Risk factors for adult death due to 2009 pandemic influenza A (H1N1) virus infection: a 2151 severe and critical cases analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The 2009 pandemic H1N1 (pH1N1) influenza showed that relatively young adults accounted for the highest rates of hospital admission and death. In preparation for pH1N1, the aim of the study is to identify factors associated with the mortality of patients with 2009 pH1N1 infection, especially for young patients without chronic medical conditions.</p><p><b>METHODS</b>Retrospective observational study of 2151 severe or critical adult cases (≥ 14 years old) admitted to a hospital with pH1N1 influenza from September 1, 2009 to December 31, 2009 from 426 hospitals of 27 Chinese provinces. A confirmed case was a person whose pH1N1 virus infection was verified by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). Severe and critical cases were defined according to the H1N1 2009 Clinical guidelines (Third Edition, 2009) released by the Ministry of Health of China.</p><p><b>RESULTS</b>Among the 2151 patients, the mean age was 34.0 years. Two hundred and ninty-three (13.6%) died during hospital stay. One thousand four hundred and forty-two patients (67.0%) had no comorbidities and 189 (13.1%) of them died. Pregnancy (OR 8.03), pneumonia (OR 8.91), dyspnea (OR 3.95), central nervous system (CNS) symptom (OR 1.55), higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (OR 1.06), Alanine aminotransferase (ALT) (OR 1.002), and the lactate dehydrogenase (LDH) level (OR 1.001) were independent risk factors for death among adults without chronic medical conditions. Higher APACHE II score (OR 1.08) and age (OR 1.06) were independent risk factors for death among adults with respiratory diseases. A multivariate analysis showed an association between mortality and CNS symptoms (OR 2.66), higher APACHE II score (OR 1.03), ALT (OR 1.006), and LDH level (OR 1.002) in patients with cardiovascular diseases. Dyspnea (OR 11.32) was an independent risk factor for patient death in patients with diabetes mellitus.</p><p><b>CONCLUSION</b>Clinical knowledge of identified prognostic factors for mortality may aid in the management of adult influenza infection.</p>

A three-year follow-up study on sera specific antibody in severe acute respiratory syndrome cases after the onset of illness / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the variation of specific antibody among convalescent of severe acute respiratory syndrome (SARS) patients through a three-year program.</p><p><b>METHODS</b>Sera samples were collected from SARS cases in the 5th, 20th and 35th month after onset of the illness. The SARS-CoV specific antibody was detected for all of them by ELISA and neutralized test simultaneously. The titer of neutralizing antibodies was calculated using Reed-Muench method, and the comparison between different time groups was analyzed regarding the variance of data on repeated measures after logarithm conversion.</p><p><b>RESULTS</b>13, 17 and 13 sera samples were collected in the 5th, 20th and 35th month after onset. Results showed that despite the fact that the positive rates of ELISA antibody were 100%, 82.4% and 84.6% respectively,the neutralizing antibody was still positive for all the samples. The average neutralizing antibody titers were 1:43 (1:16-1:203), 1:36 (1:17-1:59) and 1:21 (1:10-1:39) on the 5th, 20th and 35th month after onset, and the differences were statistically significant (F = 60.419, P < 0.001). On the 35th month after the onset, 30.8% (4/13) of the patients were still having the neutralizing antibody level of above 1:36, but the neutralizing antibody level in another 30.8% (4/13) of the patients had decreased to as low as 1:10, when the cut-off level was set as 1:8.</p><p><b>CONCLUSION</b>Results of the study indicated that the neutralizing antibody of SARS cases could last for at least three years, but the sera specific antibody in SARS cases decreased gradually when time went by. However, neutralizing antibody in some of the cases decreased to a lower level on the 35th month. Further follow-up study was worthwhile to observe the long-lasting profile of antibody existence on SARS cases.</p>

Study on the clinical epidemiology of systemic lupus erythematosus among 1433 cases / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore factors that affecting the outcome of systemic lupus erythematosus (SLE) therapy.</p><p><b>METHODS</b>Factors on the results of therapy were analysed through a case-control study.</p><p><b>RESULTS</b>The common symptoms of SLE were fever, joint pain and skin eruption on face while the common provocation factors of SLE were infection and birth. Through multivariate logistic regression analyses, factors that influencing SLE result of treatment were tachycardia, diastolic pressure step-up, complement C(3) reduction, anti-ds-DNA antibody, SLE relapse and brain syndrome with the OR values as 2.28, 2.34, 2.42, 2.47, 1.98 and 5.56, respectively.</p><p><b>CONCLUSION</b>The symptom and clinical characteristics of SLE were complicated. SLE treatment result could be influenced by tachycardia, diastolic pressure step-up, complement C(3) reduction, anti-ds-DNA antibody, SLE relapse and brain syndrome suggesting that the prognosis of SLE patients should be comprehensively considered.</p>

A survey on violence among primary and secondary school students in Hefei city / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the features of violence among primary and secondary school students in Hefei, and to set up intervention measures for violence prevention.</p><p><b>METHODS</b>Four schools in Hefei were randomly sampled in the study. A total of 3064 students completed a questionnaire.</p><p><b>RESULTS</b>16.22% of the pupils reported having suffered from violence at least once every month. The rate was higher in boys than that in girls's (chi(2) = 25.13, P = 0.000). The major assaulters were from classmates (45.80%), with hand beating (37.42%), insulting (31.21%), threatening (20.88%), and 10.49% using sticks and sharp weapons. Most violence occurred at school (46.08%), followed by at home (28.41%) and outside of schools (25.51%), with significant difference (P = 0.000). As a result, 3.33% ended up with fractures, and 0.51% with disability. 97 pupils reported having assaulted others frequently (3.21%). Being irritated (47.38%) was the major reason for the violence to occur.</p><p><b>CONCLUSION</b>Violence among primary and secondary school students in Hefei city was serious that called for targeted education be strengthened and school environment be improved.</p>

Influences of environmental factors and interaction of several chemokines gene-environmental on systemic lupus erythematosus / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the impact of environmental factors, daily lifestyle, psycho-social factors and the interactions between environmental factors and chemokines genes on systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>Case-control study was carried out and environmental factors for SLE were analyzed by univariate and multivariate unconditional logistic regression. Interactions between environmental factors and chemokines polymorphism contributing to systemic lupus erythematosus were also analyzed by logistic regression model.</p><p><b>RESULTS</b>There were nineteen factors associated with SLE when univariate unconditional logistic regression was used. However, when multivariate unconditional logistic regression was used, only five factors showed having impacts on the disease, in which drinking well water (OR=0.099) was protective factor for SLE, and multiple drug allergy (OR=8.174), over-exposure to sunshine (OR=18.339), taking antibiotics (OR=9.630) and oral contraceptives were risk factors for SLE. When unconditional logistic regression model was used, results showed that there was interaction between eating irritable food and -2518MCP-1G/G genotype (OR=4.387). No interaction between environmental factors was found that contributing to SLE in this study.</p><p><b>CONCLUSION</b>Many environmental factors were related to SLE, and there was an interaction between -2518MCP-1G/G genotype and eating irritable food.</p>