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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 11

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Literature Review
The main challenges and countermeasures about injury prevention and control in China
HU Guo-qing
2021, 25(11): 1241-1244,1281. doi: 10.16462/j.cnki.zhjbkz.2021.11.001
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Abstract:
With the continuous and rapid development of China's economy, injuries have become an important type of disease threatening the health of Chinese since the late period of the last century and continue to be one of the leading cause of deaths. Although the government of China has included injury prevention and control in the national health development plans such as Healthy China 2030 Planning Outline, Healthy China Action (2019-2030), and Chinese Children Development Outline (2021-2030), the development speed of injury prevention and control work lags behind that of infectious disease and chronic non-communicable disease considering the rapid development of China's overall health enterprise. Currently, major challenges for China's injury prevention and control consist of: (1) incomplete laws and weak law enforcement for injury prevention and control, (2) lack of a leading department to coordinate injury prevention and control in the national level, (3) lack of a professional team to take charge of daily injury prevention and control, (4) absence of necessary support for injury prevention research. The author proposes the responding strategies to address these challenges.
Original Articles
Analysis of the characteristics of micro- and nanoplastics exposure to Chinese population via ingestion and inhalation
GENG Yang, HU Man, ZHANG Yi-ning, PANG Yi-xiao, QU Wei-dong, ZHOU Ying
2021, 25(11): 1245-1250,1308. doi: 10.16462/j.cnki.zhjbkz.2021.11.002
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  Objective  To analyze the characteristics of Chinese population exposure to micro- and nanoplastics (MNPs) via food ingestion and air inhalation.  Methods  Articles published up to April 2020 were searched in PubMed, Web of science, Scopus, China National Knowledge Infrastructure, Wanfang and Weipu databases. Then, the exposure levels of MNPs by food ingestion and air inhalation pathways were caculated by referring to the Chinese population food consumption and breathing rates data. The exposure characteristics of MNPs were evaluated between Chinese and foreign population.  Results  A total of 4 511 samples data from 28 studies were retrieved. Annual consumption of MNPs among Chinese population were estimated to range from 187 000 to 328 000 particles for food ingestion depending on age and sex and increase to 192 000 and 335 000particles when air inhalation is also considered, which were larger than those of American persons. Ingestion MNPs posed largest health risk to male Chinese adults. Drinking water, seafood, bottled water as well as air represented four substantial vectors of daily MNPs expsoure. The main types of MNPs were polyethylene, polypropylene and polyethylene terephthalate for ingestion expsosure while polyethylene terephthalate, polyamide and Polyacrylonitrile for inhalation exposure.  Conclusions  Ingestion and inhalation of MNPs posed higher health risk to Chinese population in comparison to that of American population. The attempt to lower the MNPs levels in drinking water and seafood would represent the most effective means to help reduce the MNPs exposure risk to Chinese residents.
Metals source analysis and ecological risk evaluation of atmospheric PM2.5 in a city of North China
CHANG Hui-yun, TANG Da-jing, ZHAO Chuan, SUN Cheng-yao, CHEN Feng-ge, GUAN Ming-yang, ZHANG Ying
2021, 25(11): 1251-1256,1263. doi: 10.16462/j.cnki.zhjbkz.2021.11.003
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  Objective  To investigate the seasonal differences and sources of metal in PM2.5 in the main urban area of a city in North China, and to evaluate the degree of pollution and ecological harm.  Methods  Atmospheric PM2.5 samples were collected from March 2017 to February 2018. The content of metal elements were detected by inductively coupled plasma mass spectrometry (ICP-MS). The source of metals was analyzed by the enrichment factor and principal component analysis (PCA). Pollution degree was evaluated by the geo-accumulation index and the potential ecological risk index.  Results  The seasonal differences of concentration of metal elements in PM2.5 showed that it was higher in winter than that in another seasons. The results of enrichment factor analysis showed that Sb, Se and Cd were highly enriched in four seasons, so they were mainly affected by human activities, and Cr, Ni, Be were non-enrichment which mainly from nature. The results of PCA showed that metals in PM2.5 were mainly from traffic and industrial composite pollution sources, combustion activity sources, and burning and natural composite pollution sources. The results of pollution degree showed that Cr, Ni and Be could be considered as pollution-free in four seasons, and As, Sb, Se, Cd, Tl, Hg and Pb were in a moderate or higher pollution levels but there was no uniform seasonal variation. The results of potential ecological risk assessment showed that As, Cr, Ni, Tl, Hg, Pb were in slight level, and Cd was stronger than others, but the comprehensive potential ecological risk of elements was extremely strong.  Conclusions  The pollution of metal in PM2.5 mainly from traffic, industrial production and burning, etc. The pollution degree was highest in winter and had potential ecological harm. Therefore, we should pay more attention to the control and protection of PM2.5 in winter.
Assessing the excess mortality related to short-term exposure to PM2.5 in Nanjing from 2013 to 2019
SUN Feng-xia, XIONG Li-lin, YANG Hua-feng, JIA Yun-fei, CHEN Chun-jing, TANG Yan-zhao, ZHENG Yu-hong, WEI Li
2021, 25(11): 1257-1263. doi: 10.16462/j.cnki.zhjbkz.2021.11.004
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  Objective  To estimate impact of residents death and excess mortality induced by fine particulate matter (PM2.5) short-term exposure in Nanjing from 2013 to 2019.  Methods  Environmental data, meteorological data, population of community residents and death surveillance data in Nanjing was collected. Generalized additive model of time series analysis was used to analyze the effects of PM2.5 on risk of death, and estimated excess mortality related to PM2.5.  Results  The risk of residents death increased while the concentration of PM2.5 increased in Nanjing from 2013 to 2019. The number of excess mortality due to PM2.5, including non-accidental causes, respiratory diseases, cancer, circulatory diseases, cerebrovascular diseases, cardiovascular diseases was 8 479(3.21%), 1 202(4.32%), 1 424(1.60%), 4 505(3.94%), 2 613(3.79%) and 1 856(4.14%).  Conclusion  The excess mortality caused by PM2.5 was decreasing while the concentration of PM2.5 decreased in Nanjing from 2013 to 2019. The health benefits of air pollution prevention and control in Nanjing are good.
Risk factors of chronic diseases among adult residents in Nanjing City from 2017 to 2018
WANG Wei-wei, SU Jian, ZHOU Jin-yi, YANG Hua-feng, QI Sheng-xiang, WANG Chen-chen, ZHOU Hai-rong, LI Chao, YE Qing, QIN Zhen-zhen, WU Jie, HONG Xin
2021, 25(11): 1264-1268, 1275. doi: 10.16462/j.cnki.zhjbkz.2021.11.005
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  Objective  To estimate the prevalence, clustering and association of risk factors in adult residents in Nanjing City.  Methods  Using the data of chronic diseases and risk factors surveillance in Nanjing City from 2017 to 2018, 4 behavioral risk factors (current smoking, harmful drinking, insufficient intake of fruits and vegetables, and insufficient physical activity) and 4 metabolic risk factors (overweight/obesity, raised blood pressure, raised fasting plasma glucose, and dyslipidemia) were analyzed in different characteristics of adults in Nanjing; and multilevel model was applied to analyze the association and clustering of chronic disease risk factors.  Results  A total of 60 283 community-dwelling adults included in this study were selected randomly. The proportions of insufficient intake of fruits and vegetables, insufficient physical activity, current smoking, and harmful drinking were 49.94%, 28.19%, 22.26%, and 7.40%, respectively; Overweight/obesity, dyslipidemia, raised blood pressure and raised fasting plasma glucose were 43.00%, 28.35%, 26.02%, and 9.39%, respectively. There were 20 pairs of postive correlations between the 8 risk factors, and the differences were statistically significant (all P < 0.05). The proportions of 0, 1, 2, and 3 or more risk factors were 15.09%, 29.94%, 26.17%, and 28.08%, respectively. Males, high age, suburbs, low education, retired, widowed/divorced/separated people were at higher risk of clustering risk factors (all P < 0.05).  Conclusions  The exposure rate of chronic disease behavior and metabolic risk factors of adult residents in Nanjing City were relatively high, and there was a positive correlation between different risk factors. Comprehensive prevention and control strategies for multiple risk factors should be implemented for key populations.
Interaction of overweight/obesity and hyperhomocysteinemia on risk of hypertension
XIE Ming, ZENG Yuan, YUAN Shu-qian, LIU Yin-yue, ZHOU Jun-hua, HE Quan-yuan, HONG Xiu-qin, YANG Yi-de
2021, 25(11): 1269-1275. doi: 10.16462/j.cnki.zhjbkz.2021.11.006
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  Objective  To investigate the interaction between overweight/obesity and hyperhomocysteinemia (HHcy) on the risk of hypertension.  Methods  Six districts in Hunan Province (Changsha, Zhuzhou, Yongzhou, Hengyang, Yueyang, and Xiangxi) were selected from June 2013 to May 2014 by the stratified cluster sampling method. Two urban and two rural communities were randomly selected in each district. A total of 5 258 residents aged 30 or above and living in the district for at least 5 years were invited to participate in the present study. Physical examination, questionnaire survey and laboratory measurements were conducted for participants. Logistic regression model was used to analyze the association between overweight/obesity or HHcy and the risk of hypertension, and the additive and multiplicative interaction were further analyzed.  Results  Among 4 012 subjects with complete data, 1 538 were categorized with hypertension (38.3%); 39.3% participants were considered to be overweight/obese and 35.1% participants with HHcy. After adjustment with covariates such as gender, age, marital status, educational level, smoking, alcohol drinking, diet behavior and physical activity, multivariate unconditional Logistic regression analysis showed that the risk of hypertension in overweight/obese participants was 2.801 times (95% CI: 2.407-3.261) of that in participants without overweight/obesity, and the risk of hypertension in HHcy participant was 3.488 times (95% CI: 3.000-4.055) of that in normal Hcy participants. The risk of hypertension in participants with both overweight and HHcy was 10.205 times (95% CI: 8.120-12.826) of that in non-overweight/obese participants with normal Hcy. With further interaction analysis, we found that the Relative Excess Risk of Interaction, Attributable Proportion of Interaction and Interaction Index S of coexisting of overweight/obesity and HHcy were 5.218 (95% CI: 3.213-7.222), 0.527 (95% CI: 0.420-0.634) and 2.415 (95% CI: 1.848-3.156), respectively, which means that overweight/obesity and HHcy have an additive interaction effect on hypertension. There was no significant multiplicative interaction between overweight/obesity and HHcy (OR=1.246, 95% CI: 0.920-1.688).  Conclusions  Overweight/obesity and HHcy are both associated higher risk of hypertension. In addition, there is an interaction between overweight/obesity and HHcy associated with significantly elavated risk of hypertension.
Association of lifestyle with blood pressure and hypertension risk in middle-aged and older adults
ZHANG Hai-qing, HE Mei-an, ZHANG Xiao-min
2021, 25(11): 1276-1281. doi: 10.16462/j.cnki.zhjbkz.2021.11.007
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  Objective  To explore the association between lifestyle and its changes with blood pressure levels and hypertension risk in middle-aged and older people.  Methods  A total of 7 671 participants were included the analyses in Dongfeng-Tongji Cohort from 2008 to 2010. Linear and Logistic regression models were used to estimate the relationship between lifestyle and blood pressure as well as hypertension, respectively.  Results  After adjusting for confounders, the result showed the dose-response associations between increased lifestyle scores and blood pressure as well as hypertension; compared with lifestyle scored 0-1 at baseline, the systolic blood pressure, diastolic blood pressure, and mean arterial pressure decreased 4.03, 2.25, and 2.84 mm Hg in > 4 scores groups, respectively; the OR of incident hypertension risk was 0.68 (95% CI: 0.52-0.88). Each increment in lifestyle score was associated with a 9% decreased risk of incident hypertension (OR=0.91, 95% CI: 0.87-0.95). During the 5-year period from baseline to follow-up in 2013, the maintenance of > 3 scores group was associated with hypertension (OR=0.61, 95% CI: 0.47-0.80), but increment from 0-2 scores at baseline to > 3 scores at follow-up did not reduce incident hypertension risk (OR=0.87, 95% CI: 0.54-1.40).  Conclusion  In the middle-aged and older population, early and long-term adherence to a healthy lifestyle has the greatest benefit for the prevention and control of hypertension.
Association between systolic blood pressure control and cognitive function in Community-living older adults 65 years and older with hypertension
ZOU Ming-jun, HUANG Jian-wu, ZENG Yan, CHENG Gui-rong, CHEN Cong, LI Lin, LIU Dan
2021, 25(11): 1282-1286, 1292. doi: 10.16462/j.cnki.zhjbkz.2021.11.008
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  Objective  To explore the relationship between systolic blood pressure (SBP) control and cognitive impairment (CI) in older adults with hypertension.  Methods  Randomized multistage stratified cluster sampling was used to investigate older adults 65 years of age or older in the community. Mercury sphygmomanometer was used to measure the blood pressure of the right arm twice, and mini-mental state examination (MMSE) was used to assess cognitive function. Multiple Logistic regression model was used to analyze the association between SBP control and cognitive function.  Results  Intensive control (SBP < 120 mm Hg) (OR=1.519, 95% CI: 1.187-1.945) increased the risk of cognitive impairment. When participants were stratified according to age, intensive control was significantly associated with increased risk of CI in older adults 70 years of age or older (all P < 0.05). After participants were stratified by duration of hypertension, we found that intensive control and poor control (SBP > 140 mm Hg) were significantly associated with increased risk of CI (both P < 0.05) in older adults with hypertension over ten years. Further stratified by age, poor control was associated with an increased risk of CI in older adults 65-69 years of age (P=0.021).  Conclusions  In older adults with long duration of hypertension, people aged 65-69 years of age should strictly control SBP, and those aged 70 years of age or older should carefully control SBP.
Analysis on prevalence and influencing factors of hypertensive disorder complicating pregnancy among pregnant women in Jilin Province
JIANG Ting-ting, WAN Li-xin, HE Huan, YI Li-yan
2021, 25(11): 1287-1292. doi: 10.16462/j.cnki.zhjbkz.2021.11.009
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  Objective  Understanding the prevalence of hypertensive disorder complicating pregnancy (HDCP) among 139 414 pregnant women in Jilin Province and analyzing its influencing factors, to provide theoretical supports for the prevention and scientific management of HDCP.  Methods  Using the cross-sectional survey method, the hospital-based monitoring system was applied to selected the pregnant women who have delivered at 20 or more weeks in 13 monitoring hospitals in Jilin Province from January 1, 2017 to December 31, 2019, as the research subjects. Multivariate unconditional Logistic regression analysis was used to explore the influencing factors of HDCP in pregnant women.  Results  In this study, 6 400 cases of HDCP were diagnosed in pregnant women, with a prevalence rate of 4.59%. Among them, the prevalence of pregnancy complicated with chronic hypertension (335 cases), gestational hypertension (1 959 cases), mild preeclampsia (1 278 cases), severe preeclampsia (2 843 cases) and eclampsia (21 cases) was 0.24%, 1.41%, 0.92%, 2.04% and 0.02%, respectively. Multivariate unconditional Logistic regression analysis showed that pregnant women who aged 30 years and older, have two or more pregnancies, have been pregnant with twins/triplets were related to the increased prevalence of HDCP. Pregnant women who have high school/technical secondary school education level or higher and one parity or more were related to the decreased prevalence of HDCP.  Conclusions  The prevalence of HDCP among pregnant women in Jilin Province is lower than the national average level, among which the prevalence of severe preeclampsia is the highest. It is suggested to continue to strengthen the identification and management of HDCP in primary health care institutions.
Relationship between different types of obesity and metabolic index of cardiovascular disease in college students
DU Meng-xue, WU Nan, LANG Jun-jie, WANG Jing, CHEN Yu, JIN Yue-long, CHEN Yan, YAO Ying-shui
2021, 25(11): 1293-1296. doi: 10.16462/j.cnki.zhjbkz.2021.11.010
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  Objective  To investigate the correlation between different obesity types and metabolic indexes of cardiovascular disease in college students, and to provide scientific basis for the effective control of adolescent obesity and prevention of cardiovascular diseases.  Methods  In this study, 3 450 freshmen from Grade 2018 in a university of Wuhu City were selected as the research objects. Cluster sampling was used to conduct questionnaire survey and physical examination. Body Mass Index (BMI) and waist-to-height ratio (WHtR) were used as indicators to judge obesity.  Results  Among the 3 349 eligible subjects, the prevalence of compound obesity, central obesity and peripheral obesity were 6.51%、4.93% and 0.53%, respectively. Except for apolipoprotein A (APOA), there were statistically significant differences in the detection rates of metabolic abnormalities of cardiovascular diseases among different types of obesity (all P < 0.05). With the exception of APOA, the risk of cardiovascular metabolic abnormalities in compound obesity increased, compared with that in non-obese people (all P < 0.05). Compared with non-obese people, adolescents with compound obesity were 6.86 times more likely to have an abnormal number of indicators≥2 (OR=6.86, 95% CI: 4.54-10.39).  Conclusions  Adolescent with compound obesity are at higher risk of cardiovascular metabolic abnormalities. The combination of BMI and WHtR enhances the predictive effect of cardiovascular disease in adolescents.
Correlation between bisphenol A level and activation of NLRP3 inflammasome in adipose tissue of obese patients
JI Ke-ke, YUAN Shao-yun, ZHOU Yi, YAO Zhuo-meng, HONG Xu, ZHANG Xiao-fei, GE Xiao-lei, WANG Yong, SHEN Tong
2021, 25(11): 1297-1302, 1319. doi: 10.16462/j.cnki.zhjbkz.2021.11.011
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  Objective  The correlation between bisphenol A (BPA) exposure and the activation of NLRP3 inflammasomes in adipose tissue of obese patients was explored through the detection and analysis of clinical case samples.  Methods  A total of 102 obese patients undergoing metabolic surgery were included, and clinical data, demographic data, blood, urine, and surgically removed visceral fat tissue specimens were collected. Liquid chromatography mass spectrometry (LC-MS) was used to detect urine BPA concentration (Creatinine corrected BPA, BPAcr for short), and ELISA was used to detect serum and adipose tissue inflammatory cytokines IL-1β and IL-18 content. Immunofluorescence was used to detect the expression of NLRP3 in adipose tissue, qRT-PCR and immunoblot were used to detect the mRNA and protein expression levels of NLRP3 activation related molecules in adipose tissue. The correlation between urinary BPAcr and inflammatory factors in serum and adipose tissue, as well as the activation of NLRP3 in adipose tissue were analyzed.  Results  Urine BPAcr in obese patients was significantly positively correlated with body mass index (BMI), serum IL-1β, serum IL-18 adipose tissue inflammatory factors IL-1β and IL-18 levels (rs values were 0.784, 0.852, 0.737, 0.509, 0.471, all P < 0.001). The expression of NLRP3, the expression levels of NLRR3, ASC mRNA, and the protein expression levels of IL-1β and caspase-1 in ATMs of obese patients were significantly correlated with urinary BPAcr (all P < 0.05).  Conclusion  BPA exposure may activate the NLRR3 inflammasome in ATMs of adipose tissue and up-regulate the secretion of pro-inflammatory cytokines, leading to the inflammatory state of obese patients.
A cohort study on the effect of pre-onset physical exercise mediated by serum superoxide dismutase on improving the cognitive function of patients with ischemic stroke
YU Ying, CAI Ben, LYU Heng, CHU Yi-fan, ZHANG Li-na, JIA Xian-jie
2021, 25(11): 1303-1308. doi: 10.16462/j.cnki.zhjbkz.2021.11.012
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  Objective  To explore the impact of pre-ischemic stroke physical exercise on the short-term prognosis of cognitive function in patients with first ischemic stroke and the mediating role of serum SOD on this effect.  Methods  In this study, 512 patients who were first-onset diagnosed with ischemic stroke in the department of neurology of the first affiliated hospital of Bengbu Medical College were selected for a short-term cohort study from July 1, 2018 to November 30, 2019. A questionnaire was used to investigate the physical activity-related variables before the onset of the disease, and the modified montreal cognitive assessment (MoCA) scale was used for cognitive function measurement and follow-up evaluation. Logistic regression analysis model was adopted to analyze the effect of physical exercise on the short-term prognosis of cognitive function. The bootstrap method was used to analyze the mediation role of serum SOD.  Results  Compared with the non-exercise group, the patients who exercised ≥ 3 d a week, exercised at least once a day, and exercised 30~ < 60 min per day for more than 1 year had higher MoCA scale scores at 3, 6, and 12 months after discharge. The effect of physical exercise on cognitive function rehabilitation decreased continuously after follow-up for 3 months, 6 months, and 12 months, and the modification effect of serum SOD was evident at 3 months and 6 months. The mediation effect of serum SOD in promoting the short-term prognosis of cognitive function of ischemic stroke patients by physical exercise was significant, with a mediation effect of about 10%.  Conclusion  Pre-ischemic stroke regular physical exercise is a protective factor for the recovery of cognitive function after discharge from ischemic stroke, and its mechanism is correlated with serum SOD.
Effect of health intervention on exercise capacity of patients with mild to moderate chronic obstructive pulmonary disease in Pudong New Area, Shanghai
CHANG Rui, WU Kang, QIU Hua, XIAO Tian, RUAN Xiao-nan, WANG Na, FU Chao-wei
2021, 25(11): 1309-1313, 1353. doi: 10.16462/j.cnki.zhjbkz.2021.11.013
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  Objective  To evaluate the effect of health intervention on the exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in the community of Pudong New Area, Shanghai.  Methods  A random cluster sampling was used to select 10 communities from all communities in Pudong New Area, Shanghai, and divided them into the intervention group and the control group. All registered patients with mild to moderate COPD were taken as survey subjects, and a face-to-face questionnaire survey was conducted to collect basic data. Conduct multiple health intervention activities for the intervention group within 6 months, and the six-minute walk test (6MWT) and Borg subjective physical strength rating scale were used to evaluate the exercise ability of COPD patients before and after the intervention. The rank sum test and the difference in difference (DID) analysis model were used to compare the differences in walking distance and various score differences between the intervention group and the control group before and after the health intervention.  Results  After adjusting the relevant covariates, there was no significant difference in walking distance between the male group, female group, and the overall population (all P>0.05); The difference in dyspnea scores and fatigue scores in the intervention group were greater than those in the control group, and the differences were statistically significant (Z1=-4.636, P1 < 0.001; Z2=-4.912, P2 < 0.001). After adjusting the relevant covariates, the differences in male dyspnea score, fatigue score, and female fatigue score were all negative and all P < 0.05.  Conclusion  Health intervention measures relieved dyspnea and fatigue in patients with mild to moderate COPD, and improved the exercise capacity of patients with mild to moderate COPD in the Pudong New Area, Shanghai.
Spatial and temporal distribution of H5N1 avian influenza in mainland China
WEI Xiao-meng, ZHANG Juan, LI Ming-tao, PEI Xin
2021, 25(11): 1314-1319. doi: 10.16462/j.cnki.zhjbkz.2021.11.014
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  Objective  To explore the spatiotemporal distribution characteristics of the frequency of H5N1 subtype highly pathogenic avian influenza from 2004 to 2019 in 31 autonomous regions and municipalities directly under the central government in mainland China.  Methods  Based on ArcGIS10.5 and SPSS 26 software, cluster analysis and chi-square test were applied to investigate the temporal distribution characteristics and influencing factors of H5N1 epidemic disease. The spatial autocorrelation method was applied to study the spatial distribution characteristics of H5N1 epidemic diseases.  Results  Temporal cluster analysis showed that the frequency of H5N1 outbreak was clustering in the temporal distribution during both the epidemic phase (2004-2005) and the stationary phase (2006-2019), with January, February, June, and November being periods of high incidence of the disease. Global spatial autocorrelation analysis showed that the spatial distribution of H5N1 was clustering during the epidemic phase and presented a random distribution during the stationary phase of the epidemic. Local autocorrelation analysis showed that H5N1 hotspot areas in the epidemic stage were concentrated in Xinjiang and central China, mainly including Urumqi, Xianning, Yueyang, Anqing, and Jiujiang, and hotspot areas in the stable stage were mainly concentrated in northwest China. Chi-square test showed that there was a correlation between epidemic disease and bird migration.  Conclusion  The frequency of H5N1 avian influenza in mainland China has spatiotemporal clustering in the epidemic stage and only certain temporal clustering in the stable stage.
The spatial pattern and spatio-temporal evolution of COVID-19 in China
JIN Li-juan, XU Quan-li
2021, 25(11): 1320-1326. doi: 10.16462/j.cnki.zhjbkz.2021.11.015
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  Objective  To better control the spread of COVID-19, it is important to understand the spatial pattern of COVID-19 and its spatiotemporal evolution characteristics, and explore its distribution and diffusion laws.  Methods  In this study, based on the daily incidence data of COVID-19 in China from January 22 to May 26, 2020, spatial autocorrelation was used to analyze the spatial pattern of COVID-19, and center of gravity trajectory migration algorithm was used to explore spatial-temporal evolution process.  Results  In the study period, COVID-19 had strong spatial dependence at the provincial scale. From January 22 to May 26, 2020, the global spatial correlation of COVID-19 showed a trend of increasing from strong to weak. Moran's I was negative in the range of (-0.04, -0.02) and had a small fluctuation range. The COVID-19 epidemic in China showed a general pattern with Wuhan City in Hubei Province as the center, spreading to the surrounding cities and random distribution. The domestic epidemic were mainly high-low clusters, and high-high clusters were distributed in Hong Kong and Macao Special Administrative Regions, while Hubei Province had been in the high-low clusters. In the study period, the high-low cluster was only one province in Hubei Province, and the low-low clusters were mainly distributed in Heilongjiang Province and Tibet Autonomous Region. During the T1-T3 period, the epidemic spread rapidly from Wuhan City to the northwest. During the T4-T6 period, the epidemic gradually spread to the southwest. During the T7-T9 period, the epidemic spread to the northeast.  Conclusions  In the future epidemic prevention and control work, we should pay more attention to the study of epidemic spatial diffusion model, explore the factors affecting diffusion, so as to provide strong theoretical support for the formulation of precise epidemic prevention measures.
Case-control study on severe risk factors in COVID-19 patients in Fujian Province
CHEN Guang-min, LAN Mei-fang, CHEN Xiao-hong, XIE Jian-feng, OU Jian-ming, ZHENG Kui-cheng
2021, 25(11): 1327-1331. doi: 10.16462/j.cnki.zhjbkz.2021.11.016
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  Objective  To analyze the epidemiological characteristics and laboratory tests of coronavirus diseases 2019(COVID-19) cases in Fujian province and to explore the risk factors for their progression to severe cases.  Methods  The clinical and epidemiological data of COVID-19 confirmed patients with clinical final outcome (including recovery death, etc.) from January 22 to March 7 in 2020 in Fujian were collected. The risk factors of the severe cases were analyzed by univariate and multivariate Logistic regression.  Results  Up to March 7, 2020, a total of 231 patients were collected in Fujian province, among which, 39(16.88%) were severe and critical cases. The univariate analysis showed that most patients in the severe group had underlying diseases (71.80%), which was significantly higher than that in the non-severe group (34.40%) (χ2 =18.808, P < 0.001). Among them, hypertension, cardiovascular disease, lung disease, other chronic diseases and other factors were statistically different between the two groups (all P < 0.05).Then, numbers of hematological tests were statistical differences between the two groups. Multivariate Logistic regression analysis revealed that age≥65 years old (OR=17.067, 95%CI: 2.640-110.327), low level of lymphocyte (OR=4.731, 95%CI: 1.175-19.046), liver dysfunction (OR=12.458, 95%CI: 2.559-60.649), high level of calcitonin (OR=3.577, 95%CI: 1.733-7.384) and high level of C-reaction protein (OR=2.354, 95%CI: 1.012-5.478) were risk factors for the progression of COVID-19 patients to severe illness. The obtained regression equation fits the training sample well (AUC=0.941).  Conclusions  Low level of lymphocyte, liver dysfunction, high level of calcitonin and high level of C-reaction protein could be used as the early warning indicators for severe cases. More attention should be paid to elderly patients age≥65 years old and patients with the above laboratory test abnormality and timely and effective treatment should be taken.
Epidemiological and genetic characteristics of norovirus in sentinel surveillance cases of viral diarrhea in Hubei Province from 2017 to 2019
LI Jing, ZHANG Ting, ZOU Wen-jing, XU Jun-qiang, CAI Kun
2021, 25(11): 1332-1335. doi: 10.16462/j.cnki.zhjbkz.2021.11.017
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Abstract:
  Objective  To describe the epidemiologic and genetic characteristics of norovirus (NV) in sentinel surveillance cases of viral diarrhea in Hubei Province from 2017 to 2019.  Methods  A total of 1 957 fecal samples from adult and child patients with diarrhea were collected from January 1, 2017 to December 30, 2019. Samples were detected using real-time RT-PCR. Positive samples of NV GII were amplified to obtain the sequences of open reading frame (ORF)1/ORF2 junction by RT-PCR. The obtained PCR products were directly sequenced and analyzed for genotype and recombination.  Results  There was a statistically significant difference in the detection rate of NV between males and females with diarrhea (χ2 =5.18, P=0.023). There is a statistically significant difference in the detection rate of NV between patients with diarrhea in each age group (χ2 =98.04, P < 0.001), among them, the 1~ < 2 year old age group has the highest NV-positive detection rate (23.50%) in patients with diarrhea. From 2017 to 2019, there were two epidemic peaks of NV infection in Hubei Province, the peak appeared in October-December, and the low peak appeared in March-April. The main NV genotypes were GII genogroup, of which GII.4, GII.2 and GII.3 were the main subtypes. The main recombination types were GII.2[P16], GII.4[P31], GII.3[P12] and GII.4[P16].  Conclusions  There were multiple genotypes of NV infection in Hubei province from 2017 to 2019 and different recombination subtypes were found. Enhancing the monitoring of genotype and recombination of NV contributes to know the molecular epidemiology features of NV and provide theoretical basis for scientific prevention and control.
Analysis of clinical characteristics and influencing factors of respiratory syncytial virus infection among children under 5 years old in Suzhou
REN Shao-long, SHAO Xue-jun, SHI Ting, SHAN Wei, CHEN Qing-hui, XUE Jian, TIAN Jian-mei, ZHANG Tao, ZHAO Gen-ming
2021, 25(11): 1336-1340. doi: 10.16462/j.cnki.zhjbkz.2021.11.018
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Abstract:
  Objective  To analyze the clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection and explore the influencing factors in RSV infection.  Methods  First of all, the Hospitalization Information System was applied to retrospectively screened the children with acute lower respiratory infection (ALRI) who got hospitalized in Suzhou University Affiliated Children's hospital (SCH) from 2010 to 2014. Then, the detailed data in relation to their clinical diagnosis, treatment and biochemical test was collected from the medical records of ALRI inpatient and the results of their RSV tests were obtained from the Laboratory Information System. Upon a comparison drawn in clinical characteristics between RSV positive and negative ALRI cases, non-conditional Logistic regression model analysis was performed to analyze the influencing factors in RSV infection.  Results  Among the 19 257 ALRI cases involved, 4 096 were positive for RSV, with a positive rate of 21.3%. The common symptoms exhibited by RSV-infected children include coughing (99.4%), sore throat (98.3%) and wheezing (60.9%). Compared with RSV-negative patients, RSV-positive ALRI patients had higher symptom rates in respect of wheezing and shortness of breath (all P < 0.001), but lower symptom rates with regard to fever (χ2 =280.8, P < 0.001). Young age was identified as an independent risk factor of RSV infection. In comparison with those children aged 24- < 60 months, the adjusted odds ratio for RSV infection among the children aged 1- < 6, 6- < 12, and 12- < 24 months reached 4.00 (95% CI: 3.57-4.48), 2.60 (95% CI: 2.30-2.94) and 1.82 (95% CI: 1.59-2.07), respectively.  Conclusions  The children with RSV infection have higher symptom rates of wheezing and shortness of breath. Young age is an independent risk factor for RSV infection, which means the younger the age, the higher the risk of RSV infection.
Application of SARIMA-GRNN combined model in forecasting the monthly incidence of typhoid fever and paratyphoid fever
LI Wen-hao, ZENG Yu-xing, LI Xiao-yan, PENG Yuan-zhou, ZHANG Yan-wei, CHEN Qing-shan, CHENG Jin-quan
2021, 25(11): 1341-1346. doi: 10.16462/j.cnki.zhjbkz.2021.11.019
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Abstract:
  Objective  This study aimed to establish a seasonal autoregressive integrated moving average (SARIMA)-general regression neural network (GRNN) combined model, so as to provide new methodological ideas for forecasting the incidence of typhoid fever and paratyphoid fever.  Methods  Using data of typhoid fever and paratyphoid fever from January 2011 to December 2019, the SARIMA model and the SARIMA-GRNN combined model were constructed respectively, and the fitting and forecasting effects of the two models were compared.  Results  The optimal SARIMA model was SARIMA (2, 1, 1) (0, 1, 1)12 and the optimal smoothing factor of SARIMA-GRNN combined model was 0.21. The root mean squared error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) of the SARIMA-GRNN combined model fitting effect were 90.08, 71.44, and 7.07%, which were smaller than the SARIMA model's 99.44, 79.15, and 7.86% respectively. The RMSE, MAE, and MAPE of the forecasting effect were 100.86, 75.94, 9.57%, which were all smaller than 125.44, 97.33, 10.89% of the SARIMA model.  Conclusions  The SARIMA-GRNN combined model has a better fitting effect and higher forecasting effect than the traditional SARIMA model to forecast the monthly incidence of typhoid fever and paratyphoid fever in China. It can be used to predict the monthly incidence of typhoid fever and paratyphoid fever.
Effects of rotating night shift work and sleep duration on liver dysfunction among steelworkers
LI Qing-lin, WANG Han, ZHANG Xiao-hong, XUE Chao, QIN Sheng, ZHANG Sheng-kui, YUAN Ju-xiang
2021, 25(11): 1347-1353. doi: 10.16462/j.cnki.zhjbkz.2021.11.020
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Abstract:
  Objective  To investigate the effects of rotating night shift work and average sleep duration and their combined effects on liver dysfunction of steelworkers, and to provide theoretical basis for liver protection of steelworkers.  Methods  In this cross-sectional study, a total of 6 907 workers from a steel company were recruited, and their indicators were collected. These indicators were analyzed by the unconditional Logistic regression model and the restricted cubic spline function.  Results  The detection rate of liver dysfunction was 18.0%, which was significantly higher in males than in females (19.2% vs. 5.1%). After adjusting for the confounding factors, there was a non-linear dose-response relationship between duration of night shifts and liver dysfunction, and the odds of liver dysfunction in night shift workers and average frequency of night shifts > 7 nights/month were increased by 1.24 (OR=1.24, 95% CI: 1.04-1.49) and 1.29 (OR=1.29, 95% CI: 1.07-1.56), respectively. When stratified by current shift status, compared with the average sleep duration of > 5-7 h/d, the odds of liver dysfunction in shorter sleep duration (≤5 h/d) and longer sleep duration (> 7 h/d) were increased by 1.19 (OR=1.19, 95% CI: 1.01-1.43) and 1.22 (OR=1.22, 95% CI: 1.02-1.44) among night shift workers. And there was a positive interaction between longer or shorter average sleep duration and current shift status. After stratified by average sleep duration, only in the layer with an average sleep duration of > 5-7 h/d, there was no statistically significant relationship between different exposure metrics of night shift work and liver function.  Conclusion  The combined effects of rotating night shift work and longer or shorter sleep duration increases the risk of liver dysfunction, and the independent effects of rotating night shift work cannot be ignored.
Short Report
The dynamic response relationship between the incidence of Japanese encephalitis and qitameteorological factors in Gansu Province from 2014 to 2018
WANG Li-juan, LI Juan-sheng, LIU Xin-feng, YUAN Yan, ZHOU Jian-hun, JIANG Xiao-juan, MENG Lei
2021, 25(11): 1354-1359. doi: 10.16462/j.cnki.zhjbkz.2021.11.021
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Abstract:
  Objective  To use a vector autoregressive(VAR) model to analyze the dynamic response relationship between the incidence of Japanese encephalitis(JE) and meteorological factors in Gansu Province, and to provide a scientific basis for the prevention and control of JE in different weather conditions.  Methods  The incidence of JE from January 2014 to December 2018 and the meteorological data of the same period were used to establish a multivariate VAR model, and impulse response and variance decomposition were used to analyze the impact of meteorological factors on the incidence of JE quantitatively.  Results  The goodness of fit of the VAR(2) model was 0.95, the adjusted goodness of fit was 0.95, and the theil inequality coefficient was 0.06. The contribution of average temperature, hours of sunshine and rainfall to the change of JE incidence was 9.52%、2.13% and 38.62%, respectively, to the six period.  Conclusions  The VAR(2) model can be used to analyze the dynamic relationship between the incidence of JE and meteorological factors. The prevention and control of JE, the prediction and early warning can be combined with local meteorological factors.
Epidemiology of dengue virus serotype 4 cases and E gene analysis of dengue virus in Guangzhou Province from 2010 to 2019
JIANG Li-yun, LIU Yuan, SU Wen-zhe, LUO Lei, CAO Yi-min, DI Biao, WU Xin-wei, ZHANG Zhou-bin
2021, 25(11): 1360-1364. doi: 10.16462/j.cnki.zhjbkz.2021.11.022
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Abstract:
  Objective  Investigate epidemiology of dengue virus serotype 4 cases, and molecular biological characteristics of dengue virus serotype 4 circulating in Guangzhou from 2010 to 2019.  Methods  Information and serum samples of dengue patients were collected. Serotypes were confirmed by real-time PCR. Envelope (E) gene of dengue virus serotype 4 was sequenced. Phylogenetic tree was constructed, and recombination was analyzed.  Results  A total of 43 174 dengue cases were reported in Guangzhou between 2010 and 2019, of which 23 cases were confirmed as serotype 4. Serotype 4 cases can only be detected in 5 districts. An endemic of dengue virus serotype 4 broke out in 2010. The imported cases were mainly from Southeast Asia. Sequences of E gene had a high similarity with sequences from Southeast Asia. Sequences acquired in Guangzhou clustered into Indonesia genotype and Southeast Asia genotype. No recombination has been detected.  Conclusions  Supervision on dengue virus serotype 4 cases and imported cases should be enforced. Conduct propaganda of knowledge about dengue fever and personal protection should be further done among people coming back from Southeast Asia. Dengue virus serotype 4 must be prevented from spreading, especially in some districts. The genotype shift didn't cause any change of epidemic. Although there was no sign of recombination, further research is needed.

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