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Objective:To compare the application effect among Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale, Medical Outcomes Study 36-item Short Form (SF-36) scale and "Assessment for Therapeutic Efficacy on Kashin-Beck Disease" (WS/T 79-2011) standard in the evaluation of therapeutic effect of patients with Kashin-Beck disease, which could provide basis for the treatment evaluation of patients with Kashin-Beck disease.Methods:A total of 213 patients with Kashin-Beck disease in Gansu Province were investigated. WOMAC scale, SF-36 scale and standard of WS/T 79-2011 were used to analyze the quality of life of patients before and after treatment. The reliability, construct validity, content validity, discriminant validity of WOMAC and SF-36 scales were compared. Correlation between WOMAC, SF-36 scales and standard of WS/T 79-2011 were evaluated.Results:Both WOMAC and SF-36 scales had good construct validity and content validity (construct validity showed WOMAC and SF-36 scales contained 1 and 2 common factors, respectively; content validity showed WOMAC and SF-36 scales contained 3 and 8 common factors, respectively). The reliability and discriminant validity of WOMAC scale were better than those of SF-36 seale (reliability showed WOMAC reliability coefficient ≥0.934, the reliability coefficient of SF-36 scale was ranged from 0.386 to 0.999. Discriminant validity showed there were differences in 3 dimensions of the WOMAC scale before and after treatment, while there were differences in 6 out of 8 dimensions of the SF-36 scale). The correlation coefficients between WOMAC scale and standard of WS/T 79-2011 ranged from 0.175 to 0.437, the correlation coefficients between SF-36 scale and standard of WS/T 79-2011 ranged from - 0.434 to - 0.099 ( P < 0.05). Conclusion:The reliability, discriminant validity and correlation with the standard of WS/T 79-2011 of WOMAC scale are better than those of SF-36 scale in efficacy evaluation of patients with Kashin-Beck disease.
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Objective:To further investigate the prevalence of tea-drinking-borne endemic fluorosis in Tianzhu Tibetan Autonomous County (referred to as Tianzhu) Gansu Province, to accurately master the information of patients with tea-drinking-borne endemic fluorosis, and to provide scientific basis for popularizing low fluoride brick tea and carrying out patient rescue and treatment.Methods:From 2019 to 2020, according to the "Investigation Plan of Tea-drinking-borne Endemic Fluorosis in Gansu Province in 2019", in the administrative villages with the habit of drinking and selling tea, drinking water samples of local residents were collected to detect the fluorine content of water in Tianzhu, 10 families were randomly selected in each village, basic situation of each family member and the drinking situation of tea were investigated, and tea samples were collected to determine the fluorine content. At the same time, all children aged 8 - 12 in the investigation village were examined for dental fluorosis; clinical examination of bone and joint symptoms and signs was conducted for permanent residents over the age of 25 in the investigation village (excluding 25 years old), X-ray examination of bone and joint was conducted for patients with clear clinical symptoms or signs of skeletal fluorosis, and urine samples were collected to detect urinary fluorine. Ion selective electrode method was used to detect fluorine in water, tea and urine, and dental fluorosis was diagnosed by "Diagnosis of Dental Fluorosis" (WS/T 208-2011), and the "Diagnostic criteria for Endemic Skeletal Fluorosis" (WS 192-2008) was used for the diagnosis of skeletal fluorosis.Results:A total of 161 water samples were collected, and the fluorine content in water was from 0.07 to 0.68 mg/L, which met the domestic drinking water standard ( < 1.0 mg/L). A total of 1 644 side-tea samples were collected, and the annual per capita consumption of side-tea of permanent residents over 16 years old was 1.05 kg. The average fluoride content of tea was 601.99 - 991.38 mg/kg. According to the detection results of tea fluorine, 16 administrative villages with an average daily intake of tea fluorine more than 3.5 mg/d were screened, the lowest intake was 4.91 mg/d in Tuta Village Danma Township, and the highest intake was 18.98 mg/d in Huashan Village Maozang Township. A total of 253 children aged 8 - 12 years old in 14 administrative villages were investigated. There were 3 cases of very mild dental fluorosis, 2 cases of mild dental fluorosis, and 1 case of moderate dental fluorosis. The overall prevalence of dental fluorosis was 4.74% (12/253). The clinical examination of bone and joint symptoms and signs was carried out for 3 100 permanent adults over the age of 25 (excluding the age of 25) in 15 administrative villages. The X-ray examination of bone and joint was carried out for 104 patients with definite clinical symptoms and/or signs of skeletal fluorosis. Six patients with skeletal fluorosis were diagnosed, including 3 mild and 3 severe, aged 56 - 76 years. The average urinary fluorine in the investigated villages was 0.73 - 4.74 mg/L (the number of investigated was 3 100). According to the determination and classification standards of tea-drinking-borne fluorosis area, Tuta Village Danma Township, Xiding Village Dahonggou Township and Daiqian Village Zhuaxixiulong Township were determined to be in the mild area of tea-drinking-borne endemic fluorosis, while Nannigou Village Zhuaxixiulong Township was in the moderate area of tea-drinking-borne endemic fluorosis.Conclusion:Tea-drinking-borne endemic fluorosis is prevalent in Tianzhu, Gansu Province, and targeted prevention methods and control measures need to be taken.
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Objective:To master the epidemic trend of Kashin-Beck disease (KBD) in Gansu Province and provide a scientific basis for prevention and treatment of KBD.Methods:All children aged 7 - 12 or 16 years old were selected as the survey subjects in 37 KBD districts and counties in Gansu Province, clinical and X-ray monitoring results of KBD in children from 2004 to 2018 were collected to analyze the epidemic trend of the disease.Results:From 2004 to 2018, a total of 97 190 children were examined clinically and 94 180 X-ray films were taken in Gansu Province. Four hundred and twenty-eight clinical positive cases were detected, with a detection rate of 0.44%. There were 649 X-ray positive cases, and the detection rate was 0.69%. There were 435 metaphyseal positive cases, the detection rate was 0.46%. There were 214 positive cases of bone end, and the detection rate was 0.23%. The clinical positive rate was the highest (7.17%, 58/809) in 2004, followed by 2007 (4.60%, 51/1 109) and 2005 (4.48%, 187/4 173), and the positive rate in other years was less than 3%. The positive rate of X-ray was the highest (9.59%, 58/605) in 2004, followed by 2005 (5.10%, 213/4 173), 2008 (3.66%, 45/1 228) and 2006 (3.04%, 125/4 107), the positive rate of other years was less than 3%.Conclusions:The clinical positive rate and X-ray positive rate of KBD in children in Gansu Province are decreased rapidly and then maintain a low fluctuation. The effect of comprehensive prevention and control measures is remarkable.
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Objective:To analyze the epidemic range of tea-drinking-borne endemic fluorosis in Gansu Province and accurately grasp the information of tea-drinking-borne endemic fluorosis patients, so as to provide basis for popularizing low fluorine brick tea and carrying out patient rescue and treatment.Methods:From 2019 to 2020, 12 counties (cities) in Gansu Province with a history of drinking brick tea were selected as the survey points according to the "Investigation Plan of Endemic Fluorosis of Tea Drinking Type in China in 2019" and the relevant information in Gansu Province. A cross-sectional survey was conducted in all villages with the habit of drinking brick tea (including the investigation of the fluoride content in drinking water, tea, the fluoride intake of the population, the dental fluorosis and urinary fluoride content of children aged 8 to 12, and the skeletal fluorosis and urinary fluoride content of adults), and the survey results were analyzed.Results:The survey covered 125 townships in 12 counties (cities), with 8 625 households in 860 villages. One thousand six hundred and seventy-two drinking water samples were collected, and the fluoride content in water ranged from 0.01 to 1.81 mg/L. Six villages with fluoride content > 1.0 mg/L were screened. A total of 3 664 tea samples were collected, the average fluorine content of brick tea was 481.33 mg/kg, and the fluorine content ranged from 31.88 to 1 643.40 mg/kg. There were 1 076 tea samples with fluorine content less than 300 mg/kg, and the qualified rate of fluorine content in brick tea was 29.37% (1 076/3 664). Among the 12 counties (cities), 92 townships and 496 villages were still drinking brick tea. The drinking rate of brick tea in villages was 57.67% (496/860), and the annual per capita consumption of brick tea was 1.21 kg. The average daily intake of tea fluoride in adults was 1.57 mg/d. In Maqu County, Aksai County, Tianzhu County and Sunan County, the daily intake of tea fluoride of adults in 31 villages of 13 townships was more than 3.5 mg, involving 5 272 households and 15 272 people. Sixty-five patients with dental fluorosis were found in the above 31 villages. The detection rate of dental fluorosis was 3.50% (65/1 856), mainly in very mild and mild cases. Urine samples were collected from 326 children. The median of urinary fluoride was 1.44 mg/L. The clinical investigation of skeletal fluorosis was carried out in 2 189 adults. X-ray examination of bones and joints was performed in 123 patients with definite clinical symptoms and/or signs of skeletal fluorosis. Seven cases of skeletal fluorosis were positive, the detection rate was 0.32% (7/2 189). Urine samples were collected from 83 adults. The median of urinary fluoride was 1.83 mg/L. Two villages with moderate disease were identified as Yehuwan Village in Anyuan Town of Tianzhu County and Nannigou Village in Zhuaxixiulong Town. Four villages in the mild diseased areas were identified as Daiqian Village in Zhuaxixiulong Town, Xiding Village in Dahonggou Town, Tuta Village in Danma Township of Tianzhu County and Annanba Village in Akeqi Township of Akesai County.Conclusion:Most of the endemic areas of tea-drinking-borne endemic fluorosis in Gansu Province have been under control, but the risk of tea fluoride exposure still exists in some areas, so it is urgent to take targeted prevention and control measures.
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Objective:To comprehensively investigate the epidemic scope, geographic features and threatened population of tea drinking type endemic fluorosis in Gansu Province.Methods:From June 2019 to December 2020, according to the "2019 Investigation Plan on the Epidemic Situation of Tea Drinking Type Endemic Fluorosis" and the relevant information about the living habits of residents in cities (prefectures) in Gansu Province, 12 counties (cities) in 4 cities (prefectures) of Gannan, Wuwei, Jiuquan and Zhangye, which had the habit of drinking border-sale tea, were selected as the survey sites. The survey contents included temperature, altitude, the number of townships (towns), the number of administrative villages (residents' committees, referred to as villages), the total population under its jurisdiction, ethnic composition, production methods, drinking condition of border-sale tea, fluoride content of tea, etc. The fluoride content of tea was tested according to "The Fluoride Content of Brick Tea" (GB 19965-2005), and the evaluation of whether the fluoride content exceeded the standard (> 300 mg/kg) was carried out.Results:The annual average temperature of the survey sites ranged from 0.2 to 12.7 ℃, except for Zhouqu County, the annual average temperature of the other 11 counties (cities) was < 10 °C; the average altitude ranged from 1 200 to 4 874 m, and there were 6 counties (Maqu, Tianzhu, Subei, Sunan, Aksay and Luqu) with an altitude > 3 000 m. The total population of the 12 counties (cities) was 1 051 843, of which 492 597 (46.83%) were ethnic minorities who had the habit of drinking border-sale tea; among them, there were 474 620 Tibetans, 10 152 Yugurs, 4 660 Mongolians and 3 165 Kazaks. In 860 villages of 125 townships (towns), a survey was conducted on drinking condition of border-sale tea, and the survey rate was 79.48% (860/1 082); the drinking border-sale tea rates of villages and families were 57.67% (496/860) and 42.41% (3 658/8 625), respectively. From the perspective of production methods, the drinking border-sale tea rates of villages and families in the pastoral counties such as Aksay, Subei, Maqu, Luqu and Sunan, as well as in the semi-agricultural and semi-pastoral county of Tianzhu, were all > 95%. A total of 3 664 tea samples were tested, with an average fluoride content of 481.33 mg/kg. There were 2 588 tea samples with a fluoride content > 300 mg/kg, accounting for 70.63% (2 588/3 664).Conclusions:There are still a large number of populations who drink border-sale tea in Gansu Province, mainly distributes in the low-temperature and high-altitude pastoral counties such as Aksay, Subei, Maqu, Luqu and Sunan. The ethnic group most threatened by tea drinking type endemic fluorosis is Tibetans.
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Objective:To investigate the application and problems existing in the implementation of the standard of "Assessment for Therapeutic Efficacy of Kashin-Beck Disease" (WS/T 79-2011, referred to as new standard), and to provide technical basis and suggestions for further improving the standard.Methods:In 2019, a questionnaire survey was conducted and analyzed in Sichuan, Shaanxi, Qinghai and Gansu provinces and Tibet Autonomous Region on basic information, standard implementation, publicity, training and application of scoring method of joint dysfunction index of Kashin-Beck disease prevention and control technicians.Results:One hundred and thirty-four questionnaires were distributed in this survey and 132 valid questionnaires were recovered, of which 88.64% (117/132) of Kashin-Beck disease prevention and control technicians received training in the new standard and 89.39% (118/132) used the new standard; 78.03% (103/132) thought that the standard terms were clear and easy to master; 71.97% (95/132) thought it was simple, convenient and easy to operate; 49.24% (65/132) thought that the standard evaluation results were consistent with the actual improvement of patients, and 50.75% (67/132) thought that it was generally consistent; 72.73% (96/132) thought that the design was scientific, reasonable and feasible. When using the scoring method of joint dysfunction index, more than 90% of the technicians thought that the five index terms of "joint rest pain", "joint movement pain", "morning stiffness", "maximum walking distance" and "limb activity ability" were easy to understand and ask questions. When patients with Kashin-Beck disease were investigated, the constituent ratios of easy to understand the five index terms were 96.21% (127/132), 83.33% (110/132), 90.15% (119/132), 78.79%(104/132), 90.15%(119/132) and the constituent ratios of easy to answer were 95.45% (126/132), 83.33% (110/132), 89.39% (118/132), 75.00% (99/132) and 89.39% (118/132), respectively.Conclusions:The new standard terms are clear, the design is scientific and reasonable, the operation is convenient and the feasibility is strong. The evaluation results are basically consistent with the actual improvement of patients. It is suggested to add objective evaluation indexes to the scoring method of joint dysfunction index.
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Objective:To explore the effect of health education on drinking-water-borne endemic fluorosis in Gansu Province, and provide evidence for further development of health education measures.Methods:In 2011-2013, 2016 and 2017, using prospective method, 16-19 drinking-water-borne endemic fluorosis counties (cities, districts) were selected as project counties in Gansu Province each year, and 3 townships (towns) were selected in each project county. To carry out public health education activities on prevention and treatment of drinking-water-borne endemic fluorosis, school health education activities were carried out in the classes of grade 4-6 in the central primary school; 3 administrative villages were selected in each township (town) to carry out community health education activities. Before and after the health education activities, questionnaire surveys on health education of drinking-water-borne endemic fluorosis prevention knowledge were conducted among 30-50 students of grade 5 in the central primary school and 15-30 housewives lived near the schools in each township (town). Comparative analysis of the effects of health education activities was carried out.Results:The total awareness rates of prevention and treatment of drinking-water-borne endemic fluorosis in students of grade 5 and housewives were 89.55% (28 164/31 452) and 86.61% (14 976/17 292) after the intervention, respectively, which were significantly higher than those before the intervention [53.40% (16 518/30 933) and 51.88% (8 925/17 202)], and the differences were statistically significant (χ 2=1 586.16, 4 886.16, P < 0.05). Among the primary school students and housewives, the knowledge awareness rates of prevention and treatment of drinking-water-borne endemic fluorosis were increased by 36.15% and 34.73%, respectively. Conclusions:After implementation of drinking-water-borne endemic fluorosis health education intervention, the awareness rates of prevention and treatment knowledge in primary school students and housewives in Gansu Province are significantly increased. However, there are still weakness such as shortage of primary health education staff and insufficient investment in work funds, which means we can further expand the scope of health education.
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Objective:To spread the knowledge of Keshan disease prevention and control, enhance the awareness of disease prevention among the population in the diseased areas, and provide the basis for formulating scientific intervention strategies for health education of Keshan disease.Methods:From October 2017 to April 2018, 10 counties (districts) with Keshan disease were selected as project counties(districts) in Gansu Province, and 3 towns were selected in each project county (district). To carry out Keshan disease health education activities in grade 4 - 6 of each township (town) central primary school, 3 villages were selected in each township to carry out community health education activities. We carried out 6-month propaganda on knowledge of Keshan disease prevention and control among pupils and residents, distributed health education materials and held lectures. Before and after the intervention, we conducted a questionnaire survey on health education among the target population (residents under 50 and primary school students in Grade 5), evaluated the improvement level of knowledge about keshan disease, and made statistical analysis.Results:Four hundred and fifty residents were investigated pre intervention and 451 residents post intervention, the awareness rate of Keshan disease prevention and control knowledge among residents in the diseased areas increased from 45.4% (2 041/4 500) before intervention to 79.5% (3 584/4 510) after intervention (χ 2 = 1 115.9, P < 0.05). Nine hundred and forty-eight pupils were investigated before intervention and 906 pupils (primary school students in Grade 5) after intervention, the awareness rate of Keshan disease prevention and control knowledge among pupils increased from 50.8% (4 818/9 480) before intervention to 84.2% (7 631/9 060) after intervention (χ 2 = 2 343.3, P < 0.05). Conclusion:The comprehensive intervention mainly based on health education can significantly improve the awareness rate of prevention and treatment knowledge of Keshan disease among primary school students and residents, and improve their bad life style, which is of great significance to the prevention and treatment of Keshan disease.
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Objective To evaluate the efficacy of telephone interviews on the quality of life of patients with chronic Keshan disease.Methods Totally 120 cases of chronic Keshan disease patients with chronic heart failure and NYHA classification of Ⅱ-Ⅳ were enrolled among the 181 patients with chronic Keshan disease,which confirmed by case search in Heshui County and Zhengning County in Qingyang City,Gansu Province in 2015,general demographic and clinical data were collected.According to the principle of random number table grouping,these 120 patients were randomly divided into a intervention group (n =60) and a control group (n =60).Both groups were given the conventional therapy and encouraged to inquiry or given regular outpatient medical follow-up.The patients in the intervention group received telephone interviews regularly for 6 months,with a interview frequency once a week in the first month,once every two weeks in the second and third months and once a month in the fourth,the fifth and the sixth months,with about 15 to 20 minutes interviews each time.Meanwhile there was no telephone interviews in the control group.At the begining of study,and after 3 months and 6 months of study,quality of life scores were scored according to the Minnesota Heart Insufficiency Scale (MLHFQ).The scores included total quality of life,physical field scores,emotional field scores,and other field scores.The lower the score,the higher the quality of life.Results After 3 months of telephone interviews,the emotional domain score of the intervention group (10.16 ± 4.58) was lower than that of the control group (13.10 ± 5.37,P ＜ 0.05).After 6 months of telephone interviews,the patients in the intervention group (35.60 ± 16.07,6.67 ± 4.01,13.16 ± 4.13) had significantly better quality of life than those in the control group (57.19 ± 14.97,12.43 ± 5.29,18.94 ± 6.68),with lower total points of life quality,emotion area and other area scores.The differences between the two groups were statistically significant (P ＜ 0.05).Conclusions Telephone interviews may promote the quality of life for patients with chronic Keshan disease.It is an effective way in enhancing the ability of chronic Keshan disease management.
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Objective To explore the relationship between prevalence of Kashin-Beck disease (KBD) and ecological environment, and to broaden the perspective of KBD etiology. Methods In 37 counties of KBD areas in Gansu Province, information about the ecological environment and implementation situation of control measures (altitude, temperature, rainfall, evapo ration, frost free period, annual sunshine hours, population density, per capita income, the proportion of staple food, returning farmland to forest, to forestry and replant crops) and X-ray detection rate of KBD of 7-12-year-old children in 2012 - 2014 was collected. Using four quantile regression method, the regression model was introduced to analyze the 11 ecological factors which related to the pathogenesis of KBD. The effect of three points on X-ray detection rate of KBD was estimated. Results The X-ray detection rate of KBD was independent of altitude, temperature, evaporation, population density, per capita income and cash crops, and was dependent of rainfall, frost free period, annual sunshine hours, the staple food purchase ratio, and returning farmland to forest and grassland. No matter where in any place numbered, the higher rainfall (measure value:0.003 3 to 0.006 4), the longer frost free period (measure value: 0.029 2 to 0.043 8), the longer annual sunshine hours (measure value:0.001 6 to 0.001 8), and the higher staple food purchase ratio (measure value:0.019 7 to 0.027 6), the higher risk of X-ray detection rate of KBD; the higher returning farmland to forest and to grassland, the lower risk of X-ray detection rate of KBD (measure value: - 0.037 2 to - 0.013 3). Conclusion The X-ray detection rate of KBD is closely related to local ecological environment.