Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Surveillance Program, 2017 / 中国感染与化疗杂志

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.

Identification and in vitro antimicrobial susceptibility of Brucella species / 中华传染病杂志

Objective To identify Brucella species by means of bacteriological and polymerase chain reaction(PCR)methods,and to understand the drug susceptibility by in vitro susceptibility test of these strains to eight antimicrobial drugs.Methods The isolated Brucella strains were identified by standard method with conventional positive serum experiment,monophase specificity serum(A,M and R) agglutination experiment and brucella phage splitting experiment(Tb and BK2).Reference strains were set as control group.Molecular typing was performed by polymerase chain reaction(PCR)targeting Brucella surface protein 31(BCSP-31)and(abortus melitensis ovis suis,AMOS)-PCR assay which is able to distinguish among B.abortus,B.melitensis,B.ovis and B.porcine.Microdilution broth method was used to determine the minimum inhibitory concentrations(MIC)of 8 antibiotics to 27 Brucella strains isolated from blood culture,including azithromucin,ciprofloxacin,levofloxacin,doxycycline,rifampicin, gentamicin,acheomycin,and streptomycin.Results Twenty-seven strains were identified as B. melitensis,of which 21 were B.melitensis biovar 3 isolates,6 were B.melitensis biovar 1.The BCSP-31-PCR confirmed that all 27 isolates were Brucella.spp.AMOS-PCR assay confirmed that all isolates were B.melitensis.All isolates were susceptible to ciprofloxacin,levofloxacin,doxycycline,gentamicin, acheomycin,and streptomycin.Doxycycline was the most effective antibiotic(MIC900.064 mg/L),while rifampicin was moderately active to 3 isolates(MIC 2 mg/L).Conclusions Brucella isolates are susceptible in vitro to the antibiotics recommended by world health organization.Regular evaluation of antibiotic susceptibilities of Brucella strains is helpful for epidemiological investigation and antibiotic resistance monitor.

Molecular epidemiological characteristics of human derived Brucella isolated in Hohhot / 中华地方病学杂志

Objective To get knowledge of the molecular epidemiological characteristics of human derived Brucella isolated in Hohhot,and to provide experimental basis in guiding prevention and treatment of Brucella infection.Methods Twenty-seven Brucella isolates derived from patients in Affiliated Hospital of Inner Mongolian Medical University from 2013 to 2015 were identified by routine bacteriological methods and molecular methods.Multiple-locus variable number tandem repeats analysis (MLVA-16) was used to detect molecular typing and do cluster analysis.Sixteen virulent genes were detected and analyzed by polymerase chain reaction (PCR).Results Twenty-seven Brucella isolates were identified as Brucella melitensis (B.melitensis) by routine bacteriological methods and PCR.Out of them,six isolates were B.melitensis biovar 1,and twenty-one isolates were B.melitensis biovar 3.MLVA-16 analysis showed that seven genotypes were obtained from nine Brucella isolates,which showed significant difference in variable number of tandem repeats,which suggested that they originated from sporadic outbreak.Moreover,two isolates were clustered into the same clade,which suggested they were epidemiologically correlated and may be derived from the same origin.Sixteen virulent genes were detected in all of the twenty-seven isolates.Conclusions Brucella isolates from patients in Hohhot are mainly B.melitensis biovar 3 and B.melitensis biovar 1,and the distribution profile of multiple virulence genes is similar.Some isolates have showed epidemic correlation,and the epidemic mechanism should be further explored.

Changing susceptibility ofKlebsiella strains in hospitals across China：data from the CHINET Antimicrobial Resistance Surveillance Program, 2005-2014 / 中国感染与化疗杂志

Objective To evaluate the changing pattern of antibiotic resistance inKlebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014.Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility ofKlebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (CLSI-2014).Results A total of 61 406Klebsiella strains were identified between 2005 and 2014, includingK. pneumoniae (56 281 strains), K. oxytoca(4 779),Klebsiella pneumoniae subsp.Ozaenae (300) and otherKlebsiella species (46). Most (89.0%, 54 664/61 406) of theKlebsiella strains were isolated from inpatients, and 60.0% (36 835/61 406) were from respiratory tract speciems. About 16.7% (10 248/61 406) of the strains were isolated from pediatric patients aged 0-17 years and 83.3% (51 158/61 406) from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem (2.9% to 10.5%) and meropenem (2.8% to 13.4%) inKlebsiella spp. The prevalence of ESBLs-producing isolates inK. pneumoniae andK. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikacin, ceftazidime, ciprolfoxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identiifed in 5 796 (9.4%) of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 (7.8%) strains were identiifed as extensively-drug resistant (XDR), including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high (>60%) resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline (16.8%), amikacin (54.4%), and trimethoprim-sulfamethoxazole (55.5%).Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance amongKlebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.

Antibiotic resistance profile of Enterobacter in hospitals across China：data from CHINET Antimicrobial Resistance Surveillance Program from 2005 through 2014 / 中国感染与化疗杂志

Objective To investigate the distribution and antibiotic resistance proifle of clinicalEnterobacter isolates using the data from CHINET during the period from 2005 through 2014.Methods A total of 20 558 clinical strains ofEnterobacter spp. were collected from 2005 to 2014 in CHINET Antimicrobial Resistance Surveillance Program. Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method. The results were analyzed according to CLSI 2014 breakpoints.ResultsEnterobacter cloacae andEnterobacter aerogenes accounted for 71.1% (14 617/20558) and 20.1% (4 129/20 558) of all theEnterobacterisolates, respectively. The proportion ofEnterobacter spp. increased with time from 3.5% in 2005 to 4.3% in 2014. The main source of the isolates was respiratory tract, accounting for 55.2% (11 358/20 558). More than 90% of theEnterobacterisolates were resistant to cefazolin and cefoxitin, but less than 30% of the strains were resistant to cefepime, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin, gentamicin, ciprolfoxacin, meropenem, imipenem and ertapenem. TheEnterobacterisolates showed a trend of declining resistance to most antibiotics except ertapenem and meropenem. The resistance proifle ofEnterobacterisolates varied with departments where they were isolated. The strains from ICU and Department of Surgery were relatively more resistant to antibiotics. The prevalence of multi-drug resistant (MDR) strains was decreasing, but the prevalence of carbapenem-resistantEnterobacter (CRE, resistant to any of imipenem, meropenem or ertapenem) was increasing. The MDR and CRE strains were primarily isolated from ICU and Department of Surgery. At least 30% of the MDREnterobacter strains were resistant to any of the antimicrobial agents tested except meropenem, imipenem and ertapenem and at least 35% of the CRE strains were resistant to any of the antimicrobial agents tested except amikacin and ciprolfoxacin.Conclusions TheEnterobacter isolates in CHINET Antimicrobial Resistance Surveillance Program showed decreasing resistance to most of the antimicrobial agents tested since 2011, but the prevalence of CRE strains increased progressively. Effective measures should be carried out to prevent the spread of CRE strains in hospitals.

Changing resistance proifle ofProteus, Serratia, Citrobacter, Morganella andProvidencia isolates in hospitals across China：data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014 / 中国感染与化疗杂志

Objective To understand the changing resistance proifle ofProteus,Serratia,Citrobacter,Morganella andProvidencia in hospitals across China according to the data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014.Methods Antimicrobial susceptibility was tested by using Kirby-Bauer method or automatic minimum inhibitory concentration determination according to a uniifed protocol.Results A total of 21 663 clinical isolates were collected from January 2005 to December 2014. The proportion ofProteus andSerratia isolates increased with time from 1.41% in 2005 to 2.09% in 2014, and from 0.99% in 2005 to 1.28% in 2014 among all the isolates. No change was found for the proportion ofCitrobacter,Morganella, orProvidencia. Less than 10% of theProteus isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefoxitin, amikacin and tigecycline. Less than 10% of theSerratia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and tigecycline. Less than 20% of theCitrobacter isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 10% of theMorganella isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 20% of theProvidencia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, cefoxitin and tigecycline.Conclusions The antibiotic resistance ofProteus,Serratia, Citrobacter,Morganella andProvidencia isolates in hospitals across China is growing during the period from 2005 to 2014. Strengthening infection control and rational antibiotic use are effective to slow the growth of drug resistance.

Resistance profile ofSalmonella isolates in hospital across China：results from CHINET Antimicrobial Resistance Surveillance Program, 2005-2014 / 中国感染与化疗杂志

Objective To investigate the distribution and changing resistance proifle ofSalmonella isolates in hospitals across China during the period from January 2005 to December 2014.Methods Seventeen general hospitals and two children’s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method or MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion ofSalmonella isolates increased with time from 0.2% in 2005 to 0.7% in 2014. A total of 3 478Salmonella strains were collected from 19 hospitals. The proportion ofSalmonella typhimurium andSalmonella enteritidis was 27.4% and 24.4%, respectively. During the 10-year period, theSalmonella strains showed highest resistance rate to ampicillin (33.3%-64.8%), but low resistance to cefoperazone-sulbactam (0-5.3%) and ciprofloxacin (2.4%-14.3%).S. typhimurium showed higher resistance rate thanS. typhi,S. paratyphi andS. enteritidis. About 76.8% and 50.5% ofS. typhimurium were resistant to ampicillin and trimethoprim-sulfamethoxazole. The average prevalence of multi-drug resistantSalmonellawas 3.9% in the ten-year period, the highest (7.5%) was in 2005, the lowest (1.5%) in 2013.Conclusions During the period from 2004 to 2015, majority of theSalmonella isolates in hospitals across China wasS. typhimurium andS. enteritidis. Ampicillin and trimethoprim-sulfamethoxazole are no longer appropriate for empirical treatment ofS. typhimurium infection due to high resistance rate.Salmonella isolates are relatively more susceptible to third-generation cephalosporins and quinolones. Ongoing monitoring is necessary to identify multi-drug resistant strains ofSalmonella.

Antibiotic resistance profile of the bacterial strains isolated from geriatric patients in hospitals across China：data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014 / 中国感染与化疗杂志

Objective To analyze the resistance proifle of bacterial strains isolated from geriatric patients in 17 hospitals across China from 2005 to 2014.Methods A total of 17 representative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a uniifed protocol using Kirby-Bauer method and MIC determination. The results were analyzed according to CLSI 2014 breakpoints.Results The proportion of the strains isolated from geriatric patients among all the clinical isolates increased with time from 30.0% in 2005 to 32.7% in 2014. A total of 159 888 clinical isolates were collected from geriatric patient during the period from 2005 to 2014, about 33.1% of the whole patient population. Gram negative organisms and gram positive cocci accounted for 77.1% (123 229/159 888) and 22.9% (36 659/159 888), respectively. Majority (92.8%, 148 376/159 888) of the isolates were from inpatients and more than half (55.2%, 88 201/159 888) of the isolates were from sputum or other respiratory tract specimens. Methicillin-resistant strains inS. aureus (MRSA) and coagulase negativeStaphylococcus (MRCNS) accounted for an average of 67.1% and 75.9%, respectively. The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. Some strains ofE. faecalis (0.4%) andE. faecium (4.6%) were resistant to vancomycin, which was higher than average national level (0.3%, 3.2%). Vancomycin-resistant strains ofE. faecalisandE. faecium were mainly VanA type and VanB type based on their phenotype. The prevalence of penicillin-susceptibleS. pneumoniae strains was 78.2%, slightly lower than the 95.0% in Chinese adults in year 2014. The prevalence of ESBLs-producing strains was 67.5% inE. coli, 40.4% inKlebsiella (K. pneumoniae andK. oxytoca) and 34.3% inProteus mirabilis isolates on average. The strains ofEnterobacteriaceae were still highly susceptible to carbapenems (<10% resistant), followed by amikacin and the beta-lactam and beta-lactamase inhibitor combinations. Overall, 35.9% and 33.0% of theP. aeruginosa strains were resistant to imipenem and meropenem. More than 50% of theA. baumannii strains were resistant to imipenem and meropenem. The prevalence of extensively drug-resistant (XDR)P. aeruginosa (4.0%-1.8%) was higher than the average national level (2.1%-1.6%). The prevalence of XDR A. baumannii (19.2%-15.5%) and XDREnterobacteriaceae (0.1%-1.0%) was lower than the average national level (21.4%-19.7% and 0.3%-3.2%).Conclusions The proportion of clinical isolates from geriatric patients is different from average national level at the same period. The isolates from geriatric patients are more likely from inpatients, respiratory tract specimens and more likely non-fermentative gram-negative bacilli compared to average national level. The proportion of fastidious bacteria andEnterobacteriaceae species is generally lower than average national level. MRSA, VRE, ESBLs-producing strains and XDRP. aeruginosa are more prevalent in geriatric patients than in general Chinese patient population. This study suggests that surveillance of antimicrobial resistance for the clinical isolates from geriatric patients is very important for rational antimicrobial therapy.

Detection of antimicrobial resistance and OXA genes in imipenem-resistant Acinetobacter baumannii from Hohhot region / 中国感染控制杂志

Objective To realize antimicrobial resistance and carrying status of OXA carbapenemase among imi-penem-resistant Acinetobacter baumannii (IRAB)isolated from patients of Hohhot,so as to provide guidance for the prevention and control of healthcare-associated infection(HAI)caused by multidrug-resistant Acinetobacter bauman-nii .Methods 49 IRAB isolates from 3 tertiary first-class hospitals in Hohhot between January and December 2012 were collected,antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method,four geno-types(blaOXA-51-like ,blaOXA-23-like ,blaOXA-24-like ,blaOXA-58-like )of OXA carbapenemase were detected by polymerase chain reaction (PCR).Results All 49 isolated IRAB strains were found to be highly resistant to antimicrobial agents (81 .63%-100.00%)except to minocycline (8.16%);blaOXA-51-like was identified in 49 strains (100.00%),42 (85.71 %)of which also carried blaOXA-23-like gene ,blaOXA-23-lik and blaOXA-51-like were both found in three hospital, blaOXA-24-like and blaOXA-58-like weren’t found.Conclusion IRAB strains present multidrug resistance,resistant to mi-nocycline is the lowest;blaOXA-23-like is the main drug-resistance mechanism of IRAB in Hohhot.

Characteristics of Brucella’s growth curve in the Bact/Alert blood culture system / 中国感染与化疗杂志

Objective To characterize the growth curve of Brucella in Bact/Alert blood culture system which may be helpful to predict the growth of Brucella strain for earlier clinical diagnosis of brucellosis.Methods The epidemiological,clinical and labo-ratory data including growth curve of Brucella were reviewed and analyzed retrospectively for 15 cases of brucellosis as con-firmed by positive serological test and brucellosis agglutination test.Results All the 15 patients had irregular fever and history of animal exposure,even though their clinical feature and signs varied greatly.The growth curve of Brucella in blood culture showed the same chracteristics in the 15 patients,including:the time to positive alarm was about 72 hours,a longer lag phase, shorter logarithmic phase,a shorter vertical axis corresponding to the logarithmic phase,and a flat stable phase.Conclusions The clinical manifestation of brucellosis is variable and non-specific.Lack of awareness of this disease makes the clinicians mis-diagnose it easily.Therefore,blood culture is critical for clarifying the etiology in febrile patients.The growth curve of bacteria during blood culture is useful for early diagnosis of brucellosis and prevention of laboratory infections.

Clinical Distribution and Drug Resistance Analysis of 60 Stenotrophomonas maltophilia Isolates / 中华医院感染学杂志

OBJECTIVE To investigate the clinical distribution and drug resistance status of Stenotrophomonas maltophilia and provide clinical guidance for treatment.METHODS Sixty clinical isolates of S.maltophilia were identified with GNI+ cards of VITEK-32.Drug sensitivitiy were detected by Kirby-Bauer disc diffusion method.The data were analyzed by WHONET5.3 software.RESULTS Thirty-eight strains were isolated from sputum(63.3%).Infection caused by S.maltophilia mainly occurred at the departments of respiratory diseases,ICU,old cadre,et al.Sixty isolates of S.maltophilia were highly resistant to imipenem,aminoglycosides and most of ?-lactam antibiotic,but showed the lowest resistance rate(16.7%) to SMZ/TMP.Then resistance rate of S.maltophilia to minocycline,levofloxacin,cefoperazone/sulbactam,piperacillin/tazobactam,and ticarcillin/clavulanic acid was 18.3%,20.0%,21.7%,25.0% and 30.0%,respectively.CONCLUSIONS The drug resistance of S.maltophilia is extremely severe.Among different areas of china the drug resistance is obviously different.Treatment based on drug susceptibility test should be adapted as soon as possible.

Surveillance of High-level Gentamicin Resistance of Enterococcus and Analysis of Its Drug Resistance / 中华医院感染学杂志

OBJECTIVE To study resistance of Enterococcus in clinical isolates to high-level gentamicin(HLG) and investigate drug resistance of these Enterococcus.METHODS Totally 140 strains of Enterococcus were detected resistance to antibiotics by Kirby-Bauer test and agar-screening test.Data were analyzed using WHONET5.3 software.RESULTS Same result was obtained by two kinds of detecting methods,there were 73 strains of high level gentamicin resistance(HLGR,52.1%) and 67 strains of non-HLGR(47.9%),the resistance rate of HLGR was higher than that of non-HLGR,the isolation rate of vancomycin resistanct Enterococcus was 3.6%.CONCLUSIONS The most common enterococci causing hospital infection are E.faecalis and E.faecium.The drug resistance rate of E.faecium is higher than that of E.faecalis.It is imperative to select the proper method to detect HLGR of Enterococcus,and select proper antibiotic in terms of antibiotic susceptibility test during clinical therapy.

Extended-spectrum Beta-lactamases and AmpC Enzymes of Pseudomonas aeruginosa:Their Detection and Resistance Analysis / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence of strains producing extended-spectrum ?-lactamases (ESBLs) and AmpC ?-lactamases in Pseudomonas aeruginosa,and to supply the laboratory evidence for antibiotic rational application in clinic. METHODS Totally 105 clinical isolates of P. aeruginosa were identified with VITEK-32. Drug sensitivities were determined by Kirby-Bauer methods. ESBLs were detected by double-disc synergy test,and cefoxitin three dimensional test was applied to filter AmpC positive strains. RESULTS Among 105 strains of P. aeruginosa,28 strains (26.7%) were AmpC enzymes positive,20 strains (19.0%) were ESBLs positive,and 5 strains(4.8%)were AmpC+ESBLs positive. The detective rate of producing AmpC ?-lactamases strains was higher than that of producing ESBLs strains. There was significant difference between them. CONCLUSIONS ESBLs and AmpC ?-lactamases are two main enzyme types conferring resistance to ?-lactam antibiotics in clinical isolates of P. aeruginosa. Imipenem can be the first choice for treating infections caused by P. aeruginosa producing ESBLs or AmpC ?-lactamases.

Trends of institutional delivery in China and its influencing factors / 中华围产医学杂志

Objective To understand the trends of institutional delivery in recent 30 years in China and find out the main social and demographic factors. Methods Two-staged PPS method was employed for sampling; Uniform questionnaire was drafted and direct interview was adopted to collect the information. Results The institutional delivery rate was increasing rapidly with time, especially from 1990's, which had climbed to 82% in the last three years, but it was still unsatisfactory in the central and western areas. Meanwhile, most women who delivered outside the hospital were assisted only by birth attendants/village doctors or family members/friends in labor. Factor analysis showed that the women s education and occupation and their husbands, the gap of education between the couples, and the antenatal care could significantly affect their choice for where to deliver. Conclusions Great improvement had been achieved in the last several decades, and both individual characteristics, community and health facility could have influences on the women s decision on where to give birth.

Health service needs of women with reproductive tract infections in selected areas of China / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.</p><p><b>METHODS</b>A cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed.</p><p><b>RESULTS</b>The percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs.</p><p><b>CONCLUSION</b>The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.</p>

Postpartum Abuse: Effect on Postpartum Depression / 中国心理卫生杂志

Object:To understand the situation of postpartum abuse and postpartum depression Method:This was a community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan and Shaanxi provinces between Nov 1, 2001 and February28, 2002 Totally 12044 subjects were found by stratified cluster sampling Results:The incidence of postpartum depression (according to result of Zung's self-rate depression scale for one week assessment during the interview) was 20 9%, while the rate of postpartum abuse was 8 3% Women often suffered abuses with many forms (physical, sexual and emotional maltreatment), and recurrently for a long time Among them, sexual abuse was the most frequent one Multiple logistic regression showed association between abuse and depression Conclusion:The incidences of postpartum depression and postpartum abuse are high Being abused has influence on depression

Utilization of health service in women with reproductive tract infections in urban and rural areas / 中华流行病学杂志

<p><b>OBJECTIVE</b>To provide insight on psychosocial factors underlying utilization of health services of women whom perceived reproductive tract infection (RTI) symptoms.</p><p><b>METHODS</b>A cross-sectional study, adopted Aday and Andersen's Social Behaviour Model was conducted in 1998 - 1999 in China. Hebei province and Beijing were purposely chosen as the research sites. All eligible married women aged 21 to 60, 864 subjects, were interviewed in person.</p><p><b>RESULTS</b>Findings showed that the percentage of self-reported symptoms of RTIs was 35.6 in urban compared to 46.8 in the rural areas. The proportion of women with RTIs who utilized health services was 27.5 versus 26.7 percent among the two groups. Urban women, mostly 'white collar' class, with free medical service, satisfied with health providers, receiving information from health provider and having severe current experience RTIs, were more likely to use health services. Rural women, however, having both severe prior experience and current experience of RTIs, high family income, having much knowledge about self-medication, perceiving less social stigma of getting RTIs, and perceiving severity of RTIs, were more likely to use health services.</p><p><b>CONCLUSION</b>These findings showed that there was a great need on providing culturally acceptable reproductive health education at different places so as to improve women's ability of self-care. Regular medical check-up for women is also important for improving the quality of health service. Reform on health insurance seemed necessary. Factors as social stigma related to RTIs, giving women social and moral support also need to be taken into account.</p>

Study on Relationship between Quality of Obstetrical Service and Breastfeeding Rate at Discharging Hospital / 中华围产医学杂志

Objective To investigate the status of breastfeeding rate at discharging hospital and analyze influence of obstetrical service quality on breastfeeding rate, in order to improve the quality of obstetrical service and increase the breastfeeding rate. Methods A total number of 1 123 mothers who have 6~12 months babies were investigated through questionnaire including obstetrical service accepted, situation of breastfeeding rate at discharging hospital, mother's breastfeeding knowledge and behaviors with across-sectional method from August to October in 2000. Seven cities were chosen as the research site including Beijing, Changchun, Huhehaote, Xi'an, Luoyang, Kunming and Xiamen. The data were analyzed with SPSS/PC 10.0 statistical software. Results The exclusive breastfeeding rate was 52%, the full breastfeeding rate was 73% at discharging hospital. The influencing factors of breastfeeding rate at discharging hospital include mother's age, medical expenditure type, caesarean section, breastfeeding on demand, neonatal status, having milk bottle, feeding milk-powder and sweeten water in obstetrical wards, mother's breastfeeding knowledge and behavior, et al. Conclusions Breastfeeding rate at discharging hospital was low and it was related with quality of obstetrical service. So it is important to improve the quality of obstetrical service and health education on breastfeeding, in order to enhance the breastfeeding rate.

Trends of caesarean section and related social and demographic factors in China from 1971 to 2003 / 中华围产医学杂志

Objective To investigate the occurrence of cesarean section (CS) among reproductive age women in last thirty years, and explore the factors related to high CS rate. Methods Population proportional to size sampling method was employed in sampling. The sampled women were interviewed face to face. Data were double entered by EPIDATA 2.1 and analyzed by SPSS 11.5. Results The CS rate continuously increase from 0.9% in 1971-1980 to 20.2% in 2001-2002 and the speed is more and more rapid. More and more CSs were required by the women themselves and the rate increased from 19.3% in 1971-1985 to 49.7% in 2001-2002. Logistic regression analysis showed that women who were less than 30, senior high education or above and white-collar or jobless women had more than 8 times of antenatal visits, lived in eastern region and had B-ultrasound exam, were more likely to have caesarean section. Conclusions The caesarean section rate was increasing rapidly in the last thirty years especially after 1990. There are two reasons for this increase, on one hand caesa- rean sections with medical indications increase because of the progress of perinatal care and related technology; on the other hand unnecessary caesarean sections increase because of some social and demographic factors, which result in more caesarean section required by the pregnant women.

Multilevel Analysis on Maternal Mortality in Some Rural Areas / 中华围产医学杂志

Objective To analyse both micro level and macro level factors influencing maternal mortality in order to set the priority to lowering maternal mortality. Method The results of an analysis of maternal mortality were reported, based on a conceptual model that combines micro level and macro level variables taken from demographic, sociological and epidemiological research. Multi level analysis techniques were used to analyse the 1997 linked county level maternal death data and related county level social demographic and health resources data in 114 counties of 5 remote and poverty stricken provinces. Results The maternal mortality rate in research areas was as high as 159.3/100 000. The main factors influencing maternal mortality were institutional delivery rate, population density, percentage of minority population, and percentage of village without village doctor. Conclusion To advocate institutional delivery rate, to pay greater attention to minority and low population density area, and to standardised village doctors' responsibility are recommended strategies to lowering maternal mortality in remote and poverty stricken areas of China.