkz.2021.02.020

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Objective To explore the mediating and regulating effects of depression symptoms and age on cyberbullying and suicidal ideation in primary and middle school students. Methods A questionnaire survey was conducted among 11 199 primary and secondary school students using the self-designed questionnaire which named Bullying of Primary and Middle School Students and the Mental Health Scale of Chinese Middle School Students. Results Cyberbullying in primary and middle school students was positively correlated with depression symptom (r=0.22, P < 0.001) and suicidal ideation (r=0.40, P < 0.001), and depression symptom was positively correlated with suicidal ideation (r=0.38, P < 0.001). Depression symptom played a mediating role between cyberbullying and suicide ideation (β=0.33, P < 0.001). Age moderated the mediated effect of depression symptom(β=-0.01, P < 0.001). With age increasing, the effect of depression symptom on suicide ideation reduced. Conclusions The cyberbullying can affect suicide ideation through depression symptom, and age moderates the relationship between depression symptom and suicide ideation.

Depression status and influencing factors of pregnant women in early and mid-pregnancy

XU Ji-hong, YAN Pan-pan, SUN Chen

2021, 25(2): 231-234. doi: 10.16462/j.cnki.zhjbkz.2021.02.021

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Objective To investigate the depression status and influencing factors of pregnant women in early and mid-pregnancy, respectively. Methods From July 1 to December 31, 2019, 308 pregnant women were recruited through an online survey system via the general situation questionnaire, influencing factor questionnaire and Edinburgh postpartum depression scale. Logistic liner regression analysis model was used to explore the influencing factors of depression in early and mid-pregnancy. Results The incidences of depression in early and mid-pregnancy were 25.97% and 23.70%, respectively. The results of regression analysis showed that the recent negative life events, dietary satisfaction after pregnancy, and the spouse's concern were influencing factors of depression in early pregnancy (all P < 0.05). The recent negative life events, the spouse's concern, worry about current physical conditions, and pregnant women's satisfaction with leaders' care were influencing factors of depression in mid-pregnancy (all P < 0.05). Conclusions The incidence of depression in early pregnancy is higher than that in mid-pregnancy. The influencing factors of depression during early and mid-pregnancy have both common and unique factors.

Consultation delay and influencing factors among pulmonary tuberculosis patients in Huzhou City from 2008 to 2018

FU Li-juan, WANG Ye-sheng, ZHU Wen-long, WANG Wei-bing

2021, 25(2): 235-239. doi: 10.16462/j.cnki.zhjbkz.2021.02.022

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Objective To understand the characteristics, trend and influencing factors of the consultation delay in Huzhou City from 2008 to 2018, so as to provide evidence for tuberculosis (TB) prevention and control. Methods From the Tuberculosis Management Information System (TMIS), we collected the data of the TB consultation delay from 2008 to 2018 in Huzhou City. χ² test was used for single factor analysis, χ² trend test was used for time trend test of rate and composition ratio, multivariate Logistic regression model was used to analyze the influencing factors of the delay. Results From 2008 to 2018 in Huzhou City, the consultation delay rate of TB patients was 52.9%, and the overall trend was decreasing year by year (χ²_trend=149.581, P < 0.001), different gender and age groups also showed the same trend. The delayed patients were mainly male, over 60 years old, but the proportion of female was increasing (χ²_trend=10.320, P < 0.001). Multivariate Logistic regression model showed that women, elderly, local residents, follow-up, see a doctor due to symptoms, sputum positive and newly diagnosed TB patients were associated with a higher risk of consultation delay (all P < 0.05). Conclusions From 2008 to 2018, the majority of TB consultation patients in Huzhou City were males, over 60 years old but the proportion of females showed an upward trend. The delay rate showed a downward trend. Gender, age, registered residence, source of patients, sputum examination results and treatment classification were the factors influencing the consultation delay.

Application of multiple seasonal ARIMA model for predicting the incidence trend of tuberculosis in Guangzhou City

LIU Wei, LIU Yuan, HU Wen-sui, DONG Zhi-qiang, HOU Jian-rong, WANG De-dong, YANG Zhi-cong

2021, 25(2): 240-243, 248. doi: 10.16462/j.cnki.zhjbkz.2021.02.023

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Objective To explore the feasibility of applying the multiple seasonal autoregressive intergrated moving average (ARIMA) model to predict the monthly incidence of tuberculosis in Guangzhou, and to provide evidence for developing prevention and control measures. Methods The ARIMA model was established based on the monthly incidence of tuberculosis in Guangzhou from January 2010 to June 2019, and the prediction effect of the model was verified with the data from July to December 2019. Results A total of 124 311 tuberculosis cases were reported during 2010-2019 in Guangzhou, showing an overall decreasing trend, with the lowest incidence in February and the hightest in March to April. Using the best fitted model ARIMA (0, 1, 1) (0, 1, 1)₁₂ to predict the monthly incidence of tuberculosis in Guangzhou from July to December 2019, the results showed that the relative error between the actual value and predicted value ranged from 0.08% to 11.33%, and the average relative error was 1.46%. Conclusions The ARIMA (0, 1, 1) (0, 1, 1)₁₂ model can be used for short-term prediction of the monthly incidence of tuberculosis in Guangzhou.

Analysis on the influencing factors of late diagnosis of newly identified HIV/AIDS cases in Longhua District, Shenzhen, 2017-2018

ZHANG Ke-chun, CHEN Ya-qi, HU Tian

2021, 25(2): 244-248. doi: 10.16462/j.cnki.zhjbkz.2021.02.024

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Objective To analyze the basic information of late diagnosis (LD) of HIV and the factors related with LD of HIV/AIDS cases newly reported by medical institutions in Longhua District from 2017 to 2018. Methods The database was downloaded from the AIDS prevention and control information system of China's disease prevention and control information system and newly reported HIV/AIDS cases between 2017 and 2018 were included. Mean, standard deviation and other indexes were used to describe measurement data. Rate, constituent ratio and other indexes were used to describe enumeration data. The multivariate Logistic regression model was used to analyze the relevant factors of LD. Results 795 research objects were included in this study. The average age of the included cases was (32.6±10.2) years old. The proportion of LD was 39.1%, 26.0% of LD cases came from HIV voluntary counseling and testing (VCT), and 22.5% came from sexually transmitted disease clinics. Compared with participants under 30, > 30 years age group (OR=0.67, 95% CI: 0.46-0.97, P=0.032) and > 40 years age group (OR=0.55, 95% CI: 0.32-0.93, P=0.026) had lower risk of LD. Compared with transient population, permanent population (OR=2.37, 95% CI: 1.49-3.79, P < 0.001) had higher risk of LD. Compared with samples from other clinical examinations, the OR (95% CI) values of sexually transmitted disease clinics (OR=2.21, 95% CI: 1.22-4.01, P=0.009), testing before surgery (OR=1.66, 95% CI: 1.09-2.53, P=0.019), event-specific surveys (OR=2.59, 95% CI: 1.71-3.91, P < 0.001) and VCT (OR=2.23, 95% CI: 1.13-4.42, P=0.021) had higher risk of LD. Conclusions The proportion of LD in Longhua District between 2017 and 2018 was 39.1%. The factors which statiscally associated with late HIV diagnosis included age, resident population and sample source.

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2021 Vol. 25, No. 2

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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