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, Available online , doi: 10.11847/zgggws1140215
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Objective To examine car passenger safety behaviors and its associates among preschool children in a district of Beijing. Methods Using stratified cluster sampling and a self-designed questionnaire, we conducted an online anonymous survey among parents of 3 264 children aged 3 – 6 years recruited from 6 kindergartens in a district of Beijing during 27 – 31 December 2021. Results Of the 3 134 participants (96.29% of the parents recruited) with eligible responses, 38.56% reported using child safety seats for their kids in cars, followed by 31.88% and 21.16% reporting seat belt use and holding the kids in arms by caregivers while driving; taking no safety precautions at all was reported by 8.40% of the participants. Higher rates of child safety seat use were reported by parents of only children (43.75% vs. 34.05%), who were aware of child safety seat legislation (47.66% vs. 20.88%), had correct knowledge of child car passenger safety (47.58% vs. 28.54%), and always buckled up while driving contrasted with those reported by parents of two or more children, who were unaware of child safety seat legislation, had misconceptions about child car passenger safety, and did not always wear seat belt. Multivariate logistic regression analysis following promoting factors for the parents' child car passenger safety practices: having an only child (odds ratio [OR] = 1.376), with an annual household income 240 000 Chinese yuan and more (OR = 1.368), being aware of safety seat legislation (OR = 3.325), with correct knowledge of child car passenger safety (OR = 1.991), and always wearing seat belt while driving (OR = 5.231). Conclusion Child car passenger safety practice is at a relatively low level and influenced by parental demographic and economic status, awareness of knowledge about child car passenger safety, and safety driving behavior among the parents of preschool children in a district of Beijing, suggesting that relevant targeted interventions need to be promoted among the parents.
, Available online , doi: 10.11847/zgggws1141707
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Objective To examine iodine nutrition status among pregnant women in Ji'nan city, Shandong province for providing evidence to effective improvement of iodine nutrition in pregnant women. Methods A monitoring survey was conducted among 4 992 pregnant women recruited in 12 districts/counties of Jinan municipality, Shandong province during 2018 – 2021; each of the districts/counties was divided into 5 geographical regions and 20 pregnant women were selected from one subdistrict/town in each of the 5 regions. Table salt samples were collected from households of the pregnant women and urine samples of the pregnant women were also collected. Iodine content of table salt samples was measured with direct titration listed in the General Test Method for Salt Industry: Determination of Iodine (GB/T13025.7) and that of well salt and other fortified table salt samples was determined with arbitration method. Urinary iodine was detected using arsenic cerium catalytic spectrophotometry stated in WS/T107 issued by National Health and Family Planning Commission. Year- and trimester-specific urinary iodine were analyzed. Results The median ( 25% percentile [P25], 75% percentile [P75]) of iodine content was 22.31 (18.18, 25.59) mg/kg for all the 4 992 table salt samples. The coverage rate of iodized table salt was 88.92% (4 439 samples) and the usage rate of qualified iodized table salt was 72.96% (3 642 samples). There were significant yearly and regional differences in iodized salt coverage (χ2 = 72.54, χ2 = 271.04; both P < 0.05) and qualified iodized table salt usage rate (χ2 = 43.03, χ2 = 492.25, both P < 0.05); but the iodized salt coverage and qualified iodized table salt usage rate were not significantly different among the pregnant women in various trimesters of pregnancy (χ2 = 1.07, χ2 = 0.97; both P > 0.05). The median ( P25, P75) of urinary iodine was 145.70 (87.70, 216.00) μg/L for the 4 992 pregnant women. The urinary iodine concentration differed significantly among the pregnant women surveyed in different years (H = 21.97), from various districts/towns (H = 348.78), during various trimesters of pregnancy (H = 41.18), and consuming table salt with different iodine content (H = 13.23) (P < 0.05 for all). Conclusion Mild iodine deficiency existed among pregnant women in Ji'nan city during 2018 − 2021, suggesting that relevant measures should be taken to prevent iodine deficiency in the pregnant women.
, Available online , doi: 10.11847/zgggws1139435
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Objective To investigate the prevalence and genetic diversity of human astrovirus (HAstV) strains in untreated domestic sewage. Methods We collected six domestic sewage samples (one liter for each) at an inlet of an urban sewage treatment plant quarterly from January 2018 to June 2019 in in Jining city, Shandong province. After concentrated via anion membrane adsorption elution method, the viral nucleic acid in the samples was extracted with MagMAX Pathogen RNA/DNA Kit and complete open reading frame 2 (ORF2) region of HAstV was amplified using real-time reverse transcription PCR (RT-PCR). Then the amplicons were subjected to next generation sequencing (NGS). Clean data of NGS were assembled de novo to form contigs using CLC Genomics Workbench 12.0 (QIAGEN, USA) with default parameters for homology and phylogenetic analysis. Results All the six sewage samples were positive for HAstV. Totally 43 ORF2 sequences of HAstV were obtained and classified into 9 genotypes including classic HAstV-1 to HAstV-5 and novel MLB1 and VA1-3. HAstV-5 was the most common genotype (47.53%). Phylogenetic analysis revealed that local and foreign sequences clustered together in some branches, indicating the transmission of various genotypes of HAstV among different regions in the world. Conclusion The analysis results demonstrates that NGS-based environmental surveillance could greatly improve the understanding on HAstV genetic diversity.
, Available online , doi: 10.11847/zgggws1141835
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Objective To genetically characterize microbial community and Anaplasma – a major pathogen harbored by Haemaphysalis tibetensis collected in Yadong county, Tibet Autonomous Region. Methods Totally 141 ticks parasitizing on yaks were collected in Yadong county in May 2022 and the species of the ticks were identified according to amplified sequences of mitochondrial 16s rDNA of Ixodes. High-throughput sequencing was carried on the identified Haemaphysalis tibetensis using the Illumina Novaseq 6000 platform. The resulting raw data underwent processing for assembly, gene prediction, abundance analysis, and taxonomic prediction. The 16S rDNA gene fragment of Anaplasma was amplified and sequenced with nested PCR for phylogenetic analysis. Results Out of 141 adult tick samples collected, 121 were positively identified as Haemaphysalis tibetensis. According to species annotation with the National Center for Biotechnology Information (NCBI) -NR database, the most prevalent microorganisms were eukaryotes (19.78%) and bacteria (13.54%), with the dominant genera of Anaplasma, Trypanosoma, Psychrobacter, and Rickettsia and the dominant species of phagocytophilum group, Trypanosoma theileri, and spotted fever group rickettsia. Among the bacterial florae, the dominant phyla were Proteobacteria, Bacteroidetes, and Firmicutes. The phylogenetic analysis revealed a high homology of the tick-born Anaplasma and Anaplasma ovis. Conclusion In the research area, the dominant tick species parasitizing on yaks in this region is the Haemaphysalis tibetensis and the major genotype of the tick-born Anaplasma is Anaplasma ovis. The results suggest that local residents and livestock could be exposed to various tick-borne pathogens and targeted surveillance and preventive measures against tick-borne diseases should be enhanced.
, Available online , doi: 10.11847/zgggws1141808
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Objective To explore the feasibility of predicting the trend of measles epidemic using long short- term memory (LSTM) neural network model for conducting prevention and control of measles. Methods The data on 51 012 measles cases reported in Hebei province form 2004 through 2020 were collected from China Information System for Disease Control and Prevention. The LSTM neural network model was constructed and the optimal model was selected to predict the trend of measles epidemic in the province. Rooted mean squared error (RMSE) and mean absolute error (MAE) were used to evaluate the prediction of model established. Results The annual number of measles cases reported in the province during the 17-year period were 950, 4 837, 7 953, 4 973, 2 273, 3 359, 14 457, 79, 38, 353, 5 365, 3 825, 1 825, 287, 241, 130, and 67, respectively, with a persistent decline since 2015. In addition, an obvious seasonality was observed in the incidence of measles. Using the collected data of 2017, the window length of 3 was determined for the constructed LSTM neural network model, with the RMSE of 17.288 and the MAE of 12.334, and the model was adopted to predict monthly number of measles cases from 2017 through 2020. The predicted monthly numbers of measles incidence were basically consistent with the number observed and the values of RMSE and MAE for years of 2017, 2019 and 2020 were all below 10, but the values for 2018 were slightly higher. Conclusion The constructed LSTM neural network model in this study showed a good efficiency in predicting monthly measles incidence in Hebei province and the model could be used in the analysis on measles incidence trend and epidemic risk assessment.
, Available online , doi: 10.11847/zgggws1141915
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Objective To establish, evaluate and preliminarily apply grey model (1,1) [GM(1,1)] models for predicting the prevalence of common carbapenem-resistant bacteria in China. Methods We extracted the national data of 2015 – 2021 on detection rate of carbapenem-resistant Escherichia coli (CR-E.coli), carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) from the China Bacterial Drug Resistance Surveillance Network. Four GM(1,1) models were constructed using the data of 2015 – 2019. Posterior difference ratio C, small error probability P, and relative error and residual error were used to assess the accuracy of the established models in predicting prevalence of common carbapenem-resistant bacteria with the data of 2020 – 2021. The prevalence of CR-E.coli, CRKP, CRPA and CRAB for years from 2022 to 2025 in China were predicted using the four GM(1,1) models established. Results For the four established GM(1,1) models, the values of posterior difference ratio C were less than 0.50, the small probability error P were close to 1.0, and the relative errors and residual errors were less than 10%, indicating good efficacies in predicting the prevalence of CR-E.coli, CRKP, CRPA and CRAB. Based on the four established GM(1,1) models, the predicted yearly prevalence of CR-E.coli, CRKP, CRPA, and CRAB in China are 1.668%, 12.208%, 16.663%, and 52.507% for 2022; 1.698%, 12.886%, 15.930%, and 1.549% for 2023; 1.729%, 13.601%, 15.229%, and 50.608% for 2024; and 1.761%, 14.355%, 14.559%, and 49.685% for 2025, respectively, with a upward trend for the prevalence of CR-E.coli and CRKP but a downward trend for the prevalence of CRPA and CRAB. Conclusion In this study, four GM(1,1) models were established for predicting the prevalence of common carbapenem-resistant bacteria and the predictions based on the models could be used in developing strategies on the prevention and control the prevalence of CR-E.coli, CRKP, CRPA and CRAB in China.
, Available online , doi: 10.11847/zgggws1143522
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Objective To examine the scale, channels, regions and fields of China's development assistance for health (DAH) from 2000 through 2021 for the integration into global health governance. Method The data of the analysis were extracted mainly from the Development Assistance for Health Database 1990 – 2021 published by Institute for Health Metrics and Evaluation and supplementary from China's Foreign Aid (2014). SPSS Statistics 26.0 was used in descriptive statistics analysis. Results China's DAH increased from 284 million US dollars in 2000 to 1.592 billion US dollars in 2021, with an increase of 460.56%. Of all the DAH, 93.90% were channeled through bilateral agencies, but the proportions of the DAH channeled through government and social capital cooperation, development banks and United Nations agencies went up continuously during the period. The majority (58.59%) of the recipient countries of China's DAH were in sub-Saharan Africa. In terms of health focus area, 92.90% of the China's DAH was applied in strengthening of health systems of the recipient countries. Conclusion During the period from 2000 to 2021, China's DAH increased with diversified channels of disbursement and the DAH were mainly for strengthening of health systems of the recipient countries.
, Available online , doi: 10.11847/zgggws1141072
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Objective To analyze differences in the indicator framework of the Global Health Security Index (GHSI) and the scores of GHSI indicators for 195 contracting countries of International Health Regulations 2005 (IHR2005) between 2019 and 2021. Methods Yearly GHSI evaluation reports and the data on 195 contracting countries of IHR2005 on GHSI indicator scores for years of 2019 and 2021 were downloaded from official GHSI website (https://www.ghsindex.org ) and changes in GHSI indicator framework and contracting country-specific scores of GHSI indicators were analyzed. Paired T-test was used to compare between-year differences in and correlations of country-specific scores of GHSI indicators. General linear regression was adopted to assess the collinearities and correlations between total score and scores of primary/secondary indicators of GHSI for 195 contracting countries of IHR2005 in 2021. Results In 2021, the average GHSI score was 38.9 (in a scale with 5 categories and the maximum score of 100) for the 195 contracting countries of IHR2005 nearly the same as that (40.2) of 2019; none of the 195 contracting countries was assessed as having the GHSI score of the highest category (the scores of > 80 at level 5) and 66.7% of the countries were scored below 40. Compared to that of 2019, the GSHI 2021 index framework was supplemented with 3 secondary indicators, 11 tertiary indicators, and 31 questions. The results of paired T-test showed that the average score of GHSI for the 195 contracting countries in 2021 was increased by 0.1 point against that of 2019, but the difference was not statistically significant (P > 0.05). In comparison with those in 2019, following average scores decreased significantly for primary indicators of preventing the emergence or spread of pathogens (reduced by 0.6, t = – 2.413; P < 0.05) and rapidly responding to/reducing disease transmission (by 4.0, t = – 9.402; P < 0.05), secondary indicators of zoonosis prevention (by 4.8, t = – 6.590; P < 0.001) and trade and travel restrictions (by 58.3, t = – 33.158; P < 0.001). There were strong correlations between country-specific scores of secondary indicators of 2019 and those of 2021, except for the score of trade and travel restrictions (r = 0.117) and the score of implementing response plan (r = 0.237) . General linear regression analysis showed that there was no collinearity among the country-specific scores of 6 primary indicators in 2021, but the total scores of all indicators were significantly correlated with the scores of 6 primary indicators (P < 0.05 for all). Conclusion Based on the assessment using GHSI scores, none of the 195 IHR2005 contracting is well prepared for the next probable disease pandemic and the ability to prevent and respond to public health emergencies needs to be improved for the countries.
, Available online , doi: 10.11847/zgggws1140415
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Reducing sedentary behavior has become a public health priority due to significantly increased prevalence of leisure-time sedentary behaviors among people; promoting physical activity and interrupting sedentary time are among common interventions on sedentary behaviors. The built environment, as one of determinants of sedentary behavior, is increasingly being investigated and relevant studies have indicated that environmental interventions on sedentary behavior may be a more cost-effective and appropriate approach; however, few studies have specified the extent and mechanism of a distinct built environment’s impact on sedentary behavior. In this review, we summarize researches on the association of characteristics of built environment with sedentary behavior, related measurement tools, and environmental interventions on sedentary behaviors to provide references to domestic studies in this field.
Reducing sedentary behavior has become a public health priority due to significantly increased prevalence of leisure-time sedentary behaviors among people; promoting physical activity and interrupting sedentary time are among common interventions on sedentary behaviors. The built environment, as one of determinants of sedentary behavior, is increasingly being investigated and relevant studies have indicated that environmental interventions on sedentary behavior may be a more cost-effective and appropriate approach; however, few studies have specified the extent and mechanism of a distinct built environment’s impact on sedentary behavior. In this review, we summarize researches on the association of characteristics of built environment with sedentary behavior, related measurement tools, and environmental interventions on sedentary behaviors to provide references to domestic studies in this field.
, Available online , doi: 10.11847/zgggws1142044
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Facing with the growing health demands of the people, governments of all countries would promote national health to the level of national strategy, with the national health strategies of the United States and the United Kingdom being the most representative. Based on the theoretical framework of the political systems theory in this paper, we analyze policy texts relevant to health strategies of the two countries in recent years; we also conduct analyses on the semantic network, word frequency of the policy texts in different periods and co-word matrix of the policy documents to interpret the shift of health strategic priorities and the adjustment of measures in the United Kingdom and the United States under the impact of public health emergencies, and then deduce future development direction of the health strategies of the two countries. The study is intended to provide a reference for achieving the strategic goal of Healthy China Initiative.
Facing with the growing health demands of the people, governments of all countries would promote national health to the level of national strategy, with the national health strategies of the United States and the United Kingdom being the most representative. Based on the theoretical framework of the political systems theory in this paper, we analyze policy texts relevant to health strategies of the two countries in recent years; we also conduct analyses on the semantic network, word frequency of the policy texts in different periods and co-word matrix of the policy documents to interpret the shift of health strategic priorities and the adjustment of measures in the United Kingdom and the United States under the impact of public health emergencies, and then deduce future development direction of the health strategies of the two countries. The study is intended to provide a reference for achieving the strategic goal of Healthy China Initiative.
, Available online , doi: 10.11847/zgggws1141801
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Objective To establish a sensitive, reliable and rapid pre-treatment method for enrichment and nucleic acid extraction of pathogenic bacteria in water for fluorescent quantitative PCR (qPCR) detection of pathogenic bacteria in water. Methods The tester strain used in the experiment was Mycobacterium abscessus (American Type Culture Collection [ATCC] 19977) at concentration of 3.10 × 108 colony form unit (CFU)/mL. The nucleic acid of the tester strain was extracted using centrifugal column and magnetic bead extraction kits combined with elutions of different membranes. The nucleic acid extraction conditions were optimized by using beads of different materials, sizes and numbers and the number of homogenization cycles. The extracted nucleic acid was subjected to qPCR assay to compare the extraction efficiency of each method. qPCR was performed on spiked water samples using optimal extraction conditions to examine the whole process recovery and detection limits. Results The highest recovery of 81.03% ± 19.23% and detection limit of 6.20 CFU/100 mL were achieved using the procedures including 0.20 μm membrane filtration, six homogenization cycles with seven large zirconium beads, and TIANMicrobe Magnetic Envir-DNA Kit based extraction. Conclusion Using homogenizer and TIANMicrobe Magnetic Envir-DNA Kit is more efficient for the enrichment and nucleic acid extraction of pathogenic bacteria in water for qPCR detection.
, Available online , doi: 10.11847/zgggws1141094
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Objective To examine the prevalence and influencing factors of gallstone disease among rural adults in a county of Henan province. Methods We recruited 9 511 permanent rural residents aged ≥ 18 years from 17 villages in two townships of Xinxiang county, Henan province using multi-stage random cluster sampling. Face-to-face interview, physical examination, laboratory tests, and abdominal ultrasound detection were conducted among the residents during April – June 2017. Results Among the 9 461 participants completing the survey, totally 299 gallstone disease cases were identified, with a prevalence rate of 3.16% and a standardized prevalence rate of 2.28%. The results of the multivariate unconditional logistic regression showed that the participants aged ≥ 45 years, with central obesity or fatty liver were more likely to have gallstone disease; while, drinking alcohol at least 12 times a year or more was a protective factor against the disease. Conclusion The prevalence rate of gallstone disease was relatively low and mainly influenced by age, central obesity, fatty liver, and alcohol consumption among adult rural residents in a county of Henan province.
, Available online , doi: 10.11847/zgggws1141976
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Objective To examine the prevalence and influencing factors of vaccine hesitation among adult citizens during a major public health emergency for promoting vaccination in China. Methods Using random sampling and a self-designed questionnaire on vaccine hesitation and its associates, we conducted an online survey among 4 325 citizens aged 18 – 59 years in five provincial level administrative divisions (Guangdong, Hubei, Hebei, and Heilongjiang province and Beijing municipality) across China during February – March, 2021, a period of with a major public health emergency. Results Of the 4 169 eligible respondents, 1 479 (35.5%) reported vaccine hesitation. The results of unconditional multivariate logistic regression analysis showed that the respondents with following characteristics were more likely to have vaccine hesitation: being female, suffering from chronic diseases, with poor self-rated health, with high perceived risk of the epidemic, and being highly concerned about the epidemic-related information; while, the respondents ever having influenza vaccination, reporting a high community responsibility, with relatives/friends/colleagues being vaccinated with coronoavirus disease vaccine, and with the cognition on the efficacy and the safety of the coronavirus disease vaccine were less likely to have the vaccine hesitation. Conclusion Vaccine hesitation was prevalent among adult citizens in China during a major public health emergency and the hesitation was associated with gender, self-assessed health, chronic disease condition, influenza vaccination, sense of social responsibility, perceived risk of the epidemic, concern about the epidemic, coronavirus disease vaccination of relatives/friends/colleagues, and the cognition of the efficacy and the safety of the coronavirus disease vaccine.
, Available online , doi: 10.11847/zgggws1141850
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Objective To assess the effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against Streptococcus pneumonia (Spn) --associated respiratory tract infection in children with a test-negative design study. Methods We recruited totally 3 339 children at ages of 2 - 9 years hospitalized due to acute respiratory illness (ARI) and being detected for Spn isolates in sputum/bronchoalveolar lavage fluid (BALF) during 2017 – 2020 at the Soochow University Affiliated Children's Hospital for a test-negative case-control design study. The collected Spn isolates were serotyped with Quellung test. Of the all the participants, 1 264 being positive for PPV23 serotype Spn (VT-Spn) in sputum/ BALF specimens were assigned into a case group; the two control groups were 485 being positive for non-PPV23 serotype (NVT-Spn) and 1 590 being negative for Spn (Spn-).The participants’ information on PPV23 vaccination were collected from the Vaccination Registry Database of Suzhou Municipal Center for Disease Control and Prevention. The adjusted odds ratio of PPV23 vaccination was calculated with logistic regression model to estimate the vaccine effectiveness (VE) of PPV23 against Spn-associated ARI. Results Among the 1 749 Spn strains isolated, the most common serotypes were 19F, 6B, 23F, 6A and 19A; 76.56% and 72.27% were positive for 13-valent pneumococcal conjugate vaccine (PCV13) serotype and PPV23 serotype, respectively. For the participants of VT-Spn, NVT-Spn and Spn- group, the mean age were 3.88 ± 1.27, 4.02 ± 1.43, and 4.52 ± 1.92 years; the vaccination rate of PPV23 were 5.4%, 6.8%, and 5.8%, respectively; and the mean age at the vaccination was 2.53 ± 0.61 years for all the participants vaccinated., When using the NVT-Spn group as the control and after adjusting for age, clinical diagnosis, and other vaccination status, the logistic regression analysis revealed an overall PPV23 effectiveness of 18.3% (95% confidence interval [95%CI]: – 26.3% – 47.1%) for against Spn-associated ARI, an effectiveness of 15.7% for against community acquired pneumonia, and the effectiveness of 32.8, 16.5% and 57.5% for against serotype 19F, 6B and 15B Spn-associated ARI, respectively, and the effectiveness (26.0%) was better in the participants aged 2 – 5 years than that (7.6%) in those aged 5 years or elder; while using the Spn- group as the control and after adjusting for age, household registration, other vaccination status, the year of seeking medication, season of seeking medication, and clinical diagnosis, the logistic regression analysis showed a VE of 29.9% (95% CI: – 22.0% – 59.7%) for the participants aged 2 – 5 years. Conclusion PPV23 is of certain protection against Spn-associated respiratory tract infections in 2 – 9 years old children and the effectiveness decreases with the prolonged time after receiving the vaccination
, Available online , doi: 10.11847/zgggws1141760
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Objective To estimate human and financial resources allocation for tobacco control in three provinces, China in 2019 for providing evidence to relevant policy-making. Methods With stratified sampling, a survey was conducted among 30 administrative agencies, 25 professional institutions and 137 staff in those organizations in 18 districts/counties of three provinces in eastern, central and western China during July – December 2020. The information for the year of 2019 on tobacco control-related financial investment of the organizations and working hours of the staff were collected by investigators. Population weighting was used in data analysis. Results In 2019 for the eastern, central and western province, the working hours-converted number of tobacco control staff were 114.1, 139.4 and 154.2 and the total tobacco control-related investment were 45 089, 27 308 and 36 176 million Chinese yuan, respectively. Higher proportion (more than 80%) of office expenses against overall financial investment for tobacco control implementation was observed in the central and western provinces. The tobacco control-related investment per capita for the three provinces were 0.5, 0.6 and 0.8 Chinese yuan. Tobacco control publicity, smoking prevalence surveillance and smoke-free environment construction were priorities of tobacco control implementation in the three provinces. Conclusion In 2019, there was still an obvious gap in the tobacco control-related financial investment between the three provinces surveyed and those administrative divisions with better tobacco control in China and the situation needs to be concerned in the promotion of tobacco control.
E-cigarette use and its influencing factors among school youths: an online survey in 13 China cities
, Available online , doi: 10.11847/zgggws1141844
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Objective To investigate the prevalence and risk factors of e-cigarette smoking among school youths in China. Methods With stratified multistage cluster sampling, we conducted an online survey among 2 405 students aged 15 years and above from 35 high schools/vocational schools/colleges or universities in 13 China cities in 4 regions with different cultural characteristics (the north region, the Yangtze River Delta, the Pearl River Delta, and Southwest region) during September 2022 – March 2023. A questionnaire on e-cigarette use and its potential associates was compiled mainly based on Global Youth Tobacco Survey (GYTS), Chinese Perceived Stress Scale (CPSS), and Adolescent Self-Rating Life Events Checklist (ASLEC). Results Among all the students surveyed, 6.36% (153) reported e-cigarette use, with 4.57% (110) and 1.79% (43) reporting ever use and current use of e-cigarette. The age at first e-cigarette use for the e-cigarette smokers was 15.92 ± 2.03 years and the number of peers on site of the students′ e-cigarette smoking was 2.10 ± 1.34. The results of unconditional multivariate logistic regression analysis revealed following risk factors for e-cigarette use: being male (odds ratio [OR] = 4.81, 95% confidence interval [95%CI]: 3.24 – 7.15), with higher stress score (OR = 1.63, 95%CI: 1.15 – 2.33), falling out of love during past six months (OR = 2.82, 95%CI: 1.89 – 4.21), losing a friend during past six months (OR = 1.67, 95%CI: 1.17 – 2.38), and having more pocket money (compared to less than 800 Chinese Yuan per month: OR800 – 1500 = 1.90, 95%CI: 1.23 – 2.95; OR > 1500 = 2.22, 95%CI: 1.44 – 3.41); while, living with married parents was a protective factor against e-cigarette use (OR = 0.44, 95%CI: 0.29 – 0.67). Conclusion The prevalence of e-cigarette use is low and mainly influenced by gender, negative life events, amount of pocket money, and family relationship currently among school youths in China.
, Available online , doi: 10.11847/zgggws1140468
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Objective To explore the relationship between abdominal obesity index and hypertension among the elderly in Zhongshan city for the prevention and control of hypertension. Methods The data of the analysis were from 8 318 residents aged ≥ 65 years and participating in free physical examination project during June - September 2020 in a town and a district of Zhongshan city, Guangdong province. Multivariate logistic regression model was used to analyze the relationship between abdominal obesity indexes and hypertension among the residents; the abdominal obesity indexes included neck circumference (NC), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), lipid accumulation product (LAP), and China visceral obesity index (CVAI). The dose-response correlation between NC and the risk of hypertension was analyzed with restricted cubic splines. Results The observed prevalence rate of hypertension among the elderly physical examinees was 45.5% (44.4% in the males and 46.3% in the females). Compared to those in the male and female non-hypertensives, significantly higher mean values of NC (37.29 ± 2.83 cm vs. 36.41 ± 2.82 cm and 33.91 ± 2.67 cm vs. 33.04 ± 2.55 cm), WC (87.90 ± 9.51 cm vs. 84.40 ± 9.59 cm and 86.52 ± 9.48 cm vs. 83.24 ± 9.50 cm), WHR (0.93 ± 0.07 vs. 91 ± 0.07 and 0.91 ± 0.07 vs. 0.90 ± 0.07), WHtR (0.54 ± 0.06 vs. 0.52 ± 0.06 and 0.57 ± 0.06 vs. 0.55 ± 0.06), LAP (43.00 ± 38.70 vs. 32.54 ± 31.22 and 46.98 ± 39.47 vs. 58.08 ± 46.96), and CVAI (116.19 ± 42.01 vs. 98.42 ± 42.94 and 133.18 ± 30.78 vs. 119.80 ± 30.25) were measured in the hypertensives (all P < 0.001). After adjusting for age, education, marital status, monthly household income per capita, smoking, alcohol drinking, exercise, salted vegetable consumption habits, body mass index (BMI), fasting blood glucose (FPG), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C), multivariate logistic regression analysis showed that the risk of hypertension increased in the male elderly with higher NC compared to that in those with the NC of the lowest quartile (third quartile: odds ratio [OR] = 1.314, 95% confidence interval [CI]: 1.029 – 1.676; the highest quartile: OR = 1.512, 95%CI: 1.131 – 2.022) and in the female elderly with higher WHtR compared to that in those with the WHtR of the lowest quartile (second quartile: OR = 1.214, 95%CI: 1.009 – 1.463; third quartile: OR = 1.289, 95%CI: 1.084 – 1.532; the highest quartile: OR = 1.503, 95%CI: 1.223 – 1.846) ; the analysis also demonstrated that the risk of hypertension decreased in the male elderly with higher WHtR (the second quartile vs. the lowest quartile: OR = 0.636, 95%CI: 0.469 – 0.863). After adjusting for confounding factors mentioned above, the results of restricted cubic spline analysis revealed a linear dose-response relationship between NC and hypertension risk in both the male and the female elderly (χ2 = 94.62 and 128.22, both P < 0.001). Conclusion There is a positive linear correlation between NC and the risk of hypertension among the elderly in Zhongshan City.
, Available online , doi: 10.11847/zgggws1141803
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Objective To examine the associations of different obesity phenotypes with chronic disease comorbidities among middle-aged and elderly residents in Yangzhong city for precise prevention and control of chronic disease comorbidy in the population. Methods Face-to-face interview with a questionnaire developed by domestic researchers, physical examination and laboratory tests were conducted among 6 899 residents aged 40 – 69 years recruited with stratified multistage random cluster sample in urban and rural regions of Yangzhong city, Jiangsu province from November 2017 through June 2021. Multivariate ordered logistic regression model was applied to analyze the effect of different types of obesity on chronic disease comorbidity in the residents. Results Of 6 581 participants finally included in the analysis, 3 957 (60.1%) were identified as having chronic disease comorbidity; the proportions of body mass index (BMI in kg/m2) -based overweight (24.0 – 27.9) and obesity ( ≥ 28.0) were 40.7% and 12.1%; the proportions of central obesity based on waist circumference (WC, ≥ 90 cm for males and ≥ 85 cm for females), waist to hip ratio (WHR, ≥ 0.90 for males and ≥ 0.85 for females), and waist to height ratio (WHtR, ≥ 0.50) were 35.3%, 79.6%, and 63.7%; the proportions of mixed obesity indicated by BMI + WC, BMI + WHR, and BMI + WHtR were 10.5%, 11.4%, and 11.8%, respectively. After adjusting for gender, age, education, marital status, annual household income, residence region, smoking, alcohol consumption, vegetable intake, fruit intake, physical activity, daily sleep duration and family history of chronic diseases, the results of multivariate ordered logistic regression analysis showed that the participants with following different obesity phenotypes were at increased risk of chronic disease comorbidity: BMI-based overweight (odds ratio [OR] = 1.736, 95% confidence interval [95%CI]: 1.575 – 1.915), BMI-based obesity(OR = 2.325, 95%CI: 2.012 – 2.687), WC-based central obesity (OR = 1.773, 95%CI: 1.615 – 1.947), WHR-based central obesity(OR = 1.956, 95%CI: 1.739 – 2.200), and WHtR-based central obesity (OR = 1.968, 95%CI: 1.788 – 2.166), BMI + WC-based mixed obesity (OR = 2.590, 95%CI: 2.221 – 3.021), BMI + WHR-based mixed obesity (OR = 3.488, 95%CI: 2.908 – 4.185), and BMI + WHtR-based mixed obesity (OR = 2.845, 95%CI: 2.438 – 3.321). Conclusion BMI-based obesity, WC-, WHR-, and WHtR-based central obesity, and mixed obesity are all risk factors for chronic disease comorbidity among urban and rural middle-aged and elderly residents in Yangzhong city and special attention should be paid to the residents with WC-based central obesity and mixed obesity in prevention and control of chronic disease comorbidity.
, Available online , doi: 10.11847/zgggws1141941
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Objective To explore comorbidity pattern, comorbidity burden and economic burden of chronic diseases among inpatients with Parkinson's disease and Parkinsonism in Chengdu city, Sichuan province for effective treatment and management of the patients with the diseases. Methods Based on disease codes of International Classification of Diseases 10th Revision, we collected 30 436 hospitalization records of Parkinson's disease patients and 3 749 records of Parkinsonism patients for years of 2013 – 2017 from the Information System of Chengdu Medical Insurance Bureau. The comorbidity burden of chronic diseases among the inpatients was evaluated with Charlson Comorbidity Index (CCI). The comorbidity spectrum, comorbidity burden and economic burden of chronic disease among the inpatients with Parkinson's disease and Parkinsonism were described and compared statistically; the influence of CCI on economic burden of the inpatients was analyzed with multivarite linear regression model. Results The ratios of chronic disease comorbidity were 72.23% and 73.26% for 30 436 hospitalizations of Parkinson′s disease patients and 3 740 hospitalizations of inpatients with Parkinsonism during the 5-year period in Chengdu city and there was no significant difference in the ratio between the two groups of hospitalization (χ2 = 1.78, P = 0.182). For hospitalizations of both Parkinson′s disease and Parkinsonism patients, the top three most frequent comorbidity diseases (constituent ratios) were cerebrovascular disease (49.21% and 51.23%), chronic pulmonary disease (19.25% and 20.64%) and diabetes with end-organ damage (15.54% and 16.34%). In terms of multicomorbidity, the most frequent comorbid pattern of two chronic diseases was cerebrovascular disease and chronic pulmonary disease (9.45% and 11.34% for both Parkinson′s disease and Parkinsonism hospitalizations) and that three chronic diseases was cerebrovascular disease, chronic pulmonary disease, and diabetes with end-organ damage (1.30% and 2.03%); for the 21 983 hospitalizations of Parkinson's disease patients and 2 740 hospitalizations of Parkinsonism patients, the proportions of with 1, 2, 3, 4, and ≥ 5 comorbid chronic diseases were 51.95% and 47.34%, 34.67% and 35.51%, 11.44% and 14.01%, 1.74% and 2.99%, and 0.20% and 0.15%, respectively, with a significant difference in the proportions between the two groups of hospitalization (χ2 = 45.21, P < 0.001). For the hospitalizations of Parkinson′s disease and Parkinsonism patients, the average CCI of 1.39 ± 1.28 and 1.49 ± 1.36 and the average medical expenses per hospitalization were 11 031.75 ± 110.88 and 12 885.81 ± 288.57 (Chinese yuan), with significant differences in the CCI and the average medical expenses between the hospitalizations of the two groups of the inpatients (both P < 0.001). After adjusting for gender, age, hospital grade and length of stay, the results of multivariate linear regression analysis showed was no significant difference in the average medical expenses per hospitalization between the hospitalizations of Parkinson′s disease and Parkinsonism patients (β = 0.017, 95% confidence interval [95%CI]: – 0.003 – 0.071); while, the expenses increased with the increment of CCI (β = 0.066, 95%CI: 0.061 – 0.071). Conclusion The prevalence, disease and the economic burden of comorbidity of chronic diseases were high and cerebrovascular disease, chronic pulmonary disease, and diabetes with end-organ damage were the most common comorbidities among inpatients of Parkinson's disease and Parkinsonism in Chengdu city.
, Available online , doi: 10.11847/zgggws1142008
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Objective To examine the prevalence and influencing factors of spirometry examination among residents aged 40 years in Inner Mongolia Autonomous Region (Inner Mongolia) for promoting prevention and control of chronic respiratory diseases. Methods Using multistage stratified cluster and probability proportionate to size sampling and a questionnaire adopted by Chinese Center for Disease Control and Prevention, we conducted a face-to-face survey among 2 400 permanent residents aged 40 years in four prefectures/banners with chronic obstructive pulmonary disease surveillance project in Inner Mongolia during May – December 2019. The estimated prevalence of spirometry examination in the participants was calculated based on complex sampling weight design; the impact factors of spirometry examination were explored with unconditional multivariate logistic regression analysis. Results Of the 2302 participants with eligible responses, 142 reported ever having pulmonary function test. The complicated weighted proportion of spirometry examination was 5.1% for the population surveyed. The results of logistic regression analysis showed that the residents with the education of junior high school and above, being enterprise clerks or professional and technical personnel in enterprises, being workers not classified or being unemployed, being aware of the names of respiratory diseases, ever suffering from respiratory symptoms, and with the history of respiratory illness were more likely to have spirometry examination; while the female residents were less likely to have the examination. Conclusion The proportion of ever having spirometry examination was relatively low and mainly influenced by gender, education, occupation, the awareness of respiratory disease, respiratory symptoms, and the history of chronic respiratory disease among residents 40 years old and older in Inner Mongolia.
, Available online , doi: 10.11847/zgggws1141424
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Objective To explore the associations of body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR) with dyslipidemia among adult residents in Shaanxi province for developing relevant intervention strategies. Methods Using stratified multistage random cluster sampling, we recruited 6 202 urban and rural permanent residents aged 18 years and above in 10 regions covered by national surveillance on chronic diseases and risk factors in Shaanxi province. Face-to-face interview with the questionnaire for China Adult Chronic Disease and Nutrition Surveillance – 2018, physical examination, and laboratory detections were conducted among the participants during May – November, 2018. Partial correlation analysis and unconditional multivariate logistic regression were adopted in analyses on the correlations of BMI, WC, and WHtR with the risk of dyslipidemia. Results Dyslipidemia were detected in 1 994 (33.04%) of the 6 036 participants completing the survey. Laboratory detections revealed following results: (1) the mean levels (mmol/L) of the participants with underweight or normal weight/overweight/obesity were 4.56 ± 0.89/4.75 ± 0.95/4.79 ± 0.90 for total cholesterol (TC), 1.42 ± 0.99/1.80 ± 1.24/2.14 ± 1.39 for triglyceride (TG); 2.61 ± 0.78/2.79 ± 0.82/2.79 ± 0.81 for low-density lipoprotein cholesterol (LDL-C), and 1.45 ± 0.37/ 1.28 ± 0.32/1.17 ± 0.30 for high-density lipoprotein cholesterol (HDL-C); (2) the mean levels (mmol/L) of the participants with normal WC/mild central obesity/severe central obesity were 4.52 ± 0.90/4.73 ± 0.89/4.83 ± 0.98 for TC, 1.36 ± 0.96/1.76 ± 1.05/2.08 ± 1.57 for TG, 2.59 ± 0.77/ 2.77 ± 0.79/2.82 ± 0.86 for LDL-C, and 1.46 ± 0.37/1.31 ± 0.33/1.21 ± 0.31 for HDL-C; and (3) the mean levels (mmol/L) of the participants with normal WHtR/obesity were 4.46 ± 0.88/4.76 ± 0.92 for TC, 1.32 ± 0.95/1.83 ± 1.24 for TG, 2.55 ± 0.76/2.78 ± 0.81 for LDL-C, and 1.46 ± 0.37/ 1.29 ± 0.34 for HDL-C, respectively. There were significant differences in levels of TC, TG, HDL-C, and HDL-C among the participants with different BMI, WC, and WHtR (all P < 0.001). Partial correlation analysis showed that BMI, WC, and WHtR were correlated positively with TC, TG and LDL-C but negatively with HDL-C (all P < 0.001). After adjusting for gender, age, education, annual household income per capita, place of residence, smoking, and alcohol drinking, the results of multivariate logistic regression analysis demonstrated that the participants with overweight and obesity were at significantly higher risk of dyslipidemia, with the odds ratio (OR) (95% confidence interval [95%CI]) of 1.58 (1.36 – 1.82) and 2.22 (1.79 – 2.74) compared to the participants with underweight/normal weight; the results also showed that the risk of dyslipidemia was significantly higher for the participants with mild central obesity (OR = 1.49, 95%CI: 1.23 – 1.81) and severe central obesity (OR = 2.25, 95%CI: 1.79 – 2.83) in comparison with the participants with normal body weight; the dyslipidemia risk was significantly higher (OR = 1.39, 95%CI: 1.13 – 1.70) for the participants with the WHtR indicating obesity contrasting to the participants with normal WHtR. Conclusion The prevalence of dyslipidemia was high among adult residents in Shaanxi province; the dyslipidemia prevalence was closely correlated with BMI, WC, and WHtR and increased with obese conditions.
, Available online , doi: 10.11847/zgggws1142075
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Objective To investigate the prevalence of chronic kidney disease (CKD) and the association of obesity with CKD among hypertension patients registered at community health service centers in suburb of Shanghai. Methods The participants of the study were 3 600 hypertensive patients randomly recruited from chronic disease patients registered at two community health service centers in a suburban district of Shanghai city. Face-to-face interview with a self-designed questionnaire and the International Physical Activity Questionnaire, physical examination, laboratory tests were conducted among the participants during October – December 2021. Unconditional multivariate logistics regression model was adopted to analyze the association between body mass index [BMI] and CKD. Results Of the 2 991 participants finally included in the analysis, 1 037 (34.67%) were identified as having CKD and the number (proportion) of the participants with decreased estimated glomerular filtration (eGFR), proteinuria, and hematuria were 464 (15.51%), 677 (22.63%), and 99 (3.31%), respectively. After adjusting for age, sex, education, smoking, alcohol drinking, physical activity, diabetes,blood lipids and blood pressure control, unconditional multivariate logistic regression analysis revealed that the participants with obesity (BMI ≥ 28.0) were at a significantly increased risk of having CKD (odds ratio [OR] = 1.498, 95% confidence interval [95%CI]: 1.203 – 1.866), decreased estimated glomerular filtration (OR = 1.340, 95%CI: 1.001 – 1.793), and proteinuria (OR = 1.388, 95%CI: 1.088 – 1.771) compared to those with normal or low body weight (≤ 23.9). Conclusion The prevalence of CKD was high and positively correlated with obesity among hypertension patients registered at community health service centers in suburb of Shanghai.
, Available online , doi: 10.11847/zgggws1141232
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Objective To explore the prevalence and influencing factors of chronic diseases and chronic multimorbidity among Uygur rural adult residents in Xinjiang Production and Construction Corps (Xinjiang). Methods Using typical sampling, we recruited 14 851 Uygur rural residents aged ≥ 18 years in Xinjiang and conducted face-to-face interview with a self-designed questionnaire, physical examination, and laboratory tests among the residents during August – September 2016. Multivariate logistic regression model was used to analyze influencing factors of chronic diseases and chronic multimorbidity among the residents. Results Of the 12 792 eligible participants, 8 937 (69.9%) were identified as having chronic diseases and 5 770 (45.1%) having chronic multimorbidity. The three diseases most frequently identified among the participants were metabolic syndrome (identified in 33.1% of the participants), dyslipidemia (30.8%), and hypertension (29.9%); the observed top three multimorbidities of two chronic conditions were dyslipidemia and hypertension (observed in 12.2% of the participants), metabolic syndrome and fatty liver (9.7%), and dyslipidemia and fatty liver (8.8%); and the observed top three multimorbidities of three chronic conditions were metabolic syndrome, dyslipidemia and fatty liver (6.8%), metabolic syndrome, hypertension and fatty liver (6.0%), and metabolic syndrome, hypertension and musculoskeletal disorder (4.4%). The results of multivariate logistic regression analysis revealed following risk factors for chronic diseases and chronic multimorbidity of the participants: aged 40 years or older, being married or divorced or widowed, with family history of chronic diseases, being obesity or overweight, and having central obesity; while, having the education of primary school and above was a protective factor against chronic diseases and chronic multimorbidity. Conclusion The prevalence of chronic diseases and chronic multimorbidity was high and mainly influenced by age, education, marital status, family history of chronic disease, obesity or overweight, and central obesity among Uygur rural adults in Xinjiang.
, Available online , doi: 10.11847/zgggws1142382
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Objective To examine the progress of health promotion in China′s National Demonstration Zone for Comprehensive Prevention and Control of Chronic Diseases (demonstration zone) from 2010 to 2019 for promoting sustainable and high-quality development of the demonstration zones. Methods The yearly reporting data from 2010 (the year of initiation of the demonstration zone) to 2019 about health promotion in the 483 demonstration zones in 31 provincial-level administrative divisions across China were collected from the National Information Management System for Comprehensive Prevention and Control of Chronic Diseases. The implementation of health promotion in each of the demonstration zones was comprehensively evaluated in four aspects: creation of supportive environment, community participation, development of individual skills and orientation adjustment of health services. Results By the year of 2019, the coverage rate of community room for health education was 91.0% and the coverage rate of community billboard for health education was 96.1% in the demonstration zones. At demonstration zone level, the mean number (25th percentile, 75th percentile) of community-sponsored class-based health education lectures in kindergartens was 6.0 (6.0, 10.0); the mean number of class-based health education lectures in primary and secondary schools was 6.0 (6.0, 10.0); the average number of mass fitness groups was 92.0 (26.0, 250.0); the mean number of volunteers engaged in health promotion was 280.0 (62.5, 1200.0); the mean number of communities with self-health management groups was 89.0 (44.5, 174.5); the average number of self-health management groups was 99.0 (48.8, 204.3) and the mean number of individuals involved in a self-health management group was 2137.0 (842.5, 7 520.5); the average total number of lectures on personal health skill development was 510.0 (191.0, 1241.0); the average awareness rate of core knowledge on chronic diseases was 63.6% (57.8%,71.0%); the average proportion of residents with health literacy was 22.1% (17.0%, 28.1%); the average number of health instructors was 281.5 (67.8, 1207.8) in the adjustment of health service direction. Compared to those for the year of initiation of demonstration zone, significant increases in many health promotion-related indicators (the coverage rate of community room and community billboard for health education, the mean number of community-sponsored class-based health education lectures in kindergartens, the mean number of class-based health education lectures in primary and secondary schools, the mean number of volunteers engaged in health promotion, and the average proportion of residents with health literacy) were observed (all P < 0.05) for all the demonstration zones except for the zones as the fifth batch of the initiation. In 2019 for all the demonstration zones, there were significant geographically regional disparities in the coverage rate of community room and community billboard for health education, the number of mass fitness groups, the number of communities with self-health management groups, the average number of self-health management groups, the average total number of lectures on health education, the average proportion of residents with health literacy, and the number of health instructors (P < 0.05 for all); there were also significant urban-rural disparities in the coverage rate of community billboard for health education, the number of mass fitness groups, the number of communities with self-health management groups, the average number of self-health management groups, the mean number of individuals involved in a self-health management group, the average total number of lectures on health education, the average proportion of residents with health literacy, and the number of health instructors (all P < 0.05). Conclusion Some progress have been made in health promotion in China′s demonstration zones for comprehensive chronic disease prevention but there were geographically regional urban-rural disparities in the progress among the demonstration zones.
