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Application of standardized patients in health service quality assessment: a review on research progress
LI Qin-nan, WU Jian-xiong, WANG Jing,
, Available online  , doi: 10.11847/zgggws1137819
Abstract:
Assessment of health service quality is an important prerequisite for improving health service quality, and the use of standardized patients (SPs) is considered to be the gold standard for evaluating health service quality, which can effectively capture the real performance of health service providers. Application of SPs in health service quality assessment is mainly focused on primary health care, doctor - patient communication, and pharmaceutical practice. SPs method is more comprehensive, direct and accurate than the information collected from medical records, but it needs a lot of human, material and financial resources and involves complex ethical issues. Therefore, it is suggested that moral hazard should be fully considered when conducting SPs surveys, and case scripts should be designed scientifically and the standardization of SPs training should be strengthened. In addition, the effectiveness of standardized patients should be validated.
Association of antibiotic exposure with obesity: a review on research progress
CHU Lei, SU De-qi, DAI Jiang-hong
, Available online  , doi: 10.11847/zgggws1137759
Abstract:
Antibiotics are used to treat diseases in humans and animals. Antibiotic residues in the environment and food can be ingested into human body through exposure via food and drinking water. As a new environmental pollutant, antibiotics residue is closely associated with obesity, which in turn affects human health and poses a threat to public safety. The purpose of the study is to review the progress in researches on antibiotic exposure and its pathways, the relationship between antibiotics and obesity and thus the impact on population health for providing evidences to early intervention on antibiotic exposure among populations.
Construction and application of an electronic health record-based hospitalized injury surveillance system
PENG Juan-juan, XU Nai-ting, SHI Yan,
, Available online  , doi: 10.11847/zgggws1137531
Abstract:
Injury surveillance is an important part of a comprehensive disease surveillance system to be established. To analyze the occurrence and changing trends of severe injuries related to different causes and to provide evidence for formulating injury prevention and control strategies and evaluating the effects of intervention measures, a hospital electronic health record (EHR)-based injury surveillance system was constructed and applied in Shanghai. Under the development of the EHR-based surveillance system, the definition of injury cases to be reported, contents, data standards and the function and standard document of the system were formulated. The system greatly improved the quality and efficiency of injury registration by data sharing between hospital information system (HIS) and HER and between centers for disease control and prevention (CDCs) at district level and Shanghai municipal CDC, and promoted the issue of the Regulation for Shanghai Municipal Inpatient Department-based Injury Registration and Reporting.
Methods of economic evaluation on child nutrition interventions: a research progress review
XIAN Meng-yao, XU Hai-quan
, Available online  , doi: 10.11847/zgggws1136739
Abstract:
With methodological development of assessment on child nutrition interventions, relevant evaluation indicators have been developed from merely for simple health outcomes to for comprehensive economic benefits. The cost accounting on child nutrition interventions has been subdivided into various items and the indicators for cost-effectiveness is no longer limited to a single indicator. A more complete analytical framework for evaluating child nutrition interventions is established with probability method-based cost-utility analysis. In cost-benefit analysis, the income, medical expenses and assigning a value to the life year are all taken into account, which also makes the estimation of intervention benefits more comprehensive. In order to estimate the improvement of human capital for child nutrition interventions, sociological and econometric methods have also been used, and prediction model of human capital is constructed from the changes in height, years of schooling and cognitive ability due to the nutrition improvement. A trend in deep integration of multiple disciplines has been shown in economic evaluation on child nutrition interventions.
Paracancerous tissue microbiota in esophageal squamous carcinoma patients from different regions of Fujian province - a comparison study
CHEN Si-ting, RAO Wen-qing, LIN Zheng,
, Available online  , doi: 10.11847/zgggws1135963
Abstract:
  Objective  To investigate the characteristics and diversity of paracancerous tissue microbiota among esophageal squamous cell carcinoma (ESCC) patients from different regions of Fujian province for providing evidences to ESCC prevention.   Methods   Totally 120 ESCC patients were recruited after radical surgery at two municipal hospitals in two cities of Fujian province from February 2013 through October 2017. All the participants were pathologically diagnosed primary ESCC cases with local residential history of more than 10 years and with intact para-cancerous tissue/exact tumor stage/complete medical records and but without infectious disease/other primary malignant, without antimicrobial therapy/radiotherapy/ chemotherapy during two months before the surgery and without specific medicine use during one month before the surgery. A face-to-face questionnaire interview was conducted in the participants. Double-ended sequencing with 16S rRNA V3-V4 variable region was performed for para-cancerous tissue specimens. The paracancerous tissue microbiota diversity and composition were analyzed with QIIME2019.4. Multivariate unconditional logistic regression was used to assess the association of residential region with patients' paracancerous tissue microbiota.   Results   Of the 120 participants, 105 were from 4 prefectures (Zhangzhou,Fuzhou, Putian and Quanzhou prefecture) and only 15 participants from other 5 prefectures of the province. There were no significantly differences in gender, age, smoking, alcohol and tea consumption, sampling season and tumor site among the participants from various regions (all P > 0.05); while the alpha- and beta-diversity in paracancerous tissue microbiota were significantly different among the participants from various regions (both P < 0.05). The abundance of para-cancerous esophageal microbiota of 15 phyla, 22 classes, 28 orders, 48 families, 71 genera, and 85 species were calculated with QIIME 2019.4.After adjusting for confounding factors including gender, age, smoking, alcohol consumption, tea consumption, sampling seasons and tumor location, the multivariate unconditional logistic regression analysis of dominant microbiota showed that the abundance of order Rickettsiales and family mitochondria detected in the participants from Fuzhou were higher than those in the participants from Zhangzhou; while the abundance of order Sphingomonadales, family Ruminococcaceae and Sphingomonadaceae, genus Faecalibacterium and Sphingomonas detected in the participants from Fuzhou were lower than those in the participants from Zhangzhou; the abundance of class Actinobacteria,order Caulobacterales and Sphingomonadales, family Ruminococcaceae, Caulobacteraceae and Sphingomonadaceae,and genus Sphingomonas in detected in the participants from Putian were lower than those in the participants from Zhangzhou; the abundance of phylum OD1, order Rickettsiales and family mitochondria in the participants from Quanzhou were higher than those in the participants from Zhangzhou; the abundance of order Coriobacteriales, Caulobacterales and Sphingomonadales, family Ruminococcaceae, Caulobacteraceae, Sphingomonadaceae, and Coriobacteriaceae, and genus Faecalibacterium in the participants from Quanzhou were lower than those in the participants from Zhangzhou; the abundance of class Coriobacteriia,order Coriobacteriales and Caulobacterales, family Ruminococcaceae, Caulobacteraceae and Coriobacteriaceae,and genus Faecalibacterium in the participants from other regions were lower than those in the participants from Zhangzhou. After adjusting for gender, age, smoking, alcohol consumption, tea consumption, sampling season and tumor site, the multivariate unconditional logistic regression analysis on rare microbiota showed that the abundance of phylum Verrucomicrobia, class Verrucomicrobiae, order Verrucomicrobiales, family Verrucomicrobiaceae, genus Roseburia, Mycoplana and Akkermansia, and species muciniphila were more likely to be lower in the participants from Fuzhou in comparison with the participants from Zhangzhou; the abundance of phylum Verrucomicrobia, class Verrucomicrobiae, order Verrucomicrobiales, family Verrucomicrobiaceae, genus Blautia, Roseburia, Mycoplana and Akkermansia, and species Longicatena and Muciniphila were more likely to be lower in the participants from Putian, Quzhou and other regions compared to the participants from Zhangzhou.   Conclusion   Residential region is an influencing factor for paracancerous tissue microbiota among ESCC patients.
Attitude and approach to acquiring health knowledge and their influencing factors among employees in public places: a cross-sectional survey in Zhejiang province
XING Ming-luan, LI Xue-qing, WU Li-zhi,
, Available online  , doi: 10.11847/zgggws1138093
Abstract:
  Objective  To explore the status and influencing factors of attitudes and approaches to acquiring health knowledge among employees in public places in Zhejiang province.   Methods  A face-to-face survey was conducted among 1 296 employees working in hotels, public baths/swimming pools, hair/beauty salons, and waiting rooms for buses/trains in 4 prefectures/municipalities of Zhejiang province in 2019. Participants′ information on attitude and approach to acquiring health knowledge were collected with a questionnaire compiled by researchers of Chinese Center for Disease Control and Prevention. Logistic regression was used to analyze main factors influencing the approach for health knowledge acquisition.   Results  Of the 1 290 valid respondents, 986 (76.43%) reported objective need to acquire health knowledge, 1 092 (84.65%) reported the willingness to acquire the knowledge, and 1 085 (84.11%) reported ever obtaining the knowledge actively. The respondents′ attitude towards health knowledge acquisition differed significantly by age, gender, education attainment, and work type (P < 0.05 for all). Among all the respondents, the top three approaches to acquiring health knowledge were through internet surfing (reported by 89.77% of the respondents), from administrators' publicities (89.38%), and via watching television programs (87.29%). The results of logistic regression analysis revealed that higher education (college and above vs. primary school or lower) and higher annual household income (more than 200 000 vs. less than 50 000 RMB yuan) are promoting factors for acquiring health knowledge through internet surfing, with the odds ratio [OR] (95% confidence interval [CI]) of 6.819 (3.005 – 15.471) and 5.268 (1.235 – 22.465); compared to those being cleaners, the respondents being engaged in technical tasks were less likely to acquire health knowledge from administrators′ publicities (OR = 0.367, 95% CI: 0.187 – 0.720); and female gender (versus male: OR = 1.720, 95% CI: 1.209 – 2.446) and higher education (college and above vs. primary school or lower: OR = 3.438, 95% CI: 1.608 – 7.352) are promoting factors for acquiring health knowledge via watching television programs.   Conclusion  Among employees working in public places in Zhejiang province, the attitude towards health knowledge acquisition needs to be improved and special attention should be paid to the approach for health knowledge acquisition and the employees′ characteristics when developing related projects.
Internet sentiment to public health emergencies – current situation and response strategies in China: a literature-based analysis
MI Yu-qing, JIAO Min, WANG Zhen-de,
, Available online  , doi: 10.11847/zgggws1138468
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Abstract:
  Objective  To examine current situation of internet sentiment on public health emergencies and strategies for coping with the situation in China to provide evidence for administrative agencies′ effective response to the public sentiment.   Methods  Published studies relevant to internet sentiment on public health emergency published in Chinese or English up to October 30th, 2021 were retrieved through comprehensively searching Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and PubMed. Content analysis, co-word clustering and significance assessing were used to sort out and categorize the characteristics of internet sentiment on public health emergencies and strategies and problems in administrative agencies′ response to the sentiment. Ordinal ranking was adopted to evaluate the importance and severity of the strategies and problems in the agencies′ responses.   Results   Based on content analysis on 116 literatures included into the study, 29 features were identified in terms of public health emergency-related internet sentiment′s ontology, subject, content, development, communication, society, space and time. Also according to the analysis, 25 problems and 26 strategies in the responses to the internet sentiments were revealed at four stages of prevention, preparation, response and recovery in dealing with a public health emergency. The ordinal ranking for the importance/severity of the 25 problems and 26 response strategies were basically consistent in the 4 stages of public health emergency management; the top four serious problems were delayed management and prevalence of rumors due to the lack of initiative in response stage, without theoretical guidance owing to imperfect laws and regulations in preparation stage, lacking post-event evaluation and accountability as a result of imperfect systemic infrastructure in recovery stage, and too much information noise due to the absence of serial theme propaganda in prevention stage, with the severity/importance index score of 0.1263, 0.0982, 0.0355, and 0.0305; the top four important strategies included dispelling rumors actively in mass media in response state, establishing a mechanism to deal with the internet sentiment in preparation stage, establishing regulations for rapid evaluation and accountability about the internet sentiment in recovery stage, and constructing a media-wide communication system for carrying out positive publicity actively in preparation stage, with the severity/importance index score of 0.1062, 0.1016, 0.0360, and 0.0257, respectively.   Conclusion   The response to public health emergency-related internet sentiment should be integrated into the whole process responding to public health emergencies and should be addressed in each of the four stages: prevention, preparation, response and recovery. Such considerations should be aligned with risk communication strategies for public health emergency response, for better resolving of social contradictions and satisfying of public needs.
Association between Yingyangbao intervention and nutritional and health status among infants and young children in poverty-stricken areas of Hunan province
LI Hui-xia, YUAN Shan, ZHENG Jian-fei,
, Available online  , doi: 10.11847/zgggws1137868
Abstract:
  Objective  To analyze effects of Yingyangbao (YYB) intervention-a community-based complementary food supplement program on nutritional and health status of infants and young children aged 6 – 23 months in poverty-stricken regions.   Methods  A combination of multistage sampling and random isometric sampling was used to recruit 12 619 infants and young children aged 6 – 23 months in 42 poverty-stricken counties of Hunan province. Questionnaire survey, body length and weight measurement, and hemoglobin detection were conducted among the participants between August and October 2020. According to the consumption of YYB, all participants were divided into three groups of non-consumption (n = 3 438), non-effective consumption (n = 3 119) and effective consumption (n = 6 062). The prevalence rate of protein-energy malnutrition, anemia, two-week fever and diarrhea among the three groups were compared. Multivariate logistic regression was used to analyze effects of effective and non-effective consumption of YYB on nutritional and health status of participants.   Results  Among the participants with non-consumption, non-effective consumption, and effective consumption of YYB, the prevalence rates were 4.5% ,5.4% , and 4.3% for stunting, 3.4%, 3.9%, and 3.0% for underweight, 3.1%, 3.6%, and 2.7% for wasting, 29.6% , 20.8%, and 15.3% for anemia, 14.3% , 14.5% , and 11.5% for having fever in the two weeks, and 12.0% , 12.1%, and 9.2% for having diarrhea in the two weeks, respectively. Multivariate logistic regression analysis showed that among the participants, effective consumption of YYB was a protective factor against anemia (adjusted odds ratio [aOR] = 0.43, 95% confidence interval [95% CI]: 0.39 – 0.48), two-week fever (aOR = 0.79, 95% CI: 0.70 – 0.90), and two-week diarrhea (aOR = 0.75, 95% CI: 0.65 – 0.86); non-effective consumption of YYB also was also a protective factor against anemia (aOR = 0.61, 95% CI = 0.54 – 0.58). There was no significant association of YYB consumption with stunting (aOR = 0.95, 95% CI = 0.77 – 1.17), underweight (aOR = 0.89, 95% CI = 0.70 – 1.13), and wasting (aOR = 0.91, 95% CI = 0.71 – 1.17) among the participants.   Conclusion  For the infants and young children in in poverty-stricken regions, effective consumption of Yingyangbao could improve anemia and reduce the two-week prevalence rate of fever and diarrhea; but non-effective consumption of Yingyangbao is less effective than effective consumption in reducing anemia.
Effect and mechanism of CagA on miR-142-3p expression regulation in gastric cancer cells
WU Lei-lei, JIANG Fei, CHEN Xiao-wei,
, Available online  , doi: 10.11847/zgggws1135771
Abstract:
  Objective   Cytotoxin associated protein A (CagA), the main virulence factor of Helicobacter pylori (Hp), plays an important role in the occurrence and development of gastric cancer. Micro RNA (miRNA) can promote or inhibit cancer by affecting the expression of downstream mRNA molecules. The aim of the study is to explore CagA-related miRNAs and effects of the miRNAs on gastric cancer for providing evidences to the diagnosis and treatment of gastric cancer correlated with Hp-CagA infection.   Methods  MiRNAs related to both Hp infection and gastric cancer were screened in the Gene Expression Omnibus (GEO) database and relevant clinicopathological data were analyzed based on the Cancer Genome Atlas (TCGA) dataset. The prokaryotic expression system of CagA was constructed and AGS cells were transfected with different concentrations of CagA. Real-time reverse transcription-PCR (qRT-PCR) was used to detect the expression of the targeted miRNAs after transfection. Finally, the upstream and downstream related genes of miRNAs were predicted and analyzed with DIANA mirPath3.0, ENCORI and other websites and online databases.   Results  MiR-142-3p was confirmed being related Hp- CagA infection based on GEO database, TCGA dataset and cell experiment. In clinical studies, mir-142 expression was associated with the prognosis of male patients with stage I gastric cancer and female patients aged 45 – 54 and 55 – 64 years (all P < 0.05). In cytological studies, the expression of miR-142-3p was up-regulated in gastric cancer cells (P < 0.01) and the level of mir-142-3p expression was affected by Hp- CagA infection (P < 0.01). Other study results suggested that as downstream targets, phosphoinositide-3-kinase regulatory subunit 2 (PIK3R2), PIK3R5 and phosphoinositide-3 kinase, catalytic subunit delta (PIK3CD) may be closely related to the effect of miR-142-3p in progressing course of gastric cancer.   Conclusion  MiR-142-3p may promote gastric cancer progressing through pathways of PIK3R2/PIK3R5/PIK3CD and may be a potential therapeutic target.
Patterns of multimorbidity in middle-aged and elderly type 2 diabetes patients: an electronic outpatient medical record- based analysis
YAN Ze-yu, GAO Rui, SUN Ming-yue,
, Available online  , doi: 10.11847/zgggws1138135
Abstract:
  Objective  To identify multimorbidity patterns and major comorbidities in middle aged and elderly patients with type 2 diabetes mellitus (T2DM) for providing evidence to the improvement of traditional Chinese health management and clinical guidelines on multimorbidity.   Methods  We extracted electronic medical records of 21 425 middle-aged and elderly T2DM patients seeking medication from January 1, 2015 to December 31, 2019 in Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences. Association rule mining was used to identify common binary patterns of multimorbidity in the patients and the multimorbidity network for the T2DM patients was constructed. The major comorbidities were identified according to the network topological index.   Results  Of all the T2DM patients, 83.3% (17 843) were diagnosed with 16 other chronic diseases. Among the 16 chronic diseases (including coronary heart disease, congestive heart failure, atrial fibrillation, ischemic stroke, hypertension, dyslipidemia, atherosclerosis, chronic obstructive pulmonary disease, asthma, chronic nephritis, chronic hepatitis, rheumatoid arthritis, osteoarthritis, osteoporosis, depression, and anxiety), totally 76 types of binary patterns of multimorbidity were found, with the most common comorbidity of coronary heart disease and hypertension (support index = 0.45, lift index = 1.31) according the rank of support index and hypertension and coronary heart disease being one of the diseases in 15 binary comorbidities. For the T2DM patients treated with traditional Chinese medicine, the multimorbidity network plot suggested higher multimorbidity rates among hypertension, coronary heart disease, dyslipidemia, osteoporosis and osteoarthritis diseases, indicating a complex multimorbidity relationship. In the multimorbidity network constructed, coronary heart disease and hypertension were identified with the greatest node and closeness degree (nodes = 15, closeness index = 0.45). Based on the degrees of node, strength, closeness and eigenvector centrality, hypertension, coronary heart disease, dyslipidemia, osteoarthritis and osteoporosis were at the key positions in the multimorbidity network constructed and were the major comorbidities among the T2DM patients.   Conclusion  Among middle-aged and elderly patients with type 2 diabetes mellitus, hypertension, coronary heart disease, dyslipidemia, osteoarthritis and osteoporosis are the major comorbidities and the comorbities need to be concerned for effective prevention and management on multimorbidity in the patients.
Economic burden of chronic obstructive pulmonary disease patients and its influencing factors in rural Yunnan province: a population-based study
LIU Lan, WANG Xu-ming, MO Yi,
, Available online  , doi: 10.11847/zgggws1137807
Abstract:
  Objective  To analyze the economic burden of patients with chronic obstructive pulmonary disease, (COPD) and its influencing factors in rural regions of Yunnan province and to provide evidence for formulating health policies and measures to reduce the economic burden.   Methods  Face-to-face interview with a self designed questionnaire and lung function test were conducted among 7 572 permanent residents at ages of 35 years and above recruited using stratified multistage random sampling in rural regions of Yunnan province from November 2020 to November 2021. The COPD patients among the residents were identified based on results of lung function test and self reported symptoms of COPD. Both direct and indirect cost of COPD patients were estimated and the influencing factors of the cost were analyzed with structural equation modeling.   Results  Among the 7 572 participants with complete information, 954 COPD patients were diagnosed, with a prevalence rate of 12.6%. The estimated average annual COPD-related expenditure per patient was 5 787.2 Yuan (Renminbi); in which, 98.50% (5 700.5 Yuan) and 1.50% (87.2 Yuan) was direct and indirect cost. For the direct expenditure, the cost of hospitalization, outpatient service, medication, and accommodation/transportation were 3 020.7, 1 189.1, 141 8.6, and 72.1 Yuan. The results of structural equation model analysis indicated that the COPD patients′ economic burden was associated with the condition of hospitalization, frequency of outpatient visits within one year and the impact of the disease on patients’ life and work, with the standardized regression coefficient of 0.43, 0.36 and 0.27. The standardized regression coefficient for the length of hospital stay and the type of medical institution were 0.41 and 0.40; while the standardized regression coefficient for the impact of the disease on daily work, housework and daily life was 0.26, 0.23 and 0.23, respectively.   Conclusion  The economic burden of rural COPD patients is relatively high in Yunnan province. The study results suggest that early diagnosis and treatment of the disease, reducing duration of hospitalization and the level of medical institution providing hospitalization service could alleviate the economic burden of the rural COPD patients.
Association between sedentary time and semen quality in adult men: a hospital-based cross-sectional survey
ZHANG Li, YUAN Guan-xiang, LIU Pei-yi,
, Available online  , doi: 10.11847/zgggws1137843
Abstract:
  Objective   To investigate the relationship between semen quality and sedentary time.   Methods   A cross-sectional survey was conducted among 4 532 men (aged 18 – 60 years) seeking fertility consultation at a reproductive center of a hospital in Shenzhen city from March 2017 through May 2019. Questionnaire interview and semen sampling were carried out among the participants. Routine indicators of semen quality were determined with a computer assisted semen analysis system (CASA) and the relationship between sedentary time and semen quality indicators was assessed with binary logistic regression analysis.   Results  In comparison to those in the participants reporting the sedentary time of less than 4 hours per day, significantly lower sperm progressive motility rate (53.18 ± 19.59% vs. 55.29±19.15%, F = 2.96; P < 0.05) and total sperm motility rate (64.30 ± 20.16% vs. 66.57 ± 19.50%, F = 3.19; P < 0.05) were detected in the men reporting the sedentary time of 8 hours and above per day. The results of logistic regression analysis showed that compared to those with the sedentary time of less than 4 hours per day, the participants with the sedentary time of 8 hours and above per day were at a significantly increased risk of having a reduced sperm progressive motility (odds ratio = 1.29, 95% confidence interval: 1.03 – 1.62) after adjusting for age, body mass index, days of abstinence, smoking, alcohol drinking, and time of physical activity.   Conclusion  Prolonged sedentary time (≥ 8 h/day) is a risk factor for decreased sperm progressive motility in adult men.
Helmet wearing and its influencing factors among E-bike drivers and passengers in Shanghai
YU Yan, PENG Juan-juan, LI Qing-fen,
, Available online  , doi: 10.11847/zgggws1136164
Abstract:
  Objective  To examine the prevalence and influencing factors of helmet wearing among E-bike drivers and passengers in Shanghai for providing evidences to road traffic injury prevention.   Methods  From October 2015 to April 2019,totally eight waves of observational survey were carried out at eight traffic intersections selected with stratified random sampling in Shanghai city. The number of E-Bike drivers and passengers passing the traffic intersections were counted and the frequency of helmet wearing among the passers was calculated.   Results  The ratio of helmet wearing was 14.12 % among the 84 232 E-bike drivers and only 1.99 % among the 10 540 E-bike passengers observed during the surveys. The results of the bivariate probit model analysis show that the helmet wearing is 0.14 probability unit lower in the female drivers than that in the male drivers; the helmet wearing in the E-bike drivers carrying adult passengers is 0.28 probability unit higher than that in the drivers carrying minor passengers; and the E-Bike drivers′ helmet wearing in winter seasons is 0.52 probability unit higher than in summer seasons (all P < 0.01). The helmet wearing in the female E-bike passengers is 0.14 probability unit lower than in the male passengers and the E-bike passengers′ helmet wearing in winter seasons is 0.37 probability unit higher than in summer seasons (both P < 0.001). Marginal effect analyses reveal that the probability of E-bike drivers' helmet wearing in winter seasons is 14 % higher than that in summer seasons and 13% higher when carrying adult passengers than that when carrying minor passengers (both P < 0.001); when carrying passengers not wearing helmet, the probability of helmet wearing in the female E-bike drivers is 2 % lower than that in the male drivers; all the E-bike drivers' helmet wearing when carrying adult passengers is 4 % higher than that when carrying minor passengers and is 6 % higher in winter seasons than in summer seasons (all P < 0.05). The probability of helmet wearing in E-bike passengers carried by drivers not wearing helmet in winter seasons is 1 % higher than that in summer seasons (Z = 3.24, P < 0.001).   Conclusion  The prevalence rate of helmet wearing among E-bike drivers and passengers in Shanghai is generally low and presents a seasonal fluctuation. The helmet wearing of E-bike drivers and passengers is lower in females that than that in the males and helmet wearing behavior of the drivers and passengers interact each other.
Correlation between age at natural menopause and postmenopausal obesity: a population-based cross-sectional study in Guangzhou city
WU Yong-jun, ZHANG Wei-sen, ZHOU Bai-jing,
, Available online  , doi: 10.11847/zgggws1138576
Abstract:
  Objective  To analyze the correlation between early or late age at natural menopause and obesity among postmenopausal women, and to provide reference for health care of postmenopausal women.   Methods  From November 2017 through January 2020, totally 5 646 natural menopausal women aged ≥ 50 years were recruited from the voluntary participants of a prospective cohort study on chronic diseases in middle-aged and elderly residents of Guangzhou city. The women's information on demographic characteristics and physical indicators (including body mass index [BMI], waist circumference [WC], and waist-hip ratio [WHR]) were collected from the baseline survey of the cohort study. Generalized linear model, multivariate logistic regression model and restricted cubic spline analysis model were adopted in data analysis using SPSS 25.0 and STATA 16.0.   Results  For all the women aged 60.0 ± 5.8 years, the mean age at menopause was 50.3 ± 3.1 years and the age at natural menopause was u-shaped associated with obesity. After adjusting for possible confounders, the results of multivariate logistic regression analysis showed that compared with the women with a normal age at natural menopause (46 – 53 years), the women with an early age at natural menopause (< 46) were more likely to have an increased the risk of central obesity determined by WC (odds ratio [OR] = 1.32, 95% confidence interval [95% CI]: 1.03 – 1.69) or WHR (OR = 1.32, 95% CI: 1.06 – 1.64) and overweight/obesity determined by BMI (OR = 1.39, 95% CI: 1.13 – 1.71); while, the women with a late age at natural menopause (> 53) were also more likely to have an increased the risk of central obesity determined by WC ( OR = 1.34, 95% CI: 1.11 – 1.63) or WHR (OR = 1.41, 95% CI: 1.19 – 1.68) and overweight/obesity determined by BMI (OR = 1.49, 95% CI: 1.26 – 1.76).   Conclusion  Early or late age at natural menopause are associated with an increased risk of postmenopausal obesity for middle-aged and elderly women. The results suggest that the women with early or late age at natural menopause should pay more attention to muscle training and balanced diet and appropriately control the intake of food mainly providing energy.
Effect of short-term intensive brisk walking prescription on obesity in Chinese occupational population: a pair matched-control study
GUO Kai-ming, ZHAO Yi-fan, ZHAO Ping-ping, , LIN Yong-qing
, Available online  , doi: 10.11847/zgggws1139360
Abstract:
  Objective  To evaluate intervention effect of intensive brisk walking prescription on obesity in Chinese occupational population and to provide a reference for popularizing appropriate weight control program among occupational population in China.   Methods  All the participants of the study were from a 100-day vigorous walking program conducted among 31 528 in service employees in 12 provincial-level administrative divisions of China during May – August 2021 and the participants were divided into an intervention group required to complete a 4 sets of walking schedule in a day (10, 10, 15, 15 minutes of walking continuously at the speed of 100 – 150 steps per minute) and a positive control group with the same requirement as the intervention group but only 3 sets of waling schedule (10, 10, 15 minutes); the body weight in kg (BW) of the participants were measured at least once a week during the program period. From the 28 285 participants with complete information on baseline questionnaire survey and data on physical examination and vigorous waling, 5 208 pairs of intervention and control individuals were matched by tendency scores. The changes in BW, body mass index (BMI), waist circumference in cm (WC), hip circumference in cm (HC) and body fat rate in % (BFR) of the intervention and control individuals before and after the intervention were compared to evaluate the effect of intensive brisk walking prescription on the obesity indicators.   Results  For both the intervention and positive control group, the percentages and the 25th percentiles of the proportions of individuals having 10 000 steps walking per day, group walking, completing 4/3 sets of walking schedule, and BW measuring once a week were all more than 85%, indicating a good compliance with the program of the participants. Compared t o those at the beginning of the intervention program, there were significant differences at the end of the intervention for both the intervention and the positive control groups in the average values of BW (64.18 ± 11.50 vs. 65.98 ± 11.86 and 63.86 ± 11.58 vs. 65.23 ± 11.87), BMI (23.18 ± 3.16 vs. 23.77 ± 3.29 and 23.31 ± 3.19 vs. 23.78 ± 3.30), WC (81.33 ± 10.05 vs. 82.75 ± 10.25 and 81.09 ± 9.99 vs. 82.54 ± 10.14), HC (95.16 ± 6.88 vs. 96.15 ± 7.37 and 94.97 ± 6.70 vs. 96.06 ± 7.17), and BFR (26.89 ± 6.11 vs. 27.92 ± 6.18 and 27.00 ± 6.29 vs. 27.75 ± 6.37), respectively (all P < 0.01). The BW of the intensive intervention group was significantly higher than that of positive control group at the beginning of the intervention (t = – 3.25, P = 0.0012). The results of covariance analysis showed that the BW, BMI and BFR of the intensive intervention group were significantly lower than those of positive control group by the end of intervention (all P < 0.01). After adjusting confounding factors such as sex, age, residence, education, occupation, chronic disease, score for knowledge about chronic disease, psychological scale score and sleeping time, the results of multilevel model combined with multiple difference method revealed a higher decline of 0.29% in BFR of intensive intervention group compared to that of positive control group at the end of intensive intervention (t = – 2.05, P = 0.04). Further subgroup analysis demonstrated that the intensive intervention promoted the decrease of BW, BMI and BFR for the individuals with the BMI indicating overweight status, the decrease of BMI and BFR for the individuals with the BMI indicating obesity status, and the decrease of BFR for the individuals with the BMI indicating both overweight or obesity at the beginning of the intervention.   Conclusion  The short-term intensive intervention with four sets of vigorous walking schedule could reduce obesity indicators among overweight and obese in service employees in China, especially for the decline of body fat rate.
Re-hospitalization and its impact factors among depression patients in Chengdu city, 2013 − 2017
LIAO Shi-yi, WANG Yang-yang, CAI Yan,
, Available online  , doi: 10.11847/zgggws1137561
Abstract:
  Objective  To study the status and influencing factors of readmission in depression patients.   Methods  From Chengdu Municipal Medical Insurance Administration, Sichuan province, we collected 25 043 medical and reimbursement records for 16 556 depression patients having hospitalizations during the period from 2013 through 2017; the hospitalization status of the patients was analyzed. Rank-sum test and Chi-square test were used in analysis on hospitalization-related difference among subgroups of the patients; logistic regression model was used to analyze influencing factors of some patients′ readmission.   Results  The person-times of depression patient's hospitalization for 10 000 population increased from 1.92 in 2013 to 5.35 in 2017 and the person-times was higher for female population than for male population. Among all depression patients studied, the number of readmission within 30 days of discharge was 1 519 and 30-day readmission rate was 9.17%; the total number of readmission during the 5-year period was 3 854 and the 5-year readmission rate was 23.28%. The readmission rate was lower in the patients with medical insurance for urban and rural residents than that in the patients with medical insurance for urban workers. For all the re-hospitalizations recorded, the top three diagnosis at the readmission were mental and behavioural disorders (coded with F00-F99 in International Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10], accounting for 28.35% of total re-hospitalization), circulatory diseases (I00-I99, 20.17%), and respiratory diseases (J00-J99, 16.27%), respectively. Logistic regression analysis showed that female gender, aged ≥20 years, covered by medical insurance for urban workers, having the hospital stay of ≥ 8 days, and being diagnosed as recurrent depression (ICD-10 code: F33) were significant risk factors for re-hospitalization of depression patients; while, having comorbidity disease and being hospitalized in primary/secondary/tertiary hospital were significant protective factors against readmission.   Conclusion  The ratio of readmission was high among depression patients ever being hospitalized in Chengdu city and the re-hospitalization is mainly influenced by gender, age, medical insurance type, length of stay, depression type, comorbidity, and the grade of hospital providing hospitalization.
Evaluation on effectiveness and operation mechanism of management system for severe mental disorders: a literature study
YU Qin-wen, SHI Pei-wu, SHEN Qun-hong, et al (, Research Institute, of Health, Development Strategies, Fudan University, Shanghai 200032, China),
, Available online  , doi: 10.11847/zgggws1136865
Abstract:
  Objective  To analyze operational effectiveness and mechanism of management system for severe mental disorder (SMD) prevention and control in China for providing references to subsequent policy formulation.   Methods  Through searching official websites, we retrieved policy documents relevant to management on SMDs issued by governmental departments and professional institutions as of December 31, 2018 in 31 provincial-level administrative divisions (PLADs) across mainland China and analyzed the completeness and operation mechanism of the management scheme from four perspectives: management and monitoring, planning and evaluation, financing and compensation, and coordination and motivation based on evaluation standards for effectiveness of a public health system. The indicator data on management of SMD from 2014 through 2018 were also collected from National Severe Mental Disorder Information System and research literatures. The relationships between management implementation and effectiveness were analyzed using fixed effects model.   Results  For 31 PLADs in 2018, the average appropriate degree of SMD management scheme was 43.87%, with an increment of 22.08% to that in 2014 and a gap of 48.39% to the appropriate standard (85%). The dimensional appropriate degree of the SMD management scheme was the highest (64.96%) for financing and compensation mechanism but the lowest (23.69%) for coordination and motivation mechanism. For the dimension of management and monitoring in 2018 at national level, the completeness degree of content and form was relatively high (89.29%) but the degree of clarity for responsibility assignment was relatively low (24.91%), and the degree of management procedure feasibility was only 6.48%; for the dimension of planning and evaluation, the coverage of long-term planning was as high as 96.24%. The results of fixed effect model analysis showed that after adjusting for gross domestic product, significant increase of 1.00 % for completeness of regional SMD scheme, 1.54% for average standardized management rate, and 0.28% for average regular medication of SMD patients were observed (all P < 0.05).   Conclusion  The management mechanism of severe mental disorders has been steadily improved in China from 2014 to 2018; for the management scheme, the coverage of management standards and medium and long-term planning were relatively high , but the coordination and motivation mechanism and t responsibility assignment need to be improved.
Association of interaction between mental health literacy and non-suicidal self-injury with suicidal behaviors among middle school students: a cross- sectional survey in three China cities
ZHANG Zhixian, HUANG Xuexue, HU Jie,
, Available online  , doi: 10.11847/zgggws1138596
Abstract:
  Objective   To investigate the association of interaction between mental health literacy (MHL) and non-suicidal self-injury (NSSI) with suicidal behaviors among middle school students in China.   Methods  With multistage cluster sampling, totally 17 000 students were recruited from 39 middle schools in three China cities (Beijing, Zhengzhou of Henan province, and Yangjiang of Guangdong province) for self-administered anonymous survey during October 2020 – June 2021. Two scales compiled by Chinese researchers (Adolescent Mental Health Literacy Assessment Questionnaire [AMHLAQ] and Adolescent Non-suicidal Self-injury Assessment Questionnaire [ANSAQ] and a self- designed questionnaire were adopted in the survey. Multivariate logistic regression model was used to explore the association of interaction between MHL and NNSI with suicidal behavior in the students.   Results  Among the 16 853 students with valid responses, 31.3%, 16.3% and 7.5% reported ever having suicidal ideation, plan and attempt during past one year and the overall self-reported rate of NSSI was 28.9%. Multivariate logistic regression analyses revealed that inadequate MHL and NSSI are risk factors for suicidal ideation, plan and attempt. Furthermore, MHL and NSSI could exert an additive or multiplicative interactive effect on suicidal-related behaviors.   Conclusion  Among middle school students in China, suicidal-related behaviors is relatively prevalent and inadequate MHL and NSSI are risk factors for suicidal ideation, suicidal plan and suicidal attempt; the interaction between the two risk factors could increase the risk of suicide-related behaviors.
Association of mental health with myopia among children and adolescents: a cross sectional survey in Shandong province
WU Hui, XIE Long-tang, HU Yuan-yuan,
, Available online  , doi: 10.11847/zgggws1136667
Abstract:
  Objective  To explore the correlation between mental health and myopia in children and adolescents and to provide evidences for developing strategies on myopia prevention.  Methods  Using stratified cluster sampling, we recruited 10 720 students of grade 3 – 8 from 52 primary/junior high schools in 13 urban districts and 13 counties across Shandong province. The students' visual acuity was examined with Standard Logarithm Eyesight Table and computer refractometer during September – December 2020 and their mental health status were assessed simultaneously online with the Mental Health Scale for Child and Adolescent (MHS-CA) developed previously by domestic researchers.   Results  Complete information were collected from a total of 8 672 students (53.9% boys and 46.1% girls, 79.5% primary and 20.5% junior high school students). Compared to the non-myopic students, the myopic students had significantly higher MHS-CA dimension scores for thinking (17.25 ± 2.87 vs. 17.12 ± 2.86, t = – 1.97) and emotion (10.69 ± 1.93 vs. 10.57 ± 1.96, t = – 2.67) (both P < 0.05). The differences in MHS-CA dimension scores for thinking, emotion and volitional behavior between myopic students and non-myopic students became significant with the age increase of the students. There was a significant difference in MHS-CA score among the students in different geographical regions. The occurrence and development of myopia in the students differed significantly by gender (t = – 38.85), schooling grade (t = – 6.75), residence region (t = 4.26), and MHS-CA score for emotional dimension (t = – 2.63) (all P <0.05).   Conclusion  The incidence of myopia in children and adolescents of Shandong province is related to gender, age, residence region, and mental status and the impact factors need to be concerned in myopia prevention in the younger population.
Willingness to seek sexual health service and its associates in 15 – 24 years young people with online sex-seeking experience: a web-based survey in China
PAN Ling, ZHANG Da-peng, CAI Ling-ping,
, Available online  , doi: 10.11847/zgggws1138309
Abstract:
  Objective   To examine the attitude towards sexually transmitted disease and acquired immunodeficiency syndrome (STD/AIDS) and the willingness to seek STD/AIDS-related health service in Chinese young people having sexual behavior through online dating.  Methods   Using snowball sampling and 4 online social network platforms, we recruited 15 – 24 years young people with online sex-seeking experience and conducted a voluntary survey via Sojum application from September to November, 2017. A self-designed questionnaire was adopted to collected respondents′ information about demographic characteristic, sexual high-risk behaviors and willingness to seek STD/AIDS-related health service. Descriptive statistics, univariate and multivariate logistic regression were used to analyze the profile of willingness and its impact factors.  Results   Valid information were collected from 730 respondents. Of the 1 119 person-times of responses about intended options for seeking STD/AIDS-related health service, 45.9% (n = 514) reported the intention to visit public hospitals or Center for Disease Control (CDC), followed by the intention to conduct self-testing or treatment (23.6%, n = 264) and to visit private clinic or to have online consultation (19.4%, n = 217); while, 11.1% (n = 124) of the responses reported the disregarding of related healthcare seeking or even the possibility of STD/AIDS infections. Multiple logistic regression analysis revealed that the male respondents were more likely to report the disregarding of related healthcare seeking or even the possibility of STD/AIDS infections compared to the female respondents (P < 0.05) and the respondents having homosexual partners were more likely to report the intention to visit public hospitals or CDC for seeking STD/AIDS-related healthcare (P < 0.05).  Conclusion   Young people with online dating experience have a high demand for STD/AIDS-related healthcare service and different willingness/ approach to seek the healthcare, suggesting that targeted health education on STD/AIDS prevention and treatment needs to be promoted among young populations and strategies of multi-sectoral cooperation are necessary to increase the access to youth-friendly STD/AIDS service.
Prevalence and influencing factors of depression symptoms among emergency nurses in China: a nationwide cross-sectional survey
LEI Zi-hui, FENG Jing, SHEN Xin,
, Available online  , doi: 10.11847/zgggws1138660
Abstract:
  Objective  To examine the prevalence and influencing factors of depressive symptoms among emergency nurses in China.   Methods  Totally 20 136 nurses working in emergency departments at least for 6 months were recruited with stratified multistage random sampling in 31 provincial level administrative regions across China for a self-administered questionnaire survey conducted during July – September, 2019. The Center for Epidemiological Studies Depression Scale (CES-D), two scales designed by domestic experts on lifestyle and workplace violence, and a self designed questionnaire were used to collect relevant information of the participants. Descriptive statistics, chi-square test and multivariate binary logistic regression analysis were performed in data analyses with SPSS 22.0.   Results  Of 20 316 participants with valid responses, 26.82% were assessed as with depressive symptom based on the total CES-D score of 20 and above. The results of logistic regression analysis demonstrated that the participants with following characteristics were more likely to have depression symptoms: alcohol drinking (odds ratio [OR] = 1.425), abstaining from alcohol consumption (OR = 1.391), averagely working 10 hours or more per work day (OR = 1.272), perceiving a higher working pressure (OR = 2.358) or very high working pressure (OR = 5.731), and ever experiencing workplace violence (OR = 1.675/3.290/5.982 for low/moderate/high severity); while, the participants elder than 44 years (OR = 0.710), being married (OR = 0.707), having a senior professional title (OR = 0.677), with a good or fair self-assessed health (OR = 0.276 or 0.506), and with good or fair sleep quality (OR = 0.358 or 0.575) were less likely to have depression symptoms.   Conclusion  Among emergency nurses in China, depression symptom is associated with working stress, unhealthy behavioral lifestyle, and workplace violence. Working framework and management strategies for emergency departments should be improved to reduce depression symptoms in emergency nurses.
Evolution of whole society participation in AIDS prevention and control in China: a brief discussion
SUN Quan, CHENG Jun-qi, XU Xiao-jun
, Available online  , doi: 10.11847/zgggws1138899
Abstract:
Recognizing AIDS epidemic as a social problem, the article reviews the development process of society participation in AIDS prevention in China during the past 40 years from a panoramic perspective. During the period in China, the concept of AIDS prevention changed from prevention and treatment to prevention and control with a passivity to initiative transformation occurring in the development of whole society participation in AIDS containment. From a long - term consideration, the initiative of whole society participation in AIDS prevention and control needs to be promoted continuously for the construction of a prevention community for effective control of AIDS epidemic.
Survival time and related factors among child HIV/AIDS patients in Anhui province
DAI Se-ying, LIU Ai-wen, JIN Lin,
, Available online  , doi: 10.11847/zgggws1137822
Abstract:
  Objective  To examine the survival time of child human immunodeficiency virus (HIV)/AIDS patients and its influencing factors in Anhui province.   Methods  Follow-up and medication information on all laboratory confirmed AIDS patients aged ≤ 15 years at the diagnosis and being permanent residents of Anhui province were collected from National Comprehensive HIV/AIDS Information Management System up to the end of 2020 and analyzed retrospectively. The survival rate was calculated with life table method and impact factors of survival were assessed using Cox regression model.   Results  Among a total of 329 child HIV/AIDS patients being followed-up during the period, 54 died of AIDS-related diseases and the mortality rate was 2.2/100 person-years. The results of Cox proportional hazards regression analysis showed that for all the child patients, the children with AIDS at the time of first diagnosis and not receiving antiretroviral therapy were at a significantly higher risk of AIDS-related disease mortality, with the hazard ratio (HR) of 5.32 (95% confidence interval [95% CI] : 2.70 – 10.47) and 28.29 (95% CI : 14.63 – 54.70) compared to those not having AIDS at the first diagnosis and to those receiving antiretroviral therapy; among the child patients with antiretroviral therapy, the risk of AIDS-related disease mortality were significantly higher for those aged < 5 years at the first diagnosis (versus aged 11 – 15 years: HR = 6.18, 95% CI : 14.63 – 54.70 ), having AIDS at the first diagnosis (versus having HIV infection: HR = 5.07, 95% CI : 1.27 – 20.29), and with the baseline CD4 + T lymphocyte count of < 50 cells/μL (HR = 10.99, 95% CI : 2.04 – 59.20) or 50 – 200 cells/μL (HR = 8.40, 95% CI : 1.35 – 52.26) compared to the child patients with the baseline count of > 200 cells/μL, respectively.   Conclusion  Among child HIV/AIDS patients in Anhui province, antiretroviral therapy is an important factor for survival and the baseline CD4 + T lymphocyte count is the key factor affecting the effect of antiretroviral therapy.