Temperature extremes and infectious diarrhea in China: attributable risks and effect modification of urban characteristics.

Studies about the role of urban characteristics in modifying the health effect of temperature extremes are still unclear. This study is aimed at quantifying the morbidity risk of infectious diarrhea attributable to temperature extremes and the modified effect of a range of city-specific indicators. Distributed lag non-linear model and multivariate meta-regression were applied to estimate fractions of infectious diarrhea morbidity attributable to temperature extremes and to explore the effect modification of city-level characteristics. Extreme heat- and extreme cold-related infectious diarrhea amounted to 0.99% (95% CI: 0.57-1.29) and 1.05% (95% CI: 0.64-1.24) of the total cases, respectively. The attributable fraction of temperature extremes on infectious diarrhea varied between southern and northern China. Several city characteristics modified the association of extreme cold with infectious diarrhea, with a higher morbidity impact related to increased water consumption per capita and decreased latitude. Regions with higher levels of latitude or GDP per capita appeared to be more sensitive to extreme hot. In conclusion, exposure to temperature extremes was associated with increased risks of infectious diarrhea and the effect can be modified by urban characteristics. This finding can inform public health interventions to decrease the adverse effects of temperature extremes on infectious diarrhea.

Forecast and early warning of hand, foot, and mouth disease based on meteorological factors: Evidence from a multicity study of 11 meteorological geographical divisions in mainland China.

BACKGROUND: Hand, foot, and mouth disease (HFMD) is a significant public health issue in China. Early warning and forecasting are one of the most cost-effective ways for HFMD control and prevention. However, relevant research is limited, especially in China with a large population and diverse climatic characteristics. This study aims to identify local specific HFMD epidemic thresholds and construct a weather-based early warning model for HFMD control and prevention across China. METHODS: Monthly notified HFMD cases and meteorological data for 22 cities selected from different climate zones from 2014 to 2018 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) based on meteorological factors was conducted to forecast HFMD epidemics. The receiver operator characteristic curve (ROC) was generated to determine the value of optimal warning threshold. RESULTS: The developed model was solid in forecasting the epidemic of HFMD with all R square (R2) in the 22 cities above 85%, and mean absolute percentage error (MAPE) less than 1%. The warning thresholds varied by cities with the highest threshold observed in Shenzhen (n = 7195) and the lowest threshold in Liaoyang (n = 12). The areas under the curve (AUC) was greater than 0.9 for all regions, indicating a satisfied discriminating ability in epidemics detection. CONCLUSIONS: The weather-based HFMD forecasting and early warning model we developed for different climate zones provides needed information on occurrence time and size of HFMD epidemics. An effective early warning system for HFMD could provide sufficient time for local authorities to implement timely interventions to minimize the HFMD morbidity and mortality.

Growth Trajectories of Peer Norms, Self-efficacy and Condom Use Behavior Among Sexually Active Chinese Men Who Have Sex with Men: Latent Class Analysis and Growth Mixture Modeling.

Data from a randomized controlled trial in 2015 were used to estimate the growth trajectories of peer norms, self-efficacy, and condom use behavior, and to identify associated sociodemographic and behavioral factors among a sample of 804 Chinese men who have sex with men (MSM). Latent class analysis and growth mixture modeling were conducted using Mplus. Two growth trajectories were estimated for each outcome variable with good model fit. The growth trajectories of peer norms were related to age (ß = - 0.066, p < 0.05). The growth trajectories of self-efficacy were related to age (ß = 0.057, p < 0.01) and using a condom during first sexual encounter with another man (ß = 0.777, p < 0.001). The growth trajectories of condom use behavior were related to income (ß = 0.366, p < 0.01) and having casual male partners (ß = - 1.016, p < 0.001). Predictors for the growth factors within each latent class were also estimated. For subsets of MSM who are older, richer, used a condom during their first sexual encounter with another man, and do not have a casual male partner, condom videos may not have sufficient efficacy and other interventions may be necessary.

Mediation Analysis of Peer Norms, Self-Efficacy, and Condom Use Among Chinese Men Who Have Sex with Men: A Parallel Process Latent Growth Curve Model.

The objective of this study was to examine direct and indirect relationships among peer norms, self-efficacy, and condom use among Chinese men who have sex with men (MSM). A longitudinal study determined the effectiveness of a condom use video promotion among Chinese MSM in 2015. In this analysis, 804 Chinese MSM were recruited at baseline and then followed at 3 weeks and 3 months after the intervention. Parallel process latent growth curve modeling (LGM) with multiple indicators and bootstrapping was conducted using Mplus 7.4. The LGM model fit indexes were good with RMSEA = 0.046, 90% CI (0.044, 0.048), CFI = 0.956, TLI = 0.955. Our results showed that the initial measure of peer norms affected the initial measure of condom use indirectly through the initial measure of self-efficacy (αß = 0.414, 95% CI 0.260-0.759). The rate of change in peer norms over time also significantly affected the rate of change in condom use through the rate of change in self-efficacy (αß = 0.101, 95% CI 0.014-0.262). Self-efficacy mediated the association between peer norms and condom use, indicating a strong potential of causal relationship between peer norms and self-efficacy among Chinese MSM.

The effect of temperature on childhood hand, foot and mouth disease in Guangdong Province, China, 2010-2013: a multicity study.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a serious infectious disease, which has become a public health problem. Previous studies have shown that temperature may influence the incidence of HFMD, but most only focus on single city and the results are highly heterogeneous. Therefore, a multicity study was conducted to explore the association between temperature and HFMD in different cities and search for modifiers that influence the heterogeneity. METHODS: We collected daily cases of childhood HFMD (aged 0-5 years) and meteorological factors of 21 cities in Guangdong Province in the period of 2010-2013. Distributed lag non-linear model (DLNM) with quasi-Poisson was adopted to quantify the effects of temperature on HFMD in 21 cities. Then the effects of each city were pooled by multivariate meta-analysis to obtain the heterogeneity among 21 cities. Potential city-level factors were included in meta-regression to explore effect modifiers. RESULTS: A total of 1,048,574 childhood cases were included in this study. There was a great correlation between daily childhood HFMD cases and temperature in each city, which was non-linear and lagged. High heterogeneity was showed in the associations between temperature and HFMD in 21 cities. The pooled temperature-HFMD association was peaking at the 79th percentile of temperature with relative risk (RR) of 2.474(95% CI: 2.065-2.965) as compared to the median temperature. Latitude was the main modifier for reducing the heterogeneity to 69.28% revealed by meta-analysis. CONCLUSIONS: There was a strong non-linear and lagged correlation between temperature and HFMD. Latitude was strongly associated with the relationship between temperature and HFMD. Meanwhile, it had an effect on modifying the relationship. These findings can conducive to local governments developing corresponding preventive measures.

Effects and interaction of meteorological factors on influenza: Based on the surveillance data in Shaoyang, China.

BACKGROUND: Previous studies have demonstrated that meteorological factors influence the incidence of influenza. However, little is known regarding the interactions of meteorological factors on the risk of influenza in China. OBJECTIVE: The study aimed to evaluate the associations between meteorological factors and influenza in Shaoyang of southern China, and explore the interaction of temperature with humidity and rainfall. METHODS: Weekly meteorological data and disease surveillance data of influenza in Shaoyang were collected from 2009 to 2012. According to the incubation period and infectious period of influenza virus, the maximum lag period was set as 3 weeks. A generalized additive model was conducted to evaluate the effect of meteorological factors on the weekly number of influenza cases and a stratification model was applied to investigate the interaction. RESULTS: During the study period, the total number of influenza cases that were notified in the study area was 2506, with peak times occurring from December to March. After controlling for the confounders, each 5 °C decrease in minimum temperature was related to 8% (95%CI: 1-15%) increase in the number of influenza cases at a 1-week lag. There was an interaction between minimum temperature and relative humidity and the risk of influenza was higher in cold and less humid conditions than other conditions. The interaction between minimum temperature and rainfall was not statistically significant in our study. CONCLUSIONS: The study suggests that minimum temperature is inversely associated with influenza in the study area of China, and the effect can be modified by relative humidity. Meteorological variables could be integrated in current public health surveillance system to better prepare for the risks of influenza.

A time-trend ecological study for identifying flood-sensitive infectious diseases in Guangxi, China from 2005 to 2012.

BACKGROUND: Flood-related damage can be very severe and include health effects. Among those health impacts, infectious diseases still represent a significant public health problem in China. However, there have been few studies on the identification of the spectrum of infectious diseases associated with floods in one area. This study aimed to quantitatively identify sensitive infectious diseases associated with floods in Guangxi, China. METHODS: A time-trend ecological design was conducted. A descriptive analysis was first performed to exclude infectious diseases with low incidence from 2005 to 2012 in ten study sites of Guangxi. The Wilcoxon rank-sum test was applied to examine the difference in the ten-day attack rate of infectious diseases between the exposure and control periods with different lagged effects. Negative binomial, zero-inflated Poisson and zero-inflated negative binomial models were used to examine the relationship and odd ratios (ORs) of the risk of floods on infectious diseases of preliminary screening. RESULTS: A total of 417,271 infectious diseases were notified. There were 11 infectious diseases associated with floods in the preliminary screening process for flood-sensitive infectious diseases. The strongest effect was shown with a 0-9 ten-day lag in different infectious diseases. Multivariate analysis showed that floods were significantly associated with an increased the risk of bacillary dysentery (odds ratio (OR) = 1.268, 95% confidence interval (CI): 1.072-1.500), acute haemorrhagic conjunctivitis (AHC, OR = 3.230, 95% CI: 1.976-5.280), influenza A (H1N1) (OR = 1.808, 95% CI: 1.721-1.901), tuberculosis (OR = 1.200, 95% CI: 1.036-1.391), influenza (OR = 2.614, 95% CI: 1.476-4.629), Japanese encephalitis (OR = 2.334, 95% CI: 1.119-4.865), and leptospirosis (OR = 1.138, 95% CI: 1.075-1.205), respectively. CONCLUSION: The spectrum of infectious diseases which are associated with floods are bacillary dysentery, AHC, influenza A (H1N1), tuberculosis, influenza, Japanese encephalitis and leptospirosis in Guangxi. Floods can result in differently increased risk of these diseases, and public health action should be taken to control a potential risk of these diseases after floods.

Identifying different types of flood-sensitive diarrheal diseases from 2006 to 2010 in Guangxi, China.

Floods may influence different types of diarrheal diseases and epidemiological studies of pathogen-specific diarrhea due to floods in China are still needed. In addition, few studies have been conducted to quantify the lag and cumulative risk of diarrheal disease due to floods in Guangxi, China. Our study aimed to identify different types of diarrheal diseases that were sensitive to floods and to quantify their lag and cumulative impact. A matched analysis based on time series data of floods and infectious disease from 2006 to 2010 was conducted in Guangxi, China. Each flood day was treated as an independent unit in our study. A simplified assumption that each day of the flood confers the same risk was adopted before analysis. Each flood day was matched to a non-flood day by city and time. Log-linear mixed-effects regression models were used to quantify the association between different types of diarrheal diseases and floods. Lag and cumulative effects were also calculated to get delayed and overall effects. A total of 45,131 diarrhea cases were notified in the study area over the study period. After controlling for the long-term trend, seasonality, and meteorological factors, floods caused a significantly increased risk of total diarrheal diseases. The RR was highest at lag 2 days (RR=1.24, 95% CI: 1.11-1.40). Floods caused a significantly increased risk in bacillary dysentery and in other infectious diarrhea, but not in typhoid fever and paratyphoid fever. Floods were significantly associated with total diarrheal diseases and other infectious diarrhea for both cumulative lag 0-7 and 0-14 days. Our study provides strong evidence of a positive association between floods and diarrheal diseases including bacillary dysentery and other infectious diarrhea in study area. Public health interventions should be taken to prevent a potential risk of these flood-sensitive diarrheal diseases according to the different lag period after floods.

Association between floods and typhoid fever in Yongzhou, China: Effects and vulnerable groups.

BACKGROUND: Little information about the effects of floods on typhoid fever is available in previous studies. This study aimed to examine the relationships between floods and typhoid fever and to identify the vulnerable groups in Yongzhou, China. METHODS: Weekly typhoid fever data, flood data and meteorological data during the flood season (April to September) from 2005 to 2012 were collected for this study. A Poisson generalized linear model combined with a distributed lag non-linear model was conducted to quantify the lagged and cumulative effects of floods on typhoid fever, considering the confounding effects of long-term trend, seasonality, and meteorological variables. The model was also used to calculate risk ratios of floods for weekly typhoid fever cases among various subpopulations. RESULTS: After adjusting for long-term trend, seasonality, and meteorological variables, floods were associated with an increased number of typhoid fever cases with a risk ratio of 1.46 (95% CI: 1.10-1.92) at 1-week lag and a cumulative risk ratio of 1.76 (95% CI: 1.21-2.57) at lag 0-1 weeks. Males, people aged 0-4 years old, people aged 15-64 years old, farmers, and children appeared to be more vulnerable than the others. CONCLUSIONS: Our study indicates that floods could significantly increase the risks of typhoid fever with lag effects of 1 week in the study areas. Precautionary measures should be taken with a focus on the identified vulnerable groups in order to control the transmission of typhoid fever associated with floods.

Ambient high temperature and mortality in Jinan, China: A study of heat thresholds and vulnerable populations.

BACKGROUND: Understanding the health consequences of continuously rising temperatures-as is projected for China-is important in terms of developing heat-health adaptation and intervention programs. This study aimed to examine the association between mortality and daily maximum (Tmax), mean (Tmean), and minimum (Tmin) temperatures in warmer months; to explore threshold temperatures; and to identify optimal heat indicators and vulnerable populations. METHODS: Daily data on temperature and mortality were obtained for the period 2007-2013. Heat thresholds for condition-specific mortality were estimated using an observed/expected analysis. We used a generalised additive model with a quasi-Poisson distribution to examine the association between mortality and Tmax/Tmin/Tmean values higher than the threshold values, after adjustment for covariates. RESULTS: Tmax/Tmean/Tmin thresholds were 32/28/24°C for non-accidental deaths; 32/28/24°C for cardiovascular deaths; 35/31/26°C for respiratory deaths; and 34/31/28°C for diabetes-related deaths. For each 1°C increase in Tmax/Tmean/Tmin above the threshold, the mortality risk of non-accidental-, cardiovascular-, respiratory, and diabetes-related death increased by 2.8/5.3/4.8%, 4.1/7.2/6.6%, 6.6/25.3/14.7%, and 13.3/30.5/47.6%, respectively. Thresholds for mortality differed according to health condition when stratified by sex, age, and education level. For non-accidental deaths, effects were significant in individuals aged ≥65 years (relative risk=1.038, 95% confidence interval: 1.026-1.050), but not for those ≤64 years. For most outcomes, women and people ≥65 years were more vulnerable. CONCLUSION: High temperature significantly increases the risk of mortality in the population of Jinan, China. Climate change with rising temperatures may bring about the situation worse. Public health programs should be improved and implemented to prevent and reduce health risks during hot days, especially for the identified vulnerable groups.

Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study.

Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families' expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM.

Genetic and Environmental Influences on Pulmonary Function and Muscle Strength: The Chinese Twin Study of Aging.

Genetic and environmental influences on predictors of decline in daily functioning, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), handgrip, and five-times-sit-to-stand test (FTSST), have not been addressed in the aging Chinese population. We performed classical twin modeling on FEV1, FVC, handgrip, and FTSST in 379 twin pairs (240 MZ and 139 DZ) with median age of 50 years (40-80 years). Data were analyzed by fitting univariate and bivariate twin models to estimate the genetic and environmental influences on these measures of physical function. Heritability was moderate for FEV1, handgrip, and FTSST (55-60%) but insignificant for FVC. Only FVC showed moderate control, with shared environmental factors accounting for about 50% of the total variance. In contrast, all measures of pulmonary function and muscle strength showed modest influences from the unique environment (40-50%). Bivariate analysis showed highly positive genetic correlations between FEV1 and FVC (r G = 1.00), and moderately negative genetic correlations between FTSST and FEV1 (r G = -0.33) and FVC (r G = -0.42). FEV1 and FVC, as well as FEV1 and handgrip, displayed high common environmental correlations (r C = 1.00), and there were moderate correlations between FVC and handgrip (r C = 0.44). FEV1 and FVC showed high unique environmental correlations (r E = 0.76) and low correlations between handgrip and FEV1 (r E = 0.17), FVC (r E = 0.14), and FTSST (r E = -0.13) with positive or negative direction. We conclude that genetic factors contribute significantly to the individual differences in common indicators of daily functioning (FEV1, handgrip, and FTSST). FEV1 and FVC were genetically and environmentally correlated. Pulmonary function and FTSST may share similar sets of genes but in the negative direction. Pulmonary function and muscle strength may have a shared environmental background.

Genetic polymorphism of MTHFR C677T with preterm birth and low birth weight susceptibility: a meta-analysis.

PURPOSE: This study aimed at clarifying the association of maternal and neonatal methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms with preterm birth (PTB) and low birth weight (LBW) susceptibility, respectively. MATERIALS AND METHODS: A systematic search of Embase, Medline, China Biological Medicine Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang Database was performed before June, 2016. The frequencies of maternal and neonatal MTHFR C677T genotypes in the cases and controls and other information were extracted by two independent investigators. Odds ratios (ORs) with 95% confidence intervals (CIs) were adopted to estimate the relationships between MTHFR C677T polymorphisms and PTB as well as LBW by random or fixed effect models. RESULTS: Twenty-five studies from 20 articles concerning maternal and neonatal MTHFR C677T gene polymorphism with PTB and LBW were included in this study. Maternal MTHFR C677T polymorphism was associated with PTB risk under allele contrast (T vs. C, OR = 1.36, 95% CI 1.02-1.81), homozygote (TT vs. CC, OR = 1.70, 95% CI 1.07-2.68), and recessive (TT vs. CT + CC, OR = 1.49, 95% CI 1.00-2.22) model, but not dominant or heterozygote model. Maternal MTHFR C677T polymorphism was also associated with LBW risk under allele contrast (OR = 1.69, 95% CI 1.25-2.28), homozygote (OR = 2.26, 95% CI 1.44-3.54), dominant (OR = 1.71, 95% CI 1.19-2.47), recessive (OR = 1.79, 95% CI 1.42-2.26) model, but not heterozygote model. No associations between neonatal MTHFR C677T polymorphism and PTB or LBW were found under all genetic models. CONCLUSIONS: Identification of maternal MTHFR C677T mutation may play a key role for primary prevention of PTB as well as LBW and screening pregnant women of high risk in developing countries.

Bias in Self-Reported Condom Use: Association Between Over-Reported Condom Use and Syphilis in a Three-Site Study in China.

This study examined over-reporting bias in self-reported condom use and assessed its association with syphilis. A survey was conducted among 1245 female sex workers (FSWs) in three cities in China. Respondent's over-reported condom use was defined as reporting no unprotected sex for the past 24 h but testing positive for prostate specific antigen. The proportion of prevalent syphilis and active syphilis was 23 and 10 % respectively among FSWs. The proportion of over-reported condom use with sex clients only was 27-45 % among the three study sites. The proportion of over-reported condom use with all sex partners (clients, husbands, or boyfriends) was 26-46 %. FSWs who had active or prevalent syphilis were more likely to over report condom use. Self-reported condom use may not be a valid tool to measure the efficacy of HIV/STI intervention because the bias is associated with the outcome measure, i.e., syphilis.

Association between flood and the morbidity of bacillary dysentery in Zibo City, China: a symmetric bidirectional case-crossover study.

This study examined the relationship between daily morbidity of bacillary dysentery and flood in 2007 in Zibo City, China, using a symmetric bidirectional case-crossover study. Odds ratios (ORs) and 95 % confidence intervals (CIs) on the basis of multivariate model and stratified analysis at different lagged days were calculated to estimate the risk of flood on bacillary dysentery. A total of 902 notified bacillary dysentery cases were identified during the study period. The median of case distribution was 7-year-old and biased to children. Multivariable analysis showed that flood was associated with an increased risk of bacillary dysentery, with the largest OR of 1.849 (95 % CI 1.229-2.780) at 2-day lag. Gender-specific analysis showed that there was a significant association between flood and bacillary dysentery among males only (ORs >1 from lag 1 to lag 5), with the strongest lagged effect at 2-day lag (OR = 2.820, 95 % CI 1.629-4.881), and the result of age-specific indicated that youngsters had a slightly larger risk to develop flood-related bacillary dysentery than older people at one shorter lagged day (OR = 2.000, 95 % CI 1.128-3.546 in youngsters at lag 2; OR = 1.879, 95 % CI 1.069-3.305 in older people at lag 3). Our study has confirmed that there is a positive association between flood and the risk of bacillary dysentery in selected study area. Males and youngsters may be the vulnerable and high-risk populations to develop the flood-related bacillary dysentery. Results from this study will provide recommendations to make available strategies for government to deal with negative health outcomes due to floods.

Projections of hepatitis A virus infection associated with flood events by 2020 and 2030 in Anhui Province, China.

Assessing and responding to health risk of climate change is important because of its impact on the natural and societal ecosystems. More frequent and severe flood events will occur in China due to climate change. Given that population is projected to increase, more people will be vulnerable to flood events, which may lead to an increased incidence of HAV infection in the future. This population-based study is going to project the future health burden of HAV infection associated with flood events in Huai River Basin of China. The study area covered four cities of Anhui province in China, where flood events were frequent. Time-series adjusted Poisson regression model was developed to quantify the risks of flood events on HAV infection based on the number of daily cases during summer seasons from 2005 to 2010, controlling for other meteorological variables. Projections of HAV infection in 2020 and 2030 were estimated based on the scenarios of flood events and demographic data. Poisson regression model suggested that compared with the periods without flood events, the risks of severe flood events for HAV infection were significant (OR = 1.28, 95 % CI 1.05-1.55), while risks were not significant from moderate flood events (OR = 1.16, 95 % CI 0.72-1.87) and mild flood events (OR = 1.14, 95 % CI 0.87-1.48). Using the 2010 baseline data and the flood event scenarios (one severe flood event), increased incidence of HAV infection were estimated to be between 0.126/105 and 0.127/105 for 2020. Similarly, the increased HAV infection incidence for 2030 was projected to be between 0.382/105 and 0.399/105. Our study has, for the first time, quantified the increased incidence of HAV infection that will result from flood events in Anhui, China, in 2020 and 2030. The results have implications for public health preparation for developing public health responses to reduce HAV infection during future flood events.

Methadone maintenance therapy and HIV counseling and testing are associated with lower frequency of risky behaviors among injection drug users in China.

Three consecutive cross-sectional surveys were conducted among injection drug users (IDUs). Of 2,530 participants, 47.7% reported ever sharing needles, 78.2% having had unprotected sex in the last month, 34.4% not receiving either methadone maintenance therapy (MMT) or HIV voluntary counseling and testing (VCT), 4.8% ever receiving MMT-only, 36.6% ever receiving VCT-only, and 24.2% ever receiving both MMT and VCT. MMT-only and the combination of MMT and VCT had significant associations with needle sharing and on unprotected sexual behaviors. Effectively integrating VCT into MMT services is a logical way to maximize the impact of both interventions on risky behaviors among IDUs.

Citreoviridin enhances tumor necrosis factor-α-induced adhesion of human umbilical vein endothelial cells.

Endothelial adhesion plays an important role in the process of atherosclerosis, which is regulated by endothelial adhesion molecules and chemoattractant molecules. In some areas of China, citreoviridin (CIT) is considered a risk factor for the development of atherosclerosis. Here, we investigated the role of CIT in adhesion of human umbilical vein endothelial cells (HUVECs) together with the stimulation of tumor necrosis factor-α (TNF-α). Adhesion of HUVECs to monocytes was analyzed by coculture experiments using U937 cells labeled with 2,7-bis(2-carboxyethyl)-5(6)-carboxyfluorescein acetoxymethylester. The expression of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin was determined by Western blot and enzyme-linked immunosorbent assay (ELISA). The expression of monocyte chemoattractant protein-1 (MCP-1) was measured by reverse transcription polymerase chain reaction and ELISA. The activation of nuclear factor-κB (NF-κB) was assessed by Western blot and immunofluorescence staining. CIT markedly increased TNF-α-induced HUVECs adhesion to monocytes and the expression levels of ICAM-1, VCAM-1, E-selectin, and MCP-1. TNF-α-induced nuclear translocation of NF-κB in HUVECs was significantly elevated by CIT. Our study demonstrates that CIT upregulates TNF-α-induced endothelial adhesion via increasing activation of NF-κB, which results in the expression of ICAM-1, VCAM-1, E-selectin, and MCP-1. CIT plays a pivotal role in the process of endothelial cell adhesion and may thereby play an important role in the improvement of atherosclerosis in areas of China that have a high prevalence of CIT contamination and atherosclerosis.

Typology of older female sex workers and sexual risk for HIV infection in China: a qualitative study.

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. The objectives of this study were to investigate the reasons for women's entry into sex work during their 30s and to develop typology of older women sex workers. Semi-structured in-depth interviews were conducted with 63 older women sex workers and six focus-group interviews with stakeholders in three cities in China in 2012. Data were analysed inductively using constant comparative method. The mean age of participants was 43 years and the mean age of entry into sex work was 39 years. The primary reasons for entry into sex work included heavy economic burdens, limited employment opportunities and the appealing nature of sex work. Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. The development of effective HIV interventions needs to consider older women sex worker's unique characteristics and target factors that impede safer-sex practices.

Dual epidemics of syphilis and methamphetamine use among drug users in Shandong Province of China.

We assessed the types of drugs, the prevalence of HIV, syphilis, and its correlates among Shandong's drug users in China. Two consecutive cross-sectional surveys in 2009 and 2010 provided demographics, types of drugs, sexual and drug-use behaviors, and HIV-related services. Of the 1320 unique, eligible participants, 81.1% were male, two-thirds <35 years of age, 13.0% non-Shandong residents; in the past year, majority (96.4%) reported ever using methamphetamine, 3.4% using heroin, 8.6% using ≥2 types of these drugs and 8.0% injecting drugs, 63.8% having commercial sex. HIV and syphilis prevalence were 0.2% and 8.3%, respectively. In multivariable logistic regression analysis, syphilis was independently associated with female, non-Shandong residents, higher levels of education, and 2010. Synthetic drugs, especially methamphetamine, have become the predominant sources of drug addiction. The emerging epidemic of syphilis potentially driven by methamphetamine use underscored the urgency to implement an effective sex and substance use-related intervention.