Associated factors of respiratory co-infection of COVID-19 and the impact of co-infection on SARS-CoV-2 viral load.

INTRODUCTION: Emerging evidence indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected individuals are at an increased risk for co-infections. This retrospective study aims to expand the knowledge of associated factors of respiratory co-infection in SARS-CoV-2 positivity. METHODOLOGY: A retrospective study was conducted to recruit fifty-five patients with laboratory-confirmed SARS-CoV-2 positivity. We additionally tested 29 other respiratory pathogens using RT-PCR assay for the same specimens tested for laboratory-confirmed SARS-CoV-2. Both univariate and multivariate analysis were performed to identify independent factors for co-infection. Cox regression was conducted to detect the association between co-infection and viral load after controlling other related factors. RESULTS: Among all the fifty-five COVID-19 patients, the rate of co-infection with at least one other respiratory pathogen was 76.4% (42/55). The rate of bacterial co-infections was 83.3% (35/42), among which Streptococcus pneumonia was the most common co-infection. Over 70% of neutrophils proportion (OR: 4.563; 95% CI: 1.116-18.648) was an independently associated factor for bacterial co-infection, whereas fever (OR: 4.506; 95% CI: 1.044-19.441) and chest tightness (OR: 0.106; 95% CI: 0.015-0.743) for viral co-infection. The strongest promotion of SARS-CoV-2 viral decreasing load was detected from co-infection of only viruses (HR: 4.039; 95% CI: 1.238-13.177), and the weakest was found from co-infection of only bacteria (HR: 2.909; 95% CI: 1.308-6.472). CONCLUSIONS: Various co-infections variously promote SARS-CoV-2 viral decreasing load. Timely identification of co-infections aggressively contributes to COVID-19 patient management.

Analysis of recessive infection of hand, foot and mouth disease and associated risk factors among healthy children and guardians in Qingdao / 中国学校卫生

Objective@#To investigate the recessive infection rate of healthy children and guardians in different epidemic periods of hand, foot and mouth disease (HFMD) in Qingdao, analyze the risk factors affecting recessive infection, so as to provide the basis for HFMD prevention and control.@*Methods@#In the nonepidemic period of 2022, the random cluster sampling method was used to selected 546 children and guardians from 4 childcare institutions in Laoshan District and Pingdu City. In the epidemic period of 2023, 690 children and guardians were selected from 6 childcare institutions in Shibei District, Laoshan District and Pingdu District. A questionnair survey was conducted in the epidemic period. Logistic regression analysis was used to analyze the factors affecting the recessive infection. Dominance analysis was used to explore the relative importance of the risk factors affecting recessive infection.@*Results@#The results showed that the recessive infection rates of healthy children and guardians in the epidemic period were 18.84% and 13.62%, respectively; the recessive infection rates were 9.09% and 4.44% in the nonepidemic period, respectively. The results of multivariate Logistic analysis showed that rural areas (OR=4.71, 95%CI=2.57-8.61) and recessive infection of guardians (OR=18.62, 95%CI=7.45-46.56) were positively correlated with recessive infection of HFMD in healthy children (P<0.05). Washing hands (OR=0.09, 95%CI=0.04-0.20), using towels alone (OR=0.17, 95%CI=0.07-0.40), and EV71 vaccination (OR=0.42, 95%CI=0.20-0.87) were negatively correlated with recessive infection of HFMD in healthy children (P<0.05). Public toilets (OR=3.02, 95%CI=1.50-6.09) and drying bedding once per quarter (OR=3.89, 95%CI=1.75-8.68) were positively correlated with recessive infection of HFMD in healthy guardians. Housing with good lighting (OR=0.31, 95%CI=0.12-0.79), and tableware disinfection (OR=0.31, 95%CI=0.15-0.65) were negatively correlated with recessive infection of HFMD in healthy guardians (P<0.05). The results showed that recessive infection of guardians was relatively the most important for healthy children (41.51%), and tableware disinfection was relatively the most important for recessive infection of guardians (28.87%).@*Conclusions@#The recessive infections of HFMD are common among healthy populations in Qingdao, and the recessive infection rate among children during the epidemic period is relatively higher. Guardians play an important role in the recessive infection of healthy children. Therefore, healthy education should be strengthened for key populations, especially to enhance parents awareness of prevention and control to reduce the occurrence of recessive infections of hand, foot and mouth disease in children and guardians.

The effect of ambient temperature on hand, foot and mouth disease in Qingdao, China, 2014-2018.

Hand, foot, and mouth disease (HFMD) is a kind of infection gastrointestinal disease. The present study aims to explore the association between ambient temperature and HFMD in Qingdao. A distributed lag nonlinear model with Poisson distribution was adopted to explore the effects of daily mean temperature on HFMD incidence. Our results found that the high temperature had acute and short-term effects and then declined rapidly along the lag days, with the maximum risk occurring 0 day of exposure. Compared with low temperature, higher effects were observed for high-temperature exposure. Overall, we found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "J" shape, with peak value occurring at 30.5℃ (RR = 2.208, 95% CI: 1.995-2.444). Our findings suggest that ambient temperature is significantly associated with the incidence of HFMD in Qingdao. Monitoring ambient temperature changes is an appropriate recommendation to prevent HFMD.

Epidemiological Characteristics of Hand, Foot, and Mouth Disease Outbreaks in Qingdao, 2009-2018.

BACKGROUND: In China, hand, foot, and mouth disease (HFMD) outbreaks have become an important issue recent years. We analyzed the epidemiological characteristics of HFMD outbreaks in Qingdao during 2009-2018, and provided evidences for prevention and control of the disease. METHODS: Data were analyzed by descriptive analysis and correlation analysis, and throat swabs were detected for enterovirus RNA using RT-PCR. RESULTS: Overall, 116 HFMD outbreaks were reported in Qingdao during 2009-2018, with the epidemic of the outbreaks exhibiting a decreasing tendency. The characteristics of outbreaks presented two patterns, including two-peak pattern and rural area to urban-rural fringe area to urban areas pattern. Male patients were predominant in these outbreaks. The location of the outbreaks changed from nursery to community. Non-EV71/CA16 enteroviruses were gradually becoming predominant enteroviruses serotypes. The durations of outbreaks were positively correlated with response times and the number of cases. CONCLUSION: The epidemiological characteristics analysis of HFMD outbreaks could provide a scientific basis for the prevention and control the disease. Reporting and handling promptly are the keys to control epidemic outbreaks of HFMD.

Association between floods and the risk of dysentery in China: a meta-analysis.

The association between floods and the risk of dysentery remain controversial. Therefore, we performed a meta-analysis to clarify this relationship. A literature search was performed in PubMed, Web of science, and Embase for relevant articles published up to November 2019. Random-effects model was used to pool relative risks with 95% confidence intervals. The sensitivity analysis was carried out to evaluate the stability of the results. Publication bias was estimated using Egger's test. Eleven studies from 10 articles evaluated the association between floods and the risk of dysentery in China. The pooled RR (95% CI) of dysentery for the flooded time versus non-flooded period was 1.48 (95% CI: 1.14-1.91). Significant association was found in subgroup analysis stratified by dysentery styles [dysentery: 1.61 (95% CI: 1.34-1.93) and bacillary dysentery: 1.46 (95% CI: 1.06-2.01)]. The pooled RR (95%CI) of sensitivity analysis for dysentery was 1.26 (95% CI: 1.05-1.52). No significant publication bias was found in our meta-analysis. This meta-analysis confirms that floods have significantly increased the risk of dysentery in China. Our findings will provide more evidence to reduce negative health outcomes of floods in China.

Epidemiological characteristics and spatial-temporal clusters of hand, foot, and mouth disease in Qingdao City, China, 2013-2018.

BACKGROUND: Hand, foot, and mouth disease (HFMD) has become one of the most important infectious diseases recent years. Qingdao City has suffered from serious HFMD epidemic. This study aimed to describe epidemiological characteristics and investigate spatial-temporal distribution at town level in Qingdao City. METHOD: The surveillance data of HFMD during 2013-2018 were collected from the National Notifiable Disease Surveillance System. The global Moran's I statistic was used to detect the spatial autocorrelation of HFMD cases by ArcGis 10.0 software. Purely spatial and spatial-temporal analysis was used to detect epidemic clusters by SatScanTM v9.6 software. RESULTS: The annual average incidence of HFMD cases in Qingdao City from 2013 to 2018 was 123.16 per 100000, while the incidence rate of children≤5years old was 2879.80 per 100000. The majority (88.97%) of HFMD cases were aged within 0-5 years old and the males were 60.20%. Other enterovirus (EV), enteriovirus 71(EV71), and Coxsackievirus A16 (CA16) accounted for 48.75%, 30.91% and 20.34%. The seasonal peak was between May and October. HFMD had positive spatial autocorrelation at town level with global Moran's I from 0.19 to 0.31(P<0.001). Spatial-temporal cluster analysis detected six most likely clusters and three secondary clusters from 2013 to 2018. The most likely cluster was located in urban and urban-rural fringe areas. CONCLUSIONS: Urban and urban-rural fringe areas were the major locations of the clusters with other EV as the dominant pathogen between May and October. The findings suggested that the prevention and control of HFMD in Qingdao City should be focus on these high-risk periods and locations which had important public health significance for the allocation of public health resources.

Age at last birth and risk of developing epithelial ovarian cancer: a meta-analysis.

Background: Many epidemiologic studies have explored the association between age at last birth (ALB) and the risk of epithelial ovarian cancer, but the results remain controversial. Methods: A literature search was performed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and WanFang Med Online for relevant articles published up to April 2019. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effect model. Dose-response relationship was assessed by restricted cubic spline model. Results: Thirteen articles with 19,959 cases and 2,451,071 participants were included in our meta-analysis, and we found that ALB was negatively associated with epithelial ovarian cancer. The pooled RR (95% CI) of epithelial ovarian cancer for the highest versus the lowest stratification of ALB was 0.77 (0.65-0.91). Furthermore, significantly negative associations were shown in case-control studies (RR: 0.73; 95% CI: 0.60-0.88), studies conducted in North America (RR: 0.71; 95% CI: 0.60-0.84), studies with adjustment for parity (RR: 0.76; 95%CI: 0.63-0.93), studies with adjustment for tubal ligation (RR: 0.74; 95% CI: 0.58-0.94), in the subgroup analysis. In dose-response analysis, the risk of epithelial ovarian cancer decreased nonlinearly with the increase of ALB, and the negative results become significant when ALB was 22.5 years old. Conclusion: This meta-analysis suggested that ALB was negatively associated with the risk of epithelial ovarian cancer. The risk of epithelial ovarian cancer decreased gradually with the ALB for women.

Exposure to Chinese famine in early life and the risk of dyslipidemia in adulthood.

PURPOSE: Early life exposure to famine may affect the susceptibility to metabolic disorders including dyslipidemia. However, few studies explored the association between them in Chinese population. We aimed to evaluate the association between Chinese famine (1959-1961) exposure during early life and the risk of dyslipidemia in adulthood. METHODS: The study performed a historic cohort study and data were from China Health and Nutrition Survey conducted in 2009. A total of 4843 subjects born between 1941 and 1966 were categorized into fetal-infant exposed group (N = 433), childhood exposed group (N = 2132), adolescence exposed group (N = 1140), and unexposed group (N = 1138), respectively. Dyslipidemia was defined by Chinese adult dyslipidemia prevention guide (2016 edition). We compared fetal exposed group, childhood exposed group, and adolescence exposed group to unexposed group using logistic regression models to assess the effect of famine exposure on later dyslipidemia. RESULTS: The prevalence of dyslipidemia among subjects in unexposed group, fetal exposed group, childhood exposed group, and adolescence exposed group was 56.40, 64.00, 63.90, and 63.90%, respectively. Compared with unexposed group, participants exposed to famine in fetal period (OR 1.34, 95% CI 1.05-1.70), childhood (OR 1.44, 95% CI 1.23-1.69), and adolescence (OR 1.41, 95% CI 1.17-1.71) had higher risks of dyslipidemia in adults after adjustment for potential confounders. CONCLUSION: Exposure to Chinese famine in early life was associated with increased risk of dyslipidemia in adulthood. Preventing undernutrition in early life is an appropriate recommendation to reduce the prevalence of later dyslipidemia.

Dietary fiber intake is associated with a reduced risk of ovarian cancer: a dose-response meta-analysis.

Dietary fiber may reduce the bioavailability of steroid hormones and favorably regulate insulin-like growth factor 1, and therefore may be associated with ovarian cancer risk. Current evidence on the association between dietary fiber intake and risk of ovarian cancer is inconsistent. Therefore, we conducted a meta-analysis to explore the association. We hypothesized that dietary fiber intake might be associated with a reduced risk of ovarian cancer. PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases were searched for relevant articles up to September 2017. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using random-effects model. Dose-response relationship was assessed by restricted cubic spline. A total of 19 studies involving 567 742 participants were included in this meta-analysis. The summary RR of the association between dietary fiber intake and ovarian cancer risk was 0.70 (95% CI, 0.57-0.87; I2 = 83.5%, Pheterogeneity < .001). In subgroup analyses, the above-mentioned significant inverse association was found among studies conducted in North America, case-control studies, and studies assessing the association of total fiber intake with ovarian cancer risk. Dose-response analysis suggested that ovarian cancer risk decreased by 3% (RR, 0.97; 95% CI, 0.95-0.99) for each 5-g/d increment in dietary fiber intake. This meta-analysis suggests that dietary fiber intake is associated with a reduced risk of ovarian cancer. Future intervention trials are needed to test the associations between different types of fiber (including soluble, insoluble, vegetable, fruit, cereal, and legumes fiber) and ovarian cancer risk.

Association of total zinc, iron, copper and selenium intakes with depression in the US adults.

BACKGROUND: The aim of present study was to examine the associations of total zinc, iron, copper and selenium intakes from diet and supplements with depression. METHODS: Cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 in the present study. Logistic regression models and restricted cubic spline models were applied to examine the associations of total zinc, iron, copper and selenium intakes with depression. RESULTS: A total of 14834 adults aged 18 years or older (7399 men and 7435 women) were included in the present study. Total zinc, iron, copper and selenium intakes were inversely associated with depression in unadjusted model and age- and gender-adjusted model. The multivariate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of depression were 0.68 (0.49-0.94) and 0.46 (0.32-0.67) for the highest versus lowest quartile of copper and selenium intakes, respectively. The inverse associations of depression were statistically significant for the quartile 3 versus lowest quartile of total zinc (OR: 0.70; 95% CI: 0.49-0.99) and iron intake (OR: 0.66 95% CI: 0.50-0.87). Compared to those below the RDA (Recommended Dietary Allowance), participants who met the RDA for zinc (OR: 0.74; 95% CI: 0.56-0.99), copper (OR: 0.68; 95% CI: 0.56-0.82) and selenium (OR: 0.52; 95% CI: 0.39, 0.71) had significantly lower odds of depression. LIMITATIONS: This was a cross-sectional study, limiting causal inferences. Assessment of depression was based on a self- report scale. CONCLUSION: Total zinc, iron, copper and selenium intakes may be inversely associated with depression.

Famine exposure during early life and risk of hypertension in adulthood: A meta-analysis.

BACKGROUND: Many epidemiologic studies have explored the association between famine exposure and the risk of hypertension, but the results remain controversial. OBJECTIVE: A meta-analysis was performed to determine the association between early life famine exposure, fetal famine exposure, and childhood famine exposure and risk of hypertension. METHODS: A literature search was performed in PubMed, Web of science, Embase, and China National Knowledge Infrastructure for relevant articles published up to October 2016. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Sixteen studies from 14 articles for early life famine exposure, 11 studies from 10 articles for fetal famine exposure, and 10 studies from 8 articles for childhood famine exposure were included in our meta-analysis. Compared with unexposed group, the pooled RRs were (1.26; 95% CI, 1.11-1.44), (1.27; 95% CI, 1.08-1.49), and (1.32; 95% CI, 1.15-1.52) for early life famine exposure, fetal famine exposure, and childhood famine exposure, respectively. In subgroup analyses, the above-mentioned associations were consistent in cohort studies, and studies conducted in Asia. CONCLUSION: This meta-analysis confirmed the association between exposure to famine in early life and increased risk of hypertension in adulthood. Prevention of malnutrition during early life is an appropriate recommendation to prevent hypertension.

AGE-RELATED MACULAR DEGENERATION AND THE RISK OF ALL-CAUSE AND CARDIOVASCULAR MORTALITY: A Meta-Analysis of Cohort Studies.

PURPOSE: We evaluated the association between age-related macular degeneration (AMD) and the risk of all-cause and cardiovascular mortality by meta-analyses of data from prospective studies. METHODS: A literature search was performed in PubMed, Web of Science, Embase, Cocharne Library, and China National Knowledge Infrastructure for relevant articles published up to December 2016. We estimated hazard ratios with 95% confidence intervals with fixed-effect models and conducted meta-regression to explore the potential sources of heterogeneity. Small-study effect was estimated by Egger's test and funnel plot. RESULTS: We identified 13 population-based prospective cohort studies that examined the relationship between AMD and all-cause and cardiovascular mortality. Overall, the hazard ratios (95% confidence intervals) of all-cause mortality and cardiovascular mortality associated with any AMD were 1.15 (1.05-1.27) and 1.05 (95% confidence intervals: 0.87-1.26), respectively. The risk of all-cause mortality and cardiovascular mortality associated with early AMD were 1.08 (1.00-1.18) and 1.05 (0.89-1.24), and the associations with late AMD were 1.23 (1.11-1.36) and 1.28 (1.04-1.57), respectively. No evidence of small-study effect was found. CONCLUSION: This meta-analysis indicated that AMD, especially late AMD, was associated with increased risk of all-cause mortality and cardiovascular mortality based on comparisons with people who did not have AMD and who were of similar age and sex.

Cesarean section and risk of postpartum depression: A meta-analysis.

OBJECTIVE: The association of cesarean section (CS) with the risk of postpartum depression (PPD) remains controversial. Therefore, we conducted a meta-analysis to explore the association between CS and the risk of PPD. METHODS: A systematic literature search was performed in PubMed, Web of Science and Embase databases for relevant articles up to November 2016. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with fixed-effects model or random-effects model. RESULTS: A total of 28 studies from 27 articles involving 532,630 participants were included in this meta-analysis. The pooled OR of the association between CS and PPD risk was 1.26 (95% CI: 1.16-1.36). In subgroup analyses stratified by study design [cohort studies: (1.25, 95% CI: 1.10-1.41); case-control studies: (1.25, 95% CI: 1.00-1.56); cross-sectional studies: (1.44, 95% CI: 1.14-1.82)] and adjustment status of complications during pregnancy [adjusted for: (1.29, 95% CI: 1.12-1.48); not-adjusted for: (1.24, 95% CI: 1.13-1.36)], the above-mentioned associations remained consistent. The pooled ORs of PPD were 1.15 (95% CI: 0.92-1.43) for elective cesarean section (ElCS) and 1.47 (95% CI: 1.33-1.62) for emergency cesarean section (EmCS). CONCLUSION: This meta-analysis suggests that CS and EmCS increase the risk of PPD. Further evidence is needed to explore the associations between the specific types of CS and the risk of PPD.

[Development of an intelligent control system for radiography].

An intelligent control system has been designed using the single chip and the related circuit, and with the assemble language. It is connected with the common X-ray units to control the exposure dose. The result shows that three parameters for radiography are well controlled by the intelligent control system, and auto-radiography is realized.