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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 7

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The 100th Anniversary of the Founding of The Communist Party of China
The centennial development and valuable experience of public health by CPC
DAI Chang-bin, YE Dong-qing, WANG Zhao-liang
2021, 25(7): 745-748,752. doi: 10.16462/j.cnki.zhjbkz.2021.07.001
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Since the founding of the Communist Party of China(CPC), focusing on historical tasks in different periods, the Party regards public health as a basic element of the healthy development of human society and has worked hard to put it into practice.This article reviews the arduous history of public health under the leadership of the CPC, and demonstrates the valuable experience of People First, Life First, Prevention First, and CPC's leadership, and then analyzes the current challenges and puts forward some advice for further development.
Literature Review
Eliminating the public health threat of viral hepatitis in situation with both opportunities and challenges
YANG Shi-gui
2021, 25(7): 749-752. doi: 10.16462/j.cnki.zhjbkz.2021.07.002
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In the past three decades, with the implementation of vaccinating against hepatitis A, hepatitis B and hepatitis E, it has achieved remarkable achievements in controlling incidence and prevalence of viral hepatitis. At the same time, the successful development of direct-acting antiviral agents (DAA) for hepatitis C also brings hope for eliminating the public health threat of hepatitis C. However, due to the low rate of early diagnosis of viral hepatitis, the uneven availability of vaccines and antiviral drugs among countries or regions, and the lack of awareness of the harmfulness of viral hepatitis, the disease burden of viral hepatitis is still heavy. It remains a severe public health problem in global. Therefore, to eliminate the public health threat of viral hepatitis, it is necessary to improve the existing coping strategies, strengthen vaccine immunization, expand screening, and popularize antiviral treatment and other comprehensive measures. This article discusses the epidemic situation of viral hepatitis in China and the world, the current situation of prevention and treatment, the goal of WHO to eliminate the public health threat of viral hepatitis, and the action plan adopted.
Prevention and Control of Viral Hepatitis
Research progress on the basic and effective reproductive number in the epidemiology of infectious diseases
ZHANG Xiao-bao, YAN Dan-ying, CHEN Can, JIANG Dai-xi, DING Cheng, LAN Lei, WU Jie, YANG Shi-gui
2021, 25(7): 753-757, 790. doi: 10.16462/j.cnki.zhjbkz.2021.07.003
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With the occurrence of an emerging infectious disease, some epidemiological indicators are used to measure the transmission of the disease. Basic reproduction number (R0) and effective reproduction number (Re) are two crucial indicators among them. However, the definition, calculation, and interpretation of R0 and Re are misunderstood or even misused in many cases. This review introduces the definition, calculation, influence factors, epidemiology significance, notes for application, and the R0 of some common infectious diseases, aiming to provide scientific guidance for health decision-making departments to prevent and control the epidemic of infectious disease.
Original Articles
Temporal-spatial distribution characteristics and its influencing factors of tuberculosis epidemic in the Chinese mainland from 2014 to 2018
BI Sheng-xian, HU Xi-jian, ZHANG Hui-guo
2021, 25(7): 758-762, 811. doi: 10.16462/j.cnki.zhjbkz.2021.07.004
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  Objective  The number of beds per thousand, gross domestic product (GDP) per capita, population density and annual sunshine hours were investigated to analyze the spatio-temporal characteristics of tuberculosis incidence of 31 provinces in the Chinese mainland from 2014 to 2018, so as to provide a theoretical basis for the prevention and control of the spread of tuberculosis in the future.  Methods  The spatial autocorrelation analysis was performed to explore the spatio-temporal agglomeration of the incidence of tuberculosis in the Chinese mainland in each year. A geographically and temporally weighted Logistic regression analysis model was established to reveal the spatio-temporal non-stationarity of tuberculosis incidence, and to compare the fitting results with the classic Logistic regression analysis model.  Results  The global spatial Moran's I index of tuberculosis incidence in the Chinese mainland from 2014 to 2018 were 0.43, 0.44, 0.47, 0.49, 0.37, showing a certain spatiotemporal correlation. The coefficient function of the geographically and temporally weighted Logistic regression analysis model fluctuated in the interval (-1, 1), and could reflect the spatio-temporal heterogeneity of tuberculosis well. The confidence interval of each coefficient function did not contain 0, which had spatio-temporal non-stationarity. The results of the goodness of fit test were better than the classic Logistic regression analysis model.  Conclusions  The incidence of tuberculosis in 31 provinces in the Chinese mainland was closely related to four macro factors, and appropriate strategies should be formulated for tuberculosis prevention and control according to the difference of regional social macro factors.
Analysis of the health-care seeking delay and influencing factors among pulmonary tuberculosis patients in Qinghai Province, 2014-2019
LIANG Da, SHANG Yue, WANG Zhao-fen, MA Bin-zhong
2021, 25(7): 763-767. doi: 10.16462/j.cnki.zhjbkz.2021.07.005
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  Objective  To analyze the current status, trend and related influencing factors of pulmonary tuberculosis patients with delayed health-care seeking in Qinghai Province from 2014 to 2019.  Methods  The current status and trend of health-care seeking delay of pulmonary tuberculosis patients in Qinghai Province from 2014 to 2019 were described, and multivariate Logistic regression model was used to analyze the related influencing factors of health-care seeking delay of pulmonary tuberculosis patients.  Results  The health-care seeking delay rate of pulmonary tuberculosis patients was 49.6%, showing a downward trend from 2014 to 2019. And the health-care seeking delayrate among different genders and age groups patients also showed a downward trend in Qinghai Province from 2014 to 2019. Multivariate Logistic regression analysis showed that the age group ≥15 years old, recommended by disease, follow-up and retreatment were high risk factors for patients of health-care seeking delay. The risk of health-care seeking delay of non-farmer patients was lower than farmer patients.  Conclusion  From 2014 to 2019, the health-care seeking delay rate of pulmonary tuberculosis patients in Qinghai Province was relatively high, but with an annual decrease. Age, occupation, source of patients and treatment classification were the influencing factors on health-care seeking delay of pulmonary tuberculosis patients. In the future, we should pay more attention to patients at high risk for health-care seeking delay.
Analysis of tuberculosis epidemiological characteristics and application of incidence prediction model in Fujian Province from 2010 to 2019
LIN Shu-fang, ZHOU Yin-fa, ZHANG Shan-ying, DAI Zhi-song, CHEN Dai-quan
2021, 25(7): 768-774. doi: 10.16462/j.cnki.zhjbkz.2021.07.006
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  Objective  The study aims to analyze the epidemiological characteristics of tuberculosis (TB) in Fujian Province from 2010 to 2019, and establishing autoregressive integrated moving average (ARIMA) model to discuss its application in predicting the monthly incidence of TB in Fujian Province.  Methods  The incidence data of active TB reported in Fujian Province from January 2010 to June 2020 were obtained through the TB Information Management System of Chinese Center for Disease Control and Prevention. The Excel 2016, ArcGIS 10.2 and SPSS 24.0 softwares were used to describe the epidemiological characteristics of TB in Fujian Province from 2010 to 2019, and established the composite seasonal ARIMA model to predict the monthly incidence of TB.  Results  A total of 202 842 cases of active TB were reported in Fujian Province from 2010 to 2019, with an average incidence of 53.5/100 000, and the incidence showed a decreasing trend in the past decade (χ2=1 952.427, P < 0.001). Relatively few cases were reported in January, February and October, accounting for 7.1%, 6.2% and 7.6%, and there was a small peak in March, accounting for 9.2%. The incidence of TB reported in coastal city was significantly higher than that in inland area (χ2=1 169.414, P < 0.001). The number of male patients with active TB was 2.77 times than that of female patients. The incidence of TB increased with age, and reached the highest at the age of 65 to 75; and the patients were mainly in the middle and young ages, accounting for 81.5%. The proportion of patients with migrant workers was the highest, accounting for 59.9%, followed by housework and unemployment, accounting for 16.4%. The desirable prediction result obtained by ARIMA (3, 1, 2) (0, 1, 1)12, showed that the relative error was 2.4% and 95% confidence interval of the predicted value of each month contained the actual value.  Conclusion  The incidence of TB in Fujian Province presented a declining trend in the past decade. Male, young adult and migrant workers were the important population for TB control in Fujian Province. The composite seasonal ARIMA (3, 1, 2) (0, 1, 1)12 model can be used for predicting the short-term incidence of TB in Fujian Province.
An age-period-cohort study for reported incidence of hepatitis C in Zhongshan City, from 2006 to 2019
CHEN Chu-ying, CHEN Xiu-yun, WANG Man, ZHU Sui
2021, 25(7): 775-778. doi: 10.16462/j.cnki.zhjbkz.2021.07.007
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  Objective  To explore the age-period-cohort trend of reported incidence rate of hepatitis C in Zhongshan City, Guangdong Province.  Methods  The generalized additive model was used to analyze the effect of age, period and cohort on the reported cases of hepatitis C in Zhongshan City from 2006 to 2019.  Results  The annual incidence rate in Zhongshan was 28.49 per 100 000, from 2006 to 2019. The downward age effect was observed in 0-10 years old group, but increased trend was found after 10 years old. The highest RR was found in male born between 1970 and 1990, and in female born between 1960 to 1990. However, the birth cohort effect of RR increased for male born after the year 2000, but decreased for female year by year.  Conclusions  The incidence rate of hepatitis C is high in Zhongshan City. It's necessary to enhance the health education for higher risk birth cohort, especially for male born after the year 2000, and to reduce the disease transmission risk.
Spatial risk analysis of global highly pathogenic avian influenza H5N1 virus based on different methods of choosing controls
XIAO Shuang, ZHANG Jun, HU Jian, HUANG Jia-qi, XIONG Cheng-long, ZHANG Zhi-jie
2021, 25(7): 779-784. doi: 10.16462/j.cnki.zhjbkz.2021.07.008
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  Objective  To explore and compare the impacts of four sampling methods on the spatial risk analysis of global highly pathogenic avian influenza virus H5N1 (HPAIV H5N1) based on the global databases of HPAIV H5N1.  Methods  H5N1 outbreak data were collected from the official surveillance reports. The control data were obtained through four sampling methods using the ratio of 1∶4 for case to control, completely random sampling based on the country, buffer zone sampling, probability sampling based on population density and probability sampling based on the results of MaxEnt. Six influencing factors were collected, including the shortest distance from the epidemic point to the railway, highway and wild bird migration routes, land use and land cover data, altitude, and infant mortality rate. The Logistic regression model with spatial autocorrelation term was applied to analyze and compare the impacts of four sampling methods on the predicted risk through the area under the curve (AUC), sensitivity, specificity and other evaluation indicators.  Results  For the four sampling methods, their AUC values were between 0.896-0.971, showing their prediction ability were good, and the MaxEnt-based sampling method had the best predictive ability. From the perspective of predicting risk, the results of random sampling and buffer zone sampling were biased, and the result of probability sampling was underestimated, while the results for MaxEnt sampling was best.  Conclusion  The results of spatial risk modeling for global HPAIV H5N1 based on random sampling was poorest, but MaxEnt sampling had the best modelling result, whose predicted risk regions were more accurate. Hence it can provide a rational reference to select controls for the spatial epidemiologic researches of global avian influenza. It is suggested to pay attention to the selection of control sampling methods in future similar researches.
Epidemiological characteristics and spatiotemporal clusters on measles of infants under 1 year old in Henan Province from 2015 to 2019
XIAO Zhan-pei, LU Ming-xia, ZHANG Xiao-xiao, ZHANG Yan-yang
2021, 25(7): 785-790. doi: 10.16462/j.cnki.zhjbkz.2021.07.009
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  Objective  To analyze the spatial and temporal characteristics on measles of infants under 1 year old in Henan Province during 2015-2019, to provide evidence for the prevention and control of measles.  Methods  Data were collected from the Infection Disease Reporting Information System in China and the National Measles Surveillance System. The epidemiological characteristics on measles of infants under 1 year old in Henan Province during 2015-2019 were described. Spatiotemporal distribution and clustering were analyzed by using the ArcGIS 10.7 software and SaTScan 9.4 software.  Results  A total of 2 757 measles infants under 1 year old were found in Henan Province from 2015-2019 with an average annual incidence of 42.82/100 000. Most cases aged between 6-8 months old, accounting for 49.40% of the total number of cases. The epidemic peak was between January and May. The trend surface analysis found that the incidence of measles decreased gradually from the southern to northern parts, which showed an inverted U type curve. The spatiotemporal scan found three spatiotemporal aggregation areas, and the strongest areas were located in Pingdingshan and Nanyang Districts, which including 28 counties in 2015.  Conclusion  The incidence rate of measles infants under 1 year old was decreasing year by year and showing obviously seasonal rule in Henan Province, 2015-2019. Infants aged 6-8 months old are the main group of patients. The main clustering areas were located in the south central part of Henan Province, suggesting that the prevention and control measures should be further strengthened in these areas.
Analysis on the epidemiological characteristics and disease burden of Japanese encephalitis in Gansu Province
ZHAO Xiang-kai, ZHANG Xiao-shu, CUI Xu-dong, JIN Na, LIU Yan-chen, ZHAO Xin, ZHENG Hong-miao, LI Juan-sheng, SHEN Xi-ping, MENG Lei, REN Xiao-wei
2021, 25(7): 791-794, 848. doi: 10.16462/j.cnki.zhjbkz.2021.07.010
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  Objective  To explore the epidemiological characteristics and disease burden of Japanese encephalitis (JE) in Gansu Province from 2017 to 2018.  Methods  We calculated the JE morbidity, mortality, case fatality rate, and potential years of life loss by using JE case data and its follow-up data from 1 January 2017 to 31 December 2018. We compared the disease outcome of JE cases in different groups and performed binomial logistic regression analysis to explore the main influencing factors of the prognosis of JE patients in Gansu Province.  Results  The incidence, mortality and mortality of JE increased significantly with age. There were statistically significant differences in the outcome of JE cases with different ages (H=61.797, P < 0.001), different clinical types (H=53.953, P < 0.001), with or without conscious disturbance (H=64.367, P < 0.001), and with or without meningeal irritation (H=5.251, P=0.022). Binomial logistic stepwise regression results showed that age (OR=3.217, P < 0.001), clinical classification (OR=1.621, P < 0.001), and consciousness disorder (OR=1.969, P=0.002) had statistical significance in the outcome of JE cases in Gansu Province. In 2017 and 2018, the potential life loss of JE cases in Gansu Province was 945.84 person-years and 1 056.92 person-years, respectively. The loss of children was the smallest, and the loss of women was higher than that of men.  Conclusion  Compared with children, the morbidity, mortality, and fatality rate of adults JE are higher, and the potential life loss caused by JE is mainly in adults. The main factors affecting the outcome of JE cases are age, clinical classification and consciousness disorders.
Impact of Japanese encephalitis vaccination in Shijiazhuang on the incidence of Japanese encephalitis: an interrupted time series analysis
GUO Jian-hua, SUN Yin-qi, YAN Xiang-juan, ZHANG Shi-yong
2021, 25(7): 795-801. doi: 10.16462/j.cnki.zhjbkz.2021.07.011
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  Objective  To analyze the impact of Japanese encephalitis(JE) vaccine administration on the trend of JE incidence.  Methods  Interrupted time series analysis (ITSA) and segmented regression analysis (SRA) using JE incidence data in Shi Jiazhuang from 1949 to 2019 were conducted to quantitatively assess short-term and long-term effect of JE vaccination.  Results  There was a statistical significant increasing trend of JE incidence from 1949 to 1968 (β1=0.19, t =-2.01, P =0.048). With the introduction of vaccine from 1969 to 2019, JE incidence decreased immediately (β2=-7.83, t =-2.97, P =0.004) in 1969; And the average decreasing slope of JE incidence (β1+β3) was -0.04/lakh with the significant difference (β3=-0.23, t =-3.24, P =0.002). However, JE incidence increased due to the outbreak in 1969-2019 (β4=3.87, t =2.36, P =0.007). Further analysis using data on the period of pre-immunization program(1969-2007) showed that the JE incidence decreased (β2=-7.22, t =-2.98, P =0.01) in 1969 and the continuous decreasing slope was 0.29 (β3=-0.29, t =-2.73, P =0.008); And JE incidence did not increase due to the outbreak (β4=4.65, t =0.72, P =0.476) in this period. However, compared with the period of pre-immunization program, in the period of immunization program, no statistically significant decreasing of JE incidence was found in 2008 (β2=-2.89, t=-1.56, P=0.169) and in this period (β3=-0.03, t=-1.16, P=0.252); Meanwhile, JE incidence still increased due to the outbreak in this period (β4=3.62, t=4.21, P=0.001).  Conclusions  The implementation of vaccine administration in Shi Jiazhuang has made remarkable effectiveness in the JE control. However, the immunization strategies need to be adjusted according to the change of the vulnerable population of cases moving from younger children to the older adult.
Safety analysis of inactivated SARS-CoV-2 vaccine (Vero cells) during emergency vaccination in Hefei
ZHU Li-wei, CHEN Guo-jie, JIANG Ling, MA Chun-yu
2021, 25(7): 802-805. doi: 10.16462/j.cnki.zhjbkz.2021.07.012
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  Objective  To study the safety of inactivated SARS-CoV-2 vaccine (Vero cells) (SARS-CoV-2 vaccine) in Hefei during the emergency vaccination period, and to provide reference for the promotion and vaccination of this vaccine in the whole population in the later period.  Methods  A total of 19 vaccination clinics in Hefei were selected as active monitoring sites for immunization safety. Focus groups aged 18-59 years who were vaccinated with SARS-CoV-2 vaccine in Hefei from 15 December 2020 to 10 February 2021 were observed. The incidence, types and severity of adverse reactions after vaccination were descriptively analyzed.  Results  A total of 18 574 people were effectively observed, and 33 433 doses of SARS-CoV-2 vaccine were inoculated. 713 cases of general adverse reactions occurred, with an incidence of 2.13%. The incidence of adverse reactions in the first dose was 2.57%, which was higher than that in the second dose (1.58%, χ2=38.92, P < 0.001). There was no statistical significance in the incidence of general adverse reactions of inactivated vaccine produced by the two companies (χ2=3.08, P=0.082). Among the adverse events such as redness and swelling at the injection site, induration at the injection site, and fever, the incidence of grade 1, 2 and 3 adverse events were 0.65%, 1.42%, and 0.06%, but there were no ≥ grade 4, rare and extremely rare adverse events.  Conclusion  Domestic inactivated SARS-CoV-2 vaccine (Vero cells) is great safe.
Chinese prostate cancer epidemiological characteristics from 2005 to 2014
LIU Can, LI Xiang, WANG Lei, SHEN Wan-ying, XIONG Wen-jing, RANG Wei-qing
2021, 25(7): 806-811. doi: 10.16462/j.cnki.zhjbkz.2021.07.013
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  Objective  To analyze the prevalence trend of male prostate cancer morbidity and mortality from 2005 to 2014 in the "China Cancer Registry Annual Report" so as to provide reference for the prevention and treatment of prostate cancer.  Methods  All data of prostate cancer morbidity and mortality in Chinese men from 2005 to 2014 were extracted by using Excel 2019. Joinpoint regression model was used to analyze the changing trend of prostate cancer morbidity and mortality in Chinese men from 2005 to 2014.  Results  The overall standardized incidence rate and the standardized mortality rate of prostate cancer in Chinese men were on the rise from 2005 to 2014, and the two standardized rates of urban were greater than that of rural. The standardized incidence rate increased by 39.65% from 2005(5.8/100 000) to 2014(8.1/100 000). The standardized mortality rate increased by 4.34% from 2005(2.3/100 000) to 2014(2.4/100 000). The average annual percent change of standardized incidence for urban and rural men rates were 1.4% and 6.1% respectively. The average annual percent change of standardized mortality for urban and rural men were 2.51% and 2.62% respectively. The morbidity and mortality of prostate cancer increased significantly with age in Chinese men after the age of 60. Men over the age of 60 have been the main population for the prevention and treatment of prostate cancer.  Conclusions  Compared with 2005, the trend of prostate cancer morbidity and mortality in China has showed a significant increase in 2014. It is necessary to formulate and improve prophylactic and preventive measures actively for prostate cancer. Strengthening comprehensive prevention for men over 60 years of age should be stressed.
Risk stratification study of assessing cervical precancer by cytology, high risk human papillomavirus in colposcopy examination
ZHANG Yi-fang, XUE Peng, TANG Chao, LI Qing, JIANG Yu, QIAO You-lin
2021, 25(7): 812-816, 842. doi: 10.16462/j.cnki.zhjbkz.2021.07.014
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  Objective  To evaluate pooled risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) based on the various combinations of cytology, HR-HPV (high risk human papillomavirus), and colposcopy impression.  Methods  A total of 822 cases were selected from the colposcopy outpatient database of Shenzhen Maternity & Child Healthcare Hospital from January to December 2018. We assessed the risk of CIN2+ based on the combinations of three test results (cytology, HR-HPV, and colposcopy).  Results  If two of the test results were found highly abnormality (HSIL+, HPV16/18+ and high-grade colposcopic impression), the risks for CIN2+ was higher than 60%. If three highly abnormal test results were found, the risk for CIN2+ was 97.1%.  Conclusio  When at least two abnormal results in cytology HR-HPV and colposcopy are found, the CIN2+ risk was quite high. Attention should be paid to reduce unnecessary misdiagnosis and missed diagnosis.
Study on influencing factors of non-suicidal self-injury behavior and the link with suicide among youth
GUO Ya-ru, HUANG Yun-heng, LIN Yan-ting, ZHU Chun-yan, WANG Kai, JI Yi-fu, YU Feng-qiong
2021, 25(7): 817-822, 836. doi: 10.16462/j.cnki.zhjbkz.2021.07.015
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  Objective  To explore influencing factors of non-suicidal self-injury (NSSI) and the link with suicide among middle students in Hefei City, Anhui Province.  Methods  Designed questionnaires were delivered to 10 400 middle students. The detection rate of NSSI on different demographic and the influencing factors were analyzed by SPSS 22.0 software.  Results  The difference of detection rate on grades, location, family economic status, sleep quality, interest, suicide ideation, suicide attempt, suicide behaviors and depression were statistically significant (all P < 0.05). Students with high level of social support and attachment had lower frequency of NSSI (all P < 0.05). Located in town, loss interest of others, severe depression were risk factors of NSSI (all P < 0.05). Good attachment with parents and friends, high sleep quality and social support were protective factors of NSSI (all P < 0.05).  Conclusions  NSSI influenced by multiple factors. To reduce NSSI behaviors, family, society should create safe and harmonious environment for middle school students in order to reduce NSSI.
Epidemiological characteristics of road traffic injuries accepted by Shenzhen Emergency Center from 2010 to 2018
XU Bo, LI Li-ping
2021, 25(7): 823-828. doi: 10.16462/j.cnki.zhjbkz.2021.07.016
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  Objective  To investigate the current situation of road traffic injuries (RTI) among the population in Shenzhen from 2010 to 2018, and to provide references and suggestions for improving road traffic safety related policies and traffic injures prevention in Shenzhen.  Methods  Retrospective analysis was performed on the RTI data accepted by the Emergency Comprehensive Information Query Platform of Shenzhen Emergency Center from 2010 to 2018, and statistics were made on the overall situation, population characteristics, time, regional distribution and severity of RTI in Shenzhen.  Results  From 2010 to 2018, there were 79 369 cases of RTI in Shenzhen, and the ratio of injuries to instant deaths was 79.66∶1. The incidence of RTI in Shenzhen Emergency Center was generally decreasing (χtrend2=8.200, P=0.004), and the on-site death rate was also showed a decreasing (χtrend2=4.604, P=0.032) trend. The incidence rate of male was 478.90 per 100 000, which was higher than that of female (223.92 per 100 000, χ2=92.823, P < 0.001). Most of the cases were young people aged 20-40 years old, accounting for 60.16%. According to the distribution of call time, the peak hours of RTI consultation made in the hours among 7pm to 8pm and 8am to 9am of a day, and the number of RTI consultation was the lowest in the hour between 3am to 5am. In addition, the distribution of administrative regions was unbalanced. Taking the average resident population of each region as the exposed denominator during the study period, the incidence of RTI in Guangming District was 1 007.73/100 000, followed by 917.72/100 000 and 917.62/100 000 in Dapeng New District and Yantian District. The differences among different regions were statistically significant (χ2=592.057, P < 0.001). The distribution of emergency response time showed an non-normal curve, and the median time of ambulance arrival on a site of accident was 11.93 min, and the median time of ambulance arrival on an emergency department was 24.25 min.  Conclusion  According to the epidemiological characters from 2010 to 2018, the key points to preventing and controlling RTI would be: improving the road traffic management system; improving the traffic safety awareness of the key crowds; strengthening the roads regulation during the rush hours; deploying the emergency resources more rationally; shorting the emergency response time; improving the first aid system and service mode; and developing scientific precautionary measures.
Association study about physical activity and prognosis and quality of life in patients with atrial fibrillation
YUAN Zhi-quan, WU Na, XIANG Ying, LI Cheng-ying, JIA Xiao-yue, HU Qin, WU Long, CHEN Xing-hua, ZHANG Zhi-hui, ZHONG Li, LI Ya-fei
2021, 25(7): 829-836. doi: 10.16462/j.cnki.zhjbkz.2021.07.017
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  Objective  To explore the association of physical activity with prognosis and quality of life in patients with atrial fibrillation.  Methods  A total of 192 patients with new-onset atrial fibrillation were continuously included in the study. Stroke, all-cause mortality and quality of life were selected as outcomes. Clinical information and global physical activity questionnaire (GPAQ) scores were included in baseline characteristics of patients. Quality of life was evaluated by Atrial Fibrillation Effect on Quality-of-Life (AFEQT). The Cox proportional risk model was used to explore the association between physical activity and the prognosis of patients with atrial fibrillation. Spearman correlation and partial correlation were used to analyze the correlation between physical activity and quality of life.  Results  Multivariate Cox regression analysis showed that high-intensity physical activity during leisure was a risk factor for all-cause mortality in patients with atrial fibrillation (HR=9.17, P=0.001). High-intensity physical activity and high-intensity physical activity during leisure were risk factors for stroke in patients with atrial fibrillation (HR1=4.97, P1=0.020; HR2=6.24, P2=0.002). Partial correlation analysis showed that physical activity total score was positively correlated with quality of life (r=0.158, P=0.040).  Conclusion  Appropriate moderate-intensity physical activity in patients with atrial fibrillation can reduce the risk of death and stroke and improve the quality of life.
Prediction of 10-year risk for ischemic cardiovascular disease in adults aged 35 years old and above in Nanjing
WANG Wei-wei, SU Jian, HONG Xin, YANG Hua-feng, QI Sheng-xiang, WANG Chen-chen, ZHOU Hai-rong, LI Chao, YE Qing, QIN Zhen-zhen, WU Jie, ZHOU Jin-yi
2021, 25(7): 837-842. doi: 10.16462/j.cnki.zhjbkz.2021.07.018
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  Objective  To understand the exposure of risk factors related to Ischemia Cardiovascular Disease (ICVD) in a population aged ≥35 years in Nanjing and to estimate their 10-year risk of ICVD.  Methods  Multi-stage stratified cluster sampling method was used to randomly select 61 098 permanent residents ≥18 years of age in Nanjing. A total of 36 079 people aged ≥35 years old with no history of ICVD were selected as the study subjects. The "10-year Risk Assessment Table of ICVD in Chinese" was used to assess the risk of ICVD.  Results  The subjects were (53.8 ± 11.7) years old, including 17 681 men (49.0%) and 18 398 women (51.0%). The score of 10-year risk for ICVD was (5.1 ± 3.7) points, and the absolute risk was 2.1% (0.8%-5.4%); of which, the proportion of ICVD 10-year incidence risk ≥10% was 12.6%, and women were higher than men (15.0% vs 10.1%). Besides, the risk score was found increased with age, and the differences among different age groups were statistically significant (P < 0.001). The proportion of people with ICDV risk factors ≥3 was 23.0%, and the proportion of men is higher than that of women (31.8% vs 14.6%), and the difference was also statistically significant (χ2=1 509.07, P < 0.001). Among the total risk score of ICVD, smoking (34.8%) and BMI (32.5%) accounted for the highest proportion in male and female, respectively.  Conclusion  The risk of ICVD ≥10% in the population aged ≥35 years old in Nanjing in the next 10 years has exceeded 10%. Attention should be paid to the elderly, abnormal weight and hypertension population. Men should strengthen tobacco control, and women should strengthen weight health management.
Interaction effcet of percutaneous coronary intervention and frailty on poor prognosis among elderly patients with coronary heart disease
FANG Zhong, XU Xiao-dong, WANG Li-hua, YAN Ting-ting, MA Chao, ZHANG Yun
2021, 25(7): 843-848. doi: 10.16462/j.cnki.zhjbkz.2021.07.019
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Abstract:
  Objective  To investigate the interaction effect of percutaneous coronary intervention (PCI) and frailty on the short-term mortality and cardiogenic readmission rates in elderly patients with coronary heart disease (CHD).  Methods  From April 1, 2018 to November 30, 2019, the elderly patients with CHD were selected as the research objects, who were hospitalized in the Department of Cardiology of Chizhou people's hospital. The clinical data of the patients were collected. The frailty of each patient was evaluated with the frail scale. All-cause death and cardiogenic readmission after discharge were followed up. Kaplan-Meier method, Chi-square test, and t-test were used to analyze the data.  Results  A total of 273 hospitalized elderly patients with CHD were included in the study. 76 (27.84%) of them met the fattening criteria. 160 (58.61%) of them received PCI. The incidence of death due to frailty among frailly patients increased to 2.77 (95% CI: 1.41-7.04) times higher than that among non-frailly patients. The incidence of all-cause death/cardiogenic readmission among frailly patients increased to 2.73 (95% CI: 1.90-3.93) times higher than that among non-frailly patients. Among patients treated with PCI, the RR for death and all-cause death / cardiogenic readmission in the frailty group increased to 3.02 (95% CI: 1.32-6.93) and 2.96 (95% CI: 1.89-4.62) times higher than those in the non-frailty group respectively. The results of Kaplan-Meier survival analysis showed that all-cause mortality and all-cause death / cardiogenic readmission rates were significantly higher in the frail group than that in the non-frail group (all P < 0.05). However, among patients without PCI, there was no significant difference in all-cause mortality between the frailty group and the non-Frailty group (χ2=1.95, P=0.163).  Conclusion  PCI increases the risk of poor short-term prognosis in frailly elderly patients with CHD, and there may be an interact effect of PCI and frailty on the poor prognosis in elderly patients with CHD.
Application of machine learning algorithm in diabetes risk prediction of physical examination population
OUYANG Ping, LI Xiao-xi, LENG Fen, LAI Xiao-ying, ZHANG Hui-ming, YAN Chuan-jie, WANG Chu-qiong, BAI Yu, XING Zhi-qiang, LIU Xu-tao, MIAO Miao, DENG Kan, LI Wen-yuan
2021, 25(7): 849-853, 868. doi: 10.16462/j.cnki.zhjbkz.2021.07.020
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Abstract:
  Objective  To explore the predictive effect and influencing factors of Logistic regression analysis model and Light GBM algorithm on the development of diabetes in the physical examination population.  Methods  A total of 36 292 subjects without diabetes were selected from the Health Management Center of Nanfang Hospital from August 2003 to April 2019. We ramdomly selected 70% samples by stratification to construct trainingset. The independent variables were 34 indicators including gender, age, body mass index (BMI), waist circumference, heart rate, systolic blood pressure, diastolic blood pressure, and fasting blood glucose in the first physical examination. We defined the dependent variable as developing diabetes within 5 years from the first physical examination.Logistic regression analysis model and LightGBM (light gradient boosting machine) algorithm was uesd to establish diabetes prediction models, respectively. The prediction model was applied to the remaining 30% samples and the area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the prediction effect.  Results  The AUC of the Logistic regression algorithm model was 0.906, while the AUC of the LightGBM analysis model was 0.910. At the optimal critical point, the sensitivity and specificity of the Logistic regression analysis model were 81.5% and 84.3%, respectively. And the sensitivity and specificity of the LightGBM analysis model were 81.6% and 85.2%, respectively.  Conclusion  The Logistic regression algorithm model and LightGBM algorithm model have good prediction effect on the development of diabetes in the physical examination population.
Urban-rural differences in population attributable fractions for risk dementia factors
ZHANG Bo, ZHANG Lian-sheng, CHENG Gui-rong, ZENG Yan, AN Li-na, Gan Xu-guang, WU Yu-lian, LIU Dan
2021, 25(7): 854-858, 863. doi: 10.16462/j.cnki.zhjbkz.2021.07.021
Abstract(517) HTML (328) PDF(54)
Abstract:
  Objective  Based on the population attributable fraction (PAF), the ratio of dementia induced by risk factors was estimated to provide early prevention and intervention strategies.  Methods  To assess the urban-rural differences of risk factors of dementia using Chi-square test in 3 361 persons which are selected using random cluster sampling and 65 years or older. Based on the results from principal components analysis, we calculated the weighted PAF of each risk factor contributing to dementia.  Results  The overall weighted PAF for dementia risk factors in urban was 39.51%, and the weighted PAF for individual risk factors was hypertension (10.46%), overweight and obesity (9.78%), smoking (5.69%), low education (5.55%), diabetes (3.93%), lack of physical exercise (2.75%) and lack of social interaction (1.35%). The overall weighted PAF for dementia risk factors in rural was 31.66%, and the weighted PAF for individual risk factors was low education (9.21%), hypertension (6.60%), overweight and obesity (4.96%), lack of social interaction (4.94%), smoking (4.44%), diabetes (1.51%).  Conclusions  There was a significant difference in weighted PAF of each risk factor between urban and rural areas. And prevention and early intervention strategies for dementia should be given different emphasis in urban and rural areas.
Short Reports
The analysis of antimicrobial resistance for bacteria among northern, central and southern Anhui Province in 2019
HE Ling-ling, LIU Yan-yan, LI Jia-bin
2021, 25(7): 859-863. doi: 10.16462/j.cnki.zhjbkz.2021.07.022
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Abstract:
  Objective  To analyze the differences of clinical distribution and antimicrobial resistance of pathogenic bacteria among northern central and southern Anhui in 2019, and to provide a rational reference for clinicians in different regions.  Methods  The strains were collected from 38 hospitals of Anhui Center for Surveillance of Bacterial Resistance in 2019. Strains divided were according to northern, central and southern Anhui by region. WHONET 5.6 software and SPSS17.0 software were used for data analysis.  Results  The percentage of Methicillin-resistant Staphylococcus aureus in northern Anhui was higher than in central and southern Anhui. The resistance rates of cefoperazone/sulbactam for Pseudomonas aeruginosa and Acinetobacter baumannii were 20.8% and 60.4%, respectively. The percentage of Carbapenem-resistant Klebsiella pneumoniae in central Anhui was higher than those in northern Anhui and southern Anhui. The resistance rate of cephalothin for Klebsiella pneumoniae was > 40.0%, and the resistance rates of imipenem and meropenem were > 20.0%. The resistance rates of aminoglycosides and quinolones for Methicillin-resistant Staphylococcus in southern Anhui were higher than those in northern Anhui.  Conclusions  There are significant diffenences in bacterial resistance of different regions in Anhui Province. It is necessary to use antimicrobialagents rationally according to the resistance of bacteria in the local region.
Risk factors and predictive model for the progression of HBV-related acute-on-chronic liver failure
FU Xin, DING Fang, LU Jian-hua, LIU Yong-gang, YAN Hui-min
2021, 25(7): 864-868. doi: 10.16462/j.cnki.zhjbkz.2021.07.023
Abstract(636) HTML (233) PDF(60)
Abstract:
  Objective  To investigate the risk factors associated with the development of hepatitis B virus related acute-on-chronic pre-liver failure (pre-ACHBLF) to ACHBLF, and establish a new predictive model.  Methods  A total of 97 patients with pre-ACHBLF were divided into progress group and improvement group according to their clinical outcomes. Clinical data were collected. Multivariate logistic regression analysis was performed to evaluate the independent risk factors associated with the occurrence of ACHBLF, and establish a new predictive model.  Results  Total bilirubin, prothrombin time, serum creatinine and the ratio of platelet-white blood cell were independent risk factors. The risk model for predicting the occurrence of ACHBLE was established, which was Logit(P)=-1.494+1.530×TBIL(mg/dl)+3.111×PT(s)-1.711×PWR-1.786×Cr(mg/dl). Goodness of fit test Nagelkerke R2 coefficient was 0.558. Hosmer-Lemeshow test showed that the predicted performance was 76.3% (P=0.490). The area under receiver operating characteristic carve (ROC) curve was 0.83 and the optimal threshold was 13.88, suggesting that the patients with scores higher than 13.88 had an increased risk of developing ACLF.  Conclusion  The predictive model established in this study has a high value in predicting the risk of disease progression from pre-ACHBLF to ACHBLF.

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