Investigation of the Association between 45 Tag SNPs and Type 2 Diabetes Mellitus in Han Chinese Adults: A Prospective Cohort Study.

INTRODUCTION: The objective of this study was to examine the association between type 2 diabetes mellitus (T2DM) and genes identified in previous genome-wide association studies (GWASs) in rural Han Chinese adults. METHODS: This prospective study included 1,832 adults aged ≥18 years in Deqing without diabetes at baseline. The subjects were followed up for 8.7 years on average. We selected 45 susceptible tag single-nucleotide polymorphisms (SNPs) for T2DM that have been identified in GWASs and genotyped. A Cox model was constructed to calculate the adjusted hazard ratios (aHRs) for the association between SNPs and incident T2DM. RESULTS: The incidence rate of T2DM was 12.0 per 1,000 person-years. After adjustment for covariates and a Bonferroni correction, rs17584499 of protein tyrosine phosphatase, receptor-type D (PTPRD), rs11257655 and rs10906115 of cell division cycle 123 gene (CDC123), and rs12970134 of melanocortin-4 receptor (MC4R) were significantly associated with incident T2DM. The aHRs for incident T2DM were 1.75 (95% confidence interval [CI]: 1.28-2.40) and 1.61 (95% CI: 1.27-2.04) in association with an increasing number of T alleles in rs17584499 and rs11257655 under an additive genetic model, and the aHR was 1.72 (95% CI: 1.33-2.22) with an increasing number of A alleles in rs10906115. The aHRs under the dominant model were 1.82 (95% CI: 1.25-2.66) for TT + CT versus CC of rs17584499 and 2.04 (95% CI: 1.47-2.86) for AA + AG versus GG of rs10966115. The aHRs under the recessive model were 2.99 (95% CI: 1.30-6.89) for TT versus CT + CC of rs17584499, 1.92 (95% CI: 1.39-2.70) for TT versus CT + CC of rs11257655, and 2.54 (95% CI:1.22-5.29) for AA versus AG + GG of rs12970134. In addition, an increased incidence of T2DM was significantly associated with the TA haplotype of rs11257655 and rs10906115 (aHR = 1.81, 95% CI: 1.12-2.92), while a decreased incidence was associated with the CG haplotype (aHR = 0.49, 95% CI: 0.35-0.68) and the CT haplotype of rs1111875 and rs5015480 (aHR = 0.61, 95% CI: 0.37-0.98). CONCLUSION: Variants of the PTPRD, CDC123, and MC4R genes were associated with the T2DM incidence in a rural Han Chinese population.

Reduction in healthcare services during the COVID-19 pandemic in China.

INTRODUCTION: The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China. METHODS: Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak. RESULTS: Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels. CONCLUSION: The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.

Prevalence and associated factors of poor sleep quality among Chinese returning workers during the COVID-19 pandemic.

OBJECTIVES: The 2019 novel coronavirus (COVID-19) pandemic is a severe global crisis which has resulted in many public health problems. This study aimed to investigate the prevalence of poor sleep quality and its related factors among employees who returned to work during the COVID-19 pandemic. METHODS: Our online cross-sectional study included 2,410 participants aged ≥17 years in Deqing and Taizhou, Zhejiang Province, China from 5th to 14th March 2020. The questionnaire covered information on demographic characteristics, health status, workplace, lifestyle, attitude towards COVID-19, assessment of anxiety, depression and sleep quality. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) was administered to measure the poor sleep quality. Poor sleep quality was defined as a global PSQI score>5. Factors associated with sleep quality were analyzed by logistic regression models. RESULTS: In sum near half (49.2%) of 2,410 returning workers were females and the average year of subjects was 36.3 ± 9.1 years. The overall prevalence of poor sleep quality was 14.9% (95%CI: 13.5%-16.3%). The average score of PSQI was 3.0 ± 2.5 and average sleep duration was 7.6 ± 1.2 h. Independent related factors of poor sleep quality included age older than 24 years, higher education level, negative attitude towards COVID-19 control measures, anxiety and depression. CONCLUSIONS: Poor sleep quality was common and there was a shorter sleep duration among returning workers during the COVID-19 pandemic. Possible risk factors identified from this study may be of great importance in developing proper intervention for the targeted population to improve the sleep health during the COVID-19 public health emergency.

Modification effects of T2DM-susceptible SNPs on the reduction of blood glucose in response to lifestyle interventions.

In recent years, it has been demonstrated that some susceptible gene loci of type 2 diabetes mellitus (T2DM) are not only associated with the susceptibility risk of T2DM, but also the modifying effects of lifestyle interventions. To further explore the modifying effects of the single nucleotide polymorphism (SNP) on the onset of T2DM and the reduction of blood glucose in response to lifestyle interventions among the high-risk population, we performed a lifestyle intervention study in two Deqing rural communities during the period from June to December in 2017. The intensive lifestyle interventions were conducted among the study subjects of the intervention group while those in the control group only received conventional and general health education. All participants were genotyped by the MassARRY system. This study showed that for SNP rs9502570, fasting blood glucose showed a significantly greater reduction for individuals with CC + CT genotype than those with TT genotype (P=0.031). In the intervention group, the glycated hemoglobin A1C (HbA1C) decreased by 0.03% for those with CC+CT genotype, while HbA1C increased by 0.27% for those with TT genotype (P=0.012). The difference in the reduction of fasting blood glucose and HbA1c between the intervention and control groups was also statistically significant between individuals with TT and those with CC+CT genotype. For SNP rs10811661, the reduction of fasting blood glucose was significantly higher in people with TT genotype than those with CC + CT genotype (0.44 mmol/L vs 0.12 mmol/L, P=0.021). The difference in reduction of fasting blood glucose between the intervention group and control group was also statistically significant between TT and CC+CT genotype (P<0.001). In summary, the SNP genotypes of both rs9502570 and rs10811661 could modify the effects of lifestyle interventions on reducing fasting blood glucose and HbA1C among the high risk rural population for T2DM. The present study has provided supporting evidence for future development of individualized intervention measures for high-risk population of T2DM.

Recurrent gain-of-function USP8 mutations in Cushing's disease.

Cushing's disease, also known as adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas (PAs) that cause excess cortisol production, accounts for up to 85% of corticotrophin-dependent Cushing's syndrome cases. However, the genetic alterations in this disease are unclear. Here, we performed whole-exome sequencing of DNA derived from 12 ACTH-secreting PAs and matched blood samples, which revealed three types of somatic mutations in a candidate gene, USP8 (encoding ubiquitin-specific protease 8), exclusively in exon 14 in 8 of 12 ACTH-secreting PAs. We further evaluated somatic USP8 mutations in additional 258 PAs by Sanger sequencing. Targeted sequencing further identified a total of 17 types of USP8 variants in 67 of 108 ACTH-secreting PAs (62.04%). However, none of these mutations was detected in other types of PAs (n = 150). These mutations aggregate within the 14-3-3 binding motif of USP8 and disrupt the interaction between USP8 and 14-3-3 protein, resulting in an elevated capacity to protect EGFR from lysosomal degradation. Accordingly, PAs with mutated USP8 display a higher incidence of EGFR expression, elevated EGFR protein abundance and mRNA expression levels of POMC, which encodes the precursor of ACTH. PAs with mutated USP8 are significantly smaller in size and have higher ACTH production than wild-type PAs. In surgically resected primary USP8-mutated tumor cells, USP8 knockdown or blocking EGFR effectively attenuates ACTH secretion. Taken together, somatic gain-of-function USP8 mutations are common and contribute to ACTH overproduction in Cushing's disease. Inhibition of USP8 or EGFR is promising for treating USP8-mutated corticotrophin adenoma. Our study highlights the potentially functional mutated gene in Cushing's disease and provides insights into the therapeutics of this disease.

[Study on the relationship of the haplotypes of programmed cell death 1 gene and ultraviolet history with systemic lupus erythematosus].

OBJECTIVE: To investigate the relationship of gene polymorphisms of programmed cell death 1 gene (PDCD1) and ultraviolet history with systemic lupus erythematosus (SLE) among the Han population in the southern region of yangtze river in China. METHODS: With a case control design, a total of 159 SLE cases and 159 controls were enrolled in this study, and single nucleotide polymorphisms (SNPs) of the PDCD1 gene were determined by PCR-restriction fragment length polymorphism (RFLP). With the aid of the logistic regression model, the effect of gene polymorphism, environmental factor and the interaction between gene and environment were fitted under the recessive, dominant, additive and codominant mode, respectively. RESULTS: Three models were screened as the optimal models under the additive mode and one model under the dominant mode, according to the lowest value of Akaike's Information Criteria (AIC). After the control of age and gender, it was found that the frequency of ultraviolet exposure was higher in cases than in controls with significant difference under all models (P<0.05). For the haplotypes composed of the alleles of PD1.2, PD1.5 and PD1.6, there was significantly higher frequency of G-T-A haplotype (0.1196 vs 0.0363) and lower frequency of A-C-A haplotype (0.4746 vs 0.5399) in cases than that in controls (P<0.05) under the additive mode, and the G-T-A haplotype was associated with an increased risk for SLE (OR=4.319), while A-C-A haplotype was shown as a protective factor for SLE (OR=0.571). Moreover, interaction between A-C-G haplotype and ultraviolet exposure, which was related to an increased risk for SLE (beta5=1.182, Z=2.2898, P<0.05, OR=3.261), was also found under this mode. Additionally, the frequency of G-C-G haplotype was higher in cases than that in controls (0.1287 vs 0.0361) under the dominant mode with statistically significant difference (P<0.05, OR=4.332). CONCLUSION: Authors' results indicate that ultraviolet exposure, G-T-A or G-C-G haplotype and interaction between A-C-G and ultraviolet exposure may be associated with genetic susceptibility to SLE in Han population in the southern region of yangtze river in China under certain genetic modes.

How do type 2 diabetes mellitus-related chronic complications impact direct medical cost in four major cities of urban China?

OBJECTIVE: The purpose of this study was to evaluate the direct medical costs of type 2 diabetes mellitus with or without complications, and to determine the economic impact of complications on type 2 diabetic patients. METHODS: We performed a cross-sectional study of prevalent type 2 diabetes carried out in four major cities of China. The study populations were 1530 outpatients and 524 inpatients from clinics or wards of a total of 20 hospitals, using a two-phase subject enrollment process, by face-to-face interview with a unique questionnaire. RESULTS: The annual direct medical cost per patient was estimated to be 4800 Chinese Yuan (CNY) in median or 10,164 CNY in mean. There is a difference between annual direct medical costs for patients with or without complications (6056 vs. 3583 CNY; P < 0.001). It is also significantly different for the pay-out-of-pocket proportions (P = 0.015) between the patients with (44.6%) and without complications (40.4%). The direct medical cost varied significantly among the four cities (P < 0.001). Patients who simultaneously suffered microvascular and macrovascular diseases had higher direct medical cost (7600) than those with macrovascular (6000) (P = 0.012) and microvascular disease (5364) (P < 0.001), and those without both (3600) (P < 0.001). The correlation was statistically significant between the number of complications and direct medical costs (P < 0.001). CONCLUSIONS: The high economic burden raised by diabetes and its complications challenges the Chinese health-care system. It implicates an urgent need of intervention to prevent the development of long-term complications among the diabetic population, especially on the development of complications in high-cost body system.

[Using satisfaction questionnaire status version (DTSQs) to study on the reliability, construct validity and responsiveness of diabetes treatment among Chinese diabetic outpatients].

OBJECTIVE: Using 'diabetes treatment satisfaction questionnaire status version (DTSQs)' to evaluate the reliability, validity and responsiveness, among Chinese type 2 diabetes mellitus (T2DM) outpatients. METHODS: A cross-sectional study was carried out in 749 T2DM outpatients from seven hospitals in Guangzhou and Shanghai, China. The DTSQs was self-administered by patients, under the help from interviewers for those having difficulties in reading. Split-half reliability correlation coefficient, Cronbach alpha and Spearman' were used to test the reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed separately to examine the construct validity of the scale. The responsiveness of the scale was appraised by the multiple analysis of covariance (MANCOVA). RESULTS: The split-half correlation coefficient was 0.807 and the Cronbach alpha was 0.717 of the six items on satisfaction of treatment. The three factors extracted by EFA explained 67.656% of the overall variance. The relative chi2 was 4.95 and DK was 0.18 in the goodness of test by CFA. The vector of treatment satisfaction, perceived hyperglycemia and hypoglycemia were different in males versus females and in poor versus good blood glucose controlled groups. The DTSQs showed good reliability and validity among T2DM outpatients. CONCLUSION: DTSQs was applicable to Chinese T2DM patients.

[The impact of complication on quality of life among diabetic patients in urban China].

OBJECTIVE: To explore the impact of chronic complications of type 2 diabetic mellitus (T2DM) on quality of life (QOL) among T2DM outpatients in urban China. METHODS: A cross-sectional study was carried out in 1524 T2DM outpatients recruited from 15 hospitals in 4 major cities of China. Questionnaire interviews were used to collect data on general characters and complications of T2DM. SF-36 questionnaire (version 1) was used and self-completed by patients under the help from interviewers for those having difficulties in reading. T test, one-way ANOVA and generalized linear model were used to explore the association between complications of T2DM and quality of life. RESULTS: Complication was a significant predictor leading to poorer SF-36 subscale scores (decreased by 4.68 - 16.06 scores) and two summary scores (PCS, MCS). The scores of role-physical subscale (decreased by 22.45%) and role-emotional subscale (decreased by 16.28%) decreased much more than the other subscales in patients with complication. Overall, QOL was reduced by 11.02% in patients with complication. The QOL had a gradual decrease with the increasing number of complications. The average scores descended from 2.82 to 10.33 in the eight subscales with the increase of one complication. CONCLUSION: Having complication or multiple complications seemed to be predictors of poor QOL among T2DM outpatients.

The prevalence of anxiety symptoms and depressive symptoms in patients with somatic disorders in urban China: a multi-center cross-sectional study.

OBJECTIVE: To assess the prevalence of anxiety and depressive symptoms among patients with somatic diseases in urban China. METHOD: A hospital-based cross-sectional study was carried out in four major cities of China from June to August in 2004. There were 2111 eligible subjects with Stroke, Parkinson's Disease, Epilepsy, Irritable Bowel Syndrome, Functional Dyspepsia, and Menopausal Syndrome, and 317 Post-natal women were recruited from general hospitals. Self-completed hospital anxiety and depression scale (HAD) questionnaire was used for screening anxiety and/or depressive symptoms. Subjects with a HAD score of > = 9 were further assessed with Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) by certified psychologists or psychiatrists. RESULTS: The prevalence of "screened" depressive and anxiety symptoms using HAD were 11-19% and 11-22% respectively in patients with above somatic diseases and post-natal women. Assessed by HAMA/HAMD scale, the prevalence of "definite" depressive symptoms was 30%-59% in subjects with "screened" depressive symptoms, and 44%-84% in subjects with "screened" anxiety symptoms. About half of the subjects had co-morbidity depressive and anxiety symptoms. Less than one-fourth of these subjects had ever been diagnosed as depressive/anxiety disorders and been treated prior to the investigation. CONCLUSION: There is a high prevalence and low diagnosis and treatment rate of depressive and anxiety symptoms in patients with these somatic diseases in China.

[Study on risk factors of depressive and/or anxiety symptoms in patients with coronary heart disease in general hospitals of urban China].

OBJECTIVE: To explore the risk factors of depressive and/or anxiety symptoms in patients with coronary heart disease (CHD) in the general hospital of main cities in China. METHODS: A hospital-based cross-sectional study was conducted in four main cities in China in 2004. 359 CHD patients were recruited continually during six months from the outpatient and inpatient department of 7 tertiary hospitals. Face-to-face interview was used in data collection together with the self-completed HAD scale for depressive and/or anxiety symptom screening. Multinomial Logistic Model was adopted in data analysis. RESULTS: Among 359 CHD patients, 82 (22.8%) obtained a HAD score of 9 and above. Non-ambulatory patients had a statistically higher risk of depressive symptoms (OR = 17.996, 95 % CI:3.872 - 83.636); subjects younger than 65 years old, or having an education year equal or less than 9 year, or having a self-assessment of CHD deterioration had increased risk of anxiety symptoms with the ORs at 3.151 (95% CI: 1.151-8.629), 3.154(95% CI: 1.094-9.092) and 4.229 (95% CI: 1.396-12.809) respectively. Hospitalized (OR = 4.887, 95% CI: 1.711-13.960) and non-ambulatory (OR = 6.583, 95% CI: 2.776-15.612) CHD patients were more liable to suffer both depressive and anxiety symptoms. CONCLUSION: It was noticeable to health care providers both in somatic disease care and mental health care that non-ambulatory status, younger than 65 years old, lower education level, felt deterioration of CHD and hospitalization were possible risk factors for depressive and/or anxiety symptoms in patients with CHD in general hospitals in urban China.

[A cross-sectional study on the prevalence of depressive and/or anxiety symptoms in neurological patients from four cities in China].

OBJECTIVE: To describe the prevalence of depressive and/or anxiety symptoms in patients with some neurological diseases in the general hospitals of major cities in China. METHODS: A hospital-based cross-sectional study was conducted in four big cities in China in 2004. 1197 eligible subjects with Stroke, Parkinson's disease and Epilepsy were recruited from the outpatient or inpatient departments within three months. Face-to-face interview was used in data collection together with the self-completed Hospital Anxiety and Depression (HAD) scale for depressive and/or anxiety symptom, were screened. Subjects getting a HAD score of 9 and above were further assessed for depressive and/or anxiety disorders with Hamilton anxiety scales and Hamilton depression scales by the licensed psychologists or psychiatrists. RESULTS: The prevalence rates of "self-scaled" depressive and/or anxiety symptoms were 19.5%, 24.1% and 21.9% respectively in patients with stroke, Parkinson's disease and epilepsy. Among cases with "self-scaled" depressive and/or anxiety symptoms, the prevalence rates of depressive and/or anxiety symptoms were 50.8%, 73.1% and 38.6% respectively; less than 17% of subjects had obtained a diagnosis of depressive disorders and had been treated but only 4% of the subjects having obtained a diagnosis of anxiety disorders and been treated prior to the study. The sex specific prevalence varied over the somatic diseases. In patients with Parkinson's disease, the prevalence of "self-scaled" anxiety symptom was significantly higher in females than in males (21.1% vs. 12.2%; chi2 = 5. 679, P = 0.017),and the total prevalence of "self-scaled" depressive and/or anxiety symptoms was also higher in female (30.3% vs. 20.5%; chi2 = 4.978, P = 0.026); in patients with stroke while the prevalence of depressive and anxiety symptoms in female was higher than that in male (52.2% vs. 20.0%; chi2 = 6.009, P = 0.014), and a higher prevalence of depressive symptoms in female patients with epilepsy was also reported (32.4% vs. 13.6%; chi2 = 4.108, P = 0.043). CONCLUSION: It was of great importance to remind the healthcare providers and health policy makers that high prevalence of depressive and/or anxiety symptoms was found in patients with somatic diseases but with low percentages of previous diagnosis or treatment in the departments of neurology at the general hospitals in urban China.

[Improved case finding by using sputum examination in pulmonary tuberculosis suspects with clinical symptoms].

OBJECTIVE: To investigate more effective methods in case finding of tuberculosis (TB). METHODS: Sputum examination for TB suspects was applied on the basis of traditional chest X-ray screening. TB suspects with cough more than 3 weeks were subjected to a sputum examination firstly. The case finding rate of X-ray screening alone and in combination with sputum examination for TB suspects were compared. RESULTS: Nine hundred new cases of active pulmonary TB were detected by application of sputum examination to TB suspects, among which 73 more cases were found than X-ray screening alone, and the case detection rate increased 8.8% (73/827). Among the 900 new cases, 30 more cases were found than that of X-ray screening alone in 262 smear positive cases, and the case detection rate increased 12.9%. Three hundred sixty cases were culture positive, among which 63 more cases were found than X-ray screening alone, the case detection rate increased 21.2% (63/297). Among the cases detected by X-ray screening alone, the smear positive rate was 28.1% (232/827), and the culture positive rate was 35.9% (297/827). However, among the cases detected by sputum examination, 29.1% (262/900) was smear positive, and 40.0% (360/900) was culture positive. Among the 73 more cases of active pulmonary TB found by using sputum examination in TB suspects, both the smear positive and the culture positive rates were higher, 41.1% (30/70) and 86.3% (63/73) respectively, as compared to those of cases found by X-ray screening (28.1% and 35.9% respectively). CONCLUSION: Sputum examination in individuals with symptoms suggestive of pulmonary TB could find out more cases with active disease (21.2%) than chest X-ray screening alone.

Relationship between ambient air pollution and daily mortality of SARS in Beijing.

OBJECTIVE: To study the relationship between ambient air pollution and daily mortality of SARS in Beijing. METHODS: The approach of time-series Poisson regression was used to assess the relationship between daily SARS mortality, ambient air pollution, and other factors from April 25 to May 31, 2003 in Beijing. RESULTS: An increase of each 10 microg/m3 over a 5-day moving average of PM10, SO2 and NO2 corresponded to 1.06 (1.00-1.12), 0.74 (0.48-1.13) and 1.22 (1.01-1.48) relative risks (RRs) of daily SARS mortality, respectively. The relative risks (RRs) values depended largely on the selection of lag days. CONCLUSION: The daily mortality of SARS might be associated with certain air pollutants in Beijing.

[Pedigree study of pathological myopia].

90 pedigrees including 1822 individuals were investigated and analyzed to find out the genetic mode of pathological myopia in Chinese population. 169 screened nuclear pedigrees from the total were divided into two groups according to mating mode, Affected * Normal or Normal * Normal. Simple segregation analysis on A * N and N * N pedigrees was performed respectively. The results showed that A * N pedigrees fit the autosomal dominant inheritance, with segregation ratio 0.6033 and sporadic proportion 13.8%, while N * N pedigrees fit autosomal recessive inheritance, with segregation ratio 0.235245 and sporadic proportion 16.3%, although autosomal dominant inheritance could not be rejected. In complex segregation analysis,SAGE-REGD software was used to fit several genetic model, including Mendelian inheritance (major gene, dominant, recessive, codominant) and non-Mendelian inheritance (non-transmitted, environment, general), and at last all Mendelian inheritances including major gene, dominant, recessive, codominant inheritance were accepted, while codominant inheritance with minimus AIC was best fitted. Our study manifests that pathological myopia in Chinese population fits autosomal dominant and autosomal recessive inheritance with certain sporadic proportion, which demonstrates the high genetic heterogeneity of pathological myopia.

[Study on the identification of HIV/AIDS and its surveillance system in rural areas of central China].

OBJECTIVE: To explore the effective strategies for human immunodeficiency virus (HIV) surveillance and identification in rural areas of central China. METHODS: In a selected rural prefecture area of central China, an epidemiological investigation was conducted for all reported HIV/AIDS cases. A historical and analytic review was performed, with particular interests in examining the HIV epidemic reporting and identification system. RESULTS: Among all 626 reported HIV-infected individuals in the selected prefecture, 86.1% (539/626) of them were infected through commercial plasma donation or clinically operated blood transfusion. With respect to disease surveillance and identification in the area, 52.2% (327/626) of all the cases were reported by hospitals or clinics. The number and proportion of HIV/AIDS cases identified or reported at county, prefecture, and provincial levels were 207 (33.1%), 303 (48.4%) and 116 (18.5%), respectively. The number and proportion of HIV/AIDS identified through specific epidemiological investigations and/or voluntary testing had been increased in recent years. In addition, among HIV/AIDS cases that were clinically identified, the proportion of those who were identified as outpatients had steadily increased,with the highest proportion (59.3%) observed in 2004. CONCLUSIONS: In rural areas of central China where the major mode of HIV transmission was through commercial plasma donation or clinically operated blood transfusion, hospitals and clinics seemed to have played and would continue to play important roles regarding HIV identification and surveillance. The role of institutions or settings at the prefecture level regarding HIV identification and surveillance should not be ignored.