Spatio-temporal analysis of socio-economic characteristics for pulmonary tuberculosis in Sichuan province of China, 2006-2015.

BACKGROUND: The disease burden caused by pulmonary tuberculosis (TB) in Sichuan province still persisted at a high level, and large spatial variances were presented across regional distribution disparities. The socio-economic factors were suspected to affect the population of TB notification, we aimed to describe TB case notification rate (CNR) and identify which factors influence TB epidemic are necessary for the prevention and control of the disease in Sichuan province. METHODS: A retrospective cross-sectional study and an ecological spatial analysis was conducted to quantify the presence and location of spatial clusters of TB by the Moran's I index and examined these patterns with socio-economic risk factors by hierarchical Bayesian spatio-temporal model. RESULTS: A total of 630,009 pulmonary TB cases were notified from 2006 to 2015 in 181 counties of Sichuan province. The CNR decreased year by year since 2007, from 88.70 to 61.37 per 100,000 persons. The spatial heterogeneities of CNR were observed during the study periods. Global Moran's I index varied from 0.23 to 0.44 with all P-value < 0.001. The Bayesian spatio-temporal model with parametric spatio-temporal interactions was chosen as the best model according to the minimum of Deviance Information Criterion (DIC)(19,379.01), and in which the quadratic form of time was taken. The proportion of age group and education year were all associated with CNR after adjusting the spatial effect, temporal effect and spatio-temporal interactions. TB CNR increased by 10.2% [95% credible interval (CI): 6.7-13.7%] for every 1-standard-deviation increase in proportion of age group and decreased by 23% (95% CI: 13.7-32.7%) for every 1-standard-deviation increase in education year. CONCLUSIONS: There were spatial clusters of TB notification rate in Sichuan province from 2006 to 2015, and heavy TB burden was mainly attributed to aging and low socioeconomic status including poor education. Thus, it is more important to pay more attention to the elderly population and improve socioeconomic status including promoting education level in Sichuan province to reduce the TB burden.

Associations between perceived barriers and benefits of using HIV pre-exposure prophylaxis and medication adherence among men who have sex with men in Western China.

BACKGROUND: To investigate the associations between the perceived barriers and benefits of using HIV pre-exposure prophylaxis medication, including worries about the side effects, disliking taking drugs, perceived burden of taking medication, positive expectations as to the efficacy of the drugs, favourable doctor-patient relationships, and medication adherence among men who have sex with men (MSM) to provide a target for improving medication adherence and reducing HIV infection among MSM. METHODS: MSM were recruited in western China from April 2013 to October 2014, administered oral tenofovir (TDF) daily and followed up every 12 weeks for 2 years. At each follow-up, the medication rate was calculated based on the self-reported number of missed doses over 2 weeks, and then, the medication adherence was evaluated. The barriers and benefits perceived during medication were obtained by a self-administered questionnaire, and their effects on medication adherence were analysed by linear mixed models. RESULTS: A total of 411 participants were enrolled in this study, and 1561 follow-up observation points were obtained. The average medication rate was 0.62 ± 0.37, and the medication rate increased with longer follow-up (P < 0.05). The medication rate was higher among MSM who were divorced (compared to those who were unmarried, P < 0.0001). MSM with more positive expectations as to the efficacy of the drugs showed higher rates of medication (P < 0.0001), while those who were more worried about side effects had a lower medication rate (P = 0.0208). In contrast, the dislike of taking the drugs and the burden perceived during medication had no effects on the actual medication rate of taking TDF (P > 0.05). CONCLUSION: How to obtain and maintain high medication adherence among MSM is the key to the PrEP intervention strategy for effective reduction of HIV infection. For MSM in China, we should deepen their understanding of the effectiveness and safety of PrEP and increase their confidence in PrEP, thereby improving their medication adherence. TRIAL REGISTRATION: ChiCTR-TRC-13003849 . Registered on 24/06/2013.

[Validity of the Inpatient Satisfaction Questionnaire].

OBJECTIVE: To assess the validity of the self-designed inpatient satisfaction questionnaire using Structural Equation Model (SEM). METHODS: The questionnaire survey was conducted in a tertiary hospital in Sichuan in April 2016,with participants selected through a systematical sampling approach. The structural validity of the inpatient satisfaction questionnaire was assessed using SEM. The statistical analyses were performed using Lisrel8.70. RESULTS: About 98.5% of returned questionnaires were valid for data analyses,which resulted in a total sample of 2562. A good model fit was achieved: df=8.36,root mean square error of appoximation (RMSEA)=0.054,root mean square residual (RMR)=0.021,goodness-of-fit index (GFI)=0.93,adjusted GFI (AGFI)=0.91,com-parative fit index (CFI)=0.98,non-normed fit index (NNFI)=0.98,parsimony GFI(PGFI) =0.74. Factor loadings on exogenous latent variables ranged from 0.59 to 0.94,with 0.52-0.87 AVE. CONCLUSION: The questionnaire has a good construct validity,which can be used for evaluating inpatient satisfaction in tertiary hospitals.

[A Cross-sectional Study of Hepatitis B Virus Infection in Mianyang, Sichuan Province].

OBJECTIVES: To determine the prevalence and distribution of hepatitis B virus (HBV) infection in Mianyang. METHODS: Data were extracted from the 12th five-year National Science and Technology Major Projects-Integrated Prevention and Control of Major Infectious Diseases in Mianyang. A two-level logistic regression model was established to determine factors associated with HBV infection. RESULTS: About 4.91% of people in Mianyang were HBsAg positive, which increased with age. HBV infection showed aggregation at townships. Governmental spending ≥¥1 000 000 on public health was a protective factor in the regression model; whereas, age, male gender, medical workers, absent from HBV vaccination, more than 80 g/d alcohol consumption were risk factors of HBV infection. CONCLUSIONS: Mianyang had medium level of HBV infections. But high HBV prevalence can be found in some townships. The known behavior risk factors all exist in Mianyang, which can serve as a screening tool for identifying high risk populations.

[Identifying Factors Associated with Visits to Doctors using a Multilevel Zero-inflated Poisson Model].

OBJECTIVE: To determine factors influencing patient visits to doctors using a multilevel zero-inflated Poisson model with count data with excessive zero. METHODS: The data in relation to rural health services collected in Sichuan Province as part of the Fifth National Health Service Survey (2013) were used in this study. A multilevel random intercept zero-inflated Poisson model was established to identify factors associated with visits to doctors in two weeks. RESULTS: The logistic regression showed that gender, age and presence of chronic diseases were the main factors associated with the likelihood of visiting doctors in two weeks. The Poisson regression revealed that travel time to the nearest medical facility, ethnicity, marital status and educational attainment were associated with numbers of visits to doctors in two weeks. CONCLUSION: Rural residents with a high level of education, unmarried, and living close to medical facility are more likely to visit doctors than others. The multilevel zero-inflated Poisson model can be used for analyzing data with zero extra.

Visualization of therapeutic intervention for acute liver injury using low-intensity pulsed ultrasound-responsive phase variant nanoparticles.

Acute liver injury (ALI) is a highly fatal condition characterized by sudden massive necrosis of liver cells, inflammation, and impaired coagulation function. Currently, the primary clinical approach for managing ALI involves symptom management based on the underlying causes. The association between excessive reactive oxygen species originating from macrophages and acute liver injury is noteworthy. Therefore, we designed a novel nanoscale phase variant contrast agent, denoted as PFP@CeO2@Lips, which effectively scavenges reactive oxygen species, and enables visualization through low intensity pulsed ultrasound activation. The efficacy of the nanoparticles in scavenging excess reactive oxygen species from RAW264.7 and protective AML12 cells has been demonstrated through in vitro and in vivo experiments. Additionally, these nanoparticles have shown a protective effect against LPS/D-GalN attack in C57BL/6J mice. Furthermore, when exposed to LIPUS irritation, the nanoparticles undergo liquid-gas phase transition and enable ultrasound imaging.

[Image quality adapted thoracic diameters in CT coronary artery imaging].

OBJECTIVE: To evaluate the correlation between image quality and thoracic diameters, anteroposterior diameter (AP) and right-left diameter (RL) for the optimization of reducing radiation dose in coronary artery imaging with Dual-source CT. METHODS: 118 patients underwent CT coronary artery imaging (CTCA) were divided into two groups (A and B) according to body mass index (BMI). There were 58 patients in group A with BMI values > or = 25 kg/m2 and < 30 kg/m2; and 60 patients in group B with BMI values < 25 kg/m2. Scan parameters: collimation 64 X 0.6 mm, reconstruction slice thickness 0.75 mm, reconstructin interval 0.7 mm, FOV 150-180 mm, the pitch adjusted according to heart rate automatically. CT imagings were obtained with tube voltage 100 kV, tube current 330 mAs (group A) and 100 kV, tube current 220 mAs (group B). The contrast-noise ratio (CNR), signal to noise ratio (SNR), as well as blind correlation test score values were calculated to establish the relationship among BMI, AP, RL and CNR, SNR. RESULTS: RL of five levels in groups of A, B were correlated to CNRa (P < 0.05). In group A and B (except iii, iv level of Group A), AP were associated with CNRa (P < 0.05). In addition to ii, iv level of group A, v level of group B, BMI were associated with CNRa (P < 0.05). The correlation coefficient of CNRa and RL of group A except ii level was greater than that of CNRa and AP. The correlation coefficient of CNRa, SNRa and RL of group B was greater than that of CNRa, SNRa and AP. Except iii level, the correlation coefficient of CNRa, SNRa and AP of group A was greater than that of CNRa, SNRa and BMI. Except ii level, the correlation coefficient of CNRa and AP of group B was greater than that of CNRa and BMI. CONCLUSION: Thoracic diameter of RL can be used as a guider to select the appropriate scan protocol in the coronary imaging acqusition with dual-source CT.

[Responsiveness evaluation of mental intervention services system in Wenchuan earthquake area].

OBJECTIVE: To understand the mental intervention service system responsiveness. METHODS: A stratified, multi-stage random cluster sampling method was used, and a total of 211 residents in the central earthquake area were face to face interviewed by using the evaluating questionnaire of mental intervention service system responsiveness (including confidentiality, autonomy, prompt attention and so on, in sum of eight indicators). Analytic hierarchy process method was used to determine the weight of each index, carrying out a single index evaluation and fuzzy comprehensive evaluation on the mental intervention service system responsiveness, and using Spearman rank correlation and Binary logistic regression model to analyze the relationship of total satisfaction of mental intervention with each index. RESULTS: The dignity and confidentiality indicators were higher weight and rating. Prompt attention and the autonomy indicators were higher weight but lower rating, while surroundings and choice of providers indicators were lower weight and rating. It was also found that communication and social support network indicators were lower weight but higher rating. The overall assessment of mental intervention service system responsiveness ranged between "good" and "very good". All rank correlation coefficients of the indicators and the total satisfaction of mental interventions were significant (r(s) = 0.186 - 0.362, P < 0.05), except for confidentiality. The logistic regression analysis showed that the main factors of the individual variables influencing the total satisfaction were dignity (adjusted OR = 3.047, P < 0.001), surroundings (adjusted OR = 1.619, P = 0.019), and social support network (adjusted OR = 1.527, P = 0.005). CONCLUSION: The overall assessment of mental intervention service system responsiveness was high. Mental interventions should be taken positive and effective measures to improve the prompt attention, autonomy, the choice of providers and service environment.

[Health status of rural elderly with migrant children and associated factors].

OBJECTIVE: To determine the influence of children migration on the health of rural elderly in Sichuan province, and to provide reference for the subsequent research and health policy making. METHODS: Data used in the analysis were extracted from the expanded database for Western China collected in the Fourth National Health Survey in Sichuan province. The prevalence of acute illness in two weeks and the prevalence of chronic illness in the rural elderly were analysed and compared between those with different demographic characteristics and those with and without migrant children using a bivariate multi-level regression model. RESULTS: The prevalence of acute illness in two weeks and the prevalence of chronic illness in the rural elderly with migrant children were 44.0% and 44.5% respectively, significantly higher than the average level of elderly population in western rural China. No significant differences in the prevalence of two-week acute illness and the prevalence of chronic illness were observed in spite of the differences in the rank orders of diseases between whose with and without migrant children. Gender, children migration and living arrangements had a significant influence on the prevalence of acute illness in two weeks and the prevalence of chronic illness of the rural elderly. The influence of children migration differed between those who shared houses with other children and those who did not (alone or with spouse/grandchildren). CONCLUSION: Rural elderly with migrant children have poorer health than those without migrant children, especially those who live alone or with spouses and grandchildren only. The elderly with migrant children bear a greater burden of spinal disk disease perhaps because of their heavier physical workload. Greater attention needs to be paid to the health of the rural elderly with migrant children.

All-cause child mortality in minority and non-minority areas in Sichuan Province in Western China, 2008-2017.

This study aimed to evaluate the disparity in the under-five mortality rate (U5MR) between minority and non-minority areas in Sichuan Province in Western China. Data for this study was obtained from the National Health Statistics Survey System. The Cochran-Armitage trend test was used to analyze the time trend of the U5MR. We conducted Poisson regression model to compare the differences of U5MRs between minority and non-minority areas. The U5MR in Sichuan province was reduced by 62.19% from 2008 to 2017, with the minority and non-minority areas reduced by 60.48% and 65.39%, respectively. The under-five mortality risk in minority areas was approximately 1.791 times (95% CI: 1.790-1.793; P < 0.01) that in non-minority areas. The primary cause of death of children under-five years old in minority areas was the respiratory disease, which was significantly higher than that in non-minority areas (P all < 0.01). The U5MR significantly declined both in minority and non-minority areas in Sichuan Province in Western China from 2008 to 2017. However, disparities still existed between minority and non-minority areas. Respiratory diseases were the main causes of death in minority areas and corresponding rates were higher than those in non-minority areas.

[Analysis of ordinal repeated measures data using generalized estimating equation].

OBJECTIVE: To explore the application of the generalized estimating equation in the ordinal repeated measures data and hence provide methodology reference for the analysis of repeated measures data in the clinical trials. METHODS: An example was illustrated by modeling generalized estimating equation using the GENMOD command in comparison with the independent logistic regression. RESULTS: All parameters and their standard error were estimated, so every factor could be dealt with intuitive estimation of parameter. The standard errors of coefficients in generalized estimating equation are generally greater than that in independent logistic regression. CONCLUSION: Generalized estimating equation can solve the correlation between the dependent data by using working correlation matrix, and it can control strata correlation, repeated measures factor and other confounding factors effectively, so generalized estimating equation provides an effective method for the ordinal repeated measures data.

Efficacy and safety of Qi-Wei-Qing-Yan aerosol in treatment of acute pharyngitis (lung-stomach excess-heat syndrome): study protocol for a randomized controlled trial.

BACKGROUND: Acute pharyngitis accounts for an estimated 15 million patient visits in the United States. However, there is no proven effective and safe treatment. Although Chinese herbal medicine is widely used in the treatment of acute pharyngitis, there is a lack of evidence-based data. Despite several clinical trials conducted in this setting, no randomized placebo-controlled trial has been performed to date. This trial aims to investigate the efficacy and safety of Qi-Wei-Qing-Yan aerosol (QWQYA), a Chinese herbal prescription, compared with a placebo aerosol in the treatment of acute pharyngitis with lung-stomach excess-heat syndrome. METHODS/DESIGN: This is a prospective, multicenter, randomized, double-blinded, parallel-group, placebo-controlled trial. A total of 420 adult patients, of either sex, with acute pharyngitis will be enrolled from seven study sites across China. All patients will be randomly allocated to one of three parallel treatment groups: (1) QWQYA with the current propellant, (2) QWQYA with a previous propellant, and (3) the placebo aerosol with the current propellant. The study medication will be administered into the pharyngeal region in three sprays thrice daily for 5 consecutive days. The primary outcome measures are time to complete resolution of sore throat and relief rate of sore throat. Secondary outcome measures include resolution rate of sore throat, time to relief of sore throat, intensity of sore throat, and change of traditional Chinese medicine syndrome score and clinical signs score from baseline to post-treatment, as well as the occurrence of any adverse events. DISCUSSION: This will be the first clinical trial to investigate the efficacy and safety of QWQYA in the treatment of acute pharyngitis in an adult population in a multicenter, randomized, double-blinded, parallel-group, placebo-controlled manner. Not only might it establish the basis for the efficacy and safety of QWQYA in treating acute pharyngitis, but it might also provide evidence to support the use of Chinese herbal medicine in treating acute pharyngitis and thus support an alternative treatment option for management of acute pharyngitis. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-15005991.

The Serum Anti-HBs Level Among Children Who Received Routine Hepatitis B Vaccination During Infancy in Mianyang City, China: A Cross-Sectional Study.

Hepatitis B virus (HBV) prevalence has declined remarkably in children due to nationwide universal vaccination program for HBV in China. However, the persistence of immune response against HBV infection and the optimal time point when a booster vaccination should be performed remain to be elucidated. To assess the persistence and level of antibody against hepatitis B surface antigen (anti-HBs) in a representative population of age 15 and younger who received routine hepatitis B vaccination in Mianyang City, China. A cross-sectional study was conducted in 2011. One thousand five hundred twenty-six children of age 15 and younger who received three doses of 5 µg hepatitis B vaccine series during infancy but did not receive a booster vaccination later were enrolled. Of the 1,526 children, the mean age was 8.2 ± 4.1 and 739 children were male. The median anti-HBs level was 23.0 mIU/mL, and the total percentage of anti-HBs levels ≥10 mIU/mL was 60.9%. With an increase of age, median anti-HBs level, percentage of anti-HBs levels ≥10 mIU/mL, and percentage of anti-HBs levels ≥100 mIU/mL declined remarkably in the early period and reached the lowest level at the age of 3 and then remained relatively stable. The median anti-HBs level, the percentage of anti-HBs levels ≥10 mIU/mL, and the percentage of anti-HBs levels ≥100 mIU/mL in 1- and 2-year-old children were much higher than that in children aged 3-15 (p < 0.05, respectively). Immunity against HBV infection gradually decreased in early ages of children of 15 and younger who received three doses of 5 µg hepatitis B vaccine series during infancy in China. Three dosages of 10 µg hepatitis B vaccine for infants and repeated vaccination or additional booster vaccination for some children at or before age 3 should be provided to get much more powerful immunity to HBV.

[Survey of behaviors and knowledge about HIV/AIDS among intravenous drug users at a city in Sichuan Province].

OBJECTIVE: To understand high risk behaviors related to HIV/AIDS and the intravenous drug users' knowledge about HIV/AIDS. METHODS: Forty-eight intravenous drug users (IDUs) were interviewed by using questionnaires. RESULTS: The survey showed that 75% of the subjects were male, 83.3% of their educational levels were below junior middle school, and most of them lived in cities(83.0%), having no occupation or having special occupation. The age at the beginning of drug use was 11 years old, the ages in cities were earlier than those in the countryside (F = 3.898, P = 0.029). For the reasons of using drug, 58.1% of IDUs did so through curiosity; 57.1% of IDUs had ever shared the syringes and needles with others, 62.5% of them shared with fixed people. 79.5% of the IDUs had casual sex partners, and 68.75% had multiple sex partners, but only less than 40% of them used condoms when having sex with casual partner. CONCLUSION: There are many high risk factors related to the IDUs' drug addiction and sex behaviors which can facilitate the transmission of HIV.