[HIV self-testing and related factors in men who have sex with men in Shijiazhuang].

Objective: To understand HIV self-testing and related factors in men who have sex with men (MSM) in Shijiazhuang. Methods: From August to September 2020, convenient sampling was used to recruit MSM in Shijiazhuang. Online questionnaires were used to collect information about their demographic characteristics, sexual behaviors and HIV self-testing. logistic regression model was used to analyze the related factors associated with HIV self-testing. Results: In the 304 MSM respondents, 52.3% (159/304) had HIV self-testing in the past 6 months, and 95.0% (151/159) used fingertip blood HIV detection reagent. Self-purchase was the main way to obtain HIV testing reagents (45.9%, 73/159), followed by supply from MSM social organization (44.7%, 71/159). The reasons for having HIV self-testing were non-specific testing time (67.9%, 108/159) and privacy protection (62.9%,100/159), the reasons for having no HIV self-testing included inability of using (32.4%, 47/145), being unaware of HIV self-testing reagent (24.1%, 35/145), and worry about inaccurate self-testing results (19.3%, 28/145). Multivariate logistic regression analysis showed that being 18-29 years old (aOR=2.68, 95%CI: 1.20-5.94), obtaining free HIV self-testing kits in recent 6 months (aOR=8.61, 95%CI: 4.09-18.11) and making friends through Internet and social software (aOR=2.68, 95%CI: 1.48-4.88) were positive factors for having HIV self-testing. Conclusion: HIV self-testing is a more flexible and convenient way to detect HIV in MSM, and the promotion of HIV self-testing in MSM should be strengthened to further increase the HIV detection rate in this population.

[DALYs for breast cancer in China, 2000-2050: trend analysis and prediction based on GBD 2019].

Objective: Based on the data of Global Burden of Disease 2019 data, to analyze the past, current, and future burden of disability-adjusted life years (DALYs) in China and compare with the international status. Methods: The total number of DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019 for Chinese female breast cancer. The burden of DALYs in 2050 was predicted by Joinpoint using average annual percent change (AAPC). Results: In 2000-2019, the ranking of DALYs caused by female breast cancer in China rose from the fourth to the second in all female cancers. The total DALYs increased by 48.4%, of which the years lived with disability increased from 4.8% to 8.8%. The age-standardized DALY rate only slightly decreased (AAPC=-0.3%; which increased during 2016-2019, AAPC=1.6%). In 2019, the age-standardized DALY rate for breast cancer in China was 278.0/100 000. The DALYs were 2.88 million (accounting for 14.2% of the global burden and 12.1% of all female cancers burden in China), 26.5% of which attributed known risk factors (overweight and obesity were the largest: 0.34 million DALYs, but some common breast cancer risk factors were not available on the platform, such as menstruation and fertility). In 2050, the prediction suggests that the total DALYs caused by female breast cancer in China will reach 3.80 million person-years-5.16 million person-years, increasing 32.1%-79.4% over 2019. From 2000 to 2019, the peak age of DALYs and DALY rate became older, and the DALYs among females aged 65 years and above increased faster than those younger than 65 years (AAPC were 4.8% and 1.3%, respectively). In 2019, females aged 45-74 (the starting age recommended by local guidelines for breast cancer screening) contributed 74.3% of the total DALYs. Conclusions: Over the past 20 years, the age-standardized DALY rate for breast cancer in female populations in China has not changed obviously. Without the continuous expansion of effective intervention and population aging, the burden of DALYs for female breast cancer in China will increase. DALYs for breast cancer attributed leading risk factors were still limited.

Assessment of Human Health Risks in Tropical Environmental Waters with Microbial Source Tracking Markers.

Human specific microbial source tracking (MST) markers which are highly specific to human waste contamination offer the advantage of better association with human pathogens than traditional microbial indicators. However, the performance of these MST markers may vary across different geographical regions. The magnitude of MST markers also plays an important role in interpreting the health risks. This study aims to (i) validate the specificity and sensitivity of human markers for tropical urban catchments; (ii) identify the threshold concentrations of MST markers, i.e. human polyomaviruses (HPyVs), Bacteroides thetaiotaomicron (B. theta) and Methanobrevibacter smithii (M. smithii), that correspond to the acceptable gastrointestinal (GI) illness risks associated with swimming using the QMRA approach; and (iii) validate the threshold concentrations of MST markers using the surveillance data obtained from the tropical urban environment. Among the three MST markers, HPyVs showed the highest specificity (100%) to sewage samples, followed by M. smithii (97%) and B. theta (90%). All MST markers showed 100% sensitivity towards sewage contamination, with B. theta present in highest abundance in sewage, followed by HPyVs and M. smithii. This study demonstrates a risk-based framework to identify the threshold concentrations of MST markers associated with GI illness risks in environmental waters by considering two main influencing factors (i.e. decay and dilution factors). This study successfully validated the B. theta threshold concentration range (581 to 8073 GC/100 mL) with field data (370 to 6500 GC/100 mL) in estimating GI illness risks with an Enterococcus model. Field data showed that the MST markers at threshold concentrations were able to classify the safe level in more than 83% of the samples, according to GI illness risks from Enterococcus and adenovirus. The study also highlighted the lack of associations between MST markers and GI illness risks from norovirus. With comprehensive information on specificity, sensitivity and threshold concentrations of MST markers, increasing confidence can be placed on identifying human source contamination and evaluating the health risks posed in environmental waters in Singapore.

[Impact of the implementation of Beijing Tobacco Control Regulation on outpatient visits for smoking cessation in Beijing Chaoyang Hospital].

Objective: To investigate the impact of the implementation of Beijing Tobacco Control Regulation on outpatient visits for smoking cessation in Beijing Chaoyang Hospital. Methods: The outpatient visits and the proportion of returned cases to the total outpatient visits for smoking cessation in Beijing Chaoyang Hospital in past five years (2012-2016) that was before and after the implementation of Beijing Tobacco Control Regulation (June 1(st,) 2015) were analyzed. Time series seasonal index method was used to analyze seasonal variations in the outpatient visits. Results: From the implementation of Beijing Tobacco Control Regulation to December 31(th,) 2016, the average monthly outpatient visits for smoking cessation was significantly increased compared to that before the implementation [(101±37) vs (48±17), t=-7.486, P<0.001]. Meanwhile, the proportion of returned cases to the total outpatient visits was also significantly increased compared to that before the implementation [30.4% (582/1 912) vs 8.2% (161/1 966); χ(2)=309.8, P<0.001]. In addition, there were seasonal fluctuations in the number of outpatients from 2012 to 2016 , during which the outpatient visits started to increase in the second and third quarter (summer and fall) and peaked in June, but became less in the first and fourth quarter (spring and winter), and reached its nadir in January. Conclusions: With the implementation of Beijing Tobacco Control Regulation, the outpatient visits for smoking cessation have increased. Moreover, there is seasonal fluctuation in the outpatient visits for smoking cessation.

Compliance with the CURB-65 score and the consequences of non-implementation.

BACKGROUND: The CURB-65 (confusion, urea >7 mmol/l, respiratory rate ≥ 30 breaths/min, low blood pressure and age ≥ 65 years) score is a simple, well-validated tool for the assessment of severity in community-acquired pneumonia (CAP). It is unknown whether it is used routinely in China. OBJECTIVE: To determine the frequency of use of the CURB-65 score in routine hospital practice and the consequences of non-implementation. METHODS: A retrospective analysis of medical records from 1230 in-patients with CAP in a Chinese medical college-affiliated hospital. RESULTS: No CAP patient underwent the CURB-65 test at admission. Based on the British Thoracic Society guidelines, the 716 (58.2%) in-patients with a CURB65 score of 0 and the 402 (32.7%) in-patients with CURB-65 score of 1 should have received ambulatory treatment, whereas the 14 (1.2%) patients with CURB65 scores of ≥ 3 should have been admitted to the critical care unit. The maximum excess total annual costs for managing CAP patients with CURB-65 scores of 0 and 1 were estimated at respectively US$94 383.12 and US$66 313.92 in the hospital. CONCLUSIONS: The CURB-65 scoring tool in patients with CAP was not applied in routine hospital practice, resulting in inappropriate hospitalisation and excess costs.

Path integral approach to the pricing of timer options with the Duru-Kleinert time transformation.

In this paper, a time substitution as used by Duru and Kleinert in their treatment of the hydrogen atom with path integrals is performed to price timer options under stochastic volatility models. We present general pricing formulas for both the perpetual timer call options and the finite time-horizon timer call options. These general results allow us to find closed-form pricing formulas for both the perpetual and the finite time-horizon timer options under the 3/2 stochastic volatility model as well as under the Heston stochastic volatility model. For the treatment of timer options under the 3/2 model we will rely on the path integral for the Morse potential, with the Heston model we will rely on the Kratzer potential.

Assessment of an infectious disease history preceding juvenile dermatomyositis symptom onset.

OBJECTIVES: A number of studies have looked at the role of infectious diseases in triggering juvenile dermatomyositis (JDM). Previous studies have found a moderately high frequency of infectious symptoms prior to disease onset; however, no specific pathogens could be identified. We sought to correlate preceding infectious symptoms with onset and outcomes of JDM. METHODS: We studied an inception cohort of all JDM cases diagnosed at The Hospital for Sick Children (SickKids) between 1988 and 2006. Data pertaining to symptoms at onset, diagnosis and disease outcomes were abstracted. Two independent paediatric infectious disease specialists reviewed all records of patients with symptoms or tests suggestive of infection. RESULTS: A total of 110 patients were reviewed; of these, 78 had sufficient information about disease onset for inclusion. Potential indications of an infectious process prior to JDM onset were found in 55/78 (71%) patients and were further evaluated for evidence of infection temporally associated with symptom onset. Features suggestive of infection prior to JDM symptom onset were found in 40/55 [probable (30/40) or possible (10/40)]. Most children with probable infections had respiratory illnesses [24/30 (80%)]. Fewer patients than expected had disease onset during summer months. The presence of an infection at onset was not found to be associated with differences in characteristics at diagnosis or disease outcomes. CONCLUSIONS: A substantial number of JDM patients have a clinical history consistent with an infection prior to onset. Newly diagnosed patients should undergo a full infectious disease assessment as part of their initial work-up; specific attention should be given to respiratory infections.

Smoking in the home and children's health.

OBJECTIVES: We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States. METHODS: Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4. RESULTS: Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4. CONCLUSIONS: Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children's health.

Assessment of PCBs and PCDD/Fs along the Chinese Bohai Sea coastline using mollusks as bioindicators.

Mollusk samples such as bivalves and gastropods were collected from eight sampling sites along Bohai Sea coastline from northeastern China. The samples were analyzed for polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) by high-resolution gas chromatography/high-resolution mass spectrometry (HRGC-HRMS) to elucidate bioaccumulation of persistent organic pollutants in benthon. Residue levels of sigmaPCBs and sigmaPCDD/Fs were in the ranges of 66.1 to 583.6 ng/g and 0.9 to 15317 pg/g on a lipid-weight basis, respectively, The pollution source was identified using principal component analysis (PCA) in some coastal areas. It indicated that the typical pollution sources were characterized by PCB3, which was one Chinese technical product of PCBs. PCA also revealed the similarity patterns of PCBs between identical species collected from the different sites. The higher gastropod PCB concentrations were related to a former capacitor factory and the paint factories in some coastal areas, but this was not the case with the bivalves. The results of this study suggest that some gastropod species may be a potential bioindicator or "sentinel" organism for marine PCBs monitoring.

Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: correlation with esophageal variceal bleeding.

PURPOSE: Using the color Doppler velocity profile (CDVP), we investigated portal hemodynamics and their relationship with esophageal variceal bleeding (EVB) in patients with cirrhosis and portal hypertension. METHODS: The hemodynamics of the portal trunk, right anterior portal branch, and splenic vein were evaluated in 69 cirrhotic patients with portal hypertension and 46 healthy volunteers. The CDVP, a recently developed Doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vessel (velocity profile), as reflected by the profile parameter (n); and assess changes in flow volume over time (flow profile). The congestion index was calculated by dividing the cross-sectional area by the maximum cross-sectional velocity (CSVmax). The hemodynamic features were compared between patients without a history of EVB [EVB(-)] and those with a history of EVB [EVB(+)], and a logistic regression model was employed to identify factors associated with EVB. RESULTS: Compared with the healthy group, the cirrhotic group had a significantly lower mean CSVmax in the portal trunk and right anterior portal branch (both p < 0.01), a significantly elevated mean flow volume in the splenic vein and portal trunk (both p < 0.01), a significantly elevated mean ratio of splenic vein flow volume to portal trunk flow volume (SV/PT) (p < 0.001), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (all p < 0.01). In the cirrhotic group, there was a significantly higher incidence of a flat flow pattern in the right anterior portal branch and a phasic flow pattern in the splenic vein than in the healthy group (both p < 0.01). Among cirrhotic patients, the EVB(+) group had a significantly greater mean flow volume in the splenic vein (p < 0.01), greater mean SV/PT (p < 0.01), greater mean spleen size (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared with the EVB(-) group. Logistic regression analysis revealed that the SV/PT and portal trunk n value were independent EVB-related factors. CONCLUSIONS: The results suggest that portal hemodynamics in cirrhotic patients are characterized by passive congestion and increased blood flow. However, these 2 features had different preponderances in different parts of the portal venous system. Increased flow in the splenic vein may be the primary source of increased portal flow and may play a role in the development of EVB. The SV/PT and portal trunk n value may be valuable factors for predicting EVB.

Reducing harmful alcohol-related behaviors: effective regulatory methods.

OBJECTIVE: This article examines the effects of tort liability, criminal law, administrative regulation, price and availability of alcohol, and personal and state characteristics on the decisions to engage in heavy episodic drinking and to drink and drive. METHOD: Individual behavior data from the Behavioral Risk Factor Surveys (1984-95) were used in a logit analysis of the probability that a respondent engaged in heavy episodic drinking (n = 86,273), drinking and driving (n = 87,087) and drinking and driving if also a heavy episodic drinker (n = 22,261). RESULTS: Imposing tort liability on bars reduced self-reported incidents of drunk driving among all drinkers (p = .043) but did not reduce the probability of heavy episodic drinking or drinking and driving among heavy drinkers. In this first national study of the impact of social host liability, we found that such liability lowered the self-reported probability of heavy episodic drinking (p = .0004) and drinking and driving among all drinkers (p = .0005). CONCLUSIONS: Although several criminal and administrative regulations were also effective in reducing heavy episodic drinking and drunk driving, the imposition of tort liability represents a useful addition to the arsenal of alcohol-control policies.