Mortality burden from seasonal influenza in Chongqing, China, 2012-2018.

PURPOSE: To estimate influenza-associated excess mortality rates (EMRs) in Chongqing from 2012 to 2018. METHODS: We obtained weekly mortality data for all-cause and four underlying causes of death (circulatory and respiratory disease (CRD), pneumonia and influenza (P&I), chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IDH)), and influenza surveillance data, from 2012 to 2018. A negative-binomial regression model was used to estimate influenza-associated EMRs in two age groups (<65 years and ≥65 years). RESULTS: It was estimated that an annual average of 10025 influenza-associated deaths occurred in Chongqing, corresponding to 5.2% of all deaths. The average EMR for all-cause death associated with influenza was 33.5 (95% confidence interval (CI): 31.5-35.6) per 100 000 persons, and in separate cause-specific models we attributed 24.7 (95% CI: 23.3-26.0), 0.8 (95% CI: 0.7-0.8), 8.5 (95% CI: 8.1-9.0) and 5.0 (95% CI: 4.7-5.3) per 100 000 persons EMRs to CRD, P&I, COPD and IDH, respectively. The estimated EMR for influenza B virus was 20.6 (95% CI: 20.3-21.0), which was significantly higher than the rates of 5.3 (95% CI: 4.5-6.1) and 7.5 (95% CI: 6.7-8.3) for A(H3N2) and A(H1N1) pdm09 virus, respectively. The estimated EMR was 152.3 (95% CI: 136.1-168.4) for people aged ≥65 years, which was significantly higher than the rate for those aged <65 years (6.8, 95% CI: 6.3-7.2). CONCLUSIONS: Influenza was associated with substantial EMRs in Chongqing, especially among elderly people. Influenza B virus caused a relatively higher excess mortality impact compared with A(H1N1)pdm09 and A(H3N2). It is advisable to optimize future seasonal influenza vaccine reimbursement policy in Chongqing to curb disease burden.

[Investigation of oral health knowledge, attitude, behavior of 12-15 years old children in Chongqing].

OBJECTIVE: To investigate the status of oral health knowledge, attitude, behavior of 12-15 years old children and provide a theoretical basis of prevention. METHODS: Multi-stage stratified sampling method was used to extract four middle school students from Chongqing districts and counties (2 in the main urban area and 2 suburbs), and their oral health knowledge, attitudes and behaviors were investigated through questionnaires. All data were entered using Epidata and statistical analysis was performed using SPSS 21.0 software. RESULTS: A total of 3 902 valid questionnaires were collected. The proportion of people who had good brushing habits was 39.7% (1 548), the average oral health knowledge accuracy rate was 58.9%, and the average oral health positive attitude was 88.6%. The number of middle school students who attended the dental experience was 54.5% (2 127), and that of the school who received oral health education was 17.5% (681). There were gender and regional differences in brushing habits. CONCLUSIONS: The knowledge and behavior of oral health among 12-15-year-old middle school students in Chongqing need to be improved. Oral health education for middle school students should be strengthened, especially in rural and suburban areas.

The burden of influenza and pneumonia mortality attributable to absolute humidity among elderly people in Chongqing, China, 2012-2018.

OBJECTIVE: To examine the association between absolute humidity (AH) and influenza and pneumonia (P&I) mortality, and to quantify P&I mortality burden attributable to non-optimum AHs among elderly people aged ≥65 years in Chongqing, the largest municipality of China. METHODS: Daily data of P&I mortality from 2012 to 2018, and the contemporaneous meteorological data in the study area were collected. Distributed lag non-linear model (DLNM) was applied to estimate the non-linear and delayed effects of absolute humidity (AH) on P&I mortality. Then, attributable deaths were calculated for the dry and moist AH, defined as AH below and above the minimum mortality AH (MMAH), respectively. Moderate and extreme AHs were defined using cutoffs at the 2.5th and 97.5th percentiles of AH. RESULTS: The relationship between AH and P&I mortality was a U-shaped curve. The MMAH was 11.5 g/m3 (46.4th percentile). In total, 25.7% (95% confidence interval: 10.0-38.2) of P&I mortality (4673 deaths) was attributed to non-optimum AHs. Low AHs were responsible for 12.7% of the P&I death burden (95%CI: 0.2-20.1), while high AHs for 13.0% (95%CI: -9.4-25.7). Extreme low and high AHs accounted for 3.7% (95%CI: 0.1-6.8) and 3.0% (95%CI: 0-5.4) of P&I mortality. CONCLUSIONS: Our study showed that both low AHs and high AHs are responsible for considerable AH-related P&I mortality burden among elderly people. Our results may have important public health implications for the development of relevant intervention policies to reduce P&I deaths among the elderly.

[An investigation on the need, the utilization, and the influencing factors of dental services for pre-school children in selected areas in Chongqing province].

OBJECTIVE: The aim of this study is to survey the need, the utilization, and the influencing factors of dental services for children in selected areas in Chongqing province by investigating their oral health status. The survey will provide references for preventive oral health care in targeted Chongqing areas, which may improve the level of oral health among pre-school children. METHODS: Random cluster sampling was utilized according to standards of the Fourth National Oral Health Epidemiological sampling survey, and 1 300 children between the ages of three and four years old from 24 kindergartens in 12 subdistricts of three areas in Chongqing were interviewed for free dental checkups and to participate in the survey. The questionnaires were designed according to the Anderson model and were answered by the children's parents. The results were analyzed utilizing Chi-square test logistic regression. RESULTS: The prevalence rate of caries among the pre-school children in selected areas of Chongqing was 55.4%, the decay, missing, filled surface (dmfs) was 6 696, the mean dmfs was 5.2, and the caries filling constituent ratio was 2.3%. A total of 1 173 questionnaires were analyzed. The ratio for seeing a dentist for therapeutic reasons was 6.31% (74/1 173) and for prevalence was 22.93% (269/1 173). CONCLUSIONS: The oral health service needs of pre-school children in selected areas of Chongqing are large and the oral health service utilization rate is low. Oral health care processes are arduous; thus, targeted oral prevention policies should be created.

[Effect of comprehensive control and prevention for chronic disease in demonstration plot of Chongqing].

OBJECTIVE: To evaluate the effect of comprehensive control and prevention for chronic diseases in demonstration plot of Chongqing. METHODS: Residents were enrolled through multi-stage stratified random sampling method from 17 districts or counties which had successfully established demonstration plots and 21 districts or counties which had not established demonstration plots (non-demonstration plot for short) yet on May, 2012. Questionnaire was designed to survey awareness of health knowledge, health behaviors and utilization of health supportive tools. The results were analyzed by SPSS 15.0 software. RESULTS: We investigated 15 108 residents, 6156 of which were in demonstration plot and others (8951) were not. The findings revealed the percentage of the people who were aware the national action of health lifestyle in demonstration plot and in non-demonstration plot were 44.4% (2734/6157) and 40.2% (3598/8951), respectively, and the awareness of the hypertension risk of too much sodium were 72.4% (4458/6156) and 67.5% (6042/8951), respectively, and the awareness of the cardinal vascular disease (CVD) risk of obesity and overweight were 77.2% (4753/6157) and 69.6% (6230/8951), respectively. About the residents' health behaviors in demonstration plot and in non-demonstration plot, the utilization rates of salt restriction scoop or pot were 23.5% (1447/6157) and 17.9% (1602/8951), and the utilization rates of oil restriction pot were 16.7% (1028/6157) and 11.8% (1064/8951), respectively. Totally, 33 of the 37 indexes were shown higher in demonstration plot than that in non-demonstration plot (P < 0.05). CONCLUSION: The chronic diseases comprehensive control and prevention in demonstration plot was more effective, and the remarkable improvement of health knowledge and behaviors level had been achieved in demonstration plot.

[Study on the effect of intervention about acquired immunodeficiency syndrome among men who have sex with men].

OBJECTIVE: To study the outcomes of AIDS intervention programs and to provide scientific evidence for developing pertinent strategy on intervention among men who have sex with men (MSM). METHODS: MSM were recruited through snowballing and investigated by face to face interview in 2006 and 2007 respectively. SPSS 12.0 was used to compare the change of cognition about AIDS, sexual behavior, prevalence rates of HIV and Syphilis before and after the intervention program among the population under study. RESULTS: The cognition about AIDS among MSM was obviously improved after the intervention with the rate increased from 74.3% to 82.4% (P = 0.01). The rate of last time condom use among MSM increased from 56.4% to 65.5% (P = 0.00). The rate of consistent condom use during six months among MSM increased from 31.8% to 41.9% (P = 0.00). The rates of both condom use during commercial sex with men and with women did not change much among MSM. The prevalence rates of HIV in 2006 and 2007 were 10.4% and 10.8% and of syphilis in 2006 and 2007 were 9.3% and 7.3% respectively which were not significantly different between before and after the intervention. CONCLUSION: The cognition about AIDS among MSM was improved obviously. However, the rate of consistent condom use was still low, reflecting the segregation phenomenon between their behavior and cognition. All our findings implied that it was crucial to carry out AIDS prevention and control programs.

[HIV and syphilis infections among men who have sex with men in Chongqing municipality, China].

OBJECTIVE: To examine the prevalence and predictors of HIV and syphilis infections among men who have sex with men (MSM) in Chongqing municipality, China. METHODS: Cross-sectional studies were conducted in three districts of Chongqing municipality from July to September, 2006 and 2007, respectively. Questionnaire-based interviews were conducted to provide information on demographic characteristics, behaviors on sex and drug use, and HIV and sexually transmitted diseases (STD) related health services. Blood samples were tested for HIV and syphilis infections. RESULTS: Of 1773 participants, 10.6% were HIV-positive and 8.4% were sero-positive for syphilis infection. Factors independently associated with HIV infection included older age (26-35 year: AOR = 1.7, 95% CI: 1.1-2.6; >35 years of age: AOR = 2.3, 95% CI: 1.4-3.8), low level of education (AOR = 2.3, 95% CI: 1.5-3.5), having had multiple male sex partners (AOR = 1.8, 95% CI: 1.2-2.8), venues of recruitment from bathhouses/sauna (AOR = 2.3, 95% CI: 1.1-4.7), with self-reported STD symptoms in the past 12 months (AOR = 1.8, 95% CI: 1.2-2.7) and syphilis infection (AOR = 1.7, 95% CI: 1.1-2.9). CONCLUSION: The prevalence rates on both HIV and syphilis infections were considered to be high among MSM in Chongqing city. Unprotected anal sex and multiple sex partners were common in this group. Education, condom promotion, combination of HIV and STD screening, and treatment to the diseases are essential to this population in Chongqing. However, MSM had not hitherto been perceived to be in the epidemic mainstream in this area.

[Surveillance on HIV-1 incidence among men who have sex with men in Chongqing, China, 2006 - 2008].

OBJECTIVE: To estimate HIV-1 incidence among men who have sex with men (MSM) in Chongqing and to provide reasonable evidence for intervention strategy. METHODS: Using "snowballing" and convenient sampling, 2989 MSM were recruited during 2006 - 2008. BED-CEIA was applied to the leftover blood samples to estimate the crude and adjusted HIV-1 incidence rates. Incidence was stratified by venues and age groups. RESULTS: The incidence among MSM in Chongqing were 7.01%, 7.98% and 7.80% from 2006 - 2008 respectively with statistically significant differences by venues. The highest incidence was found among those who frequently visiting public baths/sauna and those MSM who find sex partners through internet, amounting to 17.87% and 12.22% respectively in 2007 and 2008. The 21 - 25 year-old group had the highest incidence in 2008, reaching 8.69%. Various adjustments brought down the estimated incidence across the three years. CONCLUSION: HIV-1 incidence among MSM maintained at a high level across the three years but without an increasing trend.

[HIV infections and heterosexual behaviors among men who have sex with men in Chongqing municipality, China].

OBJECTIVE: To understand the prevalence and risk factors for both HIV infection and prevalence rates of syphilis infection among men who exclusively have sex with men (MSM/M) or with both men and women (MSM/W) in Chongqing municipality, China. METHODS: Cross-sectional studies were conducted in Chongqing. Structured questionnaire-based interviews were conducted to provide information about demographic characteristics, behavior, HIV related health services and sexual transmitted infections (STIs). Blood samples were tested for HIV and syphilis infections. RESULTS: Of 1691 participants, 21.6% were MSM/W, with HIV prevalence as 16.1% which was significantly higher than that among MSM/M (9.4%, P < 0.001). Factors independently associated with HIV infection among MSM/W included being separated/divorced/widowed (AOR = 14.8, 95%CI: 3.1 - 71.6), having multiple male sex partners (AOR = 5.4, 95%CI: 1.8 - 16.3), unprotected anal sex behaviors (AOR = 4.6, 95%CI: 1.5 - 13.9) and syphilis infection (AOR = 4.4, 95%CI: 1.1 - 17.3). Factors independently associated with HIV infection among MSM/M were as follows: lower education (AOR = 2.6, 95%CI: 1.6 - 4.5), older age (AOR = 2.0, 95%CI: 1.3 - 3.3, 26 - 35 years vs. < 26 years; AOR = 1.9, 95%CI: 1.1 - 3.5, > 35 years vs. < 26 years), being recruited from bath house/sauna (AOR = 2.5, 95%CI: 1.1 approximately 5.6) syphilis infection (AOR = 1.9, 95%CI: 1.0 - 3.4), multiple male sex partners (AOR = 1.8, 95%CI: 1.1 - 2.9), and STIs infection (AOR = 1.7, 95%CI: 1.0 - 2.7). Heterosexual behaviors independently associated with married/cohabiting (AOR = 6.5, 95%CI: 4.4 - 9.8), self-identified as bisexual/heterosexual (AOR = 3.9, 95%CI: 2.8 - 5.5), first lifetime female sex partners (AOR = 2.2, 95%CI: 1.5 - 3.0), lack of HIV related knowledge (AOR = 1.9, 95%CI: 1.1 - 3.2), being recruited from bars/night clubs/tea bars (AOR = 1.6, 95%CI: 1.0 - 2.6), older age at sex debut (AOR = 0.6, 95%CI: 0.4 - 0.8), not offering sex for money for anal intercourses in the past six months (AOR = 0.5, 95%CI: 0.3 - 1.0) and HIV infection (AOR = 1.7, 95%CI: 1.1 - 2.7). CONCLUSION: HIV prevalence had reached a high level among men who have sex with men and women in Chongqing, China. Multiple sex partners and other high risk behaviors when having sex with men or women among MSM/W represented a unique risk group within the population of MSM that might have bridged the HIV transmission between HIV high risk group and general population. More attention need to be specifically paid to prevent HIV transmit from HIV high risk group to general population.

[A respondent-driven sampling survey on HIV and risk factors among men who have sex with men in Chongqing].

OBJECTIVE: To examine HIV prevalence and related risk factors among men who have sex with men (MSM) in Chongqing, and to explore the feasibility of using respondent-driven sampling (RDS) in the survey. METHODS: Based on results from formative research, a RDS survey was designed and conducted to collect demographic, behavioral and serologic data. RDSAT was used to calculate point estimation and confidence intervals. SPSS was used for bi-variate analysis using RDSAT exported weighed data. NETDRAW was used to draw network diagram. RESULTS: Among 617 subjects recruited, the adjusted HIV and syphilis prevalence rates were 16.8% and 10.9%, respectively. 73.0% of the subjects were 20 to 29 years old and 72.9% were officially registered residents of Chongqing. 83.4% were single, with the proportion of students the highest, accounting for 24.6%. During the last six months, 83.4% of them reported ever having anal sex, and 54.0% reported having unprotected anal sex. CONCLUSION: This survey confirmed that Chongqing had a higher reported HIV prevalence among MSM than from other Chinese cities. Comprehensive intervention services were required to address this alarmingly high prevalence, with focus on intervention through internet and those having syphilis infection. RDS seemed one of the effective ways of recruiting hidden MSM populations in Chongqing which had a large population of active MSM who did not frequently visit MSM venues as compared with snowball method.

[Drug resistance among recent HIV-1 infected men who have sex with men in Chongqing municipality of China].

OBJECTIVE: To evaluate the situation of HIV prevalence, incidence and drug resistance (DR) among recent HIV infected men who have sex with men(MSM) during the year of 2006. METHODS: A transect investigation was conducted through snowballing to recruite volunteers. HIV infected status was confirmed by ELISA and Western Blot (WB), the recent infected within 155 days were confirmed by BED-Capture ELISA Assay (BED-CEIA), which based on the principle that characteristics of the initial HIV antibody response in recent infections differs from those of established or long-term infections either by antibody titer, proportion, specificity, isotype or avidity. Bayer Trugene was applied to PCR the target sequence of HIV pol gene, and the sequences were analyzed to detect the prevalence of HIV gene mutation. Furthermore, HIV antiretroviral drug resistance among MSM was evaluated. The results were analyzed through three methods: Trugene DR 3.7 IVD (2006/07/27) Guidelines 11.0 (2005/12/15) provided by Bayer company, Stanford HIVdb and Geno2pheno. RESULTS: The prevalence and incidence of HIV among MSM were 10.4% and 7.98% PY, by three methods. There was only 1 sample found to have occurred resistant primary mutation which could be inferred that the average DR ratio was 4.55% (1/22). CONCLUSION: The incidence and prevalence of MSM in Chongqing were notable, and the mutation rate stands at a low level when comparing to researches conducted in developed countries. Secondary mutations appeared frequently, suggesting that more research need to be conducted to understand how HIV was transmitting among the carriers.

[HIV prevalence and its associated factors among men who have sex with men in Chongqing].

OBJECTIVE: To examine HIV prevalence and its associated factors among men who have sex with men (MSM) and provide the evidence for the intervention program among MSM. METHODS: A face-to-face questionnaire interview was conducted among MSM recruited by snowball sampling method in Yuzhong, Jiulongpo and Shapingba district of Chongqing from July to September, 2007. Totally, 1044 MSM were recruited. Associated factors with HIV prevalence were analyzed using forward stepwise logistic regression that HIV status was the dependent variable and demographics, AIDS awareness, sexual behaviors and the status of the intervention were independent variables. RESULTS: A total of 1044 MSM were surveyed. The rate of AIDS awareness was 89.5% among MSM. The rate of unprotected anal sex during the past 6 months was 63.8%. The prevalence of HIV and syphilis was 8.5% (89/1044) and 12.5% (131/1044) respectively. The multivariate analysis identified that the older MSM (OR = 1.69, 95% CI: 1.13 - 2.52), junior school education (OR = 1.89, 95% CI: 1.17 - 3.05), younger than 18 years old of the first sex (OR = 3.11, 95% CI: 1.20 - 8.02), more than 10 sexual partners (OR = 2.24, 95% CI: 1.24 - 4.02), the history of having sex with women (OR = 2.40, 95% CI: 1.64 - 3.51) and syphilis infection (OR = 4.52, 95% CI: 2.77 - 7.38) were independent risk factors associated with HIV infection. CONCLUSION: The rate of unprotected anal sex was high, so were the prevalence of HIV and syphilis among MSM. It should be urgent to conduct the intervention to stop AIDS rapid transmission among MSM.