[Noninvasive assessment of the risk of esophageal variceal bleeding from noncirrhotic portal hypertension].

Objective: To verify Baveno VI criteria, Expanded-Baveno VI criteria, liver stiffness×spleen diameter-to-platelet ratio risk score (LSPS), and platelet count/spleen diameter ratio (PSR) in evaluating the severity value of esophageal varices (EV) in patients with non-cirrhotic portal hypertension (NCPH). Methods: 111 cases of NCPH and 204 cases of hepatitis B cirrhosis who met the diagnostic criteria were included in the study. NCPH included 70 cases of idiopathic non-cirrhotic portal hypertension (INCPH) and 41 cases of nontumoral portal vein thrombosis (PVT). According to the severity of EV on endoscopy, they were divided into the low-bleeding-risk group (no/mild EV) and the high-bleeding-risk group (moderate/severe EV). The diagnostic value of Baveno VI and Expanded-Baveno VI criteria was verified to evaluate the value of LSPS and PSR for EV bleeding risk severity in NCPH patients. The t-test or Mann-Whitney U test was used to compare the measurement data between groups. Comparisons between counting data groups were performed using either the χ2 test or the Fisher exact probability method. Results: Considering endoscopy was the gold standard for diagnosis, the missed diagnosis rates of low/high bleeding risk EVs in INCPH/PVT patients with Baveno VI and Expanded-Baveno VI criteria were 50.0%/30.0% and 53.8%/50.0%, respectively. There were no statistically significant differences in platelet count (PLT), spleen diameter, liver stiffness (LSM), LSPS, and PSR between low-bleeding-risk and high-bleeding-risk groups in INCPH patients, and the area under the receiver operating characteristic curve (AUC) of LSPS and PSR was 0.564 and 0.592, respectively (P=0.372 and 0.202, respectively). There were statistically significant differences in PLT, spleen diameter, LSPS, and PSR between the low and high-bleeding risk groups in PVT patients, and the AUCs of LSPS and PSR were 0.796 and 0.833 (P=0.003 and 0.001, respectively). In patients with hepatitis B cirrhosis, the Baveno VI and Expanded-Baveno VI criteria were used to verify the low bleeding risk EV, and the missed diagnosis rates were 0 and 5.4%, respectively. There were statistically significant differences in PLT, spleen diameter, LSM, LSPS and PSR between the low-bleeding-risk and high-bleeding-risk groups (P<0.001). LSPS and PSR AUC were 0.867 and 0.789, respectively (P<0.05). Conclusion: Baveno VI and Expanded-Baveno VI criteria have a high missed diagnosis rate for EVs with low bleeding risk in patients with INPCH and PVT, while LSPS and PSR have certain value in evaluating EV bleeding risk in PVT patients, which requires further clinical research.

[Development of Risk Assessment Index System on HIV infection among young students based on Delphi method].

Objective: To develop a Risk Assessment Index System (RAIS) on HIV infection among young students based on Delphi method and to provide individual HIV infection risk assessment, targeted prevention and control measures. Methods: Delphi method was applied to determine the index system and weight of the assessment tool through three rounds of expert consultation and overall consideration of opinions and suggestions from 19 experts. Results: The positivity coefficients of three rounds of expert consultation were 100%. The authority coefficient of experts was between 0.887 and 0.945. The Kendall's W coefficients through first, second and third round specialist consultation was 0.379, 0.329 and 0.248, respectively (all P<0.001). The coefficients of variation in the third round were all less than 0.25, indicating that experts' opinion tend to be consistent and the results are highly reliable. The HIV infection risk assessment index system among young students consisted of 7 first grade indices and 54 second grade indices, of which weight was calculated. Conclusions: The RAIS on HIV infection for young students was initially established based on Delphi method, and could be used in the development of HIV infection risk assessment tools for personalized prevention and intervention among young students. However, the reliability, validity and effect of this assessment index system need to be further evaluated.

[Cluster analysis on survey of sexual health characteristics and health education demands in young students].

Objective: To explore the difference of sexual health characteristics and demands in students in different groups, and provide the basis for targeted sexual health eduction for AIDS prevention in young students. Methods: A survey was conducted based on the requirement of health education about sexual health and AIDS prevention in young students by the education department of Guangdong province. A two-step cluster analysis was performed on the survey data obtained by convenient sampling, the variables and number of clusters included were determined by combination of analysis results and professional knowledge. The demographic characteristics, the content and form of sexual health education needed were compared among different groups. Results: Survey data of 3 884 students were collected, and six variables were used for classification: cognition or occurrence masturbation, sexual behavior, frequency of sexual information acquisition, number of acceptable sex partners and AIDS knowledge awareness rate. By these variables, the students were classified into three levels of risk groups: high risk group (46.6%), medium risk group (39.9%) and low risk group (13.5%). As for demographic characteristics, high risk group, with a median age of 19 years, had the highest proportions of boys (65.9%), students with non-heterosexuality orientation (15.2%), urban residents (58.2%), only children (30.8%) and undergraduates (54.7%). Medium risk group, with a median age of 19 years, had the highest proportions of girls (82.7%) and vocational college students (34.0%). Low risk group, with a median age of 18 years, had the highest proportions of rural residents (52.4%), non-only child (80.6%), senior high school students (41.3%), non-boarding students (17.5%) and students without internship and part-time job experience (43.2%). In terms of health education demands, high risk group had a higher demand of information about self-identity, sexual safety, sexual decision making, contraception, abortion, and sexually transmitted disease or AIDS prevention. Medium risk group paid more attention to value on love and marriage, sexual assault. Low risk group showed a higher demand of adolescent physiology knowledge. Compared with low risk group, high risk group had a higher demand of peer education, Internet/multimedia, anonymous counseling and other forms of sexual health education. The differences were significant. Conclusion: The characteristics, sexual knowledge awareness, attitude and behavior, and health education demands of young students in different groups are different, so health education materials and methods should be developed according to the characteristics of different groups to enhance the acceptance and enthusiasm of students and improve the quality of sexual health education.

[Design and analysis of testing results of a WeChat applet for sexual health and HIV infection risk assessment in young students].

Objective: To summarize the design and analysis of testing results of a WeChat applet, which is called "Detective Bear", for sexual health and HIV infection risk assessment in young students, and evaluate its feasibility and effectiveness. Methods: Based on self-categorization theory, by using cluster analysis and Delphi expert consulting method, the framework of WeChat applet, risk assessment index system and preventive intervention content were determined. Young students were recruited by student associations for the application test, the results of the repeated tests and the satisfaction survey were collected and analyzed. Results: The study included 393 participants who repeated the test twice and 750 participants who volunteered to participate in the satisfaction questionnaire survey. The applet contains five modules: self-role judgment, self-test, risk assessment, assessment report generation and background management. The risk assessment module contains 6 first-level indicators and 55 second-level indicators. Assessment report generation module includes role diagnosis type, radar chart of HIV sexual health KAP and intervention prescription. In 393 students who repeated the test, the awareness of AIDS to be a serious sexually transmitted disease, the epidemic trend in young students in China, with active seeking HIV testing services and caring the infected improved. The satisfaction survey showed that 75.7% of students (568/750) accepted the applet, 86.5% (649/750) agreed the evaluation report, 83.1%(623/750) thought that there were some problems, but it was easy to use, 93.3% (700/750) said they can learn something from the applet and 84.1% (631/750) satisfied with the page design. Some students thought the questionnaire was too long and somewhat difficult to complete (P<0.05), and some reported that more can be learned (P<0.05). Conclusions: The applet integrates AIDS prevention related knowledge and practice into a challenging, interesting, interactive game and provide individualized, concrete risk assessment and self-intervention for young students, which can effectively help students to improve the awareness of AIDS related knowledge and get links for access to condoms, testing and other intervention services. However, its large-scale application and long-term effect need to be further tested.

[Characteristic analysis among MSM-users of the "Online HIV Acquisition Risk Assessment System" in Guangzhou].

Objective: To analyze the characteristics of levels related to the risk through self-evaluation system, among MSM users in Guangzhou, between 2015 and 2017. Methods: Between 2015 and 2017, data was collected from the users of a self-evaluation system network related to HIV infection, based on the previous 'HIV health risk appraisal model'. Information on risk factors was collected to calculate the scores and levels of risks and to estimate the incidence of HIV. Taking the reference of R value on risks as (R=0.9-1.1) in general population. The ones with very low risk, with low risk, moderate risk, high risk and very high risk were set as R≤0.5, 0.52.0, respectively. The scores of modifiable risk factors were compared with different subgroups of MSM. Results: A total of 4 601 MSM were involved in this study, with the following features presented as: aged 16-64 (28.38±7.11) years, proportions of residence from Guangzhou, Guangdong province or other provinces as 38.6%(1 776/4 601)、35.4%(1 629/4 601) and 26.0%(1 197/4 601), 59.6%(2 742/4 601) received bachelor or above degrees. 81.3%(3 741/4 601) of them claimed as having homosexual orientation. R values of risk level on very low risk, low risk level, moderate risk, high risk and very high risk appeared as 12.9%(594/4 601), 50.9%(2 342/4 601), 17.0%(783/4 601), 14.8%(682/4 601) and 4.3%(200/4 601), respectively. Scores of modifiable risk factors decreased year by year (P<0.05), among MSM in this study. In either of the groups that experiencing insertive or receptive sex, the ones with heterosexual orientation presented the highest scores of modifiable risk factors (P<0.05). Conclusions: The risk levels on HIV infections called for special attention among the users of the self-evaluation network system. Among the MSM that carrying either insertive or receptive sex role, the ones with heterosexual orientation had the highest risk levels and scores of modifiable risk factors in Guangzhou. Further study should be explored to better understand the causes of related risks.