Establishment and development of national community-based collaborative innovation demonstration areas to achieve the control target of hepatitis B in China.

BACKGROUND: The major infectious diseases of hepatitis B has constituted an acute public health challenge in China. An effective and affordable HBV control model is urgently needed. A national project of Community-based Collaborative Innovation HBV (CCI-HBV) demonstration areas has optimized the existing community healthcare resources and obtained initial results in HBV control. METHODS: Based on the existing community healthcare network, CCI-HBV project combined the community health management and health contract signing service for long-staying residents in hepatitis B screening. Moreover, HBV field research strategy was popularized in CCI-HBV areas. After screening, patients with seropositive results were enrolled in corresponding cohorts and received treatment at an early stage. And the uninfected people received medical supports including health education through new media, behavior intervention and HBV vaccinations. In this process, a cloud-based National Information Platform (NIP) was established to collect and store residents' epidemiological data. In addition, a special quality control team was set up for CCI project. RESULTS: After two rounds of screening, HBsAg positive rate dropped from 5.05% (with 5,173,003 people screened) to 4.57% (with 3,819,675 people screened), while the rate of new HBV infections was 0.28 per 100 person-years in the fixed cohorts of 2,584,322 people. The quality control team completed PPS sampling simultaneously and established the serum sample database with 2,800,000 serum samples for unified testing. CONCLUSIONS: CCI-HBV project has established a large-scale field research to conduct whole-population screening and intervention. We analyzed the HBsAg prevalence and new infection rate of HBV in the fixed population for the epidemic trend and intervention effect. The purpose of CCI-HBV project is to establish and evaluate a practical model of grid management and field strategy, to realize the new goal to control hepatitis B in China. To provide policymakers with a feasible model, our results are directly applicable. TRIAL REGISTRATION: The project was funded by the Major Projects of Science Research for the 11th and 12th five-year plans of China, entitled "The prevention and control of AIDS, viral hepatitis and other major infectious diseases", Grant Nos. 2009ZX10004901, 2011ZX10004901, 2013ZX10004904, 2014ZX10004007 and 2014ZX10004008.

Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in Gansu Province, China.

BACKGROUND: In 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province. METHODS: Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties. RESULTS: Gansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries. CONCLUSION: Microscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study.

Emergence and control of infectious diseases in China.

Infectious diseases remain the major causes of morbidity and mortality in China despite substantial progress in their control. China is a major contributor to the worldwide infectious disease burden because of its population size. The association of China with the rest of the world through travel and trade means that events in the country can affect distant populations. The ecological interaction of people with animals in China favours the emergence of new microbial threats. The public-health system has to be prepared to deal with the challenges of newly emerging infectious diseases and at the same time try to control existing diseases. To address the microbial threats, such as severe acute respiratory syndrome, the government has committed substantial resources to the implementation of new strategies, including the development of a real-time monitoring system as part of the infectious-disease surveillance. This strategy can serve as a model for worldwide surveillance and response to threats from infectious diseases.

[Cause-excluded health adjusted life expectancy: a new indicator in measuring the burden of diseases].

Based on the integration of concept and methods of cause-eliminated life expectancy (CELE), health-adjusted life expectancy (HALE) and disability-adjusted life year (DALY), a new index named cause-excluded health adjusted life expectancy (CEHALE) was developed in this study to evaluate the health impact(both fetal and non-fetal) of single disease. In order to include the impact of both premature death and health problems among those who are alive, the concept of suppositional death was introduced to calculate CEHALE. Cause-excluded health adjusted life expectancy developed in this study, should be not only easy to understand in concept, but also has theoretical support and be not affected by age structure, and be more suitable to use in comparison among different diseases and different population. Moreover, the new index is easy to calculate. So, CEHALE should be an ideal index to evaluate the impact of disease to population health.

[A convenient way for autoregressive moving average model order determination: autoregressive moving average (n, n-1) modeling strategy].

OBJECTIVE: To introduce the autoregressive moving average (ARMA)(n, n-1) modeling strategy as to a convenient way for the determination of ARMA orders. METHODS: ARMA(n, n-1) strategy was generally explained. A simulated ARMA(3,2) time series was generated and analized following this strategy. RESULTS: Combined with AIC information criteria and residue plot, the order of ARMA model was determined and complied well with the simulated data. CONCLUSION: ARMA(n, n-1) strategy may be convenient for the medical workers.

[Contribution of diabetes to the burden of diseases].

OBJECTIVE: To overview the contribution of diabetes in the burden of diseases. METHODS: Based on the data published by MOH, prevalence rate, mortality rate, cause eliminated life year were used to calculate the health burden of disease. Meanwhile, direct economic burden of diseases was presented. RESULTS: According the calculation, about 23 million of people suffered from diabetes and 90,000 died from diabetes. The cause eliminated life year attributed to diabetes is different between urban and rural, 0.21 years for urban and 0.08 years for rural. Moreover, the direct economic burden reached 1.071 billion RMB, about 1.88% of national health expenditure at the same period. CONCLUSION: The burden of diabetes, based on calculation of both health and economic burden, and will give a heavy pressure to the government and society.

[Study on classification and coding for public health information].

OBJECTIVE: To improve data unified descriptions, identification, query and management in public health service by means of establishing public health information classification framework and coding system. METHODS: Data sets created from all fields in public health, scientific research, health management were classified into four layers of frameworks primary class, sub-class, main class and subject areas by means of integration of vertical with horizontal classifications. All these classes were further abstracted, merged and coded by individual characteristics in public health systems. RESULTS: (1) 4 subject areas in diseases control and prevention, public health service, public health management and sanitation surveillance were established including a total of 18 main classes, 49 sub-classes and 205 primary classes. (2) 7 digits and 4 segments (area code, code, disease classification code) were designed including a total of 30 digits multi-classification codes. The purpose of data effectively classifying and coding by application of 50 basic data sets in 9 areas fo public health has been realized. CONCLUSION: We believe that this method is of efficiency in data classification and code for public health information communication.

[The conceptual framework for decision making data elements in public health].

OBJECTIVE: To develop a conceptual framework for decision-making data elements (indicator) in public health through determining its dimensions, sub-dimensions and their interrelationships. METHODS: On the basis of literatures review, conceptual analysis and health determinant models, a conceptual framework was set up. This framework construction followed five principles: evidence-based, applicable, public health relevant, systemic and extensible. While, with the principles of conceptualization, objective-orientation, independence, and number-restriction, the domain and subdomains were also developed. RESULTS: A conceptual framework consisting of five domains and 20 sub-domains was developed. The 5 domains were health status, non-medical health determinants, public health system performance, the resources of public health system, and characteristics of community and assurance system. The health outcome included three subdomains of health status, functional status, and death; Non-medicine health determinants domain consisted of health behavior, working and living conditions, personal resources and environmental factors; performance domain was made up of effectiveness, accessibility, efficiency, responsibility and safety; resources domain had institution resources, human resources, financial resources, equipment resources and information resources; The characteristics of community and assurance system domain was the last domain which comprises characteristics of community, public health related policy and assurance system. The complicated relationship between these domains was also described. CONCLUSION: As the abstraction of public health system, this conceptual framework comprehensively depicts the components of public health system and complicated process of public health system. This framework conforms to the medical care quality model which is made up of structure, process, intermediate results and outcomes.

[Standardizing basic data set in public health information system].

OBJECTIVES: To study methodologies and relevant data-element specifications for basic dataset development in China public health information system construction METHODS: The goals and scopes were determined through data-viewing analysis, while the function model was developed through information viewing analysis. The components and the structure of the data sets were also identified to distill data elements. RESULTS: 50 basic datasets were developed and 1513 data elements were determined in 8 main domains and one public domain in China's public health information system. The 8 domains included Expanded Immunization Program (including 7 Basic Datasets and 326 data elements), Occupational Health and Poisoning (5 Basic Datasets and 158 data elements developed), Laboratory Management (9 Basic Datasets and 118 data elements included), Public Health Emergencies (including 3 Basic Datasets and 47 data elements), Infectious Disease Surveillance (4 Basic Datasets and 177 data elements developed), Non-Chronic Disease Surveillance (3 Basic Datasets and 64 data elements developed), Maternal and Child Health (totally 8 Basic Datasets and 368 data elements developed) and Environment Health (including 4 Basic Datasets and 72 data elements). One common domain consisted of 7 basic datasets and 183 data elements. CONCLUSION: Standardizing basic datasets in public health information systems is an essential foundation in facilitating information system planning and the effective utilization of resources.

[Identification and generalization of classes of public health laboratory detection activities].

OBJECTIVE: To identify and generalize classes of public health laboratory detection activities and to discuss the method of identification and generalization of classes of Public Health Conceptual Information Model. METHODS: At first, materials should be collected from consulting literatures and experts, referring to the existing system. Then, identification and generalization of classes are got for business process analysis, writing description documents, summing up important conceptions and activities, By use-case analysis, use-case diagram and tabulation of important conception and activities and reference to PHCDM, a structural diagram of classes is constructed. RESULTS: A structure diagram of classes of public health laboratory detection activity is given. CONCLUSIONS: This is a feasible method in identification and generalization of classes of public health laboratory detection activities.

Hypertension and health-related quality of life: an epidemiological study in patients attending hospital clinics in China.

OBJECTIVE: To examine the relationship between hypertension and health-related quality of life in patients attending hospital clinics in China. DESIGN AND METHODS: A cross-sectional survey. Patients over the age of 35 years attending outpatient clinics in 18 hospitals of eight major cities of northern and southern China were interviewed between June and July, 1999. Trained fieldworkers completed questionnaires regarding demographics, hypertension knowledge and awareness, treatment history and quality of life issues. Qualified physicians performed blood pressure assessments. RESULTS: A total of 9703 volunteers were enrolled; 4510 (46.5%) had hypertension. The results showed that hypertensive subjects scored lower in the multiple linear regression analyses in most questions on the quality of life questionnaire than those without hypertension after controlling for age, sex, sociodemographic factors, and co-morbidity. There was a strikingly high prevalence of physical complaints or symptoms. Among the variables considered, age, sex, hypertension, body mass index, educational level, smoking, history of cholesterol, family history of cardiovascular diseases and history of diabetes were statistically significantly correlated with health-related quality of life. Subjects aware of having high blood pressure had a lower health-related quality of life score than subjects with high blood pressure but unaware of the diagnosis. Among treated subjects, those with controlled hypertension had higher health-related quality of life scores than those with poorly controlled hypertension. CONCLUSIONS: Hypertensive individuals represent a vulnerable population that merits special attention from healthcare providers and systems. This is especially important given that low health-related quality of life can be a risk factor for subsequent cardiovascular events or complications.

[Epidemiologic characteristics of dyslipidemia in people aged 18 years and over in China].

OBJECTIVE: To study the difference in prevalence of dyslipidemia, hypercholesterolemia, hypertriglyceridemia and low blood high-density lipoprotein cholesterol (HDL-C) between the residents of urban and rural areas of varied regions in China. METHODS: Fasting plasma levels of total cholesterol, triglyceride and HDL-C were determined with the enzyme methods for 49,252 subjects aged 18 and over during August to December, 2002. RESULTS: Prevalence of dyslipidemia in Chinese adults aged 18 and over was 18.6%, with 17.0%, 22.9% and 23.4% in the groups of 18-44, 45-59 and over 60 years old, respectively, 22.2% and 15.9% in males and females, respectively, and 21.0% and 17.7% in urban and rural areas, respectively. Prevalence of hypercholesterolemia, hypertriglyceridemia and low blood HDL-C in those aged 18 and over was 2.9%, 11.9% and 7.4%, respectively. CONCLUSIONS: Dyslipidemia has become one of important risk factors threatening health of Chinese people, with hypertriglyceridemia and low blood HDL-C as two major types in those aged 18 and over. Prevalence of dyslipidemia was nearly the same in the middle-aged and in the elderly people, and not significantly different in those living in urban areas from those in rural areas. It is very important to pay more attention to earlier comprehensive prevention and control of dyslipidemia.

Awareness, treatment and control of hypertension in patients attending hospital clinics in China.

OBJECTIVES: To determine awareness, treatment and control of hypertension in patients attending hospital clinics in China. DESIGN: A cross-sectional survey. PATIENTS AND SETTING: Patients over the age of 35 years, who were attending outpatient clinics in 18 hospitals of eight major cities of Northern and Southern China, were interviewed face-to-face between June and July 1999. METHODS: Trained fieldworkers completed questionnaires regarding demographics, hypertension knowledge and awareness, treatment history and quality of life issues. Qualified physicians performed blood pressure assessment. RESULTS: A total of 9703 volunteers enrolled, of which 4510 (46.5%) were hypertensives. Among hypertensives, 23% were unaware of their high blood pressure. Although 89% of those aware reported receiving therapy, only 56% of them were taking medication regularly, and 33% were thus controlled. Although 69% of all hypertensives measuring at examination reported taking antihypertensive therapy, only 44% of them were actually taking medication regularly. Furthermore, 73% of hypertensives believed hypertension was not a serious problem, and required no regular medication. CONCLUSIONS: The results showed that a substantial number of outpatients have a hypertensive range of blood pressure. Although most of these patients are already being treated with drug regimen, the patient's misconceptions and lack of knowledge about the disease appear to be the major cause of treatment failure. The low rate of high blood pressure control for both sexes calls for further improvements.

Interaction and its solution in individual matching case-control study.

OBJECTIVE: To indicate the deficiency of the classical method for analyzing data on individual matching case-control study in consideration of the interaction between the study factor (exposure) and the matching factor, and to find out a proper method for handling this deficiency. METHOD: First, experimental data with 50 pairs of cases and controls were used for strata analysis according to the values of a matching factor to illustrate the possible interaction between a risk factor (exposure) and the matching factor. Second, a detailed procedure was proposed for analyzing such data. RESULTS: Interaction between the study factor and matching factor was demonstrated by using strata analysis and unconditional logistic regression analysis. Therefore the results from the classical analysis for such data might be incorrect. CONCLUSION: Data from individual matching case-control study design should be dealt with strata analysis or multivariate analysis to explore and evaluate the possible interaction between the study factor and matching factor. The conclusion would be valid only after such analysis is conducted.

Tuberculosis control priorities defined by using cost-effectiveness and burden of disease.

OBJECTIVE: To define TB control priorities using cost-effectiveness and burden of disease. METHODS: An assumed cohort of 2,000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters. RESULTS: DOTS reduced 89.19% of YLL, 78.90% of YLD, and 99.98% of infectivity BOD. One DALY could be saved with 45.70 Yuan by DOTS with 3% discount. Sensitivity analysis showed that discount had effect on CER. Weight of age was insensitive to CER. The higher the DOTS cured rate, the more the cost-effectiveness. CONCLUSIONS: DOTS is a good cost-effectiveness TB control strategy. Cost-effectiveness and burden of disease can be used to define TB control priorities.

Methodology for the assessment of burden of smear-positive pulmonary TB and its infectivity.

OBJECTIVE: The study investigated the burden of smear-positive pulmonary TB and its infectivity using DALY (disability-adjusted life year) as an indicator. METHODS: An assumed cohort of 2,000 cases was set up based on the age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity under natural history and DOTS(directly observed treatment, short-course) strategy were established according to the epidemiological evidence. RESULTS: The results showed that 29.6% of DALYs would be neglected if the burden caused by the infectivity was not considered. CONCLUSION: DOTS strategy may reduce 97.3% of the number of potential cases infected, 92.9% of DALYs related to TB-patients themselves, and 99.9% of DALYs caused by TB's infectivity as well.

[SARS epidemic trends in Beijing since late April 2003].

Since May 8th, Beijing's severe acute respiratory syndrome (SARS) epidemic is on a continuous decline. Indicating and verifying measures taken since the end of April to be effective. Three stages of SARS have been distinguished in Beijing since late April, they are described in this article as rapid growth stage beginning late April until early May, decline and stable stage throughout the first week of May, and rapid decline stage since May 9th until present. These three stages depict the effectiveness of interventive measures against SARS in Beijing since late April. Information transparency towards the public is an import part among all measures taken, enhancing public awareness and understanding of the current situation and government action as well as introduce public action. Public awareness is an important factor, forming active support for government interventions.

[A new measurement for assessing the intra-household food distribution].

Discrepancy Score and Food Share to Energy Share were used to describe food distribution within a family. The results showed that dietary and nutritional status of people with discrepancy score below zero was worse than that of people with discrepancy score above zero. It proved that food allocation was closely related to dietary and nutritional status.

[Methodology on the burden of smear-positive pulmonary tuberculosis and the communicability of the disease].

The burden of patients with smear-positive pulmonary tuberculosis(TB) and that of the communicability of the disease was investigated by using disability-adjusted life year(DALY) as an indicator. An assumed cohort of 2000 cases based on the age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994 was set up. The prognostic tree and diagram model of communicability under natural history and direct observed treatment short-course startegy(DOTS) were established according to the epidemiological evidence. The results showed that 29.6% of DALYs would be neglected if the burden caused by the communicability have not been considered. The results also showed that DOTS might reduce 97.3% of potential cases infected, reduce 92.9% of DALY to patient themselves, and reduce 99.9% of DALYs caused by the communicability as well.

[Study on the relationship between body mass index and risk factors of chronic diseases of Beijing urban residences].

UNLABELLED: This study aimed to analysis the relationship among body mass index (BMI) and waist circumference (WC) with chronic diseases risk factors--serum total cholesterol (TC), triglyceridaemia(TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of chronic diseases. The data was collected from 1995 to 1998 in the study of community base integrated intervention of non-communicable chronic diseases. RESULTS: The prevalence of overweight and obesity in male was 41.7% and 14.6%, in female was 32.0% and 20.4% in this population, respectively. BMI and WC had significant positive relationship with TC, TG, SBP and DBP but negative with HDL-C and HDL-C/TC. WC had significant positive relation with FBG. The prevalence of dyslipidaemia hypertension and diabetes were significantly increased in overweight and obese groups. For early prevention, we have to pay more attention to the population with BMI > 24.0 kg/m2, they had increased risk factors of non-communicable chronic diseases.