[Current status of tuberculosis burden in China].

Tuberculosis, caused by Mycobacterium tuberculosis, is an infectious disease that most often affects the lungs. China is still among the high-burden tuberculosis countries in the world. Although the estimated incidence of tuberculosis in China has declined in recent years, the declining rate is slow. It still faces major issues such as a slower rate of decline, a widening gap between estimated and notified incidence, higher risk among middle-aged and older adults, a high number of cases among agriculture and related workers, and a heavier disease burden in the country's western regions. In addition, latent tuberculosis infection, drug-resistant tuberculosis, tuberculosis coinfection with HIV, and extrapulmonary tuberculosis have also exacerbated the disease burden of tuberculosis to some extent. This paper reviewed the epidemic characteristics of tuberculosis, the epidemiological triad, three links and two factors in the transmission process, the disease burden, and other aspects to provide a reference for formulating prevention and control strategies on tuberculosis.

Healthcare-associated carbapenem-resistant Klebsiella pneumoniae infections are associated with higher mortality compared to carbapenem-susceptible K. pneumoniae infections in the intensive care unit: a retrospective cohort study.

BACKGROUND: Klebsiella pneumoniae (KP) is an opportunistic pathogen causing severe pneumonia and sepsis. Carbapenem-resistant KP (CRKP) has become a major pathogen in many centres. AIM: To investigate the association between carbapenem resistance and the mortality rate, length of stay, and hospital cost in patients with Klebsiella pneumoniae infection. METHODS: The retrospective cohort study was conducted in the intensive care units of a large teaching tertiary hospital in southwest China between January 1st, 2020 and December 31st, 2022. To examine the impact of carbapenem resistance on mortality rates and economic burden, multivariate Cox regression and generalized linear models were constructed. FINDINGS: The study included 282 adult patients with KP infection (135 CSKP; 147 CRKP). CRKP-infected patients demonstrated higher mortality risk (unadjusted hazard ratio (aHR): 1.980; 95% confidence interval (CI): 1.206-3.248; P = 0.007; aHR: 1.767; 95% CI: 1.038-3.005; P = 0.036) compared to CSKP-infected patients. Stratified analysis, according to type of KP infection, revealed that patients with healthcare-associated CRKP infection had a significantly higher mortality risk compared to those with CSKP infection (log-rank P = 0.015). Patients with CRKP infection had longer hospital stays than those infected with CSKP (adjusted mean: 38.74 vs 29.71 days; P = 0.003), and hospital-related expenses were notably higher among CRKP patients than CSKP patients (adjusted cost: £40,126.73 vs 25,713.74; P < 0.001). CONCLUSION: CRKP infections increase mortality rates, prolong hospital stays, and raise healthcare costs. Healthcare facilities should adopt targeted strategies, including curtailing pre-infection hospitalization periods and managing medications more judiciously.

Burden of lung cancer attributed to particulate matter pollution in China: an epidemiological study from 1990 to 2019.

OBJECTIVES: The aim of this study was to examine the disease burden of lung cancer attributable to particulate matter (PM2.5) pollution in China from 1990 to 2019. STUDY DESIGN: Data from the Global Burden of Disease Study 2019 were used to estimate the disease burden of tracheal, bronchus and lung cancer attributed to PM2.5 over time in China. METHODS: Joinpoint regression models were applied to disability-adjusted life years (DALYs) to assess the time trends and estimate the impact of PM2.5 on the overall disease burden of lung cancer. Furthermore, age-period-cohort models were conducted to assess the relationships between lung cancer DALYs attributed to PM2.5 exposure and age, calendar period and birth cohort trends in China from 1990 to 2019. RESULTS: Lung cancer DALYs attributable to household air pollution from solid fuels decreased with an average annual percent change (AAPC) of 2.9 % per 100,000 population, while those attributable to ambient particular matter pollution (APE) increased (AAPC: -4.7 % per 100,000 population) over the past 30 years. The burden of lung cancer in terms of DALYs in males was higher than in females, and it demonstrated an age-dependent increase. The period and cohort effects also had significant impacts on the DALYs rates of lung cancer attributable to APE, indicating an overall increase in lung cancer DALYs for all age groups in each year. CONCLUSIONS: This study highlights the need for effective strategies to reduce PM2.5 exposure in China, particularly from outdoor sources. Gender differences and age, period and cohort effects observed in the study provide valuable insights into long-term trends of lung cancer burden attributed to PM2.5.

A quantitative assessment of the number of disease foci in papillary thyroid cancer.

AIM: Multifocality is a frequent feature of papillary thyroid carcinoma (PTC). Its prognostic value is controversial although national guidelines recommend treatment intensification if present. However, multifocality is not a binary but discrete variable. This study aimed to examine the association between increasing number of foci and risk of recurrence following treatment. METHODS: 577 patients with PTC were identified with median follow-up of 61 months. Number of foci were taken from pathology reports. Log-rank test was used to assess significance. Multivariate analysis was performed and Hazard Ratios were calculated. RESULTS: Of 577 patients, 206(35%) had multifocal disease and 36(6%) recurred. 133(23%), 89(15%) and 61(11%) had 3+, 4+ or 5+ foci respectively. The 5-year RFS stratified by number of foci was 95%v93% for 2+foci (p = 0.616), 95%v96% for 3+foci (p = 0.198) and 89%v96% for 4+foci (p = 0.022). The presence of 4 foci was associated with an over 2-fold risk of recurrence (HR 2.296, 95% CI 1.106-4.765, p = 0.026) although this was not independent of TNM staging. Of the 206 multifocal patients, 31(5%) had 4+foci as their sole risk factor for treatment intensification. CONCLUSION: Although multifocality per se does not confer worse outcome in PTC, finding 4+foci is associated with worse outcome and could therefore be appropriate as a cut-off for treatment intensification. In our cohort, 5% of patients had 4+foci as a sole indication for treatment intensification, suggesting that such a cut off could impact clinical management.

[Considerations for the development of adult vaccination in China].

Adult vaccination is an important component of the life-course immunization for all. Strengthening adult vaccination in China contributes to shrinking immunization gaps between regions and groups, enhancing the overall immunity of our population, and promoting health equity and social prosperity. Chinese adults bear the heavy burden of vaccine preventable diseases such as influenza, pneumococcal diseases and shingles, and have low coverage of vaccines against those diseases, so it is necessary to make efforts to improve adult vaccination development. This article focuses on elaborating the values of adult vaccination, introducing the current status of adult vaccination abroad, and analyzing the challenges and existing foundations for China to provide adult vaccination, and makes suggestions for the building and development of adult vaccination.

Evaluation of breast tumor morphologies from African American and Caucasian patients.

The primary aim of this research was to investigate potential differences of breast tumor morphologies across African American and Caucasian racial groups by utilizing machine learning (ML) and artificial intelligence (AI) methods. While breast cancer disparities can partially be attributed to social determinants of health, tumor biology also contributes to survival outcomes. The rate of breast tumor growth is largely dependent on the extracellular matrix (ECM). Current research suggests the cellular components of the ECM may vary among racial and ethnic populations, and this may contribute to the incidence of cancer in African Americans. We utilized a supervised AI method to evaluate morphological differences between African American and Caucasian breast cancer tumors. Images used for analysis were downloaded from the Cancer Genome Atlas (TCGA) biorepository stored in the NIH Genomic Data Commons (GDC) data portal. We designed an ML classifier using the AlexNet model provided in PyTorch's torchvision package. The model was pre-trained and adapted via transfer learning resulting in a classification accuracy of 92.1% when using our breast cancer tumor image database split into 80% of training set and 20% of testing set. We interpreted the results of the AlexNet and ResNet50 models using LIME and saliency mapping as the explainers. Based on the images from our bi-racial testing set, this study confirmed significant variations of tumor and ECM regions in the different racial groups evaluated. Based on these findings, further analysis and characterization may provide new insight into disparities associated with the incidence of breast cancer.

[Effectiveness, safety and cost of urinary follicle stimulating hormone in controlled ovarian stimulation in China: multi-center retrospective cohort study of 102 061 in vitro fertilization cycles].

Objective: To explore the effectiveness, safety and cost between urinary follicle stimulating hormone (uFSH) and recombinant follicle stimulating hormone (rFSH) in controlled ovarian stimulation (COS) in China. Methods: Data were collected from 16 reproductive centers in China covering oocytes collection time from May 1, 2015 to June 30, 2018. Eligible patients were over 18 years old, adopting COS with uFSH (uFSH group) or rFSH (rFSH group) as start gonadotropins (Gn), and using in vitro fertilization (IVF) and (or) intracytoplasmic sperm injection for fertilisation, excluding frozen embryo recovery cycle. Generalised estimating equation was used to address the violation of independency assumption between cycles due to multiple IVF cycles for one person and clustering nature of cycles carried out within one center. Controlling variables included age, body mass index, anti-Müllerian hormone level, cause of infertility, ovulation protocol, type of fertilisation, number of embryos transferred, number of days of Gn use. Results: Totally 102 061 cycles met eligibility criteria and were included in the analyses. In terms of effectiveness, after controlling relevant unbalanced baseline characteristics, compared with rFSH group, the high oocyte retrieval (>15 oocytes was considered high retrieval) rate of uFSH group significantly decreased in gonadotropin-releasing hormone agonist protocol (OR=0.642, P<0.01) and in gonadotropin-releasing hormone antagonist protocol (OR=0.556, P=0.001), but the clinical pregnancy rate per transfer cycle and the live birth rate per transfer cycle significantly increased (OR=1.179, OR=1.169, both P<0.01) in both agonist and antagonist protocols. For safety, multiple analysis result demonstrated that in the agonist protocol, compared with rFSH group, the incidence of moderate to severe ovarian hyperstimulation syndrome of uFSH group significantly decreased (OR=0.644, P=0.002). The differences in ectopic pregnancy rate and multiple pregnancy rate between the uFSH and rFSH groups were not significant (P=0.890, P=0.470) in all patients. In terms of cost, compared with rFSH group, the uFSH group had lower total Gn costs for each patient (P<0.01). Conclusion: For patients who underwent COS, uFSH has better safety, and economic profiles over rFSH in China.

Development of an intervention to manage knee osteoarthritis risk and symptoms following anterior cruciate ligament injury.

INTRODUCTION: Anterior cruciate ligament (ACL) injury is a risk factor for developing knee osteoarthritis (OA). We developed an intervention to support people manage risk factors for OA. METHODS: We conducted one-on-one interviews with 20 individuals with OA symptoms 6-15 years post ACL injury and used a nominal group process during a workshop with 40 patients and healthcare professionals (HCPs) to elicit information on the intervention content and delivery characteristics (timing, HCPs, and methods). Interview data were analyzed using content analysis. Nominal group ideas with importance ratings ≥5 of 7 met criteria for inclusion. Results were integrated, considering similarities and differences. RESULTS: Eight content categories were identified: 1. understanding knee injury and expectations about recovery; 2. understanding OA risk; 3. understanding OA signs and symptoms; 4. managing OA risk; 5. managing knee OA symptoms; 6. information for influencers; 7. credible sources; and, 8. updates on new evidence and treatments. Delivery timing reflected a lifespan approach from time of injury through symptomatic knee OA management. Although multiple media for delivery were identified, introductory face-to-face discussions and opportunity for re-accessing HCPs were critical. All HCPs who treat people with ACL should be familiar with and able to deliver the intervention. CONCLUSIONS: This co-development approach identified that an intervention to support people with ACL injury to limit and manage knee OA requires content embedded within an easily accessible, multi-media delivery model with capacity for check-back with HCPs that is appealing to different age groups and personal preferences over the lifespan post injury.

[Regional and demographic differences on passive smoking among non-smokers aged 30-79 years in 10 regions of China].

Objective: To describe the regional and demographic differences on passive non-smokers from 10 regions involved in the China Kadoorie Biobank (CKB) study. Methods: Detailed information regarding passive smoking behaviors related to 317 486 non-smokers who were 30-79 years old from the 10 study regions were gathered and analyzed. Results: Following the standardization of the 2010 China national population, the prevalence rate of passive smoking was 56.7%, and the prevalence rate of living with smokers was 66.5% among the Chinese adults. Both of the aforementioned rates were higher in rural than in urban areas. Meanwhile, the regional distribution of weekly passive smoking frequency and cumulative duration of passive smoking per week and cumulative duration of passive smoking per day were significantly different. The cumulative passive smoking duration per week increased along with the weekly frequency in people living in urban areas. Among women, the weekly passive smoking frequency was the highest, and the cumulative durations per week and per day appeared the lowest in Hunan, opposite to the situation in Henan. The prevalence of passive smoking among participants living with smokers was 2.27 times (95%CI: 2.24-2.29) of those who were not and the association appeared stronger in women (OR=2.61, 95%CI: 2.58-2.64) but not in men (OR=1.01, 95%CI: 0.95-1.06). Almost all the indicators seemed higher in women than those in men, except for the cumulative duration per day. Furthermore, these indicators appeared higher among those who were at younger age or with less education. The prevalence rates of passive smoking and living with smokers were lower but the cumulative duration per day was higher among those with lower household income. And the two rates were higher in married women and lower in married men, as compared to their counterparts. Conclusion: Regional and demographic differences in passive smoking were noticed among study population of CKB in the 10 regions.

[Predictive ability of risk assessment tool regarding HIV infection for men who have sex with men].

Objective: To analyze the predictive ability of HIV infection risk assessment tool for men who have sex with men (MSM). Sentinel surveillance data of MSM in Taizhou prefecture of Zhejiang province was used. Methods: MSM involved in AIDS sentinel surveillance program in Taizhou from 2013 to 2017 were included in the study and items listed in the HIV infection risk assessment tool for MSM was revised. Related data on questions and options involved in sentinel surveillance was collected and individual risk scores were calculated. We determined the predictive ability of this tool by comprehensive analyzing the HIV infection status and individual risk scores. Results: A total of 1 944 MSM were included in the study, with an average age of (35.04±13.28)years old. Most of them were recruited from the venues (55.7%) and 48.2% were never married. Among these MSM, HIV infection rate was 12.6%(245/1 944) with the median of risk score as 23.99, versus 20.36 from the HIV negative ones. Significant differences appeared on the risk scores between the target populations that with different HIV status (Mann-Whitney test, P=0.007). According to the principle of decision tree, MSM were divided into two groups according to risk scores: ≤18.66 and >18.66. It appeared that the risk scores were in parallel with the rates of HIV infection (χ(2)=13.102, P<0.001). Results from the multivariate analysis showed that MSM with higher risk score were more likely to be infected with HIV (>18.66 vs. ≤18.66: aOR=1.72, 95%CI: 1.27-2.32, P<0.001). Area under the ROC curve (AUC) for HIV infection was 0.553 (95%CI: 0.516-0.590, P=0.007). At the point of risk score 19.01, Youden's index appeared the maximum, with sensitivity as 0.69 and specificity as 0.43, of this tool. Conclusions: The HIV infection risk assessment tool for MSM developed based on Delphi method can predict the risk of HIV infection in MSM to some extent. MSM with higher risk score seemed likely to be infected with HIV. Items of this tool need to be adjusted for the verification of the tool through cohort studies in the near future.

[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.

Improvement of the Irrigation Scheme in the ORCHIDEE Land Surface Model and Impacts of Irrigation on Regional Water Budgets Over China.

In China, irrigation is widespread in 40.7% cropland to sustain crop yields. By its action on water cycle, irrigation affects water resources and local climate. In this study, a new irrigation module, including flood and paddy irrigation technologies, was developed in the ORCHIDEE-CROP land surface model which describes crop phenology and growth in order to estimate irrigation demands over China from 1982 to 2014. Three simulations were performed including NI (no irrigation), IR (with irrigation limited by local water resources), and FI (with irrigation demand fulfilled). Observations and census data were used to validate the simulations. Results showed that the estimated irrigation water withdrawal ( W ) based on IR and FI scenarios bracket statistical W with fair spatial agreements ( r = 0 . 68 ± 0 . 07 ; p < 0 . 01 ). Improving irrigation efficiency was found to be the dominant factor leading to the observed W decrease. By comparing simulated total water storage (TWS) with GRACE observations, we found that simulated TWS with irrigation well explained the TWS variation over China. However, our simulation overestimated the seasonality of TWS in the Yangtze River Basin due to ignoring regulation of artificial reservoirs. The observed TWS decrease in the Yellow River Basin caused by groundwater depletion was not totally captured in our simulation, but it can be inferred by combining simulated TWS with census data. Moreover, we demonstrated that land use change tended to drive W locally but had little effect on total W over China due to water resources limitation.

[Assessment of data quality of intervention in population at high risk for HIV/AIDS in China, 2014-2018].

Objective: To assess the quality of data of intervention in population at high risk for HIV/AIDS, especially in female sex workers (FSWs) and men who have sex with men (MSM), in China during 2014-2018, for the purpose of improving intervention data quality. Methods: Data accuracy was evaluated by sampling monthly reported intervention data and comparing the consistency of the information recorded in national HIV/AIDS prevention and treatment information system to original paper records. Data authenticity was assessed by visiting intervention sites and interviewing owners, manager and/or target groups at sites. The assessment results of both national level and provincial level were summarized by year and analyzed with descriptive statistical method. The data quality problems recognized by assessments were summed up. Results: The annual concordance rate of the data recorded in information system to paper records was 94.6%(17 671/18 673) in provincial level assessment and 79.4%(558/703) in national level assessment. Up to 81.6%(8 617/10 559) and 84.4% (249/295) of all sampled intervention sites were annually evaluated as "good" in provincial and state level assessments respectively. The assessment found that the intervention data in original paper records were not completely consistent to that recorded in the information system, the deficiency of ability on intervention data management, and the insufficient coverage and effect of intervention service influenced the intervention data quality. Conclusions: In general, the accuracy and authenticity of intervention data were fine in China during 2014-2018. Intervention data quality can be improved through measures of enhancing data quality management, strengthening training for the prevention and intervention in FSWs and MSM, and providing high- quality intervention service.

[Preliminary application assessment of individualized three-dimensional printing titanium mesh combined with guided bone regeneration for repairing alveolar bone defects].

Objective: To preliminarily evaluate the clinical effect of the three-dimensional (3D) printing individualized titanium mesh combined with guided bone regeneration technology for repairing alveolar bone defects. Methods: Six patients with alveolar bone defects (4 males and 2 females, aged 18-27 years, mean 23.3 years) were selected from the Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University from January to June 2018. The patients' cone-beam CT (CBCT) data was imported into the digital design software, and the individualized titanium meshes were designed based on the ideal bone mass around the implant, alveolar bone morphology and soft tissue condition. Then, the ".stl" files were output and the meshes were fabricated by 3D printing technology. The individualized titanium meshes combined with the mixture of autogenous bone and bone substitute materials were used to augmentation during operation. All patients were reviewed at 1, 3 and 6 months after surgery to observe the complications and evaluate the effect of bone augmentation. After taking out the titanium mesh, the CBCT was compared with the preoperative CBCT. The increased bone height and bone width were measured and the bone incremental volume was calculated. Results: Titanium mesh exposure occurred in 2 patients with no obvious infection, and no early removal. In 6 patients, the bone width increased by 1.75-7.54 mm (mean 3.58 mm), the bone height increased by 0.91-11.80 mm (mean 3.37 mm), and bone incremental volume increased by 247-676 mm(3) (mean 503 mm(3)). All of the cases showed sufficiently grafted volume for implant placement. Conclusions: The individualized 3D printing titanium meshes combined with guided bone regeneration could repair alveolar bone defects with excellent clinical effect, but a better design needed to be explored in the future to solve or delay the exposure of titanium mesh.

[Analysis of the contradiction between the supply and demand of Chinese graduate students' emergency professional ability in public health and preventive medicine in China].

In order to underst and the status of health emergency personnel training development and raising coping measures, electronic questionnaire surveys were conducted among 22 colleges and universities in different region of China. The result showed that colleges universities in China invested less in the training of emergency personnel. It is different and emphasized particularly for the cultivation of emergency professional ability among different types of public health students. Universities and employer hold relative evaluation of students' emergency professional ability with distinct regional differences.

[Children's non-carcinogenic health risk assessment of heavy metals exposure to residential indoor dust around an e-waste dismantling area in South China].

Objective: To evaluate the non-carcinogenic health risk of heavy metals (As, Cd, Cr, Cu, Mn, Pb and Zn) in residential indoor dust for young children around an e-waste dismantling area in South China. Methods: A village around an e-waste dismantling area in South China was selected as a research site in October 2016. Convenience sampling method was used to select 36 houses in the village and 36 dust samples were collected by vacuum cleaner. The concentrations of heavy metals (Cd, Cr, Cu, Mn, Pb and Zn) in each sample were determined and expressed by the average value. Non-carcinogenic health risk assessment was conducted using the US Environmental Protection Agency (EPA) Health Risk Assessment (HRA) model, the American Toxicology and Disease Registry (ATSDR) Target-organ Toxicity Dose (TTD) approach and the ATSDR Binary Weight-of-Evidence (BINWOE) model. Results: The mean ± SD of concentrations of As, Cd, Cr, Cu, Mn, Pb and Zn were (48.90±33.91), (5.95±3.89), (173.57±580.37), (412.71±1 190.00), (612.82±540.70), (297.41±293.22) and (1 052.81±1 156.48) mg/kg, respectively. The HI value of TTD (2.670) and BINWOE (2.933) were higher than the safety threshold of EPA recommended non-carcinogenic health risk. The HI value of TTD and BINWOE were 1.93 and 2.12 times higher than the HI value of HRA (1.386). Conclusion: There was non-carcinogenic health risk of heavy metals (As, Cd, Cr, Cu, Mn, Pb and Zn) via residential indoor dust around the e-waste dismantling area for local children.

[Interpretation for the group standards in data management for large population-based cohorts].

Precision medicine became the key strategy in development priority of science and technology in China. The large population-based cohorts become valuable resources in preventing and treating major diseases in the population, which can contribute scientific evidence for personalized treatment and precise prevention. The fundamental question of the achievements above, therefore, is how to construct a large population-based cohort in a standardized way. The Chinese Preventive Medicine Association co-ordinated experienced researchers from Peking University and other well-known institutes to write up two group standards Technical specification of data processing for large population-based cohort study (T/CPMA 001-2018) and Technical specification of data security for large population-based cohort study (T/CPMA 002-2018), on data management. The standards are drafted with principles of emphasizing their scientific, normative, feasible, and generalizable nature. In these two standards, the key principles are proposed, and technical specifications are recommended in data standardization, cleansing, quality control, data integration, data privacy protection, and database security and stability management in large cohort studies. The standards aim to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence, to improve domestic scientific research level and the international influence, and to support decision-making and practice of disease prevention and control.

Tea consumption and bone health in Chinese adults: a population-based study.

Tea is a worldwide drink with controversial effect on bone health. The sex-specific associations are unrevealed among general population. This study showed that prolonged moderate tea consumption benefited bone health in women, while no additional benefit with stronger tea. However, tea consumption was not associated with bone health in men. INTRODUCTION: Tea consumption has been shown a potentially beneficial effect on bone health in postmenopausal women. However, little is known about such association in men, and whether stronger tea instead harms bone health due to elevated urinary excretion of calcium associated with caffeine in the tea. The aim of this study was to examine the association between various metrics of tea consumption and bone health. METHODS: The present study included 20,643 participants from the China Kadoorie Biobank (CKB), who have finished both baseline survey (2004-2008) and a re-survey (2013-2014). They were aged 38-86 years at re-survey. Tea consumption was self-reported at both baseline and re-survey. Bone mineral density (BMD) was measured using calcaneal quantitative ultrasound once at re-survey. RESULTS: Compared with non-consumers, prolonged weekly tea consumers in women was associated with higher calcaneus BMD measures, with ß (95% CI) of 0.98 (0.22, 1.74) for BUA, 4.68 (1.74, 7.61) for SOS, and 1.95 (0.81, 3.10) for SI. Among prolonged weekly tea consumers, no linear increase in BMD measures with the amount of tea leaves added was observed. The SOS and SI were higher in consumers with tea leaves 3.0-5.9 g/day than in those with < 3.0 g/day, but were reduced to non-significant for those with ≥ 6.0 g/day. Tea consumption was not associated with calcaneus BMD measures in men. CONCLUSION: Prolonged moderate tea consumption benefited bone health in women but not in men. For stronger tea consumption with more tea leaves added, neither benefit nor harm to bone health was observed.

[Anemia status and related factors among left-behind children in poverty-stricken rural areas, in China, 2016].

Objective: To explore the prevalence of anemia and related factors among left-behind children in poverty-stricken rural areas in China, to provide basic information for anemia prevention and treatment for children. Methods: Data from the National Nutrition Improvement Program for Rural Compulsory Education Students in 2016 were used to express the prevalence of anemia among left-behind children. By using the multistage stratified random cluster sampling method, left-behind children of the 6-17-years-old in poverty-stricken rural areas were recruited in this study. Blood hemoglobin concentration of these students was determined by cyanmethemoglobin method. Anemia was judged by the WHO recommended standard and combined with the sea level elevation correction standard. Frequencies of food intake were collected through questionnaires. Data was then available for analysis including the level of hemoglobin and anemia rates. Relationship between anemia and food intakes as well as other influential factors was also analyzed. Results: The overall anemia prevalence (AP) was 11.6% among the participants. Rates of AP among the 6-, 7-, 15- and 16-17-years-old were 21.1%, 18.0%, 20.6% and 17.3%, respectively. Rates of AP among left-behind girls of 10-11-years-old and the 13-15-years-old were significantly higher than those in boys at the same age (P<0.01) group. Factors including: being girls (OR=1.34, 95%CI: 1.23-1.45), at grade 7 to 9 (OR=1.47, 95%CI:1.30-1.67) and mother being migrant worker (OR=1.32, 95%CI:1.16- 1.50) had higher proportions of getting anemia. Factors as living in the western area (OR=0.85, 95%CI: 0.78-0.93), taking breakfast every day (OR=0.70, 95%CI: 0.64-0.76), having meat more than twice per week (OR=0.84, 95%CI: 0.75-0.93) and having two kinds of vegetables per day (OR=0.85, 95%CI: 0.75-0.96) appeared protective. Conclusions: Prevalence of anemia in left-behind children from the poverty-stricken rural areas was high, including junior middle school students from grade 7 to 9 at the early stage of youth development, girls and children with mothers as migrant workers. Anemia should be reduced by promoting the protective factors as having breakfast, increasing intakes of meat and fresh vegetables.

Spatial-Temporal Assessment of Environmental Factors Related to Dengue Outbreaks in São Paulo, Brazil.

Dengue fever, a disease caused by a vector-borne flavivirus, is endemic to tropical countries, but its occurrence has been reported worldwide. This study aimed to understand important factors contributing to the spatial and temporal patterns of dengue occurrence in São Paulo, the largest municipality of Brazil. The temporal assessment of dengue occurrence covered the 2011-2016 time period and was based on climatological data, such as the El Niño indices and time series statistical tools such as the continuous wavelet transformation. The spatial assessment used Landsat 8 data for years 2014-2016 to estimate land surface temperature and normalized indices for vegetation, urban areas, and leaf water. Results from a cross correlation for the temporal analysis found a relationship between the sea surface temperature anomalies index and the number of reported dengue cases in São Paulo (r = 0.5) with a lag of +29 (weeks) between the climatic event and the response on the dengue incidence. This relationship, initially nonlinear, became linear after correcting for the lag period. For the spatial assessment, the linear stepwise regression model detected a low relationship between dengue incidence and minimum surface temperature (r = 0.357) and no relationship with other environmental parameters. The poor relationship might be due to confounding effects of socioeconomic factors as these seem to influence the spatial dynamics of dengue incidence. More testing is needed to validate these methods in other locations. Nevertheless, we presented possible tools to be used for the improvement of dengue control programs.