Chinese General Practice

Epidemiology and Management of Hypertension in China: an Analysis Using Data from the Annual Report on Cardiovascular Health and Diseases in China (2021)

Liyuan MA, Zengwu WANG, Jing FAN, Shengshou HU

2022, 25(30): 3715-3720. DOI: 10.12114/j.issn.1007-9572.2022.0502

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With the development of society and economy and the acceleration of population aging and urbanization, the prevalence of hypertension in China is gradually increasing, and the growth is more obvious in rural areas. The rates of awareness, treatment and control of hypertension in Chinese adults have not reached a satisfactory status despite recent improvements. The number of Chinese people suffering from hypertension is 245 million, and that of those with high normal blood pressure keeps growing, imposing a growing financial burden on residents and society. Hypertension has become a major public health problem, so it is urgent to strengthen the government-led prevention and control of hypertension.

Research of Epidemiologic Feature and Control of SARS-CoV-2 Omicron Subvariants BA.4 and BA.5

Yu WU, Jue LIU, Min LIU, Wannian LIANG

2022, 25(30): 3721-3725. DOI: 10.12114/j.issn.1007-9572.2022.0538

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The global COVID-19 is still in a pandemic state, and Omicron is still the dominant variant in the world, accounting for about 99% of the global gene sequence. Many regions around the world are experiencing the seventh wave of the epidemic. This round of epidemics is mainly caused by Omicron subvariants BA.4 and BA.5, but the epidemiological characteristics of Omicron subvariants BA.4 and BA.5 are still unclear, bringing great challenges to the prevention and control of the epidemic in countries and regions. In this study, discovery and epidemic status, the incubation period, transmissibility, clinical symptoms, case fatality rate, and the protective effect of vaccines of Omicron subvariants BA.4 and BA.5 were reviewed, in order to provide reference for scientific prevention and control of Omicron subvariants BA.4 and BA.5.

Awareness and Skills of Correctly Donning and Doffing Personal Protective Equipment in SARS-CoV-2 Omicron Containment Workers from a Mobile Cabin Hospital

Wendi JIANG, Jinjin WANG, Shanshan LI, Yang YANG, Shuai HAO, Zhihui TONG, Wenpeng CAI

2022, 25(30): 3726-3733. DOI: 10.12114/j.issn.1007-9572.2022.0555

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Background

The transmission speed and concealment of the Omicron variant of SARS-CoV-2 have been enhanced. The awareness level and skills of correctly donning and doffing personal protective equipment (PPE) in SARS-CoV-2 containment workers from the mobile cabin hospital are associated with their own health status, and the overall quality of COVID-19 pandemic control.

Objective

To understand the awareness and skills of correctly donning and doffing PPE in SARS-CoV-2 containment workers from a mobile cabin hospital.

Methods

By use of cluster sampling, 460 SARS-CoV-2 containment workers were selected from the Fourth Branch of Shanghai Mobile Cabin Hospital located in the National Exhibition and Convention Center (Shanghai) , from April 10 to May 10, 2022. Their awareness and skills of correctly donning and doffing PPE were assessed using an online survey with a self-developed questionnaire named Awareness of Correctly Donning and Doffing Personal Protective Equipment, and using an onsite performance assessment with a self-developed questionnaire named Skills of Correctly Donning and Doffing Personal Protective Equipment, respectively.

Results

The survey obtained a response rate of 83.5% (384/460) . According to the survey, both doctors and nurses had significantly higher average scores with regards to the operations at the first donning area, second donning area, front doffing area and first doffing area, second doffing area, and hand hygiene disinfection than public security officers and fire fighters (P<0.05) . All of the 460 cases completed the onsite performance assessment. Both doctors and nurses obtained lower average scores in terms of completing the operations at the first donning area, and donning steps in clean area into contaminated area than public security officers and fire fighters (P<0.05) . Doctors had much lower average score for completing the operations at the first donning area than nurses (P<0.05) .

Conclusion

There were significant differences in the levels of awareness and skills of correctly donning and doffing PPE in SARS-CoV-2 containment workers by occupation. Targeted and focused trainings and supervisions should be carried out to improve the mismatching between the levels of awareness and skills.

Timing of Antihypertensive Initiation in Gestational Hypertension—Early Intervention Can Reducec Clinical Risk

Na LI, Wenli CHENG

2022, 25(30): 3733-3738. DOI: 10.12114/j.issn.1007-9572.2022.0517

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Gestational hypertensionis a serious adverse factor that endangers the health of women during pregnancy and the growth and development of the fetus. The incidence of gestational hypertension in pregnant women in China is 6% to 8%, with the liberalization of the fertility policy in China, the average age of pregnant women has increased, and risk factors such as overweight, obesity, and diabetes have generally increased, the potential risk of gestational hypertension is more prominent among them. In the diagnosis of gestational hypertension, the opinions of international experts are relatively consistent that ≥140/90 mm Hg is the threshold for diagnosing gestational hypertension, but there is still few high-level studies can be used as the evidence supporting the time to start antihypertensive treatment. In recent years, the recommendations of various hypertension academic organizations on the treatment and control target value of pregnant women with chronic hypertension have also been controversial. This article elaborates on the harm of gestational hypertension and the time to initiate blood pressure reduction, analyzes the early intervention effect of gestational hypertension and new methods for the prevention and treatment of gestational hypertension, in order to provide clinical evidence for the antihypertensive treatment of gestational hypertension.

Application of Minimal Clinically Important Difference in Outcome Assessment Tools for Bronchiectasis Treatment

Jiarui GUAN, Jiaming REN, Yang XIE, Peng ZHANG

2022, 25(30): 3739-3746. DOI: 10.12114/j.issn.1007-9572.2022.0290

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Increased bronchiectasis (BE) prevalence has imposed heavy economic burden on patients and their families, greatly affecting the quality of life of patients. With increased use of patient reported outcome (PRO) in bronchiectasis treatment assessment, researchers not only focus on statistical pre-and post-treatment differences (P<0.05) , but also pay attention to minimal clinically important difference (MCID) . Currently, there is still a lack of relevant data about MCID in BE-PRO assessment tools. We reviewed the latest research on the use of MCID in BE-PRO assessment tools, aiming at providing a quantitative basis for outcome assessment in BE treatment.

Consensus and Disagreement in the Debate on the Bidirectional Effects of Alcohol Consumption on the Cardiovascular System

Jinxia REN, Leiming LUO

2022, 25(30): 3747-3754. DOI: 10.12114/j.issn.1007-9572.2022.0299

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Today's world, there is an increasing number of people drinking alcoholic beverages. Drinking alcohol can induce several diseases and is a serious threat to human health, but whether it has a positive effect on the cardiovascular system is controversial. Traditional beliefs have suggested that small to moderate amounts of alcohol consumption (female intake of ≤ 1 standard amounts of alcoholic beverages daily, male intake of ≤ 2 standard amounts of alcoholic beverages daily, 1 standard amounts of alcoholic beverages=12-15 g pure ethanol) might be beneficial for the treatment of cardiovascular diseases (such as atherosclerotic cardiovascular disease) , whereas heavy drinking (intake of > 2 standard amounts of alcoholic beverages daily) leads to impairment of the cardiovascular system, the bidirectional effect of a "J" - shaped curve. In recent years, there has been a growing debate on whether traditional ideas are correct, involving many aspects such as the pattern of drinking, the type of alcoholic beverage and the different types of CVD that they affect. This article discusses the consensus and disagreement in the debate on bidirectional effects of drinking on cardiovascular system by pooling and analyzing recent results from relevant studies at home and abroad, finding that although there is no consistent view in the current relevant studies, most research results suggest that small to moderate alcohol consumption may benefit cardiovascular health, especially in middle-aged and elderly people with pre-existing atherosclerosis and cardiovascular disease. It may provide ideas for developing lifestyle intervention guidelines for cardiovascular disease prevention and control in the future.

Body Composition Analysis during Allogeneic Hematopoietic Stem Cell Transplantation in Overweight/Obese Patients with Hematologic Diseases

Hui ZHOU, Chenjie LING, Shengli XUE, Jing YANG

2022, 25(30): 3755-3760. DOI: 10.12114/j.issn.1007-9572.2022.0392

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Background

With the rise of overweight/obese people around the world, the prevalence of allogeneic hematopoietic stem cell transplantation (HSCT) for treating hematologic diseases in this population is also increasing. Obesity has been reported to be associated with poor prognosis after transplantation. More research should be conducted to improve the poor outcome in these patients.

Objective

To analyze the characteristics of body composition changes in overweight/obese patients with hematologic diseases during allogeneic HSCT, providing evidence and ideas for the delivery of nutritional intervention in the transplantation for these patients.

Methods

Two hundred and twelve hematologic disease patients with allogeneic HSCT were selected from the First Affiliated Hospital of Soochow University from November 2018 to March 2021. Baseline data, including personal demographics and clinical information, were collected. SPSS 26.0 software was used to compare the changes in body composition and abnormal glucolipid metabolism parameters between patients with normal BMI (normal group, n=137) and those with overweight/obesity (overweight/obese group, n=75) on the day before and after pretreatment, as well as 14 days after transplantation.

Results

The normal and overweight/obese groups had no significant differences in sex ratio, mean age, diagnosis, preconditioning regimen and HLA typing (P>0.05) . Fourteen days after the allogeneic HSCT, overweight/obese patients had obviously decreased body weight (t=14.271, P<0.001) , fat-free body weight (t=12.344, P<0.001) , skeletal muscle mass (t=14.119, P<0.001) , BMI (t=14.119, P<0.001) and fat-free mass index (FFMI) (t=12.344, P<0.001) , insignificantly changed body fat (P>0.05) , and significantly increased body fat percentage and visceral fat area (t=-3.258, -2.478, P<0.05) . Compared with normal BMI group, overweight/obese group had a more significant decrease in muscle-related indicators such as fat-free body weight, skeletal muscle mass and FFMI (t=3.525, 3.728, 3.545, P<0.05) at 14 days after the allogeneic HSCT. Moreover, the incidence of abnormal fasting glucose and hypercholesterolemia in overweight/obesity group was significantly higher (χ²=7.250, 4.665, P<0.05) .

Conclusion

We found that overweight/obese patients had a more significant decrease in skeletal muscle mass, a tendency of visceral fat accumulation, and a higher risk of abnormal glycolipid metabolism after the allogeneic HSCT. In view of this, more attention should be given to body weight and body composition in the overweight/obese patients, and corresponding nutrition intervention should be provided to them during the peri-transplant period.

Protective Effect of Bufei Jianpi Formula on Mucosal Barrier in a Rat Model with Chronic Obstructive Pulmonary Disease

Congcong ZHANG, Ya LI, Suyun LI, Jing MAO

2022, 25(30): 3761-3767. DOI: 10.12114/j.issn.1007-9572.2022.0307

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Background

Themucosal structure of the respiratory tract is similar to that of the gastrointestinal tract in humans, which is the body's first line of defense against the invasion of pathogens through the function of mucosal barrier. When the respiratory tract infection stimulates the airway mucosa to produce a local immune response, it affects the intestinal tract through migration and homing, resulting in the weakening of the local mucosal anti-infection ability, inducing mucosal barrier damage, and further aggravating chronic obstructive pulmonary disease (COPD) .

Objective

To explore the effects of Bufei Jianpi Formula on the expression levels of inflammatory factors in lung tissue, and the content of lung-gut related peptides in lung and colon tissues in a rat model of stable COPD based on a typical viscera theory of Traditional Chinese Medicine, namely "the lungs and large intestines are interior-exteriorly related" .

Methods

This experiment was carried out from September 2019 to December 2020. Fifty SPF SD rats were selected, and equally and randomly divided into control, model, Bufei Jianpi, aminophylline and probiotics groups. Except for the control group, the rats in other groups received cigarette smoke exposure combined with intranasal instillation of lipopolysaccharide (LPS) in the first eight weeks of intervention for establishing a COPD model. From the ninth week of intervention, rats in the control and model groups received intragastric administration of 0.9% sodium chloride solution, and those in Bufei Jianpi, aminophylline and probiotics groups received intragastric administration of Bufei Jianpi Formula, aminophylline and probiotics, respectively. The rats were sacrificed after 12 weeks of intervention. The pathological changes of lung and colon tissues were observed under an optical microscope, the expression levels of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) in lung tissue were detected by immunohistochemistry. The contents of secretory immunoglobulin A (SIgA) in bronchoalveolar lavage fluid (BALF) , substance P (SP) and vasoactive intestinal peptide (VIP) in lung and colon tissues were detected by enzyme-linked immunosorbent assay (ELISA) .

Results

In terms of morphology, the lung and colon tissue structures of rats in the control group were basically intact. In the model group, the trachea was narrowed and surrounded by a lot of inflammatory cells with thickened bronchial wall. The improvement in histopathology of the lung tissues was the most obvious in Bufei Jianpi group. The colon tissue of rats in the model group was damaged, which was manifested by numerous shed epithelial cells, and crypts in different shapes and sizes. Bufei Jianpi group demonstrated better improvement in histopathology of the colon tissue. There were statistically significant differences in the expression levels of TNF-α, IL-10, SP and VIP in the lung tissue of the five groups of rats (F_TNF-α=70.640, F_IL-10=8.444, F_SP=108.700, F_VIP=4.665, P<0.05) . The expression level of SIgA in BALF differed significantly across five groups of rats (F=26.370, P<0.05) . The expression levels of SP and VIP in colon tissue also varied significantly across five groups of rats (F_SP=136.600, F_VIP=13.980, P<0.05) . Compared with the control group, the expression levels of TNF-α and SP in the lung tissue and those of SP and VIP in the colon tissue of the model group were increased (P<0.05) ; the expression levels of IL-10 and VIP in the lung tissue, and expression level of SIgA in the BALF of the model group were decreased (P<0.05) . Compared with the model group, the expression levels of TNF-α and SP in the lung tissue and those of SP and VIP in the colon tissue of the Bufei Jianpi group were decreased (P<0.05) ; the expression levels of IL-10 and VIP in the lung tissue, and expression level of SIgA in the BALF of the Bufei Jianpi group were increased (P<0.05) .

Conclusion

Compared with the model group, the improvement in the lung-gut related peptides indices in three treatment groups was better, and the improvement was the best in the Bufei Jianpi group. Bufei Jianpi Formula could improve symptoms of lung inflammation and pathological damage of lung and intestine tissues. The mechanism may be related to the involvement in regulating the content of SIgA, SP and VIP, and enhancing local mucosal immunity and barrier function.

Application of TeamSTEPPS in the Management of Out-of-hospital Medication Safety for Patients with Chronic Heart Failure

Fang HE, Fulan WANG, Liling XIE, Shuya LING, Mingchao XIAO

2022, 25(30): 3768-3774. DOI: 10.12114/j.issn.1007-9572.2022.0314

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Background

Due to long treatment cycle and medication dependence, patients with chronic heart failure (CHF) face many risks of out-of-hospital medication. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based patient safety tool, which has been studied rarely in the management of out-of-hospital medication safety in CHF patients.

Objective

To discuss the role of TeamSTEPPS in the out-of-hospital medication safety management in CHF patients.

Methods

A total of 134 CHF patients hospitalized in the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2020 were selected, and were divided into the intervention group (n=62) and control group (n=61) according to the number of ward, receiving routine medication safety management, and TeamSTEPPS-based medication safety management, respectively. The medication error was evaluated before discharge and 6 months after discharge by the Medication Error Questionnaire developed by us. The medication knowledge, attitude and practice (KAP) were evaluated before discharge, 1, 3 and 6 months after discharge by a self-developed Medication KAP Scale. Cardiac function, dyspnea and edema were evaluated before discharge, 3 and 6 months after discharge. The readmission and all-cause mortality were collected 3 and 6 months after discharge. The safety attitude of medical workers was measured before intervention and 6 months after intervention by the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) .

Results

The prevalence of ignoring the content of the prescription, omission error, wrong time error, wrong dose error, taking medication without a doctor's advice and unauthorized drug withdrawal differed between the two groups 6 months after discharge (P<0.05) . The readmission rates of the intervention group 3 and 6 months after discharge were lower than those of the control group (P<0.05) . The scores of teamwork climate, safety climate, perceptions of management, job satisfaction and stress recognition in medical workers providing services for the intervention group 6 months after intervention were higher than those before intervention (P<0.05) . The results of two-factor repeated measures ANOVA showed that the duration and type of medication safety management had significant interaction effects on the medication KAP scores, NYHA class, dyspnea and edema in two groups (P<0.05) . The duration of medication safety management had an significant main effect on the medication KAP scores, dyspnea and edema in two groups (P<0.05) . The type of medication safety management had a significant main effect on the medication KAP and edema in two groups (P<0.05) . The medication knowledge scores of the intervention group 3 and 6 months after discharge were higher than those of the control group (P<0.05) . The intervention group had higher medication attitude score but lower medication practice score than the control group 1, 3 or 6 months after discharge (P<0.05) . The medication knowledge and medication attitude scores increased in both groups 1, 3, 6 months after discharge (P<0.05) . The medication practice score increased in the intervention group 1, 3, 6 months after discharge, but decreased in the control group at 1 month after discharge (P<0.05) . The medication knowledge score at 1 month after discharge was lower than that 3 or 6 months after discharge in the intervention group (P<0.05) , but the opposite was found in the control group (P<0.05) . The dyspnea score at 6 months after discharge was lower than that before discharge in the intervention group (P<0.05) . The edema score before discharge was higher than that 3 and 6 months after discharge in the intervention group (P<0.05) . The intervention group had higher edema score 3 and 6 months after discharge than the control group (P<0.05) .

Conclusion

The use of TeamSTEPPS in out-of-hospital medication safety management in CHF patients could improve the medication safety and symptoms in patients as well as enhance the safety culture of the healthcare team.

Factors Associated with Mental Health Status in People Addicted to New Synthetic Drugs: a Path Analysis

Jingjing LIU, Linan WANG, Xueying ZHOU, Xinran ZHU, Shumei ZHUANG

2022, 25(30): 3775-3782. DOI: 10.12114/j.issn.1007-9572.2022.0319

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Background

The prevalence of synthetic drug abuse is high. In China, synthetic drugs have become the most commonly abused drugs characterized by strong addiction and great difficulty in quitting. The addicts are easily prone to serious psychological dependence and other psychological problems, which leading to relapse after withdrawal treatment. Therefore, exploring the influencing factors of mental health status in individuals addicted to new synthetic drugs has clinical and social significance for the prevention and management of synthetic drug addicts.

Objective

To explore the associated factors of mental health status and their intercorrelations in individuals addicted to new synthetic drugs.

Methods

One hundred and ninety-six people getting addicted to new synthetic drugs with inpatient withdrawal treatment were selected from Ankang Hospital of Tianjin Municipal Public Security Bureau from January 2018 to April 2019. Sociodemographic data and drug abuse-related clinical data were collected. The Symptom Checklist-90 (SCL-90) , Eysenck Personality Questionaire-Revised, Short Scale For Chinese (EPQ-RSC) , and Simplified Coping Style Questionnaire (SCSQ) were used to investigate the mental health. Spearman rank correlation analysis was used to analyze the inercorrelations of the influencing factors of mental health. SPSS 22.0 software was used for statistical analysis, and AMOS 22.0 was used to build a model for path analysis of data.

Results

The average total score of SCL-90 rated by the participants was (206.62±26.66) , which was higher than that rated by Chinese norm (P<0.001) . Moreover, the average score of each domain rated by the participants was also higher that rated by Chinese norm (P<0.001) . Spearman rank correlation analysis showed that the total score of SCL-90 was negatively correlated with age (r_s=-0.285, P<0.001) , and positive coping (r_s=-0.749, P<0.001) , but was positively correlated with economic income (r_s=0.210, P=0.003) , daily dose of a new synthetic drug (r_s=0.375, P<0.001) , negative coping (r_s=0.754, P<0.001) , and dimensions of personality traits 〔psychoticism (r_s=0.915) 、introversion and extroversion (r_s=0.748) 、neuroticism (r_s=0.549) 、lying (r_s=0.979) , P<0.001) 〕. Path analysis revealed that personality traits and coping styles could directly or indirectly affect the mental health status, and coping styles played a partial mediating role in the relationship of personality traits with mental health status.

Conclusion

The prevalence of normal mental health was low in people addicted to new synthetic drugs, which was mainly associated with personality traits and coping styles. In view of this, it is suggested to improve the mental health of these addicts by taking actions to develop positive coping styles and reduce negative coping styles according to their personality traits.

Effect of Modified First Three Postures of the Baduanjin Exercise in Patients with Cervical Spondylotic Radiculopathy

Jinkang TU, Fangfang LI, Tengfei FU, Xiaoqiong WU, Jing CHEN, Weiwei LU, Guiziwei SHEN, Jun CHEN

2022, 25(30): 3783-3788. DOI: 10.12114/j.issn.1007-9572.2022.0262

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Background

Cervical spondylotic radiculopathy (CSR) prevalence is increasing, and it tends to be higher in younger people. The traditional Baduanjin exercise has obvious effects on improving the functions of muscles around the neck and shoulder, spine functions and mental state, but it is difficult to adhere to the exercise.

Objective

To examine the effect of modified first three postures of Baduanjin on improving clinical symptoms, anxiety, pain and quality of life anxiety and quality of life in CSR patients.

Methods

Seventy-two CSR patients were recruited from Rehabilitation Medicine Clinic, Fudan University Zhongshan Hospital from March to August 2021 and equally divided into a usual rehabilitation group and a modified Baduanjin group based on a computer-generated randomized algorithm. Both groups received usual rehabilitation interventions, including infrared therapy, traction, deep muscle stimulation (DMS) , and modified rotational cervical joint loosening, three times a week for a total of 4 weeks. The modified Baduanjin group additionally received modified first three postures of Baduanjin, 3 times a week, for 12 consecutive weeks. Cervical vertebra status was assessed by Yasuhisa Tanaka 20 Score Scale (YT20SS) , level of anxiety was assessed by the Zung Self-rating Anxiety Scale (SAS) , the level of neck pain was assessed by the Visual Analogue Scale (VAS) , and the quality of life was assessed by the Chinese version of the 36-item Short Form Survey (SF-36-C) at baseline, and the end of four, eight and 12 weeks of interventions.

Results

Except for 12 cases (four dropouts and two with abnormal data in the usual rehabilitation group, three dropouts and three with abnormal data in the modified Baduanjin group) , the remaining 60 cases were included for analysis. Compared with the usual rehabilitation group, modified Baduanjin group had higher YT20SS and SF-36-C, and lower SAS and VAS scores after four, eight, and 12 weeks of interventions (P<0.05) . In modified Baduanjin group, the results of the 4 measurements revealed that there were significantly successive increases in YT20SS and SF-36-C (P<0.05) , and significantly successive decreases in SAS and VAS scores (P<0.05) .

Conclusion

The modified first three postures of Baduanjian are time-saving and easy-to-perform, could contribute to the improvement of clinical symptoms, anxiety, neck pain and quality of life in CSR patients. Moreover, they are time-saving and easy-to-perform, so they are worthy of application and promotion for clinical rehabilitation and home-based usual rehabilitation for CSR.

Prevalence and Influencing Factors of Immunological Non-response in HIV/AIDS Patients with Second-line Antiretroviral Therapy

Dongli WANG, Yanke AI, Jun YUAN, Xiuxia MA, Huijun GUO, Qianlei XU, Yantao JIN

2022, 25(30): 3789-3795. DOI: 10.12114/j.issn.1007-9572.2022.0294

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Background

The lopinavir/ritonavir (LPV/r) -based second-line antiretroviral therapy (ART) has been used for treating HIV/AIDS patients in China for more than 10 years, but post-therapy immunological non-response (INR) in these patients has been rarely studied.

Objective

To explore the prevalence and influencing factors of post-therapy INR in HIV/AIDS patients switching from first- to second-line ART.

Methods

Data (including general information and three-year follow-up information after switching to second-line ART) were collected from the Database of TCM Treatment for AIDS and AIDS Prevention and Control Information System, involving 3 016 HIV/AIDS patients (baseline CD₄⁺ T cell count<200 cells/μl) who switched to second-line ART during January 2009 to December 2015. The prevalence of INR was estimated using the follow-up information. Multivariate Logistic regression analysis was performed to investigate the influencing factors of INR.

Results

The prevalence of INR in the patients after switching to second-line ART during the first, second and third years of follow-up was 42.34% (774/1 828) , 32.31% (608/1 882) , and 24.11% (421/1 746) , respectively. The results of multivariate Logistic regression analysis showed that gender〔female: OR=0.60, 95%CI (0.49, 0.73) 〕 and the baseline CD₄⁺ T cells count〔<50 cells/μl: OR=3.42, 95%CI (2.51, 4.69) ; 50-100 cells/μl: OR=3.26, 95%CI (2.50, 4.27) ; 101-150 cells/μl: OR=1.51, 95%CI (1.19, 1.92) 〕were associated with the prevalence of INR in the first year of follow-up (P<0.05) ; gender〔female: OR=0.70, 95%CI (0.57, 0.86) 〕, age〔40-50 year: OR=1.37, 95%CI (1.05, 1.80) ; >50 year : OR=1.81, 95%CI (1.36, 2.42) 〕, route of infection〔blood: OR=1.40, 95%CI (1.06, 1.85) 〕, duration of HIV positive〔3-6 years: OR=1.48, 95%CI (1.02, 2.13) 〕, duration of HAART therapy before switch to second-line ART〔3-5 year: OR=0.66, 95%CI (0.48, 0.90) ; >5 year: OR=0.71, 95%CI (0.53, 0.95) 〕and baseline CD₄⁺ T cells count〔<50 cells/μl: OR=2.54, 95%CI (1.84, 3.49) ; 50-100 cells/μl: OR=2.49, 95%CI (1.90, 3.27) ; 101-150 cells/μl: OR=1.59, 95%CI (1.23, 2.05) 〕were associated with the prevalence of INR in the second year of follow-up (P<0.05) ; age〔>50 year: OR=1.8, 95%CI (1.31, 2.49) 〕, route of infection〔blood: OR=1.45, 95%CI (1.07, 2.00) 〕, baseline CD₄⁺ T cell count〔<50 cells/μl: OR=2.07, 95%CI (1.52, 2.82) ; 50-100 cells/μl: OR=2.14, 95%CI (1.57, 2.92) ; 101-150 cells/μl: OR=1.49, 95%CI (1.12, 1.98) 〕 were associated with the prevalence of INR in the third year of follow-up (P<0.05) .

Conclusion

The prevalence of INR in the HIV/AIDS patients after switching to second-line ART during the first, second and third years of follow-up was 42.34%, 32.31%, and 24.11%, respectively. Gender, age, baseline CD₄⁺ T cell counts, infected with HIV via contaminated blood or blood products were the influencing factors of immunological non-response. In addition, immune status is suggested to be specially focused in male patients , aged over 50 years and those the baseline CD₄⁺ T cells count <150 cells/μl.

Influencing Factors of Latent Tuberculosis Infection in Patients Living with HIV/AIDS

Zeshun JIANG, Zhenggui YANG, Jiangping LI, Xue HAN, Lifang REN, Shenghong QI, Xinyi LIU, Lan LIU

2022, 25(30): 3796-3802. DOI: 10.12114/j.issn.1007-9572.2022.0336

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Background

Tuberculosis is the leading cause of death in patients living with HIV/AIDS, and HIV infection is also a major risk factor for latent tuberculosis infection (LTBI) developing to tuberculosis. So screening and treatment of LTBI is an important measure to prevent the incidence of tuberculosis to reduce the mortality rate in this population.

Objective

To examine the prevalence of LTBI and associated factors, and to identify the high-risk individuals among HIV/AIDS patients in Yinchuan urban areas, Ningxia Hui Autonomous Region, providing a scientific basis for the preventive treatment of tuberculosis in this population.

Methods

A total of 546 HIV/AIDS patients who were treated in designated institutions for HIV/AIDS management in the urban area of Yinchuan, Ningxia Hui Autonomous Region from March to August 2021 were selected. By use of an on-site survey in combination with reviewing management files, general information (including demographic characteristics such as sex, age, ethnic group, education level, marital status, annual household income per capita, occupation, BMI, smoking and drinking) and clinical information (chronic disease prevalence, closely contacting with tuberculosis patients, time since the HIV/AIDS diagnosis, duration of antiviral treatment, other co-infections, recent CD₄⁺ T cell count) were collected. LTBI was screened by the tuberculin skin test (TST) . The general information was compared between those with LTBI (n=133) and those without (n=413) . Multivariate Logistic regression analysis was used to explore the influencing factors of LTBI in HIV/AIDS patients. R software was used to establish a restricted cubic spline model to fit the dose-effect relationship between CD₄⁺ T cell count and the risk of LTBI.

Results

The prevalence of LTBI detected by TST was 24.4%. Married 〔OR=0.544, 95%CI (0.321, 0.922) , P<0.05〕was associated with decreased risk of LTBI in HIV/AIDS, while smoking〔OR=1.919, 95%CI (1.213, 3.037) , P<0.05〕, and closely contacting with tuberculosis patients 〔OR=11.100, 95%CI (2.889, 42.648) , P<0.05〕were associated with increased risk of LTBI in HIV/AIDS. The fitting results of the restricted cubic spline model showed that the CD₄⁺ T cell count and LTBI risk had an approximate "n" -shaped nonlinear relationship (non-linear test χ²=29.080, P<0.001) .

Conclusion

To reduce the incidence of LTBI in people living with HIV/AIDS, more attention and timely preventive treatment should be given to those unmarried, smokers, and close contacts of tuberculosis patients. In addition, multiple methods are recommended for screening for LTBI in those with low CD₄⁺ T cell count.

Influence of HIV-related Knowledge and Anticipated Stigma on Depression of Men Who Have Sex with Men: a Latent Class Analysis

Zhenwei DAI, Mingyu SI, Yijin WU, Xu CHEN, Jiaqi FU, Yiman HUANG, Hao WANG, Weijun XIAO, Fei YU, Guodong MI, Xiaoyou SU

2022, 25(30): 3803-3809. DOI: 10.12114/j.issn.1007-9572.2022.0360

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Background

Chinese men who have sex with men (MSM) have a higher prevalence of depression than the general population. Long-term depression symptoms could increase the risk of having physical harm, self-harm and suicide. Therefore, depression issues among MSM need to be solved urgently.

Objective

To explore the latent classes of depression, and the influence of HIV-related knowledge and anticipated stigma on depression among MSM.

Methods

Usingthe General Information Questionnaire, HIV Knowledge Questionnaire, Anticipated HIV Stigma Scale and 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) , an online questionnaire survey was conducted from December 2020 to March 2021 via the same-sex social network of Blued7.5. A total of 1396 MSM with HIVinfection or unclear status of HIVinfection were sampled by use of convenience sampling to attend the survey. The latent classes of depressive symptoms were analyzed by latent class analysis. Multinomial Logistic regression analysis was used to explore the correlation of the latent class of depression with HIV-related knowledge or anticipated HIV stigma.

Results

Finally, 1 394 cases (99.9%.) who returned responsive questionnaires were included. The 10 items of CES-D-10 were taken as observed indicators, and exploratory latent class analysis was employed to identify the latent classes of depression based on model from 1 to 5 classes. The 4-class model was finally selected, and the probabilities of each class were 40.1% (no obvious depression) , 21.6% (possible risk of depression) , 28.0% (possible mild depression) , and 10.3% (possible moderate to severe depression) . The accuracy of the classification was assessed by test for homogeneity according to the cut-off value of CES-D-10 (0=no depression, 1=depression) and the results of latent class analysis (0= no obvious depression and possible risk of depression, 1= possible mild depression and possible moderate to severe depression) , and the result showed that Kappa=0.735 (P<0.001) . Multinomial Logistic regression analysis indicated that a high level of HIV-related knowledge (OR=0.926, P=0.001) , undergraduate attainment or above (OR=0.642, P=0.003) were related to possible risk of depression. The anticipated HIV stigma (OR=1.594, P<0.001) and being married (OR=0.593, P=0.026) were related to possible mild depression. A high level of HIV-related knowledge (OR=0.935, P=0.026) , anticipated HIV stigma (OR=2.239, P<0.001) and no long-term employment (OR=1.518, P=0.045) were related to possible moderate to severe depression.

Conclusion

The depression in MSM population presented obvious category characteristics, which may be a new idea for tailoring interventions to depression in MSM. Relevant authorities may cooperate with social media to deliver interventions incorporated with HIV-related knowledge and anticipated HIV stigma to prevent and control the development of depression in MSM.

Hospital-school-based Posture Assessment, Vision Screening and Health Management for Children and Adolescents

Rongmei LIU, Shuaibin LIU, Quanshun ZHENG, Yuxi BAI, Xuzhu ZHAO, Changwei NIU, Shunli SHI, Guoping ZHOU

2022, 25(30): 3810-3816. DOI: 10.12114/j.issn.1007-9572.2022.0251

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Background

The prevalence of health problems in Chinese children and adolescents is high. The mention of myopia, obesity, caries, scoliosis and other health problems in adolescents in the Healthy China 2030 Initiative Indicates that these problems have become the national concerns. The establishment of a long-term, standardized disease screening and management mode by the community health center (CHC) in combination with schools in service coverage areas of the CHC will provide a new idea for strengthening the health management of children and adolescents by the CHC.

Objective

To perform posture assessment and vision screening in full-time students receiving the nine-year compulsory education in schools in the service coverage area of Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area using a CHC-school-based approach, to identify problems in disease screening and management for children and adolescents, to analyze the practice and advantages of CHC-school-based disease screening and management, and to develop a CHC-school-based health management model for children and adolescents.

Methods

This study was conducted from May to November 2021. Cluster sampling was used to select grades 1-9 full-time students (n=11 318) in 225 classes of 6 primary schools and 3 middle schools in the areas covered with health services delivered by the Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area. All of them received posture assessment and vision screening.

Results

Among the participants, 6 260 were male and 5 058 were female; 7 979 were pupils, and 3 339 were junior high school students. The prevalence of abnormal posture was 41.34% (4 679/11 318) . With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, and toe valgus increased, while that of knee hyperextension, flat feet and pes valgus decreased (P<0.05) . The prevalence of 1, 2, 3 and 4 or more abnormal postures was 29.13% (3 297/11 318) , 8.60% (973/11 318) , 3.01% (341/11 318) , and 0.60% (68/11 318) , respectively. Male students had higher prevalence of thoracic kyphosis, scoliosis, flat feet and toe valgus, and lower prevalence of knee hyperextension, X-shaped legs, O-shaped legs and foot valgus than female students (P<0.05) . The prevalence of abnormal vision was 74.99% (8 486/11 318) . The prevalence of myopia, hyperopia, and astigmatism was 41.75% (4 725/11 318) , 26.14% (2 959/11 318) , and 7.09% (802/11 318) , respectively. With the increase of grade, the prevalence of myopia increased and that of hyperopia decreased (P<0.05) .

Conclusion

At present, the abnormal posture rate of children and adolescents in Zhengzhou is about 40%, and the myopia rate exceeds 40%. With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, toe valgus and the prevalence of myopia increased, but there is a lack of effective and normal screening and health management systems. As the hospital-school approach could improve the effectiveness and normalization of the health screening and management for children and adolescents, so this approach is recommended to be used in further improvement of the top-level design and efficacy assessment of health management in children and adolescents. In addition to CHC school-based management, the health management of children and adolescents also involves the efforts of themselves and their families, which is equally important as the former two.

Community-based Prevention and Control of Myopia in School-age Children: an Explorative Study

Jie WANG, Shiming LI, Dapeng MU, Li ZHANG, Tiantian CHENG, Ningli WANG

2022, 25(30): 3817-3824. DOI: 10.12114/j.issn.1007-9572.2022.0250

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Background

Myopia is an important cause of visual impairment and has become a public health problem all over the world. In China, myopia has a high incidence rate and age of onset of which is becoming younger. There is no clinical method to reverse myopia in children. Therefore, it is important to standardize the screening for ametropia to realize early detection and intervention of myopia. As a primary care institution, a community health center may accurately understand the prevalence of myopia in teenagers in its service coverage area. So giving full play to the role of community health center has important practical significance for the containment of myopia in children and adolescents.

Objective

To explore the feasibility of community-based prevention and control of myopia in school-age children.

Methods

A cohort study was conducted. The information about visual acuity and refractive status of students in a primary school in Beijing's Chaoyang District from September 2019 to September 2021 were collected for statistical analysis, among which four groups of data in September 2019, September 2020, March 2021 and September 2021 were finally included according to the inclusion and exclusion criteria, with a total of 5 558 records. Then, based on the data, an electronic students' refractive database was established, with uncorrected visual acuity, corrected visual acuity, refractive status (power of a spherical lens, power of a cylindrical lens, axis) , prevalence of wearing glasses or orthokeratology incorporated. The warning levels of vision screening were set to be 0, 1, 2 and 3 from low to high. The visual change, visual warning level, spherical equivalent (SE) of students were compared by grade. The visual changes and warning level evolution at different times were compared at the individual level. Corresponding interventions were implemented for different warning levels, and the intervention results were analyzed and discussed.

Results

There were statistically significant differences in uncorrected distance visual acuity (UDVA) among students by grade (F=100.413, P<0.05) . The UDVA differed significantly in male or female students (F=47.168, 53.042, P<0.05) . Compared with the lower grade students (grades 1 and 2) , middle and higher grade students (grades 3, 4, 5 and 6) had lower UDVA (P<0.003) . The UDVA decreased with the increase in grade in male and female students, and the decline in female students was faster. The composition of the warning levels of myopia risk assessed based on the UDVA in male and female students in all grades was similar, mainly composed of 0, 1, and 3 levels. With the increase in grade, the number of low warning level (level 0) gradually decreased, while that of high warning level (level 3) gradually increased. The SE in students differed obviously by grade (F=474.728, P<0.05) . The SE also differed much in male or female students (F=121.704, 123.807, P<0.05) . With the increase of grade, SE tended to be negative, and the difference in SE between left and right eyes was statistically significant (t=-4.67, P<0.05) . The negative trend of SE for the right eye was more remarkable, suggesting that the warning level of the right eye was higher, and the right eye was more prone to myopia. The follow-up of three consecutive years for assessing individual visual changes revealed that the results of four UDVA screening differed significantly in all students and female students (F=8.727, 10.221, P<0.05) . The UDVA result screened in March 2021 for all students decreased significantly compared with that screened in September 2019 or September 2020 (P<0.008) , so did the UDVA result screened in September 2021 (P<0.008) . During the evolution of warning level, higher warning level was associated with lower possibility of returning to the low warning level, and the possibility of progressing to a higher warning level increased with the growth of warning level.

Conclusion

The visual acuity and refractive status of students in this primary school in Beijing's Chaoyang District were not optimistic. With the increase in grade, the UDVA decreased and the number of high warning level gradually increased. To actively contain myopia in school-age children, it is suggested to establish a community-based vision screening and warning mechanism, and to promote the containing of myopia by home-school-community collaboration efforts.

Relationship between Obstructive Sleep Apnea Hypopnea Syndrome and Bone Metabolism: a Systematic Review and Meta-analysis

Yunping MU, Xiaoxue WEI, Kadier SAJIDANMU·, Daqiao ZHU, Changgui SHI, Bingqian ZHU

2022, 25(30): 3825-3833. DOI: 10.12114/j.issn.1007-9572.2022.0104

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Background

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with bone metabolism in Western population. Chinese population manifest different development progress of OSAHS and bone metabolism owing to their own specific physiological characteristics compared to the Western population. Although the association between OSAHS and bone metabolism may be confounded by underlying diseases, the association between them among healthy Chinese people remains unknown.

Objective

To examine the relationship between OSAHS and bone metabolism in Chinese people without underlying conditions using a review and Meta-analysis, providing evidence for improving bone health.

Methods

This review was conducted following the PRISMA guidelines. Electronic databases, such as PubMed, Embase, and CINAHL, were searched from inception to December 2020 for studies regarding bone metabolism and OSAHS in Chinese adults (aged≥18 years) in which those with and without OSAHS were classified as OSAHS and control groups, respectively (OSAHS was diagnosed based on the Guidelines for the Diagnosis and Management of Obstructive Sleep Apnea Hypopnea Syndrome) . Outcome indicators include one or more bone metabolism indicators. Three researchers independently performed literature screening and data extraction. Two researchers independently performed the quality appraisal using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Data were analyzed using Stata 15.1.

Results

Ten studies were included, with a total of 898 participants, and 653 of whom had OSAHS. Nine were cross-sectional studies and one was a quasi-experimental study. According to the JBI quality assessment tool, the nine cross-sectional studies were of high quality on items 1 to 5, and 4 of which did not control for the confounding factors. Based on the Meta-analysis, compared to the control group, OSAHS group had lower lumbar BMD 〔SMD (95%CI) =-1.758 (-2.300, -1.217) 〕, lower femoral neck BMD〔SMD (95%CI) =-1.260 (-1.949, -0.571) 〕, higher β-CTX〔SMD (95%CI) =0.803 (0.122, 1.484) 〕, and higher P1NP〔SMD (95%CI) =0.820 (0.318, 1.321) 〕. Apnea-hypopnea index had a negative correlation with lumbar BMD〔r (95%CI) =-0.36 (-0.57, -0.12) 〕 and positive correlations with β-CTX〔r (95%CI) =0.39 (0.29, 0.47) 〕and P1NP〔r (95%CI) =0.36 (0.16, 0.53) 〕.

Conclusion

Among Chinese adults without underlying conditions, OSAHS may reduce BMD by increasing bone resorption, thereby elevating the risk of osteoporosis or fractures.

Risk Factors for Acute Kidney Injury in Severe Acute Pancreatitis: a Meta-analysis

Meiying CHEN, Muxin CHEN, Mingxin WANG, Chanmei ZHENG, Wanzhu CAI, Aixin LIANG, Chunjiao ZHOU

2022, 25(30): 3834-3842. DOI: 10.12114/j.issn.1007-9572.2022.0452

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Background

Acute kidney injury (AKI) is a common complication and a key poor prognostic factor in severe acute pancreatitis (SAP) . It is rather challengeable to prevent and treat AKI in SAP, but early assessment and intervention of related risk factors can prevent or delay its development.

Objective

To systematically analyze the risk factors of AKI in SAP.

Methods

Databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, CQVIP and SinoMed were searched for articles about the risk factors of AKI in SAP from inception to January 2022. Two researchers independently performed literature screening according to inclusion and exclusion criteria, data extraction, and methodological quality assessment. RevMan 5.4 and Stata 15.1 were employed for Meta-analysis.

Results

In total, 21 studies were included, including 3 823 patients. Meta-analysis demonstrated that being male〔OR=1.42, 95%CI (1.21, 1.68) , P<0.001〕, drinking history〔OR=1.51, 95%CI (1.14, 2.01) , P=0.004], higher APACHE Ⅱ score〔MD=5.69, 95%CI (2.95, 8.44) , P<0.001〕, Ranson score〔MD=2.58, 95%CI (2.27, 2.88) , P<0.001〕, and CTSI score〔MD=1.48, 95%CI (0.17, 2.80) , P=0.030〕; increased lencocyte count〔MD=0.96, 95%CI (0.47, 1.44) , P<0.001〕, IL-33〔MD=28.36, 95%CI (19.05, 37.67) , P<0.001〕, CRP〔MD=17.38, 95%CI (12.39, 22.38) , P<0.001〕, Scr〔MD=49.50, 95%CI (24.80, 74.19) , P<0.001〕, PCT〔MD=6.74, 95%CI (3.36, 10.12) , P<0.001〕, neutrophil gelatinase-associated lipocalin (NGAL) 〔MD=18.31, 95%CI (11.82, 24.80) , P<0.001〕, and serum lactate〔MD=0.87, 95%CI (0.27, 1.46) , P=0.004〕; prevalence of hypoxemia〔OR=9.42, 95%CI (4.81, 18.44) , P<0.001〕, hypertension〔OR=1.35, 95%CI (1.06, 1.72) , P=0.010〕, diabetes〔OR=1.56, 95%CI (1.20, 2.04) , P<0.001〕, and coronary heart disease〔OR=3.20, 95%CI (1.41, 7.24) , P=0.005〕; use of mechanical ventilation〔OR=5.00, 95%CI (2.76, 9.07) , P<0.001〕; prevalence of shock〔OR=11.60, 95%CI (3.37, 39.91) , P<0.001〕, infection〔OR=5.78, 95%CI (3.10, 10.79) , P<0.001〕, multiple organ dysfunction syndrome (MODS) 〔OR=7.28, 95%CI (3.56, 14.88) , P<0.001〕, abdominal bleeding〔OR=5.51, 95%CI (1.38, 22.09) , P=0.020〕, acute respiratory distress syndrome (ARDS) 〔OR=9.61, 95%CI (4.14, 22.27) , P<0.001〕, and abdominal compartment syndrome (ACS) 〔OR=5.79, 95%CI (3.75, 8.93) , P<0.001〕; long stay in the ICU〔MD=8.77, 95%CI (2.76, 14.79) , P=0.004〕were risk factors of AKI in SAP.

Conclusion

Male, drinking history, higher APACHEⅡ score, Ranson score and CTSI score, elevated inflammatory markers (lencocyte count, IL-33, CRP, Scr, PCT, NGAL) and elevated serum lactate, underlying disease prevalence (hypoxemia, hypertension, diabetes, coronary heart disease) , use of mechanical ventilation, prevalence of shock, infection, MODS, abdominal bleeding, ARDS, and ACS, long stay in the ICU may be risk factors for AKI in SAP. Clinical medical workers should early identify and intervene SAP patients with the above-mentioned risks, so as to reduce the incidence of AKI.

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