[Research progress on the effect of common metabolism-related comorbidities on health outcomes and management strategies in patients with chronic hepatitis B]

With the increasing life expectancy and lifestyle changes of patients with chronic hepatitis B (CHB), the significance of comorbidities of chronic non-communicable diseases (NCDs) in disease progression and health prognosis of CHB patients is gaining prominence. This study aims to explore the association between CHB and NCDs comorbidities, focusing on the impact of common metabolism-related diseases, such as metabolic syndrome and diabetes, on the health outcomes of CHB patients. We also summarize studies on integrating the management of comorbidities in CHB patients and provide relevant recommendations for effective management. The findings of this study serve as a foundation for understanding the clinical characteristics and prevalence trends, reducing the disease burden of comorbidities among CHB patients, and establishing a comprehensive and coordinated management system for comorbidities.

Spatial-temporal distribution of preterm birth in China, 1990-2020: A systematic review and modelling analysis

BACKGROUND

Little is known about the long-term trends of preterm birth rates in China and their geographic variation by province.

OBJECTIVES

To estimate the annual spatial-temporal distribution of preterm birth rates in China by province from 1990 to 2020.

DATA SOURCES

We searched PubMed, EMBASE, Web of Science, CNKI, WANFANG and VIP from January 1990 to September 2023.

STUDY SELECTION AND DATA EXTRACTION

Studies that provided data on preterm births in China after 1990 were included. Data were extracted following the Guidelines for Accurate and Transparent Health Estimates Reporting.

SYNTHESIS

We assessed the quality of each survey using a 9-point checklist. We estimated the annual preterm birth risk by province using Bayesian multilevel logistic regression models considering potential socioeconomic, environmental, and sanitary predictors.

RESULTS

Based on 634 survey data from 343 included studies, we found a gradual increase in the preterm birth risk in most provinces in China since 1990, with an average annual increase of 0.7% nationally. However, the preterm birth rates in Inner Mongolia, Hubei, and Fujian Province showed a decline, while those in Sichuan were quite stable since 1990. In 2020, the estimates of preterm birth rates ranged from 2.9% (95% Bayesian credible interval [BCI] 2.1, 3.8) in Inner Mongolia to 8.5% (95% BCI 6.6, 10.9) in Jiangxi, with the national estimate of 5.9% (95% BCI 4.3, 8.1). Specifically, some provinces were identified as high-risk provinces for either consistently high preterm birth rates (e.g. Jiangxi) or relatively large increases (e.g. Shanxi) since 1990.

CONCLUSIONS

This study provides annual information on the preterm birth risk in China since 1990 and identifies high-risk provinces to assist in targeted control and intervention for this health issue.

Violent behavior and the network properties of psychopathological symptoms and real-life functioning in patients with schizophrenia

Objective

To assess the interplay among psychopathological symptoms and real-life functioning, and to further detect their influence with violent behavior in patient with schizophrenia.

Methods

A sample of 1,664 patients with post-violence assessments and their propensity score-matched controls without violence from a disease registration report system of community mental health service in Guangdong, China, were studied by network analysis. Ising-Model was used to estimate networks of psychopathological symptoms and real-life functioning. Then, we tested whether network properties indicated the patterns of interaction were different between cases and controls, and calculated centrality indices of each node to identify the central nodes. Sensitivity analysis was conducted to examine the difference of interaction patterns between pre-violence and post-violence assessments in violence cases.

Results

Some nodes in the same domain were highly positive interrelations, while psychopathological symptoms were negatively related to real-life functioning in all networks. Many symptom-symptom connections and symptom-functioning connections were disconnected after the violence. The network density decreased from 23.53% to 12.42% without statistical significance (p = 0.338). The network structure, the global network strength, and the global clustering coefficient decreased significantly after the violence (p < 0.001, p = 0.019, and p = 0.045, respectively). Real-life functioning had a higher node strength. The strength of sleeping, lack of spontaneity and flow of conversation, and preoccupation were decreased in post-violence network of patients.

Conclusion

The decreasing connectivity may indicate an increased risk of violence and early warning for detecting violence. Interventions and improving health state based on nodes with high strength might prevent violence in schizophrenia patients.

[Research progress on the comorbidity between hepatitis B virus infection and noncommunicable diseases]

With the decline in hepatitis B virus (HBV) incidence and the increase in the life expectancy of infected individuals, the population infected with HBV is experiencing rapid aging, leading to an escalating risk of co-morbid chronic noncommunicable diseases (NCDs). This study summarizes research related to the comorbidity between HBV and NCDs, discussing the aging of the HBV-infected population, the mechanisms, prevalence, and management of this comorbidity. This study provides insights into potential directions for future research on the comorbidity between HBV and NCDs and aims to provide a basis for further research and the development of prevention and treatment strategies for the comorbidity of NCDs among HBV-infected individuals in China.

[Causal links between long-term exposure to NO2 and the risk of cardiovascular hospitalization]

Objective: To determine the causal association between long-term Nitrogen dioxide (NO₂) exposure and the risk of cardiovascular hospitalization. Methods: Based on a sub-cohort of a community-based prospective cohort study, a total of 36 271 participants were recruited from 35 communities randomly selected in Guangzhou in 2015. The annual average exposure of NO₂, demographic characteristics, lifestyle factors, and information on the causes of hospitalization was collected. We applied marginal structural Cox models to investigate the effect of NO₂ on cardiovascular hospitalization. Demographic and behavioral factors also stratified results. Results: The mean age of participants in the present study was (50.9±17.8) years, and the cardiovascular admission rate was 8.7%, with 203 822 person-years of follow-up. The annual mean NO₂ concentration was 48.7 μg/m³ during 2015-2020. For each 10 μg/m³ increase in NO₂ concentrations, the HRs (95%CIs) of total cardiovascular hospitalization, cardiovascular hospitalization, and cerebrovascular hospitalization were 1.33 (1.16-1.52), 1.36 (1.16-1.60) and 1.25 (1.00-1.55), respectively. Participants who were never married/married, with secondary education, high exercise frequency, or non-smokers/current smokers may be more susceptible than their counterparts. Conclusion: Long-term exposure to NO₂ significantly increased hospitalization risk for cardiovascular disease.

Potential Gains in Health-Adjusted Life Expectancy by Reducing Burden of Noncommunicable Diseases in 188 Countries: A Population-Based Study

OBJECTIVES

This article quantifies the potential gains in health-adjusted life expectancy for people aged 30 to 70 years (HALE_[30-70]) by examining the reductions in disability in addition to premature mortality from noncommunicable diseases (NCDs).

METHODS

We extracted data from the Global Burden of Disease Study 2019 for 4 major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 2010 to 2019. Estimates of the potential gains in HALE_[30-70] were based on a counterfactual analysis involving 3 alternative future scenarios: (1) achieve Sustainable Development Goals target 3.4 but do not make any progress on disability reduction, (2) achieve Sustainable Development Goals target 3.4 and eliminate NCD-related disability, and (3) eliminate all NCD-related mortality and disability.

RESULTS

In all scenarios, the high-income group has the greatest potential gains in HALE_[30-70], above the global average. For all specific causes, potential gains in HALE_[30-70] decrease as income levels fall. Across these 3 scenarios, the potential gains in HALE_[30-70] globally of reducing premature mortality for 4 major NCDs are 3.13 years, 4.53 years, and 7.32 years, respectively. In scenario A, all income groups have the greatest potential gains in HALE_[30-70] from diabetes and chronic respiratory diseases. In scenarios B and C, the high-income group has the greatest potential gains in HALE_[30-70] from cancer intervention, and the other income groups have the greatest potential gains in HALE_[30-70] from cardiovascular diseases intervention.

CONCLUSION

Reducing premature death and disability from 4 major NCDs at once and attaching equal importance to each lead to a sizable improvement in HALE_[30-70].

[Burden of non-communicable diseases attributable to population aging in China, 1990‒2050]

Objective: The direction and intensity of population aging on the burden of non-communicable diseases (NCDs) in China from 1990 to 2019 were analyzed, and the burden of NCDs in 2050 was predicted. Methods: The disease-specific disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) in the Chinese population from 1990 to 2019 were obtained from the Global Burden of Disease Study.The differences in indicators from 1990 to 2019 were attributed to the contribution of age structure, population size, and all other causes. The Bayesian age-time-cohort models were used to predict DALYs from NCDs to 2050. Results: The absolute level of DALYs caused by NCDs increased by 7.460 million from 1990 to 2019, and the age structure contributed 186.0% (95% Uncertainty Intervals (UIs): 178.4%-193.6%), population size contributed 77.0% (95% UIs: 69.5%-80.8%), all other causes contributed -163.0% (95% UIs:-163.1%- -159.3%). DALYs caused by NCDs consist of 2.527 million YLLs and 4.934 million YLDs, in which the contribution of age structure to YLLs and YLDs was 414.6% (95% UIs: 396.2%-432.5%) and 69.1% (95% UIs: 66.7%-71.4%), respectively. From 2019 to 2050, the diseases with increased DALYs due to changes in age structure are cardiovascular diseases, neoplasms, chronic respiratory diseases, neurological disorders, sense organ diseases, diabetes and kidney diseases, musculoskeletal disorders, digestive diseases, mental disorders, and skin and subcutaneous diseases in descending order. Conclusions: From 1990 to 2019, except for skin and subcutaneous diseases, the burden of other NCDs attributable to population aging increased, mainly due to disability. By 2050, the burden of NCDsattributable to population aging will continue to rise.

[The role of the high-level public health school in the development of the Center for Disease Control and Prevention]

The Ministry of Education and other four departments jointly issued the Notice on the Construction of high-level schools of public Health, proposing that "it will take ten years to build a number of high-level schools of public health, and form a high-quality education development system to adapt to the construction of modern public health system". At present, the construction of high-level public health schools in various universities in China is in full swing. The high-level School of Public Health and the CDC have played an important role in constructing the national public health system and the human health community. The high-level public health schools are of strategic significance and important value to the development of the CDC. The review presents reflections and insights on the role of high-level public health schools in the development of the CDC and the challenges they might face.

[Progress in research on HIV cluster detection and response]

HIV cluster detection and response (CDR) is a critical strategy to end the HIV epidemic by offering information to identify prevention and care services gaps. The risk metrics for HIV clusters can be classified into three groups: growth-based metrics, characteristic-based metrics, and phylogeny-based metrics. When identifying HIV risk clusters, the public health response can reach people in the affected networks, including people with undiagnosed HIV, people with diagnosed HIV who might not be accessing HIV care or other services, and people without HIV who would benefit from prevention services. To provide references for HIV precise prevention in China, we summarized the risk metrics and the intervention measures for CDR.

[Association between physical exercise and non-alcoholic fatty liver disease in people infected with hepatitis B virus]

Objective: To investigate the association between physical exercise and non-alcoholic fatty liver disease (NAFLD) in people infected with HBV. Methods: The information about the 3 813 participants infected with HBV, including the prevalence of NAFLD, prevalence of physical exercise and other covariates, were collected from the National Science and Technology Major Project of China during 2016-2020. The logistic regression model was used to evaluate the association between physical exercise and NAFLD in HBV infected patients, and subgroup analysis was performed to identify the effect modifiers. Results: A total of 2 259 HBV infected participants were included in the final analysis and 454 (20.10%) had NAFLD. After adjusting for covariates, we found that moderate physical exercise was a protective factor for NAFLD (OR=0.66, 95%CI: 0.46-0.94). Subgroup analysis suggested that the protective effect of moderate physical exercise on NAFLD might be stronger in women (OR=0.61, 95%CI: 0.36-1.01), those <45 years old (OR=0.24, 95%CI: 0.06-0.80), those who had low education level (OR=0.16, 95%CI: 0.04-0.49), those who had low annual income (OR=0.39, 95%CI: 0.16-0.89 for <30 000 yuan RMB; OR=0.64, 95%CI: 0.40-1.00 for 30 000-80 000 yuan RMB), those who had hypertension (OR=0.45, 95%CI: 0.21-0.88), those with BMI ≥24.0 kg/m² (OR=0.66, 95%CI: 0.43-1.01), those who had more daily fruit or vegetable intake (OR=0.61, 95%CI: 0.38-0.97), those who had more daily meat intake (OR=0.49, 95%CI: 0.23-0.97), and those who had no smoking history (OR=0.66, 95%CI: 0.45-0.95) or passive smoking exposure (OR=0.61, 95%CI: 0.37-0.97). Conclusions: Among HBV infected patients, moderate physical exercise was negatively associated with the prevalence of NAFLD. Women, young people, those who had low education level, those who had low annual income, those with hypertension, those with high BMI, those who had more daily fruit or vegetable and meat intakes, and those who had no smoking history or passive smoking exposure might be more sensitive to the protective effect.

[Association between response to repeated negative HIV testing and risk sexual behaviors in men who have sex with men in Chengdu]

Objective: To investigate the association between the response to repeated negative HIV testing and the risk sexual behaviors in men who have sex with men (MSM) in Chengdu. Methods: A total of 610 MSM were recruited by convenience sampling method through Chengdu Tongle Health Consultation Service Centre from March to May 2022. Data were collected from the MSM through questionnaire survey, including the demographic characteristics, sexual behaviors in the past 6 months, the response to rerpeated negative HIV testing. Univariate and multivariate logistic regression models were conducted to analyze the association between the response to repeated negative HIV testing and risk sexual behavior. Results: A total of 579 (94.9%) participants participated in the questionnaire survey and 354 (61.1%) subjects were included in the study.For the negative HIV testing, some MSM believed that they had taken effective protection measures (17.03±2.20), some believed that they were lucky (7.50±1.87) and some believed that they were at low risk (8.87±3.62). Multivariate logistic regression model showed that protected sexual behavior was negatively associated with group sex (aOR=0.80, 95%CI: 0.67-0.95), lucky was positively associated with casual sex (aOR=1.20, 95%CI: 1.06-1.35), inconsistent condom use (aOR=1.21, 95%CI: 1.06-1.37), group sex (aOR=1.26, 95%CI: 1.00-1.60), and multiple sexual partners (aOR=1.24, 95%CI: 1.09-1.42) and low risk perception was positively associated with multiple sexual partners only (aOR=1.08, 95%CI: 1.01-1.15). Conclusions: There were high levels of recognition of protected sexual behavior and lucky dimensions in response to repeated negative HIV testing and well risk perception in MSM in Chengdu. In HIV testing and counseling services, intervention and risk warning should be strengthened in MSM who believed that they are lucky to improve their awareness of safe sex and reduce the negative effects of fluke mind.

Effects of family multi-generational relationship on multimorbidity and healthy life expectancy for second generations: insight from the China Health and Retirement Longitudinal Study

OBJECTIVE

In the context of aging, Chinese families consisting of more than three generations (grandparents, parents, children) are the norm. The second generation (parents) and other family members may establish a downward (contact only with children) or two-way multi-generational relationship (contact with children and grandparents). These multi-generational relationships may have the potential effect on multimorbidity burden and healthy life expectancy in the second generation, but less is known about the direction and intensity of this effect. This study aims to explore this potential effect.

METHODS

We obtained longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which included 6,768 people. Cox proportional hazards regression was used to assess the association between multi-generational relationships and the number of multimorbidity. The Markov multi-state transition model was used to analyze the relationship between multi-generational relationships and the severity of multimorbidity. The multistate life table was used to calculate healthy life expectancy for different multi-generational relationships.

RESULTS

The risk of multimorbidity in two-way multi-generational relationship was 0.830 (95% CIs: 0.715, 0.963) times higher than that in downward multi-generational relationship. For mild multimorbidity burden, downward and two-way multi-generational relationship may prevent aggravation of burden. For severe multimorbidity burden, two-way multi-generational relationship may aggravate the burden. Compared with two-way multi-generational relationship, the second generations with downward multi-generational relationship has a higher healthy life expectancy at all ages.

CONCLUSION

In Chinese families with more than three generations, the second generations with severe multimorbidity burden may aggravate the condition by providing support to elderly grandparents, and the support provided by offspring to the second generations plays a vital positive role in improving the quality of life and narrowing the gap between healthy life expectancy and life expectancy.

Measurement and projection of the burden of disease attributable to population aging in 188 countries, 1990-2050: A population-based study

Background

Quantitative attribution of the burden of disease due to population aging is an important part of setting meaningful global health priorities. This study comprehensively examines the burden of disease attributable to population aging in 188 countries from 1990 to 2019, incorporates a comprehensive range of diseases, and projects the burden of disease due to population aging till 2050.

Methods

We extracted data from 1990 to 2019 for 188 countries from the Global Burden of Disease Study 2019. We decomposed the change in disease burden into the contribution of the age structure of the population, population size, and age-specific disability-adjusted life years (DALYs) rates due to all other reasons. We used the Bayesian age-period-cohort model to evaluate the effects of age on temporal trends, and then to predict the possible disease burden in 2050.

Results

At the global level, the change in total DALYs associated with age structure, population size, and all other reasons is 27.4%, 16.8%, and 89.4% (absolute level of DALYs attributable to age structure: -15.20 million, 9.32 million, and -49.58 million) of the absolute level of DALYs gap between 2019 and 1990. The absolute level of DALYs changes attributable to age structure for communicable, maternal, neonatal, and nutritional diseases were negative in all income groups from 1990 to 2019. For non-communicable diseases, the contribution was positive except in the low-income group. For injuries, the contribution was positive in lower-middle-income groups and low-income groups. By 2050, DALY rates decreased in all income groups, if compared to 2019. However, a total of 132 countries may see a gradual increase of all-cause DALYs attributable to population aging.

Conclusions

The direction and intensity of the effects of population aging on the burden of disease vary by region and disease, with huge implications for global health in the future.

[Willingness to use the three types of pre-exposure prophylaxis and associated factors among men who have sex with men in Chengdu]

Objective: To investigate the willingness to use three types of pre-exposure prophylaxis (PrEP) and its associated factors among MSM in Chengdu. Methods: A total of 793 MSM were recruited through Chengdu Tongle Health Consultation Service Centre between November 2021 to January 2022. Data were collected, including demographic characteristics, sexual behaviors in the last six months, PrEP-related stigma, HIV anticipated stigma, MSM internalized stigma, and willingness to use three types of PrEP. Univariate and multivariate logistic regression models were conducted to investigate the associated factors of willingness in using the three types of PrEP. Results: Among 793 participants, willingness to take on-demand PrEP was higher (68.3%). Higher education and multiple sexual partners increased the willingness to use oral PrEP, higher education [compared with junior high school or below, high school or technical secondary school (aOR=2.43, 95%CI: 1.13-5.21), junior college (aOR=2.67, 95%CI: 1.27-5.61), bachelor degree (aOR=3.21, 95%CI: 1.52-6.74), master degree or above (aOR=3.77, 95%CI: 1.54-9.26)], multiple sexual partners (aOR=1.54, 95%CI: 1.12-2.11) were positively associated with daily oral PrEP. HIV anticipated stigma was positively associated with the willingness in using all three types of PrEP: daily oral PrEP (aOR=1.07, 95%CI: 1.02-1.12), on-demand PrEP (aOR=1.09, 95%CI: 1.03-1.15), and injectable PrEP every 8 week (aOR=1.06, 95%CI: 1.01-1.11). Conclusions: The overall willingness in using PrEP in MSM in Chengdu is relatively high, and the promotion of PrEP is highly feasible. In the future, we should continue to promote publicity and education on HIV and PrEP-related knowledge in this population, improve the cognitive level, and guide MSM to establish the correct motivation for PrEP use.

A clinical model and nomogram for early prediction of gestational diabetes based on common maternal demographics and routine clinical parameters

AIM

We aimed to develop a risk prediction model for gestational diabetes mellitus (GDM) based on the common maternal demographics and routine clinical variables in Chinese population.

METHODS

Individual information was collected from December 2018 to October 2019 by a pretested questionnaire on demographics, medical and family history, and lifestyle factors. Multivariable logistic regression was performed to establish a predictive model for GDM by variables in pre- and early pregnancy. The consistency and discriminative validity of the model were evaluated by Hosmer-Lemeshow goodness-of-fit testing and ROC curve analysis. Internal validation was appraised by fivefold cross-validation. Clinical utility was assessed by decision curve analysis.

RESULTS

Total 3263 pregnant women were included with 17.2% prevalence of GDM. The model equation was: LogitP = -11.432 + 0.065 × maternal age (years) + 0.061 × pre-pregnancy BMI (kg/m² ) + 0.055 × weight gain in early pregnancy (kg) + 0.872 × history of GDM + 0.336 × first-degree family history of diabetes +0.213 × sex hormone usages during pre- or early pregnancy + 1.089 × fasting glucose (mmol/L) + 0.409 × triglycerides (mmol/L) + 0.082 × white blood cell count (109/L) + 0.669 × positive urinary glucose. Homer-Lemeshow goodness-of-fit testing indicated a good consistency between predictive and actual data (p = 0.586). The area under the ROC curve (AUC) was 0.720 (95% CI: 0.697 ~ 0.744). Cross-validation suggested a good internal validity of the model. A nomogram has been made to establish an easy to use scoring system for clinical practice.

CONCLUSIONS

The predictive model of GDM exhibited well acceptable predictive ability, discriminative performance, and clinical utilities. The project was registered in clinicaltrial.gov.com with identifier of NCT03922087.

Developing and validating a Chinese multimorbidity-weighted index for middle-aged and older community-dwelling individuals

OBJECTIVE

To develop and validate an index to quantify the multimorbidity burden in Chinese middle-aged and older community-dwelling individuals.

METHODS

We included 20,035 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS) and 19,297 individuals aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Health outcomes of physical functioning (PF), basic and instrumental activities of daily living (ADL and IADL) and mortality were obtained. Based on self-reported disease status, we calculated five commonly used western multimorbidity indexes for CHARLS baseline participants. The one that predicted the health outcomes the best was selected and then modified through a linear mixed model using the repeated individual data in CHARLS. The performance of the modified index was internally and externally evaluated with CHARLS and CLHLS data.

RESULTS

The multimorbidity-weighted index (MWI) performed the best among the five indexes. In the modified Chinese multimorbidity-weighted index (CMWI), the weights of the diseases varied greatly (range 0.2-5.1). The top three diseases with the highest impact were stroke, memory-related diseases and cancer, corresponding to weights of 5.1, 4.3 and 3.4, respectively. Compared with the MWI, the CMWI showed better model fits for PF and IADL with larger R2 and smaller Akaike information criterion, and comparable prediction performances for ADL, IADL and mortality (e.g. the same predictive accuracy of 0.80 for ADL disability).

CONCLUSION

The CMWI is an adequate index to quantify the multimorbidity burden for Chinese middle-aged and older community-dwelling individuals. It can be directly computed via disease status examined in regular community health check-ups to facilitate health management.

Increased Central and Peripheral Thyroid Resistance Indices During the First Half of Gestation Were Associated With Lowered Risk of Gestational Diabetes-Analyses Based on Huizhou Birth Cohort in South China

OBJECTIVES

The study aimed to explore the relationship of thyroid function and resistance indices with subsequent risk of gestational diabetes (GDM).

DESIGN

This was a longitudinal study embedded in the Huizhou Birth Cohort.

METHODS

A total of 2,927 women of singleton pregnancy were recruited from January to October of 2019. Thyroid central resistance indices were evaluated by Thyroid Feedback Quartile-Based index (TFQI), Thyrotrophy T4 Resistance Index (TT4RI), and TSH Index (TSHI) based on plasma-free thyroxine (FT4) and thyroid-stimulating hormone (TSH) levels during the first half of pregnancy. Thyroid peripheral sensitivity was assessed by free triiodothyronine (FT3) to FT4 ratio (FT3/FT4), a proxy of deiodinase activity. GDM was diagnosed between 24 and 28 weeks of gestation by a standardized 75 g oral glucose tolerance test. Multivariable linear and logistic regression was applied to examine the associations of thyroid markers with GDM risk.

RESULTS

FT3 and FT3/FT4 were positively associated with both fasting and post-load glucose levels, while TSH, TSHI, TT4RI, and TFQI were negatively associated with 1 and 2 h post-load glucose levels. Compared with the lowest quartile, GDM risk in the highest quartile increased by 44% [odds ratio (OR) = 1.44; 95%CI, 1.08-1.92; p_trend = 0.027] for FT3 and 81% (OR = 1.81; 95%CI, 1.33-2.46; p_trend < 0.001) for FT3/FT4, while it lowered by 37% (OR = 0.63; 95%CI, 0.47-0.86; p_trend = 0.002] for TSHI, 28% for TT4RI (OR = 0.72; 95%CI, 0.54-0.97; p_trend = 0.06), and 37% for TFQI (OR = 0.63; 95%CI, 0.46-0.85; p_trend < 0.001).

CONCLUSIONS

This longitudinal study indicated that higher FT3 and FT3/FT4 and lower central thyroid resistance indices were associated with increased risk of GDM.

Equity of geographical access to public health facilities in Nepal

Introduction

Geographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available.

Methods

Based on the up-to-date dataset of Nepal formal public health facilities in 2021, we measured the geographical accessibility by calculating the travel time to the nearest public health facility of three levels (ie, primary, secondary and tertiary) across Nepal at 1×1 km² resolution under two travel modes: walking and motorised. Gini and Theil L index were used to assess the inequality. Potential locations of new facilities were identified for best improvement of geographical efficiency or equality.

Results

Both geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation is available to everyone, the population coverage within 5 min to any public health facilities would be improved by 62.13%. The population-weighted average travel time was 17.91 min, 39.88 min and 69.23 min and the Gini coefficients 0.03, 0.18 and 0.42 to the nearest primary, secondary and tertiary facilities, respectively, under motorised mode. For primary facilities, low accessibility was found in the northern mountain belt; for secondary facilities, the accessibility decreased with increased distance from the district centres; and for tertiary facilities, low accessibility was found in most areas except the developed areas like zonal centres. The potential locations of new facilities differed for the three levels of facilities. Besides, the majority of inequalities of geographical accessibility were from within-province.

Conclusion

The high-resolution geographical accessibility maps and the assessment of inequality provide valuable information for health resource allocation and health-related planning in Nepal.

[Epidemiological characteristics of local outbreak of COVID-19 caused by SARS-CoV-2 Delta variant in Liwan district, Guangzhou]

Objective: To analyze the epidemiological characteristics of a local outbreak of COVID-19 caused by SARS-CoV-2 B.1.617.2(Delta) variant in Liwan district, Guangzhou, and provide evidence for the further prevention and control of the Delta variant of COVID-19. Methods: From May 21 to June 18, 2021, the incidence data of COVID-19 caused by Delta variant were obtained from National Notifiable Disease Report System of Chinese Disease Prevention and Control Information System and Liwan District Center for Disease Control and Prevention of Guangzhou.Frequency analysis (proportions), histograms, and percentage stacked area plots were used to describe the epidemiological characteristics of the outbreaks. The incubation period and time-varying reproduction numbers (R_t) estimations were used for the further analysis. Results: By June 18, 2021, a total of 127 COVID-19 cases caused by Delta variant was reported in Liwan district. The youngest case was aged 2 years and the oldest was aged 85 years. There were 18.9% (24/127) aged <18 years, 43.3% (55/127) aged 18-59 years, and 37.8% (48/127) aged ≥60 years, the male to female ratio of the cases was 1∶1.35 (54∶73). The cases were mainly retired people (32.3%, 41/127), the jobless or unemployed (18.1%, 23/127), and students (16.5%, 21/127). The infections mainly occurred in Baihedong (70.1%, 89/127) and Zhongnan street (23.6%, 30/127) communities in the southern area of Liwan district. The median incubation period of the Delta variant infection was 6 days (range: 1-15 days). The clinical classification were mainly common type (64.6%, 82/127). The basic reproduction number (R₀) was 5.1, R_t which once increased to 7.3. The transmissions mainly occurred in confined spaces, such as home (26.8%), restaurant (29.1%), neighborhood (3.9%), and market (3.1%), the household clustering was predominant. Close contacts tracing (66.1%) and community screening (33.1%) were the main ways to find the infections. Conclusion: The COVID-19 outbreak caused by Delta variant in Liwan district of Guangzhou was highly contagious, with the obvious characteristics of household clustering and high proportions of cases in adults aged 18-59 years and elderly people aged ≥60 years.

Research capacity of global health institutions in China: a gap analysis focusing on their collaboration with other low-income and middle-income countries

Introduction

This paper presented qualitative and quantitative data collected on the research capacity of global health institutions in China and aimed to provide a landscaping review of the development of global health as a new discipline in the largest emerging economy of the world.

Methods

Mixed methods were used and they included a bibliometric analysis, a standardised survey and indepth interviews with top officials of 11 selected global health research and educational institutions in mainland China.

Results

The bibliometric analysis revealed that each institution had its own focus areas, some with a balanced focus among chronic illness, infectious disease and health systems, while others only focused on one of these areas. Interviews of key staff from each institution showed common themes: recognition that the current research capacity in global health is relatively weak, optimism towards the future, as well as an emphasis on mutual beneficial networking with other countries. Specific obstacles raised and the solutions applied by each institution were listed and discussed.

Conclusion

Global health institutions in China are going through a transition from learning and following established protocols to taking a more leading role in setting up China’s own footprint in this area. Gaps still remain, both in comparison with international institutions, as well as between the leading Chinese institutions and those that have just started. More investment needs to be made, from both public and private domains, to improve the overall capacity as well as the mutual learning and communication within the academic community in China.

[Analysis on job burnout status and its influencing factors among female workers of labor-intensive enterprises]

Objective: To analyze the status and its influencing factors of job burnout among female workers of labor-intensive enterprises. Methods: A total of 750 female workers from 5 labor-intensive enterprises in Guangdong Province were selected as the study subjects by random cluster sampling method in August, 2019. 665 valid questionnaires were collected, and the effective recovery rate was 88.67%. The Maslach Burnout Inventory-General Survey was used to assess job burnout and its influencing factors were analyzed. Results: Among 665 female workers, 429 (64.51%) found to have different levels of burnout, among which 380 (57.14%) were mild to moderate burnout and 49 (7.37%) were severe burnout. The comprehensive scores of job burnout in different age, marital status, current post working age, working time per week, personal monthly income, working system and occupational stress groups were statistically significant (P<0.01) . There were significant differences in the score of emotional exhaustion in different age, marital status, current working age, working time per week, personal monthly income and occupational stress groups (P<0.05) . There were significant differences in the dimensions of depersonalization in different age, weekly work time, personal monthly income, working system and occupational stress groups (P<0.05) . There were significant differences in the dimensions of low individual achievement in different education levels, weekly work time, working system and occupational stress groups (P<0.05) . Conclusion: The female workers of labor-intensive enterprises are generally have mild to moderate job burnout. The main influencing factors of job burnout are weekly work time and occupational stress.

Model-based spatial-temporal mapping of opisthorchiasis in endemic countries of Southeast Asia

Opisthorchiasis is an overlooked danger to Southeast Asia. High-resolution disease risk maps are critical but have not been available for Southeast Asia. Georeferenced disease data and potential influencing factor data were collected through a systematic review of literatures and open-access databases, respectively. Bayesian spatial-temporal joint models were developed to analyze both point- and area-level disease data, within a logit regression in combination of potential influencing factors and spatial-temporal random effects. The model-based risk mapping identified areas of low, moderate, and high prevalence across the study region. Even though the overall population-adjusted estimated prevalence presented a trend down, a total of 12.39 million (95% Bayesian credible intervals [BCI]: 10.10–15.06) people were estimated to be infected with O. viverrini in 2018 in four major endemic countries (i.e., Thailand, Laos, Cambodia, and Vietnam), highlighting the public health importance of the disease in the study region. The high-resolution risk maps provide valuable information for spatial targeting of opisthorchiasis control interventions.

[Using Markov Chain Monte Carlo methods to estimate the age-specific case fatality rate of COVID-19]

Objectives: The COVID-19 epidemic has swept all over the world. Estimates of its case fatality rate were influenced by the existing confirmed cases and the time distribution of onset to death, and the conclusions were still unclear. This study was aimed to estimate the age-specific case fatality rate of COVID-19. Methods: Data on COVID-19 epidemic were collected from the National Health Commission and China CDC. The Gamma distribution was used to fit the time from onset to death. The Markov Chain Monte Carlo simulation was used to estimate age-specific case fatality rate. Results: The median time from onset to death of COVID-19 was M=13.77 (P(25)-P(75): 9.03-21.02) d. The overall case fatality rate of COVID-19 was 4.1% (95%CI: 3.7%-4.4%) and the age-specific case fatality rate were 0.1%, 0.4%, 0.4%, 0.4%,0.8%, 2.3%, 6.4%, 14.0 and 25.8% for 0-, 10-, 20-, 30-, 40-, 50-, 60-, 70- and ≥80 years group, respectively. Conclusions: The Markov Chain Monte Carlo simulation method adjusting censored is suitable for case fatality rate estimation during the epidemic of a new infectious disease. Early identification of the COVID-19 case fatality rate is helpful to the prevention and control of the epidemic.

[Estimating the distribution of COVID-19 incubation period by interval-censored data estimation method]

Objectives: The COVID-19 has been the public health issues of global concern, but the incubation period was still under discussion. This study aimed to estimate the incubation period distribution of COVID-19. Methods: The exposure and onset information of COVID-19 cases were collected from the official information platform of provincial or municipal health commissions. The distribution of COVID-19 incubation period was estimated based on the Log- normal, Gamma and Weibull distribution by interval-censored data estimation method. Results: A total of 109 confirmed cases were collected, with an average age of 39.825 years. The median COVID-19 incubation period based on Log-normal, Gamma, and Weibull distribution were 4.958 (P(25)-P(75): 3.472-7.318) days, 5.083 (P(25)-P(75): 3.511-7.314) days, and 5.695 (P(25)-P(75): 3.675-7.674) days, respectively. Gamma distribution had the largest log-likelihood result. Conclusions: The distribution of COVID-19 incubation period followed the Gamma distribution, and the interval-censored data estimation method can be used to estimate the incubation period distribution.

[Estimating the basic reproduction number of COVID-19 in Wuhan, China]

Objective: The number of confirmed and suspected cases of the COVID-19 in Hubei province is still increasing. However, the estimations of the basic reproduction number of COVID-19 varied greatly across studies. The objectives of this study are 1) to estimate the basic reproduction number (R(0)) of COVID-19 reflecting the infectiousness of the virus and 2) to assess the effectiveness of a range of controlling intervention. Methods: The reported number of daily confirmed cases from January 17 to February 8, 2020 in Hubei province were collected and used for model fit. Four methods, the exponential growth (EG), maximum likelihood estimation (ML), sequential Bayesian method (SB) and time dependent reproduction numbers (TD), were applied to estimate the R(0). Results: Among the four methods, the EG method fitted the data best. The estimated R(0) was 3.49 (95%CI: 3.42-3.58) by using EG method. The R(0) was estimated to be 2.95 (95%CI: 2.86-3.03) after taking control measures. Conclusions: In the early stage of the epidemic, it is appropriate to estimate R(0) using the EG method. Meanwhile, timely and effective control measures were warranted to further reduce the spread of COVID-19.

[Fitting and forecasting the trend of COVID-19 by SEIR(+CAQ) dynamic model]

Objectives: Fitting and forecasting the trend of COVID-19 epidemics. Methods: Based on SEIR dynamic model, considering the COVID-19 transmission mechanism, infection spectrum and prevention and control procedures, we developed SEIR(+CAQ) dynamic model to fit the frequencies of laboratory confirmed cases obtained from the government official websites. The data from January 20, 2020 to February 7, 2020 were used to fit the model, while the left data between February 8-12 were used to evaluate the quality of forecasting. Results: According to the cumulative number of confirmed cases between January 29 to February 7, the fitting bias of SEIR(+CAQ) model for overall China (except for cases of Hubei province), Hubei province (except for cases of Wuhan city) and Wuhan city was less than 5%. For the data of subsequent 5 days between February 8 to 12, which were not included in the model fitting, the prediction biases were less than 10%. Regardless of the cases diagnosed by clinical examines, the numbers of daily emerging cases of China (Hubei province not included), Hubei Province (Wuhan city not included) and Wuhan city reached the peak in the early February. Under the current strength of prevention and control, the total number of laboratory-confirmed cases in overall China will reach 80 417 till February 29, 2020, respectively. Conclusions: The proposed SEIR(+CAQ) dynamic model fits and forecasts the trend of novel coronavirus pneumonia well and provides evidence for decision making.

[Trends of female reproductive health status in Bangladesh from 1999 to 2018]

Objective: To analyze the changes of relevant indicators in reproductive health status among Bangladeshi women from 1999 to 2018 and to assess whether the 2030 Sustainable Development Goals (SDGs) can be achieved. Methods: Data were obtained from both the Bangladesh Demographic and Health as well as from the Maternal Mortality and Health Care Surveys. The trends of SDGs indicators related to reproductive health from 1999 to 2018 were analyzed and compared, and the average annual rate of change was calculated. Development index was used to assess the difficulty of achieving the SDGs. Results: The maternal mortality rate increased first and then leveled off from 2001 to 2016. From 1999 to 2018, the coverage of reproductive health care services and the proportion of women who had the right to make the decision on their own health care service, were generally increasing. Proportion of the following areas as: "contraceptive needs, women who consider that partner violence is justified, the rate of early marriage, and the rate of early childbearing etc.", were declining at various degrees. Development index of the antenatal care coverage, rate of delivery in medical facilities, percentage of live births attended by medically trained providers and the rate of postnatal care etc., were less than 1. The development indices of the maternal mortality rates were close to 1, while all the other indicators were greater than 1. Conclusions: The reproductive health-related SDGs indicators in Bangladesh appeared somehow degrees of progress from 1999 to 2018. However, for most indicators, the average annual rate of change was still lower than the expected to achieve the 2030 target which called for acceleration in the next few years.

Assessment of control strategies against Clonorchis sinensis infection based on a multi-group dynamic transmission model

Clonorchiasis is one of the most important food-borne trematodiases affecting millions of people. Strategies were recommended by different organizations and control programmes were implemented but mostly in short-time periods. It's important to assess the long-term benefits and sustainability of possible control strategies on morbidity control of the disease. We developed a multi-group transmission model to describe the dynamics of C. sinensis transmission among different groups of people with different raw-fish-consumption behaviors, based on which, a full model with interventions was proposed and three common control measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental modification) and their possible combinations were considered. Under a typical setting of C. sinensis transmission, we simulated interventions according to different strategies and with a series of values of intervention parameters. We found that combinations of measures were much beneficial than those singly applied; higher coverages of measures had better effects; and strategies targeted on whole population performed better than that on at-risk population with raw-fish-consumption behaviors. The strategy recommended by the government of Guangdong Province, China shows good and sustainable effects, under which, the infection control (with human prevalence <5%) could be achieved within 7.84 years (95% CI: 5.78-12.16 years) in our study setting (with original observed prevalence 33.67%). Several sustainable strategies were provided, which could lead to infection control within 10 years. This study makes the effort to quantitatively assess the long-term effects of possible control strategies against C. sinensis infection under a typical transmission setting, with application of a multi-group dynamic transmission model. The proposed model is easily facilitated with other transmission settings and the simulation outputs provide useful information to support the decision-making of control strategies on clonorchiasis.

Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data

Background

Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited.

Objective

This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app.

Methods

A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status.

Results

A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=−0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=−0.8306; P<.001) and a lower positive emotion score (beta=−0.3743; P<.001).

Conclusions

The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time.

A Recurrence Predictive Model for Thymic Tumors and Its Implication for Postoperative Management: a Chinese Alliance for Research in Thymomas Database Study

OBJECTIVE

Our aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection.

METHODS

The Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model.

RESULTS

A total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group.

CONCLUSIONS

A 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.

[Spatial distribution of cancer-related burden in Guangzhou from 2010 to 2013]

Objective: To evaluate the burden and to describe the characteristics of spatial distribution caused by malignant tumors among different administrative areas in Guangzhou from 2010- 2013. Methods: Based on data from the Cancer Registry system and population in Guangzhou in 2010- 2013, disability-adjusted life year (DALY) was assessed on the disease burden of cancer, in accordance with the method used in the Global Burden of Disease study. Results: The crude incidence rates of cancer appeared as 256.22/10(5) in 2010-2011 and 270.04/10(5) in 2012-2013, with the crude mortality rates as 143.17/10(5) and 148.01/10(5), respectively, in Guangzhou. Cancers caused 606 238.95 DALYs in 2010-2011 and 623 763.80 DALYs in 2012-2013 for both sexes and 37.63 and 37.81 person year per 1 000 persons, with the standardized DALY rates as 34.51‰, 34.00‰ respectively. Three administrative districts (Yuexiu, Haizhu and Liwan) were with the largest disease burden of cancers that accounted for 45% of the DALYs for the whole Conghua district, with liver cancer was the leading cancer on DALYs, and tracheal, bronchus and lung cancer ranked the first in the other districts. Conclusions: In Guangzhou, disease burden caused by cancers was both prominently seen in the newly developed urban area and the old districts. It remains an arduous task to continue programs on control and prevention of cancers in this city.

[Health-related quality of life and health-adjusted life expectancy among patients with chronic non-communicable diseases, in Guangdong province]

Objective: To estimate the health-related quality of life (HRQOL) and health-adjusted life expectancy (HALE) which were associated with chronic non-communicable diseases (NCDs) in people from Guangdong province of China. Methods: Data on both NCDs prevalence and EuroQol-5 Dimensions-3 Levels measured HRQOL were gathered from the Fifth National Health Survey in Guangdong province, 2013. Logistic regression model and multiple linear regression model were employed to explore the impact of NCDs on HRQOL. Life expectancy (LE) and HALE were used to evaluate the comprehensive impact of chronic diseases on population health. Results: A total of 68 550 inhabitants were included in the analysis. Graded logistic regression showed that the impact of chronic diseases on all dimensions of quality of life was statistically significant after adjusting for social demographic characteristics. The greatest health impact was on the pain/discomfort health dimension [OR=4.48 (95%CI:4.20-4.77)], followed by anxiety/depression[OR=3.95 (95%CI: 3.62- 4.31)], daily activities [OR=3.69 (95%CI: 3.37-4.04)], mobility [OR=3.63 (95%CI: 3.34-3.94)]and ability on self-care [OR=3.30 (95%CI: 2.98-3.66)]. Losses of LE and HALE caused by NCDs were 12.7 and 14.6 years respectively while the overall expected gain was 3.8 years in HALE, when NCDs were taken away. Conclusions: Our data showed that NCDs had shortened the healthy life span of patients through reducing the HRQOL and also causing heavy disease burden on both patients with NCDs and the communities. Health-care related policies on NCDs need to be developed, for the elderly, in particular.

Prenatal exposure to perfluoroalkyl substances is associated with lower hand, foot and mouth disease viruses antibody response in infancy: Findings from the Guangzhou Birth Cohort Study

BACKGROUND

Perfluoroalkyl substances (PFASs) are synthetic chemicals widely used in industry and for commercial products. Their immunomodulatory effects are a growing health concern in children. Hand, Foot and Mouth Disease (HFMD) is a common childhood viral infection, and increased incidence of which has parallel the rise in PFAS exposure in the Asia-Pacific region.

OBJECTIVE

We conducted the first study to assess whether prenatal exposure to PFAS was associated with a reduction in HFMD virus antibodies in infants.

METHODS

We enrolled 201 mother-infant pairs from the Guangzhou Birth Cohort Study from July to October 2013. High performance liquid chromatography-mass spectrometry was employed to determine concentrations of specific PFAS isomers in cord blood. Neutralizing antibodies titers were measured against two HFMD viruses, enterovirus 71 (EV71) and coxsackievirus A 16 (CA16), in cord blood serum and blood serum at three months of age.

RESULTS

Higher umbilical cord blood PFAS concentrations were associated with lower EV71 and CA16 antibody concentrations. A doubling in the composite sum of cord blood PFASs in three month old infants was associated with significant increase in the risk of HFMD antibody concentration below clinical protection level (≥1:8 titers) for CA16 (odds ratio, OR: 2.74 [95% confidence interval (CI): 1.33, 5.61] and for EV71 (OR = 4.55, 95% CI: 1.45, 4.28). This association was higher in boys at three months of age for CA16.

CONCLUSIONS

Our findings suggest that cord blood PFAS exposure is associated with lower HFMD antibody in infancy. Given the widespread nature of PFAS exposures and the high global incidence of HFMD globally, these findings have substantial public health implications and therefore, these associations need to be replicated in a larger study to more definitively address the risk.

[Impact of the 90-90-90 goal and pre-exposure prophylaxis on HIV transmission and elimination in men who have sex with men in China: A mathematical modeling study]

Objective: To establish a dynamic compartmental model to predict the impact of HIV testing and treatment and pre-exposure prophylaxis (PrEP) on the annual incidence of HIV infection in men who have sex with men (MSM) in China from 2018 to 2037. Methods: A dynamic compartmental model was developed to describe the HIV epidemic in MSM in China. The model was parameterized using data from the literature available. We used MATLAB 7.0 software for data simulation and graphics rendering. We analyzed HIV transmission among MSM and estimated the impact of expanded HIV testing and treatment and PrEP on HIV elimination in MSM. Results: Under the current policy, the number of new HIV infections would reach 770 000, the infection rate would reach 11.1% and the incidence rate would reach 0.72/100 person years in MSM in the next 20 years. Under the 90%-90%-90% goal, 440 000 new infections (57.7%) would be reduced, the HIV infection rate would decline to 5.7% and the incidence rate would decline to 0.24/100 person years in the next 20 years, but it is still unlikely to achieve the goal of HIV elimination. With 100% PrEP compliance, the required PrEP coverage rates for achieving HIV elimination in the next 10, 15 and 20 years would be 65%, 32% and 19%, respectively. Conclusion: It is necessary to strengthen the comprehensive intervention in MSM, continue to expand HIV testing and treatment, and improve PrEP adherence and coverage to further control and eliminate the epidemic of HIV/AIDS in MSM.

Intimate relationship characteristics as determinants of HIV risk among men who have sex with regular male sex partners: a cross-sectional study in Guangzhou, China

Background

China faces a serious HIV epidemic among men who have sex with men (MSM), and a large proportion of new infections are attributed to their regular male sex partners (RP). The objective of this study was to investigate the association between intimate relationship characteristics and HIV-related behaviors among MSM with RP in Guangzhou, China.

Methods

A convenience-sampling method was used in data collection. A total of 608 MSM were screened, of whom 406 HIV negative MSM with at least one RP in the past six months were used for data analysis. Three-step logistic regressions were used to analyze the data.

Results

The prevalence of unprotected anal intercourse (UAI) with regular male sex partners, non-regular male sex partners, and concurrent UAI in the past six months was 53.9%, 23.6%, 20.7%, respectively. Variables associated with UAI with regular male sex partners included expectations for this relationship (adjusted odds ratio in multiple forward stepwise logistic regression, OR_m = 1.66) and open communication about the sexual relationship (OR_m = 1.79), while expectations for the relationship (OR_m = 0.46 to 0.54) and conflicts of interest (OR_m = 5.46 to 5.97) were associated with concurrent UAI and UAI with non-regular male sex partners.

Conclusion

Intimate relationship characteristics were related to HIV-related risk behaviors. Future HIV prevention interventions should take MSM couples into consideration, include a focus on the quality of their intimate relationships, and encourage open communication about their sexual relationships.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3044-6) contains supplementary material, which is available to authorized users.

[Correlation between percentage of body fat and simple anthropometric parameters in children aged 6-9 years in Guangzhou]

Objective: To evaluate the accuracy of simple anthropometric parameters in diagnosing obesity in children in Guangzhou. Methods: A cross-sectional study, including 465 children aged 6-9 years, was carried out in Guangzhou. Their body height and weight, waist circumference (WC) and hip circumference were measured according to standard procedure. Body mass index (BMI), waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Body fat percentage (BF%) was determined by dual-energy X-ray absorptiometry. Multiple regression analysis was applied to evaluate the correlations between age-adjusted physical indicators and BF%, after the adjustment for age. Obesity was defined by BF%. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of the indicators for childhood obesity. Area under-ROC curves (AUCs) were calculated and the best cut-off point that maximizing 'sensitivity + specificity-1' was determined. Results: BMI showed the strongest association with BF% through multiple regression analysis. For 'per-standard deviation increase' of BMI, BF% increased by 5.3% (t=23.1, P<0.01) in boys and 4.6% (t=17.5, P<0.01) in girls, respectively. The ROC curve analysis indicated that BMI exhibited the largest AUC in both boys (AUC=0.908) and girls (AUC=0.895). The sensitivity was 80.8% in boys and 81.8% in girls, and the specificity was 88.2% in boys and 87.1% in girls. Both the AUCs for WHtR and WC were less than 0.8 in boys and girls. WHR had the smallest AUCs (<0.8) in both boys and girls. Conclusion: BMI appeared to be a good predicator for BF% in children aged 6-9 years in Guangzhou.

The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study

OBJECTIVE

To investigate the relationship between job satisfaction, work stress, work-family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China.

METHODS

From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work-family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis.

RESULTS

A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work-family conflict.

CONCLUSION

Job satisfaction, work stress, work-family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention.

Effects of in utero and Postnatal Exposure to Secondhand Smoke on Lung Function by Gender and Asthma Status: The Seven Northeastern Cities (SNEC) Study

BACKGROUND

Little information exists on whether gender or asthma status modifies the effects of secondhand smoke (SHS) exposure on lung function.

OBJECTIVE

To evaluate whether gender or asthma status modifies the association of SHS exposure with lung function.

METHODS

A total of 6,740 children (average 11.6 years) were recruited from 24 districts of 7 cities in northeast China in 2012. SHS exposure included exposure to environmental and maternal smoking both in utero and during early childhood (postnatal). Lung function was measured using electronic spirometers. Two-step regressions were used to analyze the association between SHS and lung function.

RESULTS

In utero and postnatal exposure to SHS was independently associated with decreased lung function in both genders; however, this association was greater among males. For example, when exposed to maternal smoking during pregnancy, the adjusted odds ratio (aOR) for decreased forced vital capacity (FVC) was 6.46 (95% confidence interval [CI]: 2.58-16.17) among males, while only 2.16 (95% CI: 0.96-4.88) among females. More positive associations between SHS exposure and decreased lung function were detected among nonasthmatic compared with asthmatic children. Nonasthmatics had significantly larger deficits from in utero exposure to maternal smoking, which concerned decreased lung FVC function (aOR = 2.58, 95% CI: 1.28-5.21) and decreased lung forced expiratory volume in 1 s (FEV1) function (aOR = 2.32, 95% CI: 1.01-5.33). A similar pattern was also observed for the associations between SHS exposure and continuous pulmonary function test measurements.

CONCLUSIONS

SHS exposure was associated with decreased lung function. Males and nonasthmatics seem to be more susceptible than their respective counterparts.

Phase II trial of S-1 plus leucovorin in patients with advanced gastric cancer and clinical prediction by S-1 pharmacogenetic pathway

Background

The first one-arm phase II trial aimed to evaluate and predict efficacy and safety of S-1 plus oral leucovorin (S-1/LV) as first-line chemotherapy for patients with advanced gastric cancer (AGC), using S-1 pharmacogenetic pathway approach.

Patients and methods

A total of 39 patients orally took S-1 at conventional dose and LV simultaneously at a dose of 25 mg twice daily for a week, within a 2-week cycle. The primary endpoint was overall response rate (ORR), while the secondary endpoints were progression-free survival (PFS), time to failure (TTF), overall survival (OS), disease control rate (DCR), and adverse events (AEs). Peripheral blood was sampled prospectively for baseline expression of dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), thymidine phosphorylase (TP), and thymidylate synthase (TS), CYP2A6 gene polymorphisms, and 5-FU pharmacokinetics.

Results

The ORR and DCR were 41.0 and 76.9%. The median PFS, TTF, and OS were 4.13, 3.70, and 11.40 months. Grade 3–4 AEs occurred in only 13 patients, and grade 4 AEs occurred in only 1 of them. High OPRT/TS and peritoneal metastasis (vs. liver metastasis) independently predicted responding. High OPRT/DPD independently predicted grade 3–4 AEs. High AUC_0–24h of 5-FU and metastatic/recurrent sites ≤2 (vs. >3) independently predicted prolonged PFS. Low baseline plasmic DPD independently predicted prolonged OS.

Conclusions

Two-week, oral S-1/LV regimen demonstrated promising efficacy and safety as first-line chemotherapy for AGC.

ClinicalTrials.gov identifier

NCT02090153

Electronic supplementary material

The online version of this article (doi:10.1007/s00280-016-3209-1) contains supplementary material, which is available to authorized users.

Comparison of body mass index with abdominal obesity for identifying elevated blood pressure in children and adolescents: The SNEC study

Body mass index (BMI) and waist circumference (WC) are two common ways to measure obesity. There is a debate, however, about which of these two measures are more closely associated with elevated blood pressure (BP). The aim of this study is to investigate the prevalence of obesity and whether BMI and WC is better associated with elevated BP in children and adolescents. A representative sample of 8613 Chinese youth aged 7-17 years from seven cities in Northeastern China was selected and measurements of height, weight, WC, BP were taken from 2012 to 2013. The average age of the children was 11.3±2.3years. The prevalence of overweight/obese and abdominal obesity in the subjects was 35% and 44.8%, respectively. We found that both BMI and WC were significantly associated with elevated BP. An increase of 1kgm^-2 in BMI was associated with a 1.10 (1.08-1.12, 95% CI) increased risk of an elevated BP diagnosis in boys, and a 1.14 (1.11-1.16, 95% CI) increased risk in girls. Meanwhile, a 1cm increase in WC correlated with a 1.03 (1.02-1.04, 95% CI) and a 1.05 (1.04-1.06, 95% CI) increased risk of higher BP in boys and girls, respectively. Compared to the normal-weight youth, subjects with elevated BMI (BMI>85th) had higher risk of elevated BP (OR: 2.42, 95% CI: 2.13-2.75) than that of in elevated WC participants (OR: 2.00, 95% CI: 1.77-2.27). Therefore, BMI may associate better with elevated BP than WC in Chinese youth in our Seven Northeastern Cities study.

Job satisfaction and associated factors among healthcare staff: a cross-sectional study in Guangdong Province, China

OBJECTIVES

This cross-sectional study aimed to explore job satisfaction among healthcare staff in Guangdong following the health system reforms in 2009, and to investigate the association between job satisfaction and work stress, work-family conflict and doctor-patient relationship.

DESIGN

Cross-sectional survey.

SETTING

The Fifth National Health Service Survey was carried out in Guangdong, China.

PARTICIPANTS

All participants in this study were healthcare staff including physicians, nurses and public health staff from hospitals, health service centres and health clinics. A total of 6583 questionnaires were distributed and collected. After excluding the incomplete questionnaires, 5845 questionnaires were included for the analysis.

OUTCOME MEASURES

Sociodemographic information and scores for evaluating job satisfaction, work stress, work-family conflict and doctor-patient relationship were obtained using the questionnaire developed by the National Health and Family Planning Commission of the People's Republic of China. To assess the significantly associated factors on job satisfaction of the healthcare staff in Guangdong, a binary logistic regression model was used.

RESULTS

Based on the 5845 valid responses of the healthcare staff who worked in Guangdong, the mean score of overall perception of job satisfaction was 3.99 on a scale of 1-6. Among the sociodemographic variables, occupation, educational background, professional status, years of service, annual income and night shift frequency significantly influenced the level of job satisfaction. Work stress, work-family conflict and doctor-patient relationship also had significant effect on job satisfaction.

CONCLUSIONS

The overall job satisfaction exceeded slightly dissatisfied (score 3) and approached slightly satisfied (score 4). Measures to enhance job satisfaction include the reduction of workload, increase of welfare, maintaining moderate stress and balancing work-family conflict. Moreover, relevant laws should be issued to protect the healthcare staff from violent acts.

Positive associations of serum perfluoroalkyl substances with uric acid and hyperuricemia in children from Taiwan

To investigate the risk of hyperuricemia in relation to Perfluoroalkyl substances (PFASs) in children from Taiwan, 225 Taiwanese children aged 12-15 years were recruited from 2009 to 2010. Linear and logistic regression models were employed to examine the influence of PFASs on serum uric acid levels. Findings revealed that eight of ten PFASs analyses were detected in >94% of the participants' serum samples. Multivariate linear regression models revealed that perfluorooctanic acid (PFOA) was positively associated with serum uric acid levels (β = 0.1463, p < 0.05). Of all the PFASs analyses, only PFOA showed a significant effect on elevated levels of hyperuricemia (aOR = 2.16, 95%CI: 1.29-3.61). When stratified by gender, the association between serum PFOA and uric acid levels was only evident among boys (aOR = 2.76, 95%CI: 1.37-5.56). In conclusion, PFOA was found to be associated with elevated serum levels of uric acid in Taiwanese children, especially boys. Further research is needed to elucidate these links.

Reliability, validity and responsiveness of the Chinese version of Liver Disease Quality of Life Questionnaire in viral hepatitis patients

AIM: To determine the reliability, validity and responsiveness of the Chinese version of Liver Disease Quality of Life Questionnaire (LDQOL1.0) in viral hepatitis patients.

METHODS: The questionnaire was administered to 100 patients with viral hepatitis and 91 returned the questionnaire. Cronbach α, ceiling effect and flooring effect were calculated to test the reliability of this questionnaire. Relationship coefficients between liver disease specific dimensions and SF-36 were calculated to test the standard validity of the questionnaire. Exploring factor analysis was used to test the questionnaire's construct validity. Responsiveness was tested by comparing scores of patients with different Child Pugh scores. Pearson coefficient was used to show the relationship and ANOVA analysis was used to test responsiveness.

RESULTS: Cronbach α ranged from 0.33 (95%CI: 0.08-0.52) to 0.9 (95%CI: 0.90-0.99), and 80% of domains had a Cronbach α value higher than 0.7. Ceiling effects ranged from 0% to 39.6%, and flooring effects ranged from 0% to 34.1%, with most domains having the values less than 20%. Six of twelve domains were related closely with SF-36 (Pearson coefficient > 0.5, P < 0.05). Exploring factor analysis showed that 7 of 12 domains concurred with original imagination. Responsiveness showed that 6 of 12 domains were good (F: 0.353-21.29, P < 0.05).

CONCLUSION: Most domains of LDQOL1.0 had good reliability, validity and responsiveness when it was used to test quality of life in Chinese patients with viral hepatitis.

Gender-specific differences of interaction between obesity and air pollution on stroke and cardiovascular diseases in Chinese adults from a high pollution range area: A large population based cross sectional study

BACKGROUND

Little information exists regarding the interaction effects of obesity with long-term air pollution exposure on cardiovascular diseases (CVDs) and stroke in areas of high pollution. The aim of the present study is to examine whether obesity modifies CVD-related associations among people living in an industrial province of northeast China.

METHODS

We studied 24,845 Chinese adults, aged 18 to 74 years old, from three Northeastern Chinese cities in 2009 utilizing a cross-sectional study design. Body weight and height were measured by trained observers. Overweight and obesity were defined as a body mass index (BMI) between 25-29.9 and ≥30 kg/m(2), respectively. Prevalence rate and related risk factors of cardiovascular and cerebrovascular diseases were investigated by a questionnaire. Three-year (2006-2008) average concentrations of particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were measured by fixed monitoring stations. All the participants lived within 1 km of air monitoring sites. Two-level logistic regression (personal level and district-specific pollutant level) was used to examine these effects, controlling for covariates.

RESULTS

We observed significant interactions between exposure and obesity on CVDs and stroke. The associations between annual pollutant concentrations and CVDs and stroke were strongest in obese subjects (OR 1.15-1.47 for stroke, 1.33-1.59 for CVDs), less strong in overweight subjects (OR 1.22-1.35 for stroke, 1.07-1.13 for CVDs), and weakest in normal weight subjects (OR ranged from 0.98-1.01 for stroke, 0.93-1.15 for CVDs). When stratified by gender, these interactions were significant only in women.

CONCLUSIONS

Study findings indicate that being overweight and obese may enhance the effects of air pollution on the prevalence of CVDs and stroke in Northeastern metropolitan China. Further studies will be needed to investigate the temporality of BMI relative to exposure and onset of disease.

Novel immunological and nutritional-based prognostic index for gastric cancer

AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer.

METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias.

RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage II-III disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.

CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.

Reliability and validity of the Chinese version of the Liver Disease Quality of Life Questionnaire (LDQOL 1.0)

AIM: To evaluate the reliability and validity of Chinese version of Liver Disease Quality of Life Questionnaire (LDQOL 1.0)

METHODS: This was an observational, cross-sectional study in Chinese patients from Beijing University Shenzhen Hospital. Feasibility was assessed by analyzing administration times and missing responses. Ceiling and flooring effects were calculated and reliability was tested by examining internal consistency (Cronbach's alpha). Convergent validity was tested by examining correlations between LDQOL disease specific and Short Form health survey with 36 questions (SF-36) dimensions.

RESULTS: A total of 48 patients were included for analysis. Mean age was 39.3 years and 73% of the sample were male. Mean time to complete questionnaire was 35.8 min ±12.2 min. Missing responses were highest on the dimensions of sexual functioning. Ceiling effects were over 20% on 1 of the LDQOL's 12 disease-specific scales. Cronbach's alpha coefficients were over 0.70 on all but 6 dimensions. Correlations between SF-36 and LDQOL disease-specific dimensions generally fulfilled the hypotheses.

CONCLUSION: The Chinese version of the LDQOL 1.0 has shown satisfactory reliability and validity.