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Research/development, approval and marketing of medicine and test reagents for major public health events: a comparison between China and foreign countries
YAN Zi-qi, FENG Zhan-chun, CHEN Chao-yi,
 doi: 10.11847/zgggws1133142
Abstract(716) HTML(404) PDF 617KB(133)
Abstract:
The epidemic of coronavirus disease 2019 is a severe test for China's response to major public health emergencies. Through literature reviews, we summarized approval system and process for research/development and marketing of medicine and test reagents related to responses to major public health emergencies in many foreign countries and conducted comparative studies on the system and process at home and abroad for providing references to relevant system construction and administrative management China.
Impact of temperature on hand, foot and mouth disease and its attributable risk in Guangdong province
GAO Qi, LIU Zhi-dong, WANG Shu-zi,
 doi: 10.11847/zgggws1132059
Abstract(868) HTML(391) PDF 1008KB(212)
Abstract:
  Objective  To study the impact of ambient temperature on hand, foot and mouth disease (HFMD) and to explore the source of heterogeneity in the impact and the HFMD burden attributable to ambient temperature in Guangdong province.   Methods  The data on daily reported HFMD cases and meteorological condition from 2009 through 2016 in Guangdong province were collected. The distributed lag nonlinear model (DLNM) was adopted to assess the effect of average daily ambient temperature on HFMD incidence at city level with the pooled effect estimates from multivariate meta-regression model analysis. Fraction and number of HFMD incidents attributable to variation in ambient temperature were estimated according to the results of DLNM analysis.   Results   Totally 2 279 647 HFMD cases were reported during the period. The risk of HFMD incidence increased with the increment of average daily ambient temperature. The cumulative relative risk (RR) of HFMD incidence reached the highest for the average daily ambient temperature of 30.5 ℃ versus that of 24 ℃(RR = 1.24, 95% confidence interval [95% CI]: 1.12 – 1.37). The most obvious effect of low average daily ambient temperature on HFMD incidence was on the lag day 8 but that of high temperature was on the lag day zero. The disparity in the effect of average daily ambient temperature on HFMD incidence among various cities was derived from population density, growth rate of gross domestic production, location longitude, and average annual temperature/humidity/hours of sunshine. The estimated total number of HFMD incidents attributed to the exposure to high average daily temperature was 241 918, accounting for 10.61% (95% CI: 9.67% – 11.53%) of all the cases during the period. When exposed to high average daily ambient temperature, the elderly and the children less than 5 years old were at a higher risk of HFMD incidence than other populations.   Conclusion  High average daily ambient temperature could increase the risk of HFMD incidence and the impact of the high temperature may appear immediately or at lag days. The results suggest that specific measures should be taken in vulnerable populations during seasons with high temperature for the prevention of HFMD incidents.
Trajectory of and impact of macro factors on AIDS incidence in Shaanxi province, 2006 – 2018
Ni ZHU, Chao LI, Ti-cao ZHOU,
 doi: 10.11847/zgggws1129184
Abstract(2798) HTML(783) PDF 562KB(201)
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  Objective   To analyze variation trend of AIDS incidence and the association of macroeconomy and health service with AIDS incidence in Shaanxi province from 2006 to 2018.  Methods   The data on registered AIDS cases and demographics in Shaanxi province from 2006 to 2018 were extracted from National Disease Prevention Information System; the indicators for macroeconomy and health service of the same period were collected from Shaanxi province statistics yearbooks. Multi-level models were adopted to analyze variation trend in AIDS incidence and influences of macroeconomy on AIDS incidence during the period.  Results   A non-linear correlation between the AIDS incidence and the time of year and an over time accelerated upward trend in the AIDS incidence were observed. The local fiscal revenueis positively correlated with the incidence of AIDS (β = 0.002, P < 0.001); whereas, the number of health institutions per 1 000 peoplewas negatively correlated with the AIDS incidence (β = – 0.306, P = 0.023).  Conclusion   The incidence of AIDS varied with an accelerated upward trend and was closely related to social macro factors during 2006 – 2018 in Shaanxi province.
Prevalence characteristics and temporal-spatial clustering of hand, foot and mouth disease in Yunnan province, 2009 – 2019
Xiu-lian SHEN, Yu-chen JIA, Ji-bo HE,
 doi: 10.11847/zgggws1129557
Abstract(1695) HTML(799) PDF 1139KB(218)
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  Objective  To analyze prevalence characteristics and spatial-temporal aggregation of hand,foot and mouth disease (HFMD) in Yunnan province from 2009 to 2019.  Methods  The data on HFMD incidents in 129 counties/districts of Yunnan province during 2009 – 2019 were extracted from National Disease Prevention and Control Information System and relevant population data were collected from statistics yearbooks issued by provincial statistical bureau. The prevalence characteristics of HFMD was analyzed with descriptive statistics and spatial-temporal clustering of HFMD was assessed using SaTScan 9.5 software.  Results  A total of 752 209 HFMD cases were reported and the in Yunnan province during the period, with an average annual incidence of 145.93/100 000. More HFMD incidents were reported among scattered living children aged < 5 years and more incidents occurred during April – July in a year. In 2009, the counties/districts with higher HMFD incidence were mainly located in the central region of Yunnan province; but from 2010, more counties/districts with higher HFMD incidence were gradually identified around the central region along with the increase in annual HFMD incidence in the province. SaTScan spatial-temporal scanning analysis demonstrated an obvious temporal clustering of HFMD mainly during April - July in a year; the scanning analysis also revealed spatial clustering of HFMD incidence in three prefecture regions (Kunming, Yuxi and Honghe) in 2009 and 2010, while, another three prefecture regions (Qujing, Wenshan and Chuxiong) with spatial clustering of the incidence were identified during 2011 – 2018 and totally eight prefecture regions with spatial clustering of the incidence were found in 2019.  Conclusion  There were obvious spatial-temporal clustering of HFMD incidence in Yunnan province from 2009 to 2019 and the regions with spatial clustering of HFMD incidence enlarged from the central to southeastern Yunnan gradually; the situation should be concerned for effective control of HFMD epidemic in the province.
Permanent teeth caries among 12- to 15-year-old school children s in Henan province, 2015: prevalence and influencing factors
Feng-juan LI, Li-ru WANG, Xu WANG,
 doi: 10.11847/zgggws1128386
Abstract(1734) HTML(754) PDF 523KB(140)
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  Objective  To examine the prevalence and impact factors of permanent teeth caries among 12 – 15 years old children in Henan province.   Methods   According to the methodology of the Fourth National Oral Health Survey, we conducted oral examination and questionnaire survey among 3 840 children aged 12 – 15 years recruited from 12 middle schools in four districts/countries of Henan province with stratified multistage probability proportionate to size sampling (PPS) during September – December, 2015.   Results   Among the 3 786 children with complete information, 1 411 had caries; the prevalence rate of permanent teeth caries was 37.27%; the average decay-missing-filled teeth (DMFT) was 0.73; and the caries filling ratio was 9.26%. There were no significant differences in prevalence rate of permanent teeth caries (37.46% vs. 37.07%) and mean DMFT index (0.74 ± 1.37 vs. 0.73 ± 1.23) between the urban and the rural children; but the caries filling ratio was significantly higher among the urban children than that among the rural children (14.31% vs. 4.09%, χ2 = 85.862; P < 0.05). Compared to the boys, the girls had significantly higher prevalence rate of permanent teeth caries (42.34% vs. 32.34%), mean DMFT index (0.86 ± 1.37 vs. 0.60 ± 1.20), and caries filling ratio (10.39% vs. 7.69%) (P < 0.05 for all). Multivariate logistic regression demonstrated that gender, age, paternal education, self-perceived oral health status, and dental care experience were significantly associated with the prevalence of permanent teeth caries among the children.  Conclusion  The permanent teeth caries is prevalent among 12 – 15 years old children in Henan province and interventions on oral health should be promoted among the children.
Effectiveness of risk communication and its influencing factors during an influenza epidemic in early 2018 in China
Chao-yi CHEN, Wei XU, Qiao ZHANG,
 doi: 10.11847/zgggws1127538
Abstract(3834) HTML(645) PDF 556KB(63)
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  Objective  To examine the satisfaction to risk communication and its main influencing factors in the public during an influenza epidemic in early 2018 in China and to provides references for improving the effectiveness of risk communication in health emergency response.  Methods  An online survey was conducted among 2 960 net users in China during a period of influenza epidemic from January to March 2018. A questionnaire on the satisfaction to public health risk communication was designed and distributed via Wechat and QQ platform. Descriptive statistics, Chi-square tests, and multivariate logistic regression were used in data analyses.  Results  Valid information were collected from 2 796 respondents (45.71% males and 54.29% females) aged 18 – 78 years. Of the respondents, 70.92% reported being satisfied with the public health risk communication on the influenza epidemic but 29.08% reported unsatisfaction, with a significant difference (χ2 = 340.69, P < 0.001). Multivariate logistic regression analysis revealed that the respondents with following characteristics were more likely to report the satisfaction to their perceived risk communication related to the epidemic: living in a rural region (odd ratio [OR] = 2.046), with an education of and below (OR = 2.723), reporting a positive emotion (OR = 1.369), paying an attention to the influenza epidemic-related information (OR = 3.245), being confidence in governmental administration (OR = 1.894), being interactive with the information in new media (OR = 1.923), and searching for relevant information via new media (OR = 1.763).  Conclusion  Government departments could make a full use of new media to improve the effectiveness of health risk communication in response to public health emergencies.
Effects of family-involved hand washing intervention on prevention of infectious diseases among children in kindergartens
Li-feng ZHANG, Xiu-qun QIN, Ning-ning ZHANG,
 doi: 10.11847/zgggws1128071
Abstract(1243) HTML(2191) PDF 653KB(56)
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  Objective  To determine initial efficacy of a family-involved hand washing intervention on the improvement of hand hygiene of children and the prevention of infectious diseases among children in kindergartens.  Methods  A cluster-randomized controlled trial was conducted among 490 children (averagely aged 4.28 ± 0.33 years) and their parents at 16 classes from 4 kindergartens in Guangzhou city from March to June in 2018, and there were 8 classes in each group by randomization. Totally 247 children and their families were enrolled in the intervention group with family-involved hand washing intervention, and 243 children and their families in the control group with regular health education. The behavior of hand washing among the children and their parents and the incidence of infectious diseases of children between the two groups were compared.  Results  Hand washing behaviors of the children were significantly different between the two groups after the intervention (hand washing before eating [b = − 0.207], after toilet use [b = − 0.106], after going out [b = − 0.149], and with seven-step procedure [b = − 0.113]; all P < 0.05). The hand washing before eating, after toilet use and going out, and with seven-step procedure 2 months after the intervention, the hand washing before eating 4 months after the intervention, and the hand washing before eating and with seven-step procedure 6 months after the intervention were significantly better among the children of intervention group than among those of the control group (all P < 0.05). The hand washing of the parents in the intervention group were significantly better than that of parents in the control group 2 months after the intervention (hand washing before eating [χ2 = 8.750], after toilet use [χ2 = 7.243], after going out [χ2 = 15.557]; all P < 0.05). The cumulated incidence of acute gastrointestinal and respiratory infections was significantly lower among the children in the intervention group than among those in the control group (9.3% vs. 16.0%, χ2 = 5.031; P = 0.025) during the 12-month follow-up.   Conclusion  The family-involved hand washing intervention is effective in improving hand hygiene behaviors among kindergarten children and their parents and reducing infectious diseases in the children, suggesting that the intervention is of significance for infectious disease prevention in kindergartens.
Association between carotid artery abnormality and cigarette smoking among male adult residents at high-risk of cardiovascular disease in Jiangsu province
Yi-bin GU, Hong-yan SHENG, Ye WU, Yuan BI,
 doi: 10.11847/zgggws1128447
Abstract(1795) HTML(877) PDF 522KB(120)
Abstract:
  Objective   To examine the relationship between carotid artery abnormality and smoking in male adult residents at high-risk of cardiovascular disease (CVD) in Jiangsu province, and to provide evidences for prevention and treatment of subclinical atherosclerosis and early CVD.   Methods   From September 2015 to June 2016, we conducted screenings on individuals at high-risk of CVD among 35 – 75-year-old permanent residents (n = 71 511) in 31 urban communities and rural villages and towns selected with cluster sampling in 6 cities of Jiangsu province; then a questionnaire survey, physical examination, laboratory test and carotid artery ultrasound examination were carried out in 4 821 male residents at high-risk of CVD to analyze the relationship between carotid artery abnormality and smoking.   Results   Among the 4 821 high-risk individuals, 2 783 (57.73%) were diagnosed with carotid artery abnormality, of which, 761 (27.34%), 1 791 (64.57%), and 225 (8.09%) were carotid intima thickening, carotid plaque, and carotid stenosis, respectively. After adjusting confounding factors such as age, education, marriage, average annual family income, residence, and history of alcohol drinking/hypertension/diabetes/dyslipidemia, the results of unconditional multivariate logistic regression analysis demonstrated that for all the high-risk individuals, the smokers were more likely to have carotid artery abnormality (compared to non-smokers: odds ratio [OR] = 1.391, 95% confidence interval [95% CI] = 1.214 – 1.593); the results also revealed two significant risk factors of carotid artery abnormality for the 2 699 high-risk individuals being current or former smokers: smoking filter-tipped cigarettes (compared to smoking cigarettes without filter: OR = 1.440, 95% CI = 1.184 – 1.750) and breathing in cigarette smoke deeply (breathing the smoke into throat vs. into mouth: OR = 1.420, 95% CI = 1.081 – 1.865 and breathing the smoke into lung vs. into mouth: OR = 1.338, 95% CI = 1.104 – 1.622).   Conclusion   The prevalence rate of carotid artery abnormality is relatively high and the abnormality is strongly associated with smoking among male adult residents at high-risk of cardiovascular disease in Jiangsu province.
Preventive medicine physician system in the United States and its implications for China
Gang LI, Da FENG, Shang-feng TANG,
 doi: 10.11847/zgggws1129364
Abstract(1604) HTML(2029) PDF 509KB(134)
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Medical education system and licensed physician management system in the United States are two relatively mature institutions with successful operation. This study systematically reviewed the policy content of the preventive medicine physician system in the United States by establishing a theoretical analysis framework covering the education, employment admittance, deployment, professional title, and incentive pay system. This study discussed the identity crisis of public health physicians in China and considered that Chinese public health physicians are not preventive medicine physicians. The study suggested that for improving public health physician system in China, the connotation of public health physicians should be rectified; the criterion for admittance of public health physicians should be upgraded; and approaches for the transition between clinicians and public health physicians should be diversified.
Psychological difficulty and prosocial behavior among school-aged children in difficult and normal families: a comparison analysis
Ben-feng DU, Zhen-xiao HUANG, Xuan WANG,
 doi: 10.11847/zgggws1122613
Abstract(1222) HTML(754) PDF 611KB(49)
Abstract:
  Objective  To examine disparities in psychological difficulty and prosocial behavior among the children in difficult families (CDF) and in normal families and to provide empirical evidences for assessing the mental health needs of CDF and developing a moderately inclusive child welfare system.  Methods  The data of the study were from a national survey on CDF conducted during August-September of 2018. The participants were 6 – 15 years old children (2 099 CDF and 666 age- and gender-matched control children in normal families) recruited with multistage sampling in 7 provincial regions across China. Household face-to-face interviews were carried out in the participants using the Strengths and Difficulties Questionnaire (SDQ). Independent sample t test and monotonic ordinal rank-sum test (Matel-Haenszel χ2) were adopted in analyses.  Results  Compared to those in the control children, the score and abnormality detection rate of emotional symptoms (2.107 ± 1.977, 15.5%) and peer-communication (3.449 ± 1.497, 8.5%) were significantly higher in the 6 – 9 years old CDF (all P < 0.05); but the score of prosocial behavior (5.229 ± 2.366) was significantly lower in the 6 – 9 years old female CDF (P < 0.001). In contrast to the controls, the 10 – 15 years old CDF had significantly higher score and abnormality detection rate of hyperactivity-inattention (3.459 ± 1.691, 3.7%), emotional symptoms (2.121 ± 1.987, 7.4%), conduct problems (2.214 ± 1.563, 8.7%), and peer-communication (3.352 ± 1.445, 8.1% ) (P < 0.001 for all); however, the 10 – 15 years old CDF had significantly lower score but higher abnormality detection rate of prosocial behavior (5.570 ± 2.337, 28.3%) (both P < 0.001); the prosocial behavior score of 10 – 15 years old CDF was significantly lower in the males (5.630 ± 2.372) and the females (5.500 ± 2.295) than in the controls (both P < 0.01).   Conclusion  The 6 – 15 years old children in difficult families are at high risk of various psychological difficulties and may perform prosocial behaviors poorly; the situation needs to be concerned, especially for the girls and the elder children.
Dairy product consumption behavior among residents in Shanxi province: a cross-sectional survey
Yan XIONG, Dan GUO, Jia-hui LIANG,
 doi: 10.11847/zgggws1124274
Abstract(1454) HTML(647) PDF 525KB(25)
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  Objective  To examine the cognition on and behaviors of dairy product consumption and their influencing factors among residents of Shanxi province to provide references for developing programs of health education on dairy products consumption.  Methods  Using stratified multistage random sampling, we carried out a self-administered anonymous questionnaire survey among 3 288 residents recruited in 75 counties/districts of Shanxi province from December 2018 to March 2019. Chi-square test, Ridit analysis and binary logistic regression analysis were used in data analyses.  Results  Of all the participants at ages of 15 to 84 years (mean = 30.97 ± 13.37), 44.19% (1 453) were male and 55.81% (1 835) were female. Only 14.93% (491) of the participants reported a great concern about dairy product safety. The reported concern about dairy product safety differed significantly by gender (χ2 = 17.404), age (χ2 = 59.962) and residential place (χ2 = 31.304) (all P < 0.05); the male participants (\begin{document}$\bar R$\end{document} = 0.482), the participants aged ≤ 20 years (\begin{document}$\bar R$\end{document} = 0.473), and those living in rural regions (\begin{document}$\bar R$\end{document} = 0.469) reported lower concern about dairy product safety. Logistic regression analysis revealed that participants with a monthly household income of ≤ 500 yuan (RMB) per-capital were less likely to consume dairy products compared to those with the income of > 500 yuan (P < 0.05); the participants paying a great attention on dairy safety incidents when purchasing were less likely to consume dairy products compared to those paying a little attention on the incidents (P < 0.05); whereas, the participants with the Engel’s coefficient of < 60% were more likely to consume dairy products in comparison to those with the Engel’s coefficient of ≥ 60% (P < 0.05).  Conclusion  Dairy product consumption is insufficient and the concern on dairy product safety is at a low level among adult resident in Shanxi province. Governmental departments should take measures to promote the cognition on and consumption of dairy products in the public.
Status quo of contracted family doctor services in China: a literature study
Mei-xuan LI, Xiu-xia LI, Xin XING,
 doi: 10.11847/zgggws1122093
Abstract(3530) HTML(2169) PDF 483KB(174)
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  Objective  To examine the status of and research progress in contracted family doctor services in China and to summarize general problems existing in the implementation the services for providing references for the development of applicative mode of contracted family doctor services in China.  Methods  Studies on contracted family doctor services in China published till April 2018 were systematically searched through China National Knowledge Infrastructure (CNKI), Chinese Biomedicine Database (CBM), Wanfang and Chinese Science-Technology Periodical Database (VIP) database. EndNote X7 and Excel 2010 were used to manage and analyze the retrieved studies.  Results  All the 24 finally included articles were cross-sectional studies, of which 20 and 4 were conducted among urban and rural residents. Higher rates (36% – 96%) of awareness about contracted family doctor services were reported by studies conducted among residents in Guangdong province, followed by among those (16% – 90%) in Beijing. Higher proportions (42% – 100%) of participating in contracted family doctor services were reported by the studies conducted among the residents in Beijing, followed by those (30% – 74%) in Shanghai. A higher rate (86.33%) of satisfaction to contracted family doctor services was reported by the studies conducted among the residents in Beijing, followed that (56% – 80%) in Guangdong province. Major hindering factors for the implementation of contracted family doctor services indicated by the studies were shortage of family doctors, lack of awareness on the services among the public, low salary of family doctors, imperfect management, incentive, insurance, and information support for the services.  Conclusion  The rate of awareness about, participating in, and satisfaction to contracted family doctor services are higher among residents in economically developed provinces/municipalities and in urban area than among those in less developed regions and in rural areas in China. More researches on the issue need to be performed for effective implementation of contracted family doctor services.
Centralized procurement of anticancer drugs at provincial level in China
Hong-yu PENG, Chen LI, Rui-zhi ZHANG,
 doi: 10.11847/zgggws1124834
Abstract(1490) HTML(922) PDF 584KB(35)
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A government-led centralized procurement pattern for purchasing medicines in medical institutions at province/municipality level has been established basically in China so far; however, control in procurement price and establishment of effective purchasing process are still need be promoted for the procurement system. The government has tried to use tax reduction as an opportunity to achieve a significant decline in sale price for end users of the drugs. The study examined the implementation of centralized procurement of anticancer drugs in medical institutions at province/municipality level across the country and analyzed disparities in procurement schemes among the provinces and municipalities to provide references and suggestions for perfecting the implementation of centralized procurement of anticancer drugs at provincial level.
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Basic guideline of the function for vaccination vehicle (T/CPMA 025 — 2021)
 doi: 10.11847/zgggws1136036
Abstract(8) HTML(5) PDF 392KB(4)
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Elderly care needs and its influencing factors among older rural residents in five provinces of China
LI Yuan-lei, KANG Zheng, LI Yue-huan,
 doi: 10.11847/zgggws1126748
Abstract(1255) HTML(690) PDF 516KB(34)
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  Objective  To examine the demands for elderly care and its associates among older rural residents and to provide evidences for improving elderly care services in China.  Methods  Using stratified multistage random sampling, we recruited 600 residents aged ≥ 60 years at 20 villages in 5 provinces across China and conducted a survey among the elderly with a self-designed questionnaire on the status and related factors of elderly care needs From January to March 2019.  Results  Totally 560 (43.2% male and 56.8% female) residents completed the survey. For all the respondents, the average score for overall care was 6.01 ± 1.83 out of the full mark of 17; the average domain score for emotional care was higher than that for daily life care (2.79 ± 0.88 vs. 1.67 ± 1.83) and the score (1.56 ± 0.74) for medical care was the lowest among the domain scores. The top three emotional care needs reported by the respondents were harmonious neighborhood relationship, children′s company and community activity and the top three daily life care needs were caregiver′s service, financial support and children′s care. For medical care, the respondents paid more attentions to improving medical conditions and reducing medical expenses. Based on the results of multivariate linear regression analysis, main impact factors were education, self-care ability, whether with children living nearby, and whether having regular physical examination for care needs of the rural elderly.  Conclusion  The elderly in rural China need more emotional care and daily life care, especially those with lower education, without self-care ability, without children′s care, and having no regular physical examination.
Awareness, treatment and control of hypertension and their influencing factors among 40 years old and above hypertensive patients in rural regions of Liaoning province
Wei GUO, Yuan-meng TIAN, Li JING,
 doi: 10.11847/zgggws1126424
Abstract(4688) HTML(3308) PDF 534KB(87)
Abstract:
  Objective  To examine the awareness, treatment and control of hypertension and their influencing factors among hypertensive patients aged ≥ 40 years in rural regions of Liaoning province and to provide references for the prevention and control of hypertension.  Methods  Using stratified random cluster sampling, we carried out a survey including questionnaire interview, physical examination and laboratory test among 10 926 permanent residents aged ≥ 40 years in 19 administrative villages of 4 counties, Liaoning province from September 2017 to May 2018. The awareness, treatment and control of hypertension and their correlates in 6 623 hypertensive patients identified from the participants of the survey were analyzed.  Results  Among the 6 623 hypertensive patients, the crude and standardized rate were 47.50% and 44.25% for hypertension awareness, 35.41% and 31.34% for hypertension treatment, and 3.59% and 3.18% for hypertension control, respectively. Unconditional multivariate logistic regression analysis revealed that the patients with following characteristics were more likely to have higher hypertension awareness and treatment rate: female gender, aged ≥ 50 years, overweight/obesity, lack of physical exercise, family history of hypertension, history of diabetes, and high triglyceridemia; the patients with an average annual household income of 5 000 to 9 999 yuan RMB were more likely to have a high hypertension awareness rate; the patients with low serum high-density lipoprotein cholesterol were more likely to have a high hypertension treatment rate; the patients aged 50 – 69 years, lack of exercise, with family hypertension history were more likely to have a high hypertension control rate; whereas, the patients being current alcohol drinkers and with high serum total cholesterol were more likely to have low hypertension awareness, treatment and control rate; the patients with an average annual income of ≥ 20 000 yuan RMB were more likely to have a low hypertension control rate.  Conclusion  The rate of hypertension awareness, treatment and control are low and the rates are associated with gender, age, average annual household income, current alcohol drinking, physical exercise, family history of hypertension, history of diabetes, overweight/obesity, high total cholesterol, high triglyceridemia, and low high-density lipoprotein cholesterol among hypertension patients aged 40 years and above in rural regions of Liaoning province.
Interactive effect of temperature and air pollutants on years of life lost due to lung cancer among residents in Hexi district of Tianjin city
Jing-wei ZHANG, Li-hong FENG, Miao WANG,
 doi: 10.11847/zgggws1125192
Abstract(4516) HTML(747) PDF 1042KB(12)
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  Objective  To explore interactive effect of air pollutants and temperature on years of life lost (YLL) due to lung cancer and to provide references for studies on impacts of lung cancer mortality.  Methods  We collected data of Hexi district on lung cancer mortality in the residents, air pollutants monitoring, and meteorology observation during the period from January 1, 2015 to December 31, 2017. Bivariate response surface model, uni- and multi-pollutant and temperature interactive model were established using non-linear lag distribution to analyze the interactive effect of air pollutants and temperature on lung cancer-related YLL in the population of the district.  Results  Relative to the reference temperature of 16.3 ℃, high temperature (34 ℃) and low temperature (– 13 ℃) increased YLL of lung cancer by 1.12% (95% confidence interval [95% CI]: 0.58% – 2.16%) and 1.49% (95% CI: 0.16% – 14.25%). Particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO), one-hour average ozone (O3-1h), and eight-hour average ozone (O3-8h) could increase YLL of lung cancer by 1.00% (95% CI: 0.98% – 1.03%), 1.01% (95% CI: 0.95% – 1.08%), 1.01% (95% CI: 0.99% – 1.03%), 1.03% (95% CI: 0.98% – 1.09%), and 1.03% (95% CI: 0.98% – 1.09%), respectively. Under the low temperature, a 10 μg/m3 increment in PM2.5 and NO2 could increase the YLL of lung cancer by 4.14% (95% CI:0.55% – 7.85%) and 5.44% (95% CI: – 4.80% – 16.78%).   Conclusion  High and low temperature, PM2.5, NO2, CO, O3-1h and O3-8h can all increase daily YLL of lung cancer in an exposed population and the effect of PM2.5 and NO2 are stronger under low temperature.
Variation in scope of government concerns over infectious diseases in Liaoning and Jilin province: a literature study
Lin PAN, Qun-hong WU, Chao-yi CHEN,
 doi: 10.11847/zgggws1125734
Abstract(1166) HTML(568) PDF 544KB(10)
Abstract:
  Objective  To analyze variations in the scope of infectious disease epidemics concerned by government departments and the relationship between the changes and incidences of class A and B infectious diseases in Liaoning and Jilin province for developing strategies on infectious disease prevention and control.  Methods  By searching official websites and internet databases, we retrieved policy documents referring to the prevention and control of infectious diseases published by government departments and health institutions of Liaoning and Jilin province from 2005 through 2016. Descriptive analyses were performed and Spearman correlation and univariate linear regression analysis were used to explore the correlation between the concern scope and local incidences of notifiable class A and B infectious diseases.  Results  We totally retrieved 32 and 45 documents issued by Liaoning and Jilin provincial departments and institutions during the period. Compared to that in 2005 in Jilin province, the indicator for the scope of infectious diseases concerned by provincial departments increased by 41.00% and the incidence of notifiable class A and B infectious diseases decreased by 79.63/100 000 in 2017, respectively, with an obvious inverse correlation between the indicator and the incidence. During the period, the indicator for the scope of infectious diseases concerned by Liaoning provincial departments increased from 28.85% to 75.00% but no significant correlation was observed between the indicator and the local incidence of notifiable infectious diseases.  Conclusion  The scope of infectious disease epidemics was increasingly concerned by local government departments of Liaoning and Jilin province during the period from 2005 to 2017 and the governmental concern is one of important factors for the prevention and control of infectious diseases.
Utilization of outpatient service and its influencing factors among chronic disease patients in China: an Anderson model-based analysis
Lin PAN, Qun-hong WU, Tong ZHENG,
 doi: 10.11847/zgggws1125766
Abstract(3132) HTML(2429) PDF 584KB(32)
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  Objective  To examine status quo and influencing factors of outpatient service utilization among chronic disease patients in China and to provide evidences for promoting the utilization of outpatient services in the patients.  Methods  Using convenient and snowball sampling, we recruited 1 059 chronic disease patients (hypertension, diabetes, cardiovascular diseases and malignant tumor) in 7 provincial level regions in eastern, central and western China and conducted a online self-administered questionnaire survey between October 2018 and March 2019. Anderson model was adopted to analyze influencing factors of outpatient service utilization among the patients.  Results  The two-weeks rate of outpatient service utilization was 37.36% among the 1 036 patients with valid response. Unconditional multivariate logistic regression analysis demonstrated that the respondents with poor household economic condition, having siblings, and suffering from two or more chronic diseases were more likely to utilize outpatient medical service; while, those living in western regions, being manual workers, with average annual income per capita of 5 000 yuan RMB, and participating in the New Rural Cooperative Medical Scheme were less likely to utilize outpatient medical service. Enabling resources (including income per capita, household economic status, type of medical insurance and number of siblings) were the most significant impact factors for the utilization of outpatient service among the respondents, followed by demographic indicators and number of chronic diseases suffered from.  Conclusion  The two-weeks rate of outpatient service utilization is low and mainly influenced by living region, occupation, average annual income per capita, family economic status, type of medical insurance, number of siblings and number of chronic diseases suffered from among chronic disease patients in China.
Evaluation on influencing factors of doctor-patient information communication in China: a grounded theory-based cross-sectional survey
Yue ZHANG, Rong-bin YU, Jin-fan WANG
 doi: 10.11847/zgggws1124619
Abstract(1295) HTML(717) PDF 554KB(44)
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  Objective  To explore influencing factors of doctor-patient information communication (DPIC) and to provide evidences for improving the situation of DPIC in China.  Methods  To screen influencing factors of DPIC based on grounded theory, we conducted an expert fractal analysis and semi-structured interviews among 8 schoolors engaged in medical humanities education and research, 20 senior doctors and 20 patients in three tertiary hospitals in Nanjing city using purposive sampling. With the coded influencing factors prelimilarily determined, we compiled a questionnaire. Then we conducted an on-site self-administered questionnaire survey among 2 727 medical professionals and 1 781 patients and their relatives recruited using cluster random sampling at tertiary hospitals in 23 municipalities/provinces across China during March – May 2016. We analyzed the data collected for weighting and ranking all influencing factor of DPIC by comprehensive and average impact scores calculated for each of the factors.  Results  Of the surveyed medical professionals and patients and their relatives, 45.9% and 44.1% reported a strong willingness to conduct DPIC; 75.9% and 71.4% affirmed the necessity of governmental agencies' role in DPIC; 49.0% and 53.9% evaluated the role of media and network in DPIC as very necessary; 21.6% and 18.0% approved representative role of medical associations in the process of DPIC but only 14.5% and 26.7% approved the representative role of consumers associations. There were significant disparities between medical professionals and patients and their relatives in attitudes towards DPIC and its relevant dimensions mentioned above (all P < 0.01). The rank order from high to low for impact scores of DPIC influencing factors was governmental administration (score = 3.69), demand for the communication (3.34), media and network (3.18), medical association (2.56), and consumer association (2.21) among the medical professionals; while among the patients and their relatives, the rank order was government administration (3.61), media and network (3.32), demand for the communication (3.25), consumer association (2.71), and medical association (2.47).  Conclusion  A good doctor-patient information communication comes from the joint efforts among medical staff, patients, government agencies, media and network, and relevant social organizations. The study result suggests that a comprehensive platform needs to be established to promote the communication.
Effect of New Rural Cooperative Medical Scheme adjustment on health service utilization in rural residents
Qin LI, Biao YANG, Ya-nan CHEN,
 doi: 10.11847/zgggws1124141
Abstract(1135) HTML(1715) PDF 503KB(6)
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  Objective  To study the effect of New Rural Cooperative Medical Scheme (NRCMS) adjustment on health service utilization among rural residents in Ningxia Hui Autonomous Region (Ningxia).  Methods  We extracted the data on 38 804 rural residents over the age of 15 years from the dataset of four waves of household survey conducted in 2009, 2011, 2012 and 2015 in four counties of Ningxia; the surveys were a part of the pilot medical reform project – “Constructing an Innovative Payment System and Improving Health Performance”. Difference-in-differences model was used to analyze the effect of NRCMS adjustment on residents’ health service utilization.  Results  Significantly decreased rate of visiting a doctor during two weeks (odds ratio [OR] = 0.783, 95% confidence interval [95% CI]: 0.632 – 0.969) was observed among the participants in the two counties with the NRCMS adjustment in 2012, one year after the implementation of the adjustment, compared to that among the participants in the two counties without the adjustment; significant increase in yearly hospital admission rate (OR = 1.231, 95% CI: 1.014 – 1.493) was also observed among the participants in the two counties with NRCMS adjustment in 2015, five years after the adjustment implementation, in comparison to that in the two counties without the adjustment.  Conclusion  Among the rural residents in Ningxia, the adjustment in New Rural Cooperative Medical Scheme had a negative impact on the rate of visiting a doctor during two weeks significantly one year after the adjustment but the effect of the adjustment on hospital admission rate was of significance five years after the adjustment and the persistence of the effect needs follow-up study.
Prevalence and risk factors of diabetes mellitus among retreatment pulmonary tuberculosis patients
Yan MA, Jian DU, Wei-wei GAO,
 doi: 10.11847/zgggws1123713
Abstract(1210) HTML(609) PDF 535KB(17)
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  Objective  To explore tuberculosis – diabetes mellitus (DM) comorbidity and its risk factors among retreatment pulmonary tuberculosis patients (PTB) and to provide references for prevention and treatment of PTB-DM comorbidity.  Methods  We recruited 395 retreatment PTB patients at 22 medical institutions designated for PTB treatment across China and divided the patients into a PTB and a PTB-DM group according to the comorbidity of DM; then we carried out a questionnaire survey among all the patients from October 2009 to December 2012. Chi-square test was used to compare differences in demographics and other characteristics between the patients of the two groups; multivariate logistic regression analysis was used to explore risk factors of DM comorbidity.  Results  Of all the patients, 15.2% (60) were PTB-DM and 84.8% (335) were simple PTB; there were significant differences between the two groups in age (χ2 = 10.459, P = 0.005 3), body mass index (BMI) (χ2 = 15.070, P = 0.000 5), occupation (χ2 = 11.620, P = 0.002 9) and marital status (χ2 = 9.999, P = 0.006 7). Aged 40 – 59 years (odds ratio [OR] = 2.159, 95% confidence interval [95% CI]: 1.050 – 4.439), aged 60 years and above (OR = 5.017, 95% CI: 1.485 – 16.951), with a body mass index (BMI) of < 18.5 kg/m2 (OR = 4.946, 95% CI: 1.279 – 8.705), with a BMI of ≥ 24 kg/m2 (OR = 5.732, 95% CI: 1.918 – 17.133), and being married (OR = 4.476, 95% CI: 1.248 – 10.504) were significant risk factors of PTB-DM comorbidity.  Conclusion  The complication of diabetes mellitus is associated with age, body mass index, and marital status among retreatment pulmonary tuberculosis patients.
Comparison of public needs-based scientific decision-making in health emergency management between Liaoning and Jilin province: a literature study
Yang GUO, Lu WANG, Chao-yi CHEN,
 doi: 10.11847/zgggws1124766
Abstract(1538) HTML(1059) PDF 603KB(10)
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  Objective  To analyze the status of public needs-based scientific decision-making in health emergency management in Liaoning and Jilin province and the disparity in the decision-making between the two provinces for improving health emergency management.  Methods  By searching official websites and internet databases, we systemically and extensively retrieved 163 authoritative documents and reports on health emergency management published by government agencies and health institutions of Liaoning and Jilin province from 2000 through 2017. Descriptive analyses on scientific decision-making were performed using SPSS 22.0; Spearman correlation analysis and liner regression were adopted to assess the correlation between scientific rationality in target setting and the efficiency of health emergency management.  Results  The measure of scientific rationality in target setting for health emergency management increased from 2.1% in 2000 to 55.7% in 2017 in Liaoning province and from 2.1% in 2000 to 39.3% in 2017 in Jilin province. There were positive correlations between scientific rationality in target setting and the efficiency of health emergency management in both Liaoning and Jilin province, with the correlation coefficients of 0.735 and 0.691 and the adjusted R2 of 0.511 and 0.445, respectively.  Conclusion  The measure of scientific rationality in target setting for health emergency management increased greatly and the management efficiency was promoted in Liaoning and Jilin province.
Incidence of crayfish-related rhabdomyolysis syndrome in some regions along Yangtze River, 2016
Shi-cong LI, Hui-lai MA, Xu-hua GUAN,
 doi: 10.11847/zgggws1122791
Abstract(1595) HTML(2550) PDF 509KB(24)
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  Objective  To investigate epidemiological characteristics of crayfish-related rhabdomyolysis (RM) syndrome in regions along Yangtze River in 2016.  Methods  We conducted a field epidemiologic survey on 811 RM cases reported in Anhui, Jiangsu and Hubei province along Yangtze River during 2016 to analyze clinical and prevalence characteristics of the disease.  Results  Of all the cases, 69.3% were female and 78.1% were aged between 20 and 49 years. Main symptoms of the cases were muscle ache, fatigue and digestive disorder-induced pain; five times increased serum creatine kinase (CK) was detected among 84.0% of the cases. Retrospective surveys found that consumption of crayfish, shrimp offal, and alcohol were risk factors for the incidence of the disease. The incidences occurred mainly at home and the crayfish consumed by the cases were mainly from wild fishing.  Conclusion  There is a causal correlation between the incidence of rhabdomyolysis syndrome and crayfish in some regions along Yangtze River in 2016, suggesting that monitoring on crayfish eating-related diseases should be strengthened.
Haze-related health protective behaviors among citizens in Beijing city: an online survey
Xiu-ying FU, Lu HUANG, Wen-li ZHU,
 doi: 10.11847/zgggws1124158
Abstract(1556) HTML(2702) PDF 539KB(20)
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  Objective  To examine the status quo of haze-related health protective behaviors among citizens in Beijing city for providing evidences to develop targeted health education strategies and intervention measures.  Methods  In November 2018, we distributed a self-designed questionnaire on cognition on haze-related health risk and protective behaviors via internet to all members of official account of Dongcheng District Center for Disease Control and Prevention registered in Beijing city. All voluntary responses were collected two weeks after the distribution.  Results  A total of 15 698 questionnaires were distributed and 15 334 valid response questionnaires were received, with a response rate of 97.7%. Of all the respondents, 93.5% and 92.4% reported decreased going out and physical exercise under smog weather; 96.2% and 86.1% reported wearing mask when going out and using air purifiers at home under smog weather condition, respectively. The proportion of reporting haze-related health protective behaviors was significantly higher among the respondents aged 18 – 44 years, females, and the college students (all P < 0.05) and the proportion was positively correlated significantly with the level of cognition on health hazards of haze and the concern about haze weather condition (P < 0.05 for all).  Conclusion  The prevalence rate of haze-related health protective behaviors is relatively high among citizens in Beijing city but health education on cognition and protection of haze condition still needs to be promoted in key population groups.
Progress in researches on correlation between chronic obstructive pulmonary disease and air pollution
De-hui KONG, Zhong-jie FAN
 doi: 10.11847/zgggws1124553
Abstract(2096) HTML(1342) PDF 537KB(33)
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Recent studies have shown a significant relationship between ambient particulate matter (particulate matter less than 10 or 2.5 μm in aerodynamic diameter) and the onset, aggravation or death of chronic obstructive pulmonary disease (COPD), but the studies on the correlation between air gaseous pollutants(carbon monoxide, nitrogen dioxide, sulfur dioxide, ozone)and COPD did not reach a consistent conclusion. There was a few studies on the association between chronic exposure and COPD. This paper reviews the latest researches on the correlation between air pollutants and COPD, analyzes the influence of climate, population characteristics and human geography factors on the effect of air pollution on COPD, and aims to evaluate the degree of correlation between different pollutants and the incidence, acute exacerbation and death of COPD, and discuss the future research direction and prevention and control strategies.
Safe drug use among oldest-old community hypertension patients in Tangshan city
Xiao-bin MA, Chang-xiang CHEN
 doi: 10.11847/zgggws1124309
Abstract(2843) HTML(2409) PDF 488KB(32)
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  Objective  To investigate the status and of influencing factors safe drug use among oldest-old community residents with hypertension in Tangshan city of Hebei province, and to provide evidences for improving health management among elderly hypertension patients in communities.  Methods  Using random cluster sampling, we recruited 1 882 hypertensives aged ≥ 75 years at community health care centers covered by a secondary and a tertiary hospital in Tangshan city; we then carried out a household survey among the oldest-old hypertension patients with a questionnaire on safe drug use from July 2016 to January 2017.  Results  The mean scores of safe medication behavior for the 1 853 respondents with complete information was 30.17 ± 4.72 in the scale with a maximum score of 40 for the highest level of safe drug use. Multivariate regression analysis demonstrated following significant influencing factors for safe drug use among the respondents: education (β = 2.487), perceived happiness in life (β = – 5.833), attitude toward life and death (β = 1.667), frequency of participation in community activities (β = – 3.856), frequency of neighborhood communication (β = – 4.808), communication with children (β = – 2.044), frequency of contacting with friends (β = – 2.876), talking with people (β = – 1.480), attitude toward development of the elderly care (β = – 1.633), and medical burden (β = – 1.886) (all P < 0.05).  Conclusion  Community health care workers should make efforts to promote attitude and behaviors about safe drug use among elderly hypertension patients.
Clarity of responsibilities for all parties in public health emergency response in Liaoning and Jilin province: a literature analysis
Jian-hua GONG, Cheng-yue LI, Ling-zhong XU,
 doi: 10.11847/zgggws1124622
Abstract(1697) HTML(1024) PDF 780KB(11)
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  Objective  To analyze the clarity of responsibilities for all parties in public health emergency (PHE) response and the relationship between the clarity and the response efficacy in Liaoning and Jilin province for providing references for the improvement in public health organization system construction.  Methods  We searched literatures and documents referring to responsibility assignment for all parties in PHE response published by government agencies and professional institutions in the two provinces from 2000 through 2017 via public websites, China National Knowledge Infrastructure (CNKI), Wanfang Data and Web of Science. Cluster analysis and qualitative and quantitative methods were used to evaluate the clarity of the responsibility assignment for all parties of the two provinces. Spearman correlation and linear regression were used to analyze the relationship between the clarity and response efficacy.  Results  For the administration in Liaoning and Jilin province, the index for the clarity of the responsibilities assignment increased gradually from zero in 2000 to 20.60% and 21.95% in 2017; the index for response efficacy also gradually increased from 40.00% and zero to 53.33% and 60.00%, respectively. Significantly positive correlation between the clarity and the response efficacy was observed in Liaoning and Jilin province, with the correlation coefficients of 0.496 and 0.605, respectively (both P < 0.05).  Conclusion  The clarity of responsibilities for all parties in public health emergency response and the response efficacy have been improved in Liaoning and Jilin province since 2000, indicating an improvement in the construction of public health organization system of the two regions.
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2021, 37(6): .  
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2021, (6): 1-6.  
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Criterion, Guideline, Consensus
Expert consensus on the China Pertussis Initiative
Vaccine and Immunology Branch of the Chinese Preventive Medicine Association, Chinese Preventive Medicine Association
2021, 37(6): 905-914.   doi: 10.11847/zgggws1134552
Abstract(241) HTML(80) PDF 974KB(76)
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Some countries with high coverage of diphtheria, tetanus and pertussis combined vaccines have experienced pertussis epidemics and/or local outbreaks since 1980s. This phenomenon is called “pertussis resurgence”. In recent years, pertussis epidemics in several provinces of China have resurged dramatically, arousing great concern from all parties. By referring the working model of the Global Pertussis Initiative, the Chinese Preventive Medicine Association has organized and launched the China Pertussis Initiative. A group of experts in this field has analyzed data of current pertussis in China and identified problems posed by the disease. This expert consensus was completed based on the discussions of the latest national and international research progress, epidemiological trends and immunization strategies of pertussis, with special aims to provide guidance for the surveillance, prevention and control of pertussis in China.
Special Report – Popularizing Health Knowledge for Better Health Literacy among Residents
Changing trend in health literacy about chronic disease prevention and treatment among Chinese residents, 2012 – 2017: an age-period-cohort analysis
JIANG Wen, ZHANG Lan-chao, LI Wei-hao,
2021, 37(6): 915-920.   doi: 10.11847/zgggws1134861
Abstract(59) HTML(16) PDF 606KB(21)
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  Objective  To analyze changing trend and in health literacy about chronic disease prevention (HLCDP) and its associated factors among 15 – 69 years old residents in China from 2012 to 2017 for providing references to the promotion of HLCDP in the population.  Methods  Using simple random sampling, we extracted the data on 89 153 urban and rural residents aged 15 – 69 years from the dataset of National Health Literacy Surveillance conducted yearly from 2012 to 2017 across China. A multi-level fixed effect model was constructed using hierarcal age-period-cohort (APC) method to explore changing trend in HLCDP and its associates.  Results  For the years from 2012 to 2017, the proportion of the residents with HLCDP were 8.52%, 11.01%, 9.01%, 10.05%, 10.25%, and 13.96%, respectively, with an overall upward trend (χ2 = 118.69, P < 0.001). Similar changing trends in net and crude period effect on HLCDP were observed, with a fluctuation from 2012 to 2016 and a rapid increase between 2016 and 2017. After adjusting for demographic factors and health status, the results of multi-level fixed effect model analysis showed that the residents with the education of primary school and above, being medical staff and having a better self-perceived health status were more likely to have a higher HLCDP; while, the residents being ethnic minorities, being farmers or workers, living in central or western regions or in rural areas were more likely to have a lower HLCDP. Significantly increased proportion of the residents having HLCDP were observed in 2013, 2015 and 2017 compared to that in corresponding previous one year, with the odds ratios of 1.200,1.116 and 1.535 (all P < 0.01). The period effect on the variation of HLCDP was significant, but the age-effect or the cohort-effect were not significant (both P > 0.05).  Conclusion  Among Chinese residents, the net period effect on HLCDP increased generally from 2012 to 2017 and the effect was greater for the period from 2016 to 2017. Attention should be paid to the impact of period effect and some demographic factors on changing trend of HLCDP.
Changing trend in infectious disease prevention-related health literacy and its influencing factors among 15 – 69 years old residents in Hubei province, 2014 – 2018
LUO Yan, MA Li-na, ZHOU Liang,
2021, 37(6): 921-925.   doi: 10.11847/zgggws1129683
Abstract(1470) HTML(1917) PDF 501KB(92)
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  Objective   To investigate changing trend in infectious disease prevention-related health literacy and its influencing factors among residents in Hubei province from 2014 to 2018 and to provide evidences for making policies on infectious disease prevention.   Methods  We conducted yearly surveys among 15 – 69 years old permanent residents (n = 14 708) selected with stratified multistage random cluster sampling in 12 counties/prefectures/districts across Hubei province between 2014 and 2018. A questionnaire compiled by National Health and Family Planning Commission for health literacy survey among Chinese residents was adopted and the collected information on infectious disease prevention-related health literacy were analyzed statistically.   Results   For the five waves of the yearly survey, the proportion of the participants with infectious disease prevention-related health literacy (scored 80 and above in a full scale of 100 for knowledge about infectious diseases) were 11.3%, 14.8%, 17.7%, 15.4% and 20.5%, respectively. The results of multivariate logistic regression analysis revealed following significant promotion factors of infectious disease prevention-related health literacy of the participants: being surveyed in the later year (odd ratio [OR] = 1.049, 95% confidence interval [95% CI]: 1.015 – 1.084), at younger ages (25 – 34 vs. 64 – 69: OR = 1.417, 95% CI: 1.129 – 1.778; 35 – 44 vs. 64 – 69: OR = 1.498, 95% CI: 1.207 – 1.860) and with higher education (college and above vs. being illiterate: OR = 6.422, 95% CI: 4.912 – 8.396).   Conclusion   The infectious disease prevention-related health literacy was increased slowly but still at a low level and significantly influenced by years, age and education among 15 – 69 years old residents in Hubei province.
Health literacy and its influencing factors among primary and high school students in Nanjing city, China
WANG Na, REN Hong-fu, CHEN Xu-peng,
2021, 37(6): 926-929.   doi: 10.11847/zgggws1127501
Abstract(57) HTML(11) PDF 504KB(16)
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  Objective  To examine the level and associates of health literacy (HL) among primary and high school students in Nanjing city of Jiangsu province and to provide evidences for developing targeted interventions on HL in the students.  Methods  Using two-stage random cluster sampling, we recruited 4 498 students aged 9 – 17 years at 36 primary and high schools in all administrative districts of Nanjing municipality and conducted a self-administered questionnaire survey during May – June, 2018. Chi-square test and the multivariate logistic regression model were adopted to explore the influencing factors of HL.  Results  Among the 4 401 students completing the survey, 85.7% were assessed with adequate HL and the proportions of the students with adequate HL were 73.7%, 90.3%, and 95.1% for the grade 4 – 6 pupils, junior high school students, and senior high school students, respectively. The results of multivariate logistic regression analysis demonstrated that the students with following characteristics were more likely to have adequate HL: girl students (versus boy students: odds ratio [OR] = 1.56, 95% confidence interval [95% CI]: 1.30 – 1.87); upper grade students (OR = 4.29, 95% CI: 3.45 – 5.33 for junior high school vs. primary school and OR = 8.29, 95% CI: 6.24 – 11.01 for senior high school vs. primary school); reporting better self-rated academic performance (OR = 1.86, 95% CI: 1.48 – 2.34 for normal vs. poor and OR = 3.07, 95% CI: 2.42 – 3.89 for good vs. poor); and higher parental educational attainment (versus lower: OR = 1.78, 95% CI: 1.42 – 2.24).  Conclusion  Among primary and high school students in Nanjing city, the health literary is at a relatively high level and mainly influenced by gender, schooling grade, self-rated academic performance, and parental educational attainment.
Health literacy among residents in Wuhan city, 2016 and 2018: a comparative analysis
MEI Xin, CHEN Gong, WU Chun-yan,
2021, 37(6): 930-935.   doi: 10.11847/zgggws1128122
Abstract(41) HTML(10) PDF 538KB(14)
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  Objective  To compare health literacy among residents in Wuhan city in 2016 and 2018 for providing evidences to the development of relevant health policies and interventions.  Methods  Using the National Residents' Health Literacy Monitoring Questionnaire developed by the China Health Education Center, we conducted cell phone- or computer-aid face-to-face survey among 4 500 and 5 300 permanent residents selected with multistage random sampling in Wuhan city, Hubei province in 2016 and 2018, respectively.  Results  The proportion of the residents with overall health literacy increased significantly from 11.79% in 2016 to 19.29% in 2018 (χ2 = 97.063, P < 0.001) and the proportions the residents with health literacy dimensions increased from 22.88% to 33.95% for basic knowledge and concepts, 9.92% to 17.29% for healthy lifestyle and behavior, and 14.74% to 33.20% for basic skills in the three year period, respectively. In 2016, the proportions of the residents with health literacy on the six public health problems in descendant order were 44.42% for safety and first aid, 33.73% for scientific health concept, 19.74% for health information, 16.73% for infectious disease prevention and treatment, 12.75% for basic medical care, and 11.48% for chronic disease prevention and treatment; whereas, the proportions were 57.79% for safety and first aid, 52.81% for scientific health concept, 40.96% for health information, 27.84% for basic medical care, 26.05% for infectious disease prevention and treatment, and 18.98% for chronic disease prevention in 2018, with significant difference compared to those in 2016. However, for the residents surveyed in 2018, the proportion with health literacy on chronic disease prevention, infectious disease prevention and basic medical care were still low and less than 50% of the residents answered correctly to the questions on benefits of eating soy products such as tofu and soy milk, right ways of dealing with coughing and sneezing, and medical description of liver.  Conclusion  Health literacy was improved in 2018 compared to that in 2016 but health lifestyle and behaviors and health literacy on infectious disease prevention, chronic disease prevention and basic medical care were still at a low level among the residents in Wuhan city. The results suggest that targeted health education should be promoted in the population.
Progress in researches on association of health literacy with health outcome among cancer patients
LI Shi-lin, FANG Yi, YOU Li-li
2021, 37(6): 936-938.   doi: 10.11847/zgggws1132275
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Cancer is increasingly prevalent and seriously endangering human health. Although some progresses have been achieved in researches on multiple treatments of cancer with the development of medical science, the subjective initiative of each individual still plays an irreplaceable role in improving the prognosis among cancer patients. Health literacy, as an individual′s “internal cause”, involves the individual′s education level, mental health, self-care capability, and other traits. A cancer patient′s health literacy may exert an important impact on the health outcome of the patient. The study reviews advances in researches on different health outcomes of cancer patients associated with disparities in their health literacy in order to provide new ideas and methods for improving the prognosis and quality of life of cancer patients from a public health perspective.
Epidemiological Research
Knowledge, attitude and behavior about dietary salt reduction among family chefs and members in six provinces of China
SHEN Dan-yang, ZHANG Xiao-chang, YIN Zhao-xue,
2021, 37(6): 939-942.   doi: 10.11847/zgggws1131624
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  Objective   To examine the knowledge, attitude and behavior about dietary salt reduction among family chefs and their family members in six provinces of China, and to provide evidences for formulating strategies and measures for dietary salt reduction in communities.   Methods   The participants of the study were 1 576 family chefs and their family members ( ≥ 18 years old) recruited with multistage random sampling in 60 urban communities and rural villages of 6 provincial-level regions (Qinghai, Hebei, Heilongjiang, Sichuan, Jiangxi, and Hunan) of China; then electronic device-aided face-to-face interviews and blood pressure measurements were carried out among the participants during September – November 2018. A self-designed questionnaire was used to collect the participants' information on dietary salt reduction-related knowledge, attitude and behavior.   Results   Among the participants, the rates of awareness on dietary salt reduction-related knowledge were 16.24% for recommended daily table salt intake for adults, 19.67% for low sodium salt, 31.41% for salt content index on food package labels, 76.27% for high salt consumption increasing the risk of hypertension, and 20.11% for reasonable low salt intake not reducing physical strength, respectively. Of the participants, 80.65% reported a positive attitude towards reducing salt intake at meals; 85.91%, 53.87%, 24.19%, and 14.91% reported not eating snacks containing salt, not eating salted food, using table salt with low sodium, and asking for adding less salt in dishes when eating out or ordering a takeout food. Compared to their family members, the family chefs had significantly higher rates of being aware of excessive dietary salt intake as a risk factor for hypertension (78.43% vs. 74.11%) and holding a positive attitude towards reducing salt intake at meals (85.66% vs. 75.63%) but a lower rate of being aware of salt content index on food package labels (26.14% vs. 36.68%) (P < 0.05 for all).   Conclusion   The rate of having a positive attitude towards dietary salt reduction is high, but both the rate of being aware of dietary salt reduction-related knowledge and putting dietary salt reduction into practice are relatively low among the family chefs and their family members in six provinces of China.
Development and validation of a prognostic nomogram for HIV/AIDS patients with antiretroviral therapy
ZHOU Tao, LI Yue-fei, BAI Xue,
2021, 37(6): 943-949.   doi: 10.11847/zgggws1132568
Abstract(28) HTML(18) PDF 886KB(6)
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  Objective   To establish and verify a nomogram for accurately predicting the mortality risk of human immunodeficency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients receiving antiretroviral therapy (ART).   Methods   From China Information System for AIDS Prevention and Control, we extracted the data on HIV/AIDS patients registered during the period from 2006 through 2019 in Xinjiang Uygur Autonomous Region. Univariate and multivariate Cox proportional hazard regression analysis were carried out for the data on 3 272 HIV/AIDS patients of modeling group to determine the factors to be included in the nomogram. The area under the receiver-operating characteristics curve (AUC-ROC) and calibration curve were adopted to assess the prediction accuracy of the established nomogram for the data of modeling group and verifying group (1 636 HIV/AIDS patients). Decision curve analysis (DCA), x-tile analysis and Kaplan-Meier curve were used to evaluate the clinical utility of the established nomogram.   Results   Based on the results of multivariate Cox proportional hazard regression analysis, the established nomogram model included following independent factors for predicting the prognosis of HIV/AIDS patients with ART: hemoglobin, body mass index, gender, aspartate aminotransferase, disease staging according to criterions proposed by World Health Organization, delay time between HIV infection and ART, and CD4 cell count. The AUC-ROC of the established nomogram is 0.781 (95% confidence interval [95% CI]: 0.703 – 0.861) for the modeling group and that for the verification group is 0.829 (95% CI: 0.758 – 0.896). The calibration curve for the survival of the patients during the 3-year period demonstrated a good consistency between the survival rate predicted by the nomogram and that observed actually. The survival rate was predicted based on the established nomogram for the patients at different (low, moderate and high) risk of mortality assessed according to nomogram scoring resulted from the analysis.   Conclusion   The study established a nomogram which could provide accurate and meaningful predictions for the survival of the HIV/AIDS patients with antiretroviral therapy.
Relationship between soil selenium content and liver cancer mortality: a monitoring data analysis with generalized additive model
LONG Xiao-juan, XU Cheng-dong, YU Shi-cheng,
2021, 37(6): 950-953.   doi: 10.11847/zgggws1131355
Abstract(32) HTML(7) PDF 620KB(11)
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  Objective   To analyze the relationship between soil selenium content and liver cancer mortality in 156 districts/counties covered by a vital registration system in China and to provide references for the application of trace selenium in the prevention and treatment of liver cancer.   Methods   We collected following data for the 156 districts/counties: population sampling survey in 2012, liver cancer mortality and hepatitis B/C incidence in 2012, disease behavioral risk factor survey in 2010, socio-economic development and healthcare resources in 2013, and interpolatedly estimated soil selenium content based on sampling survey data published in 1994. Dimension reduction process was performed for socio-economic development and healthcare resource indicators with factor analysis. Generalized additive model was adopted to analyze the relationship between soil selenium content and liver cancer mortality. SAS for Windows 9.4 was employed and the significant level was set to be 0.05 in data statistics.   Results   There was a nonlinear relationship between soil selenium content and liver cancer mortality. Two common factors were derived in dimension reduction for indicators of socio-economic development and healthcare resources, representing economic development and health resource, and the cumulative contribution rate of the two common factors was 91.24%. The results of generalized additive model analysis revealed a significant difference between the complete model of liver cancer mortality and the model without soil selenium content as a non-parametric variable (P < 0.001). The non-parametric smooth component effect graph demonstrated an analogous ‘N’ shape correlation between soil selenium content and the non-parametric smooth component of liver cancer mortality.   Conclusion   Higher soil selenium content may correlate with increased risk of liver cancer mortality but moderate to upper soil selenium content may associate with low liver cancer mortality. The results should be concerned when conducting selenium supplementation-related liver cancer prevention.
Status quo of prevention and control of cardiovascular and cerebrovascular diseases in Shandong province: a Chinese′s cardiovascular health index-based evaluation
CHU Jie, TIAN Xue-ying, JIANG Ying-ying,
2021, 37(6): 954-959.   doi: 10.11847/zgggws1128070
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Abstract:
  Objective  To comprehensively evaluate the prevalence, prevention and management of cardio-cerebrovascular disease (CVD) in Shandong province for promoting effective CVD prevention and control in the province.   Methods  A Chinese′s cardiovascular health index (CHI) system was established with literature review and Delphi consulting method. The weights of various dimensions and indexes of the system were determined with analytic hierarchy process and the original data on CVD were collected from five dimensions (namely A for disease prevalence, B for risk factor exposure, C for risk factor control, D for disease treatment, and E for public health policy and service). After homogenization, standardization, and percentaging, each dimension and total CHI score were finally obtained. Then the estimated CHI scores of Shandong province were compared with those of the whole country and its neighboring provinces.  Results  The established CHI is composed of 52 indicators covering five dimensions, with a maximum score of 100. The estimated total CHI score for Shandong province was 52.9, ranking eighth among those for provincial level regions in the country and higher than the national average (49.4). The CHI dimension C and E score for Shandong province were 57.3 and 60.3 and the rank order of the two scores were the 8th and 10th among the scores for provincial level regions in the country from high to low; however, the rank order of CHI scores of dimension A (53.9), B (50.9) and D (38.1) were the 14th, 20th, and 20th, respectively, versus the scores of all other regions. Among the 52 indicators, the Shandong province′s scores for healthy behavior, successful smoking cessation rate, and health expense were higher than the national averages; but the scores for premature death probability, metabolic parameters, concentration of particulate matter ≤ 2.5 μm in mean aerodynamic diameter (PM2.5), hypertension prevention and control, diabetes prevention and control, treatment outcomes, and residents′ health literacy were all lower than the averages.   Conclusion   Based on the CHI evaluation on CVD prevention and control in Shandong province, the performance in risk factor prevention and control and construction of public health policy and service capability are good but the effectiveness for control of disease prevalence and risk factor exposure and for disease treatment need to be improved.
Prevalence, awareness, treatment and control rate of diabetes and their correlations with socioeconomic status among middle-aged and elderly residents in Yangzhong city
FENG Xiang, FENG Xue-qiang, BIAN Ying-guang,
2021, 37(6): 960-964.   doi: 10.11847/zgggws1125726
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Abstract:
  Objective  To examine the prevalence, awareness, treatment and control rate of diabetes and their relationship with socioeconomic status (SES) among middle-aged and elderly community residents in Yangzhong city of Jiangsu province and to provide references for promoting diabetes prevention and control.  Methods  Using stratified multistage random cluster sampling, we recruited 2 644 residents aged 40 years and above at 6 communities/towns in Yangzhong municipality of Jiangsu province. Questionnaire interview, physical examination and laboratory detection were conducted among the residents from September 2018 to March 2019. Multivariate logistic regression analysis were used to analyze correlations of SES with the prevalence, awareness, treatment and control rate of diabetes. The concentration index (CI) of the prevalence, awareness, treatment and control rate of diabetes were calculated to evaluate health equity.  Results  Among the 2 591 residents completing the survey, 275 (10.6%) were diagnosed with diabetes. Of the 275 diabetic participants, 148 (53.8%) were aware of the disease; 116 (42.2%) were under treatment for the disease; and 34 (12.4%) had their blood glucose under control. After adjusting for confounding factors such as gender, age, marital status, residence, smoking, alcohol consumption, physical exercise, and body mass index (BMI), multivariate logistic regression analysis revealed following associations of SES with diabetes-related indicators among the participants: (1) higher education was correlated with decreased diabetes prevalence (junior high school and above vs. illiterate/semiliterate: odds ratio [OR] = 0.486, 95% confidence interval [95% CI]: 0.304 – 0.778); (2) retirement was related to increased rate of awareness on diabetes (retiring vs. being on a job: OR = 5.026, 95% CI: 1.360 – 18.568) and increased rate of diabetes treatment (OR = 2.944, 95% CI = 1.043 – 8.311); (3) middle and high average annual personal income were associated with increased blood glucose control rate (middle vs. the lowest: OR = 6.354, 95% CI: 1.228 – 32.883; high vs. the lowest: OR = 8.404, 95% CI: 1.616 – 43.700). The education- and occupation-related CI values were – 0.029 5 and – 0.017 4 for diabetes prevalence, – 0.009 3 and – 0.014 1 for awareness on diabetes, – 0.008 6 and – 0.011 0 for diabetes treatment, and – 0.013 8 and – 0.027 5 for blood glucose control, respectively; the per capita annual income-related CI for diabetes prevalence and awareness were – 0.002 6 and – 0.001 4, but for diabetes treatment and blood glucose control were 0.020 7 and 0.077 1.  Conclusion  The prevalence of diabetes is at a general level but diabetes awareness, treatment and blood glucose control are at a low level among the middle-aged and elderly residents in Yangzhong city; the residents′ diabetes-related indicators are correlated with their socioeconomic status and there is diabetes-related health inequity due to different socioeconomic status.
Lung cancer mortality risk and its risk factors in Heilongjiang province: a Bayesian spatio-temporal modeling analysis
GUO Yu-zhu, YU Chuan-chuan, XU Ning,
2021, 37(6): 965-973.   doi: 10.11847/zgggws1133288
Abstract(110) HTML(15) PDF 1119KB(22)
Abstract:
  Objective  To explore temporal-spatial distribution and risk factors of lung cancer mortality risk in Heilongjiang province, and to provide evidences for prevention and control of lung cancer.   Methods  We collected the data on lung cancer and chronic obstructive pulmonary disease (COPD) mortality in Heilongjiang province from 2008 through 2017 and relevant data on demographics, ambient air pollutants, social economic development were also collected simultaneously. Integrated nested Laplace approximation-based Bayesian spatio-temporal model was used to estimate annual prefecture-specific and district/county-specific standardized mortality ratio (SMR) of lung cancer and to analyze relative risks of lung cancer mortality attributed to various known risk factors.   Results   During the 10-year period in the province, the lung cancer mortality risk generally increased significantly, although the spatio-temporal pattern of lung cancer SMR was different in different districts/counties. From 2008 to 2017 among 132 districts/counties of the province, the number of district/county with higher lung cancer mortality risk (relative risk [RR] > 1.0 compared to overall risk of the province) increased from 9 to 69. The prefecture-specific age-standarized mortality rate (ASMR) of COPD was positively associated with the SMR of lung cancer (RR for all = 1.10, 95% confidence interval [95% CI]: 1.04 – 1.16; RR for males = 1.09, 95% CI: 1.03 – 1.16; RR for females = 1.10, 95% CI: 1.04 – 1.16). No significant associations were observed between the SMR of lung cancer and other factors including the proportion of the population over 60 years old, annual cigarette consumption per capita (lag 20 years), particulate matter ≤ 2.5 μm in mean aerodynamic diameter (lag 8 years), regional gross domestic production per capita (lag 10 years), the proportion of employed population in urban mining industry (lag 5 years) and the proportion of agricultural population (lag 20 years). A 1/100 000 increment in ASMR of COPD was associated with a 0.34% (95% CI = 0.22% – 0.46%) increase in district/county-specific SMR of lung cancer for all population; while for male and female population, the increase were 0.29% (95% CI: 0.19% – 0.40%) and 0.33% (95% CI: 0.20% – 0.46%), respectively.  Conclusion  The overall risk of lung cancer mortality was significantly increased from 2008 to 2017 in Heilongjiang province and COPD may be an important risk factor for the mortality. The results suggest that lung cancer screening should be carried out in COPD patients for effective prevention and control of lung cancer mortality.
Experimental Study
Assessment on quality of complex amino acid chelated calcium and its calcium supplementation effect in rats
SONG Jia-le, LIU Guo-feng, JIAO Kui, SONG Ya-hui,
2021, 37(6): 974-977.   doi: 10.11847/zgggws1129689
Abstract(46) HTML(18) PDF 758KB(10)
Abstract:
  Objective  To prepared complex amino acid chelated calcium (CAACC) with a by-product of Chlamys farreri processing and to assess the quality and calcium supplementation effect of the prepared CAACC for effective utilization of Chlamys farreri processing by-product.   Methods  The quality and stability of the prepared CAACC were assessed with detections of heavy metals and other harmful substances, Fourier transform infrared spectroscopy (FTIR) and in vitro simulation of gastrointestinal digestive system. Meanwhile, the calcium supplementation effect of CAACC was evaluated with visceral index, serum biochemical index, bone mineral density and other indicators in experimental rats.   Results  The detection results indicated that the prepared CAACC met relevant quality standards, with high absorption and utilization rate. In experimental rats, the apparent absorption rate of calcium ions in CAACC was (81.83 ± 8.48)% and the retention rate was 81.37 ± 5.53%; furthermore, bone mineral density of the rats treated with the prepared CAACC increased significantly (P < 0.05).   Conclusion  The complex amino acid chelated calcium prepared with a by-product of Chlamys farreri processing is a potential and efficient calcium supplement agent.
Effect of GASP-1-ShRNA on proliferation and apoptosis of lung cancer cells and tumor formation in nude mice
HAN Gui-liang, SHI Yan, JIAO Ting,
2021, 37(6): 978-981.   doi: 10.11847/zgggws1129849
Abstract(33) HTML(27) PDF 698KB(3)
Abstract:
  Objective  To explore the effect of G-protein coupled receptor-associated sorting protein 1-short-hairpin RNA (GASP-1-ShRNA) on proliferation and apoptosis of lung cancer cells and tumor formation in nude mice.  Methods  GASP-1-shRNA1, GASP-1-shRNA2 and GASP-1-shRNA3 were transfected into lung cancer A549 cells with Lipofectamine 2 000. Colony formation test and flow cytometry were used to detect proliferation and apoptosis of A549 cells from groups of GASP-1-shRNA1 transfection, blank control, and empty vector transfection, respectively. The A549 cells′ expressions of Ki67, cleaved caspase-3, B cell lymphoma-2 protein (Bcl-2) and Bcl-2-associated X protein (Bax) were determined with Western blot. An orthotopic xenograft mouse model was established through injection of GASP-1-shRNA1-transfected cells into hind leg tissues in nude mice. The tumor growth of the model mice were observed and the expressions of ki67 and caspase-3 protein in tumor tissues were detected with immunohistochemistry.  Results  The mRNA and protein expression of GASP-1 in A549 cells were down-regulated after transfections of GASP-1-shRNA1, GASP-1-shRNA2, and GASP-1-shRNA3, especially in the GASP-1-shRNA1 transfected A549 cells. The down-regulation of GASP-1 could inhibit proliferation and promote cell apoptosis of the A549 cells. In vivo experiments, down-regulated GASP-1 could restrain tumor growth by inhibiting proliferation and promoting apoptosis of the A549 cells.  Conclusion  Down-regulation of GASP-1 could inhibit proliferation and promote apoptosis of lung cancer A549 cells.
Survey and Report
Detection rate of high risk individuals of cardiovascular disease and its correlates among residents aged 35 – 75 years in old urban region of Guangzhou city
LIU Lan, SUN Min-ying, LI Yao-hui,
2021, 37(6): 982-985.   doi: 10.11847/zgggws1127721
Abstract(43) HTML(9) PDF 485KB(9)
Abstract:
  Objective  To examine the prevalence and influencing factors of being at high risk of cardiovascular disease (CVD) among adult residents living in old urban regions of Guangzhou city and to provide evidences for implementing related interventions in the population.  Methods  From 2017 to 2018, we conducted a survey, including questionnaire interview, physical examination and laboratory test, for identifying individuals at high CVD risk among 4 904 permanent residents aged 35 – 75 years recruited using cluster sampling in an old urban region of Guangzhou city, Guangdong province. In this study, the high CVD risk is defined as having one of following four indicators: CVD history, hypertension, dyslipidemia, and with a 20% of probability for suffering from CVD within next 10 years based on the standards recommended by World Health Organization. Univariate and multivariate logistic regression analysis were adopted to explore influencing factors of CVD risk and its detection among the residents.  Results  Among the 4 892 participants (mean age = 58.83 ± 8.31years) completing the survey, the age- and gender-adjusted detection rate of with a high CVD risk was 15.17% and the adjusted detection rate of CVD history, hypertension type, dyslipidemia, with a 20% of probability for suffering from CVD within next 10 years were 2.13%, 6.68%, 6.82%, and 1.69%, respectively. Multivariate logistic regression revealed that the participants aged 55 – 64 and 65 – 75 years were more likely to be detected with high CVD risk, with odds ratio (OR) (95% confidence interval [95% CI]) of 1.74 (1.20 – 2.53) and 2.67 (1.82 – 3.92). For the participants, significant factors positively associated with the detection of high CVD risk included overweight (OR = 1.36, 95% CI : 1.16 – 1.60), obesity (OR = 1.80, 95% CI : 1.43 – 2.26), current smoking (OR = 1.35, 95% CI : 1.07 – 1.71), and alcohol drinking during past one year (OR = 1.24, 95% CI : 1.05 – 1.47). While underweight was a factor reversely related to the detection of high CVD risk.  Conclusion  More effective interventions on body weight control, unhealthy lifestyle and dyslipidemia should be promoted among middle aged and elder community residents for cardiovascular disease prevention.
Professional identity among undergraduates majoring in public health and preventive medicine in the context of COVID-19 epidemic: a cross-sectional survey
YU Chen, LIU Xia, TAO Li-yuan,
2021, 37(6): 986-989.   doi: 10.11847/zgggws1134642
Abstract(101) HTML(17) PDF 476KB(16)
Abstract:
  Objective  To examine the status of professional identity among undergraduates majoring in public health and preventive medicine in the context of coronavirus disease 2019 (COVID-19) epidemic for providing evidences to the training of public health professional, improvement of professional identity and stabilization of professional workforce in China.  Methods  Using convenient sampling, we recruited 457 undergraduates majoring in public health and preventive medicine in four universities in Beijing city, Hubei and Sichuan province for an online survey conducted during September – October, 2020. A self-designed questionnaire was used in the study.  Results  For the 402 participants with valid information, the average score of professional identity was 3.39 ± 0.52, indicating a moderate level of professional identity; the average scores of six professional identity dimensions were 2.89 ± 0.52 for cognition, 3.17 ± 0.65 for emotion, 3.75 ± 0.65 for behavior, 3.50 ± 0.76 for commitment, 3.58 ± 0.49 for value, and 3.44 ± 0.71 for expectation, respectively. Multivariate linear stepwise regression analysis showed that the participants with following characteristics were more likely to have a higher professional identity: studying in lower grade (β = 0.062, P < 0.001), being an only child (β = 0.118, P = 0.034), with a family member engaged in medical work (β = 0.148, P = 0.002), and preferring to work as a medical worker after experiencing COVID-19 epidemic (β = 0.524, P < 0.001).  Conclusion  Among the Chinese undergraduates majoring in public health and preventive medicine, the professional identity is at a moderate level and mainly influenced by studying grade, whether being an only child, whether with a medical worker in family members and experience of public health emergency.
Association of obsterical history and induced abortion with Ureaplasma urealyticum infection among married women
JIANG Nan, WU Jun-qing, XU Shuang-fei,
2021, 37(6): 990-993.   doi: 10.11847/zgggws1127970
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Abstract:
  Objective   To examine the prevalence of Ureaplasma urealyticum (UU) infection in married women and the correlation of UU infection with obsterical history, induced abortion history, and sexual behavior and to provide evidences for the prevention and control of reproductive tract infection.   Methods   Using cluster random sampling, we recruited 650 married women aged 20 – 49 years from physical examinees at a medical institution in Shanghai city and then a self-administered questionnaire survey, gynecologic examination and laboratory detection were conducted among the women from March 2016 through February 2017.   Results  Of 597 participants with complete information, 358 (60.0%) were diagnosed with UU infection. Unconditional multivariate logistic regression analysis demonstrated that primary contraception method, the age at first sexual intercourse and parity were influencing factors for UU infection. Compared with those not taking contraceptive measures, the participants using condom as a main method of contraception had a lower risk of UU infection (odds ratio [OR] = 0.575, 95% confidence interval [95% CI]: 0.331 – 0.998); the UU infection risk of the participants having first sexual activity at the age of ≥ 24 years was lower than that of those having the activity at the age of ≤ 21 years (OR = 0.588, 95% CI: 0.368 – 0.939); the participants with the parity greater or equal to 2 had a lower UU infection risk than those with the parity less than 2 (OR = 0.601, 95% CI: 0.400 – 0.903). No statistical correlation of induced abortion history and the sexual intercourse frequency with UU infection was observed.   Conclusion   The prevalence rate of UU infection is high among married women and having first sexual intercourse at elder age and promoting condom use may reduce UU infection risk among the women.
Knowledge about COVID-19 prevention, personal preventive practice and its associates among primary and middle school students in Wuhan city
LI Yi-lin, WU Chun-yan, MEI Xin,
2021, 37(6): 994-998.   doi: 10.11847/zgggws1129507
Abstract(79) HTML(16) PDF 594KB(14)
Abstract:
  Objective  To examine the knowledge about prevention of conronavirus disease 2019 (COVID-19) among primary and middle school students in Wuhan city and the students’ preventive behavior and its influencing factors to provide evidences for developing intervention measures.  Methods  Totally 16 431 students were selected from 18 primary and middle schools in three districts of Wuhan city with stratified cluster random sampling and an online anonymous questionnaire survey was carried out among the students from February 16 to March 1, 2020, the period with COVID-19 epidemic.  Results  Among the 15 428 students (93.9% of the selected) with valid responses, more than 90% reported the awareness on following 6 items of knowledge about COVID-19 prevention: always wearing a face mask when going out, washing hands before eating, washing hands after toilet use, opening window for ventilation or using an air disinfecting machine for indoor air disinfection, staying at home as much as possible, and avoiding activities; however, less than a half of the students were aware of wearing a mask special for children, replacing a mask accumulatively used for 2 – 4 hours, washing hands after contacting an animal or disposing animal waste, not touching eyes, nose or mouth with hands, and having sufficient sleeping. Only 40.8% of the students were assessed with good practice about COVID-19 prevention during previous one month. Logistic regression analysis revealed following significant influencing factors for the students′ preventive behavior during previous one month: gender, age, grade, maternal occupation, maternal education, time-point answering the questionnaire, and traveling history.  Conclusion  Personal behavior about COVID-19 prevention is at a low level among primary and middle school students in Wuhan city and relevant health education needs to be promoted among the students.
Prevalence characteristics and spatial clustering of Japanese B encephalitis in Jiangsu province, 2005 – 2018: a surveillance data analysis
ZHANG Yu-fu, YANG Wei-fang, CHU Hong-liang
2021, 37(6): 999-1002.   doi: 10.11847/zgggws1123842
Abstract(29) HTML(23) PDF 561KB(11)
Abstract:
  Objective  To analyze prevalence characteristics and spatial clustering of Japanese B encephalitis (JE) and the correlation between the occurrence of JE and the seasonal fluctuation of Culex tritaeniorhynchus in Jiangsu province during 2005 – 2018 for providing evidences to JE prevention.  Methods  Data on reported JE cases and demographics in Jiangsu province during 2005 – 2018 were extracted from National Disease Control Information System and the data on Culex tritaeniorhynchus density in the province for years of 2008 – 2018 were collected from vector monitoring system. Descriptive statistics were used in data analyses.  Results  Totally 495 JE cases were reported during the period in Jiangsu province and a decreasing trend in the annual JE incidence was observed (χ2 = – 16.11, P < 0.01). Of all the reported cases, 92.73% were children aged 1 – 14 years. Obvious seasonal variation in JE incidence was detected and more cases were reported between 7th July and 7th September in a year (relative risk = 86.48, log likelihood ratio = 726.97; P < 0.01). The peak period of JE incidence was in July in South Jiangsu but in August in Northern Jiangsu. Purely spatial scan analysis results demonstrated the clustering of JE cases mainly in three cities in the northern and one city in the southern of Jiangsu province. For the period of 2008 – 2018, the monthly average number of JE cases statistically correlated with the lag day 30 monthly average density of Culex tritaeniorhynchus measured at live-stock sheds (r = 0.79, P < 0.01).  Conclusion  The incidence of JE was closely related to the seasonal fluctuation of Culex tritaeniorhynchus density in Jiangsu province, suggesting that monitoring on Culex tritaeniorhynchus density and comprehensive anti-mosquito measures should be promoted, especially in regions with clustering of JE cases.
Height and weight among 7 – 18 years old urban and rural primary and high school students in Sichuan province: a cross-sectional analysis with LMS method
SHI Chun-li, ZHOU Liang, ZHANG Li,
2021, 37(6): 1003-1007.   doi: 10.11847/zgggws1127082
Abstract(24) HTML(7) PDF 693KB(4)
Abstract:
  Objective  To construct percentile curves for height and weight of child and adolescent students using coefficient of skewness-median-coefficient of variation – Lambda-Mu-Sigma (LMS) method and to analyze rural urban difference in growth and development of the students for the application of LMS method in relevant researches.  Methods  Using cluster random sampling, we selected 25 475 students aged 7 – 18 years in 110 primary and high schools in urban and rural regions across Sichuan province in 2018. Based on the data of height and weight measurement, the 5th, 50th and 95th percentile (P5, P50 and P95) curves for the urban and rural students were constructed using LMS method with the software (LMS chartmaker Light Version 2.54) and the differences between the urban and rural students with the height and weight of P5, P50 and P95 values were analyzed.  Results  The urban and rural differences in average height for the boy students with the P5, P50 and P95 value were 0.03, 1.20 and 1.60 cm, and those for the girl students were – 0.32, 0.88 and 0.95 cm; while, the urban and rural differences in average weight for the boy students with the P5, P50 and P95 value were 0.18, 0.96 and 1.85 kg, and those for the girl students were – 0.25, 0.29 and 1.55 kg, respectively.  Conclusion  For the child and adolescent students in Sichuan province, the urban and rural difference in average height and weight are larger in the boy students than in the girl students and both the differences are larger in the students with higher percentile values than in the students with lower percentile values. For the students with 50th and 95th percentile value of height and weight, the urban and rural differences increase first and then decrease with the increment of the sutdents′ age.
Prevalence characteristics of pertussis in Zaozhuang city, 2013 – 2018: an analysis on surveillance data
SUN Xi-wang, BIAN Chang-ling
2021, 37(6): 1008-1011.   doi: 10.11847/zgggws1128075
Abstract(1373) HTML(728) PDF 639KB(67)
Abstract:
  Objective  To analyze prevalence characteristics of pertussis in Zaozhuang city of Shandong province during 2013 – 2018 and to provide evidences for effective prevention and control of pertussis.  Methods  Information on all pertussis cases reported in Zaozhuang city during 2013 – 2018 were extracted from the National Infectious Disease Report Information Management System and analyzed with descriptive statistics and circular distribution. Excel 2013 and SPSS 21.0 were adopted in data processing. ArcGis 10.6 was used to perform visual display.  Results  A total of 507 pertussis cases were reported during the 6-year period in the city and the average annual incidence was 2.07/100 000. The annual pertussis incidence in 2018 was 2.83 times higher than that in 2017. Circular distribution analysis revealed an incidence peak during 17 – 18 of July in a year and a high incidence season from July to September in a year. The most (476, 93.52%) of the reported pertussis cases were scattered children and more than a half (294, 57.76%) of the cases were children less than one year old. The highest prefecture-specific average annual incidence rate was 2.89/100 000 and the highest town-specific average annual incidence rate was 7.83/100 000.  Conclusion  During 2013 – 2018 in Zaozhuang city, the incidence of pertussis increased obviously and the incidence peak was in summer season. Timely and supplementary vaccination should be promoted among children less than one year old and scattered children for pertussis prevention.
Suitability of human resource allocation for maternal health care in Beijing and Shanghai: a literature analysis
MA Dong-ping, YIN Wen-qiang, ZHENG Wen-gui,
2021, 37(6): 1012-1014.   doi: 10.11847/zgggws1123237
Abstract(47) HTML(22) PDF 591KB(4)
Abstract:
  Objective  To analyze the suitability of human resource for maternal health care (MHC) and changing trend of maternal mortality rate (MMR) and their regional disparities in Beijing and Shanghai municipality during the period from 2000 through 2017.  Methods  We retrieved research literatures on human resource for MHC in respects of staff size (n = 166), professional quality (n = 312) and incentive mechanism (n = 115) in Beijing and Shanghai municipality from 1995 to 2017 and assessed the suitability of human resource allocation using a comprehensive indicator. Spearman correlation and linear regression analysis were used to analyze the relationship between the suitability of human resource allocation and MMR.  Results  The indicator for the suitability of human resource for MHC increased from 26.20% and 25.60% in 2000 to 39.00% and 57.60% in 2017 in Beijing and Shanghai municipality. The regression analysis resulted in a significant correlation between the human resource allocation suitability and MMR only in Shanghai (P < 0.01).  Conclusion  The suitability of human resource allocation for maternal health care was improved yearly both in Shanghai and Beijing municipality during 2000 – 2017 but the staff size still needs to be increased. The association of human resource allocation with maternal mortality rate is more obvious in Shanghai municipality.
Association between serum uric acid and non-alcoholic fatty liver disease risk among physical examinees: a case-control study
CHEN Bing-bing, LI Hui-quan, PAN Xin-ting,
2021, 37(6): 1015-1018.   doi: 10.11847/zgggws1125545
Abstract(1456) HTML(3162) PDF 506KB(50)
Abstract:
  Objective  To explore the association between serum uric acid (SUA) and non-alcoholic fatty liver disease (NAFLD) among residents in Nanping city of Fujian province and to provide evidences for developing intervention on NAFLD.  Methods  We enrolled 2 328 attendees aged 18 – 70 years at a physical examination center of a general hospital in Nanping city of Fujian province and conducted questionnaire interview, physical examination and laboratory detection among the participants from April 2015 through August 2017. In the participants, 543 NAFLD cases were diagnosed based on imaging diagnostic criteria recommended by the National Guidelines for Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease – 2010 Revision and assigned into the case group; the controls were 1 785 participants without NAFLD. Statistical analyses were performed to assess the association of SUA with NAFLD.  Results  The SUA of the cases was significantly higher than that of the controls (375.24 ± 93.36 μmol/L vs. 313.20 ± 76.59 μmol/L, t = – 15.664; P < 0.001). The detection rates of NAFLD were 8.34%, 23.52%, 22.51%, and 43.13% for the participants in the lowest, second, third, and the highest quartile of SUA content, respectively. Unconditional multivariate logistic regression analysis revealed that compared to those in the lowest quartile of SUA content, the participants in the second and the highest quartile were at increased risk of NAFLD, with the odds ratios (95% confidence interval) of 2.05 (1.35 – 3.11) and 2.02 (1.29 – 3.17) after adjusting for gender, age, education, occupation, monthly average income, smoking, alcohol drinking, physical exercise, history of chronic diseases, body mass index, systolic pressure, diastolic pressure, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, glutamyltranspeptidase, creatinine, and fasting blood glucose.  Conclusion  High serum uric acid could increase the risk of non-alcoholic fatty liver disease in 18 - 70 years old population.
Responsibility assignment among institutions of maternal health care system in Beijing and Shanghai: a literature study
TIAN Zhuang, LI Li, CHEN Fei,
2021, 37(6): 1019-1022.   doi: 10.11847/zgggws1122394
Abstract(48) HTML(6) PDF 776KB(2)
Abstract:
  Objective  To compare the disparity in responsibility assignment among various functional institutions of the maternal health care (MHC) system between Beijing and Shanghai and to explore the feasibility of quantitative evaluation on the degree of well-defined responsibility assignment.  Methods  We systematically and extensively collected documents and materials on MHC issued by administrative agencies of Beijing and Shanghai municipality published during 2000 – 2017. Then we extracted relevant information from 649 retrieved documents (232 relevant to Beijing and 417 to Shanghai) and analyzed the information quantitatively to assess the responsibility assignment among various functional institutions of MHC system in the two municipalities. Spearman correlation and linear regression analysis were used to analyze the relationship between the degree of well-defined responsibility assignment of MHC system and maternal mortality rate (MMR).  Results  The relevant information-derived index for the degree of well-defined responsibility assignment of MHC system increased from 1.8% in 2000 to 23.7% in 2017 in Beijing municipality; while, the index increased from 9.5% to 28.0% in Shanghai, indicating a relatively low level for the MHC system's well-defined responsibility assignment. There was an inverse correlation between the index for well-defined responsibility assignment of MHC system and MMR in the two municipalities.  Conclusion  The responsibility assignment among various functional institutions of the maternal health care system was improved and the improvement facilitated maternal health care practice in Beijing and Shanghai during 2000 – 2017; but the responsibility assignment for nonmedical institutions should be well defined. The study verified the feasibility of quantitative assessment on responsibility assignment among various functional institutions of the maternal health care system.
Inspection technology
Simultaneous rapid determination of 12 microcystins in surface water with ultra performance liquid chromatography-tandem mass spectrometry
WANG Jun-lin, ZHANG Jing-shun, HU Zheng-yan,
2021, 37(6): 1023-1026.   doi: 10.11847/zgggws1126674
Abstract(60) HTML(26) PDF 578KB(9)
Abstract:
  Objective  To establish a rapid method for simultaneous determination of 12 microcystins in surface water with ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS).  Methods  Surface water samples were firstly freeze-thawing for three times, then directly filtered with glass fiber filters for injection. When several or one of the microcystins under the concentration of relevant limit of quantification, GF/C glass fiber was used for filter and an Oasis HLB SPE column was used for the concentration and purifying. The 40% methanol aqueous solution was used for washing; after elution with methanol, equal volume of ultrapure water was added for dilution, and then filtered through synthetic fabric membrane for injection. The separation of the analytes was carried out on an ACQUITY UPLC BEH C18 column (100 mm × 2.1 mm, 1.7 μm) with gradient elution using bobile phases of 0.2% (v/v) formic acid aqueous solution and methanol mix with acetonitrile at ratio of 2 to 3 containing 0.2% (v/v) formic acid. The 12 microcystins were detected with positive electrospray ionization in multiple reaction monitoring modes, and quantified by external standard methods. Toxicity equivalent factor conversion was used for total toxicity analysis of the detected microcystins.  Results  The linear ranges of 12 microcystins were 0.1 – 5.0 ng/mL and the correlation coefficients were greater than 0.995. The limits of detection and quantification were 0.006 – 0.012 μg/L and 0.02 – 0.04 μg/L for SPE method and 0.03 – 0.06 μg/L and 0.1 – 0.2 μg/L for direct injection, respectively. The recoveries were in the range of 83.07% – 108.27% with the relative standard deviations ranging from 0.46% – 12.76% (n = 6). Then the established method was used for the determination of 6 surface water samples and several kinds of microcystins were detected in 4 of the samples.  Conclusion  The established method is rapid, simple, sensitive and accurate, and could be applied in determination of 12 microcystins in surface water.
Overview
Status quo of newborn screening and patient registration for rare diseases
CHANG Jing-hua, ZHAO Yi-hao, ZHENG Xiao-ying,
2021, 37(6): 1027-1030.   doi: 10.11847/zgggws1129393
Abstract(49) HTML(19) PDF 481KB(8)
Abstract:
Newborn screening and patient registration system are the basis for rare disease management. This study introduces the status of international newborn screening and rare disease registration, summarizes their characteristics, and provides information and references for improving and promoting rare disease management in China.
Effects of air pollution on female fertility and pregnancy: a review
ZHANG Rui-xian, LI Yang, OU Qiu-sheng,
2021, 37(6): 1031-1034.   doi: 10.11847/zgggws1125343
Abstract(1474) HTML(149) PDF 566KB(15)
Abstract:
Air pollution exerts a lot of adverse effects on human health, including on female fertility. However, the exact mechanism of the adverse effects on human fertility is unclear. We conducted a systematic review of previous researches on the influence of air pollution upon female reproduction to fully understand the effect of air pollution on human fertility. The research sites and major pollutants concerned are different among various population epidemiology researches and laboratory studies. The sites of epidemiological investigations included petrochemical plants and traffic roads and the pollutants concerned mainly included particulate matter < 10/2.5 microm in aerodynamic diameter (PM10/2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3) and other compositions related to coal combustion and traffic exhaust. These studies are mainly based on the evaluation of air pollutants on various stages of egg development, fertilized egg formation and implantation, clinical conception, in vitro fertilization and embryo transfer, abortion, and preterm labor. Despite the bias caused by different design types and many confounding factors, these studies to some extent provide clues for the in-depth study of the mechanism of air pollution's influence on female reproduction.
Progress in researches on in vitro alternative model for nephrotoxicity evaluation
CHI Hui-qin, LI Zi-yin, WANG Yan,
2021, 37(6): 1035-1040.   doi: 10.11847/zgggws1126789
Abstract(1789) HTML(998) PDF 537KB(32)
Abstract:
With the introduction of Toxicity Testing in the 21st Century: A Vision and Strategy, the focus of toxicity testing has shifted from animal experiments to in vitro models using human resource cells or cellular components. As kidney is a major target for drug-induced toxicity and the drug-induced toxicity remains a major problem in developing new drugs, a predictive in vitro model is urgently needed to evaluate the renal toxicity of exogenous compounds. However, current in vitro cellular models poorly replicate both the morphology and the function of kidney tubules and therefore fail to demonstrate injury responses to that would be nephrotoxic in vivo. The resource and characteristics of cellular models, cell culture conditions, and readouts of injury are important in establishing an in vitro model. The development of differentiation of pluripotent stem cells into multiple renal cell types, 3 dimensional culture systems and kidney-on-a-chip technology, omics technology and high-content screening have opened a range of potential new platforms for evaluating compounds nephrotoxicity and promoted in vitro to in vivo extrapolation. This study summarizes the latest advances in in vitro nephrotoxicity assessment models.