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Objective:To explore the risk factors and the treatment outcomes of rifampicin-resistant tuberculosis (RR-TB) in Guizhou Province.Methods:The clinical data of 16 548 pulmonary tuberculosis patients with drug sensitivity test results registered in the Tuberculosis Information Management System in China from designated tuberculosis hospitals of 88 counties (cities, districts) in Guizhou Province from January 2014 to December 2018 were collected. The gender, age, occupation, ethnicity, patient registration classification, molecular biology or Lowenstein-Jenden (L-J) solid culture results of positive sputum culture patients, and treatment outcomes were retrospectively analyzed. Cohen′s kappa coefficient was used to analyze the consistency between molecular biology and L-J solid culture in detecting rifampin resistance. Chi-square test and non-conditional logistic regression model were used to analyze the risk factors of mono-rifampicin resistance tuberculosis and multidrug-resistant tuberculosis (MDR-TB) and the factors affecting treatment outcomes.The measurement data were compared by chi-square test or Fisher exact test. Results:The detection rate of RR-TB in the newly diagnosed cases was 6.79%(807/11 883), and that in the retreated cases was 30.01%(1 400/4 665). The drug sensitivity tests of 184 sputum culture positive RR-TB samples were performed by both L-J solid culture and molecular biology, and the rifampicin resistance detection rates were 20.65%(38/184) and 16.85%(31/184), respectively. The consistency between two methods was good ( kappa=0.697, 95% confidence interval ( CI) 0.564-0.830, P<0.01). Multivariate logistic regression analysis showed that patients aged 20 to 39 years old (odds ratio ( OR)=1.679, 95% CI 1.134-2.487) and aged 40 to 60 years old ( OR=1.526, 95% CI 1.019-2.283) were the high risk groups for MDR-TB. Treatment failure ( OR=27.753, 95% CI 22.455-34.300; OR=2.982, 95% CI 1.544-5.760, respectively), relapse and return ( OR=5.381, 95% CI 4.563-6.346; OR=3.897, 95% CI 2.901-5.234, respectively) were both high risk factors for MDR-TB and mono-rifampicin resistance tuberculosis. The treatment rate of RR-TB patients was 39.96% (396/991) from 2014 to 2016. Among 396 treatment cases, 138(34.85%) were cured and 16(4.04%) died. The patients aged>60 years old had lower cure rate (12.68%(9/71) vs 39.69%(129/325)) and higher death rate (11.27%(8/71) vs 2.46%(8/325)) than those aged ≤60 years. The differences were both statistically significant ( χ2=18.732, P<0.01; Fisher′s exact test, P=0.003). Conclusions:The RR-TB patients in Guizhou Province are mainly re-treated. Young and middle-age (20-60 years old) and treatment history are risk factors for RR-TB. The patients over 60 years old have a low cure rate and a high mortality rate. It is suggested to strengthen the screening, treatment and management of RR-TB to reduce the spread of tuberculosis.
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Objective:To investigate the prevalence of autism spectrum disorders (ASD)among children in kindergartens in Xi′an urban districts.Methods:A stratified cluster sampling method was adopted, and selected all children from 12 kindergartens in 6 urban districts of Xi′an.Primary screening positive children with ASD were identified by filling out the Autism Behavior Checklist (ABC) by their parents and the guardians reports, and then the beha-vioral observations were made to identify suspicious ASD children.Finally these children were diagnosed in the hospital through the autism diagnostic observation schedule, 2 nd edition (ADOS-2). The data were calculated with SPSS 18.0. Results:Totally, 38 cases with ASD were diagnosed among 5 178 children, the prevalence of children ASD in kindergartens in Xi′an urban districts was 7.3‰, and the 95% confidence interval was 4.98‰-9.62‰.The prevalence of ASD in children was statistically significant in different age groups ( χ2=9.914, P<0.05) and gender groups ( χ2=18.812, P<0.05). The accuracy of ASD screening by guardians reports is better than that by ABC. Conclusions:(1)The prevalence of ASD children in kindergartens in Xi′an urban districts is at high level in similar reports in China.If ASD children at the special education institutions and home are considered, the overall prevalence rate is higher, indicating that the prevalence of ASD children in China may be underestimated.(2)With the increase of age, the attendance rate of ASD children in kindergartens has a decreasing trend.
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Objective To explore the early clinical characteristics and influencing factors in children with autism spectrum disorders(ASD).Methods From January 2005 to December 2014,193 children with ASD were collec-ted by continuous grouping method from Children's Rehabilitation Training Center in Xi'an.According to the 1∶1 matched case-control study requirements,and the other 193 children from kindergartens and primary schools in the urban areas of Xi'an were collected as healthy control group from March 1 to July 1,2016.The age of children in the case group was(40.78±14.86)months and the age of the healthy control group was(40.61±14.40)months.There were 167 boys and 26 girls in 2 groups and the ratio of boys to girls was 6.42∶1.00.The general status questionnaires,medical history questionnaire,diagnostic chart,Autism Behavior Checklist(ABC)and Family Environment Scale of Chinese version(FES-CV)were completed by parents between 2 groups.Childhood Autism Rating Scale(CARS)was completed by doctors in the case group.By using Excel software,the original questionnaires were completed in 2 entries by 2 persons to set up the database.All data were analyzed by SPSS 17.0 statistical software and conditional Logistic regression was used for multivariate analysis.Results Seventy point eight percent(137/193 cases)of children with ASD had been found abnormal under 2 years old or at 2 years old,and 54.9％(106/193 cases)had been diagnosed under 3 years old or at 3 years old.The average delay from the discovery to the diagnosis was 17 months.The initial abnormalities appea-rances were mainly manifested as no response to calling in 153 cases(79.3％),very little active contact with others in 141 cases(73.1％),silent or less use of oral language in 137 cases(71％),avoiding contact with the eyes of others or lack of facial expressions in 121 cases(62.7％).Their signs were easy to be misdiagnosed as mental retardation and language retardation.Children in the case group began to walk alone at the age of 8 months to 3 years old,and only 62.2％(120/193 cases)of them could walk alone at the age of 18 months or before.The age of conscious speech was at 8 months to 4 years and 4 months,and only 39.4％(76/193 cases)of the ASD children could speak at the age of 18 months or before.The total scores of the ABC scale of the case group were(56.520±22.140)scores and the sub-scales and total scores were significantly higher than those of the healthy control group,and the difference was statistically significant(t=16.845,27.390,16.527,26.320,23.371,32.206,all P<0.001).The positive consistent rate of ABC and clinical diagnosis was 56.5％.The total scores of CARS in the case group was(36.4±8.6)scores,and the positive consistent rate of CARS and clinical diagnosis was 78.8％.There was a statistical significance between the 2 groups in parental education,mother's occupation,family history(x2=29.670,44.593,15.439,6.095,all P<0.05),and there were statistical significance in the main caregivers,family harmony and family income(x2=19.006,7.129,109.027,all P<0.05).There was no statistical significance between the 2 dimensions of independence and achievement orientation between the 2 groups(t=-1.559,-0.139,P=0.120,0.890).The case group in the family cohesion,expressiveness,intellectual-cultural orientation,active-recreational orientation,moral-religious emphasis,organization and control of the 7 dimension scores were significantly lower than those in the healthy control group,and the differences were statistically significant(t=-7.683,-5.734,-8.762,-14.109,-2.026,-4.530,-2.464,all P<0.05).In the case group,the scores of the conflict dimension were higher than those of the healthy control group,and the difference was statistically significant(t=4.925,P<0.001).There was a statistical significance between the 2 groups in gestational age and birth hypoxia(x2=6.898,27.180,all P<0.05).According to multivariate analysis of Logistic regression,people other than parents serving as the primary support,anoxia of newborn,mother of non professional and technical personnel and lower scores of family active-recreational orientation might be the risk factors of ASD,family per capita income of 3 000 Yuan RMB or more monthly,mother education level of high school and above,and lower scores of family conflict might be the protective factors for ASD.Conclusions Clinical features of most ASD children can be easily identified under 2 years old,but if the diagnosis is delayed,the related intervention is late,so importance should be attached to early diagnosis.Mother's occupation and education level,family economic status,family environment,their supervisors,and anoxia of newborn may be the effective entry points in the prevention and treatment of ASD.
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<p><b>BACKGROUND</b>To investigate the surveillance trend of birth defects, incidence, distribution, occurrence regularity, and their relevant factors in Xi'an City in the last 10 years for proposing control measures.</p><p><b>METHODS</b>The birth defects monitoring data of infants during perinatal period (28 weeks of gestation to 7 days after birth) were collected from obstetrics departments of all hospitals during 2003-2012. Microsoft Excel 2003 was used for data input, and Statistical Package for the Social Sciences version 16.0 (International Business Machines Corporation, New York, NY, USA) was used for descriptive analysis. χ2 test, Spearman correlation and linear-by-linear association trend test were used for statistical analyses.</p><p><b>RESULTS</b>The birth defect rate declined from 9.18% in 2003 to 7.00% in 2012 (χ2 = 45.001, P < 0.01) with a mean value of 7.85%, which is below the Chinese national average level (χ2 = 20.451, P < 0.01). The order of five most common birth defects has changed. The incidence of congenital heart disease (CHD) increased with time, particularly after 2012, it became the most frequent type (r s = 0.808, P < 0.001). Till then, the number of neural tube defects (NTDs) declined significantly (χ2 = 76.254, P < 0.01). The average birth defects rate of 8.11% in rural areas was higher than that in urban areas (7.56%, χ2 = 7.919, P < 0.01) and much higher in males (8.28%) than that in females (7.18%, χ2 = 32.397, P < 0.01). Maternal age older than 35 years (χ2 = 35.298, P < 0.01) is the most dangerous age bracket of birth defects than maternal age younger than 20 years (χ2 = 7.128, P < 0.01).</p><p><b>CONCLUSIONS</b>A downward trend of birth defects was observed in Xi'an City from 2003 to 2012. NTDs significantly decreased after large-scale supplemental folic acid intervention, while the incidence rate of CHD significantly increased.</p>