Determination of biological exposure limit of damage in red blood cells caused by exposure to polycyclic aromatic hydrocarbons using benchmark dose method in general population / 公共卫生与预防医学

Objective To explore the biological exposure limit of blood system damage caused by long-term exposure to polycyclic aromatic hydrocarbons (PAHs) in non-occupational population by using the benchmark dose method, and to provide relevant reference for further improving the assessment of PAHs-induced health damage effects. Methods Adult residents living in downwind direction of a coke-oven plant in Shanxi Province were selected as the research subjects, and the information collected from baseline was used as the control. The metabolites of PAHs in urine were used as exposure biomarker, and the abnormal rate of red blood cell index was used as response biomarker. The relationship between urinary OH-PAHs and the erythrocyte damage rate was analyzed, and the benchmark dose (BMD) and the lower confidence limitation for the benchmark dose (BMDL) were calculated using Bayesian dose-optimizing software. Results The urinary PAH metabolites were mainly naphthalene and fluorene. The detection concentrations of 2-OHFlu and 1-OHPhe in the final year were higher than those in the baseline (P<0.05). With the increase of exposure years, the abnormal rate of red blood cells in the final year was higher than that in the baseline (P<0.05). In addition, the abnormal rate of red blood cells increased with the increase of the concentrations of five metabolites of PAHs in urine, and the chi-square trend test was significant (P<0.05). The benchmark dose (BMD) of OH-PAHs was 0.67 μmol/mol Cr, 0.82 μmol/mol Cr, 1.40 μmol/mol Cr and 0.78 μmol/mol Cr, respectively. The BMD of 2-OHNap in people with barbecue diet habits was 0.23 μmol/mol Cr. The BMD of 2-OHNap in people without barbecue diet habits was 1.44 μmol/mol Cr. Conclusion There is a dose-response relationship between the concentration of PAHs metabolites in urine and the damage of red blood cells. Long-term exposure to PAHs can lead to hematological damage. It is suggested that targeted public health interventions should be formulated to reduce the exposure of the general population to PAHs.

Analysis of clinical features of varicella in 33 neonates / 中国新生儿科杂志

Objective:To study the clinical characteristics, diagnosis, complications and prognosis of neonatal varicella.Methods:From September 2008 to December 2019, the clinical data of hospitalized neonates with varicella in our hospital were retrospectively analyzed.Results:A total of 33 cases of neonatal varicella were reviewed, including 18 males and 15 females, 32 full-term infants and 1 premature infant. The gestational age (GA) was (38.8±1.2)w and birth weight (BW) was (3 670±247)g. The onset of the disease occurred at 14.0 (8.0,19.0)d and was diagnosed at 18.0 (11.5,23.0)d. The hospital stay duration was (8.1±3.7)(2~20)d. All mothers denied varicella history or varicella vaccination. Among the 33 infants, 29 had a history of varicella/zoster exposure. All 33 infants had typical rash and 25 had fever, body temperature (38.3±0.6) ℃ and duration (2.4±1.4) d. 13 cases were congenital varicella, 20 cases were acquired varicella. 24 cases abnormality of cardiac enzymes, 11 cases skin infection, 8 cases liver damage, 4 cases pneumonia, 6 cases granulocytopenia/agranulocytosis, 9 cases anemia, 4 cases sepsis and 1 case viral encephalitis were diagnosed. 20 infants received intravenous antiviral therapy (acyclovir), 17 were treated with antibiotics, 15 were given intravenous immunoglobulin (IVIG), 8 received both antiviral therapy and IVIG and 6 were treated with recombinant human granulocyte stimulating factor. 31 infants were cured and discharged. 2 infants were discharged after improvement of rashes. All infants reported complete recovery on telephone follow-up.Conclusions:Most neonatal varicella cases have a definite exposure history. Besides rashes, complications including pneumonia, liver damage, myocardial injury, granulocytopenia/agranulocytosis, viral encephalitis are common. Intravenous antiviral therapy with acyclovir and combined treatment of IVIG and symptomatic support can often achieve a good prognosis.

Effects of radical radiotherapy combined with different regimens of chemotherapy on radiation intestinal injury in patients with non-metastatic anal squamous cell carcinoma / 中华胃肠外科杂志

Objective: To investigate the effects of radical radiotherapy combined with different chemotherapy regimens (fluorouracil-based versus docetaxel plus cisplatin) on the incidence of radiation intestinal injury and the prognosis in patients with non-metastatic anal squamous cell carcinoma. Methods: A retrospective cohort study was conducted to recruit non-metastatic anal squamous cell carcinoma patients who underwent chemoradiotherapy in the Sixth Affiliated Hospital of Sun Yat-sen University and Nanfang Hospital from July 2013 to January 2021. Inclusion criteria: (1) newly diagnosed anal and perianal squamous cell carcinoma; (2) completed radical radiotherapy combined with concurrent chemotherapy; (3) tumor could be evaluated before radiotherapy. Exclusion criteria: (1) no imaging evaluation before treatment, or the tumor stage could not be determined; (2) patients undergoing local or radical resection before radiotherapy; (3) distant metastasis occurred before or during treatment; (4) recurrent anal squamous cell carcinoma. A total of 55 patients (48 from the Sixth Affiliated Hospital of Sun Yat-sen University and 7 from Nanfang Hospital) were given fluorouracil (the 5-FU group, n=34) or docetaxel combined with the cisplatin (the TP group, n=21). The evaluation of radiation intestinal injury, hematological toxicity and 3-year disease-free survival (DFS) rate were compared between the two groups. The effects of chemotherapy regimen and other clinicopathological factors on the incidence and severity of acute and chronic radiation intestinal injury were analyzed. The assessment of radiation intestinal injury was based on the American Cancer Radiotherapy Cooperation Group (RTOG) criteria. Results: During radiotherapy and within 3 months after radiotherapy, a total of 45 patients developed acute radiation intestinal injury, including 18 cases of grade 1 (32.7%), 22 cases of grade 2 (40.0%) and 5 cases of grade 3 (9.1%). No patient developed chronic radiation intestinal injury. Among the 34 patients in the 5-FU group, 21 had grade 2-3 radiation intestinal injury (21/34, 61.8%), which was significantly higher than that in the TP group (6/21, 28.6%) (χ(2)=5.723, P=0.017). Multivariate analysis showed that 5-FU chemotherapy regimen was an independent risk factor for radiation intestinal injury (HR=4.038, 95% CI: 1.250-13.045, P=0.020). With a median follow-up period of 26 (5-94) months, the 3-year DFS rate of patients in TP group and 5-FU group was 66.8% and 77.9%, respectively, whose difference was not significant (P=0.478). Univariate analysis showed that the DFS rate was associated with sex, age, tumor location, T stage, N stage, and induction chemotherapy (all P<0.05), while the DFS rate was not associated with chemotherapy regimen or radiation intestinal injury (both P>0.05). Multivariate analysis revealed that age ≥ 50 years old was an independent risk factor affecting the prognosis of patients (HR=8.301, 95% CI: 1.130-60.996, P=0.038). Conclusions: For patients with non-metastatic anal squamous cell carcinoma, radical radiotherapy combined with TP chemotherapy regimen can significantly reduce the incidence of radiation intestinal injury as compared to 5-FU regimen. However, due to the short follow-up time, the effect of different chemotherapy regimens on the prognosis is not yet clear.

Preliminary study on the causes of anemia in newborns delivered by human immunodeficiency virus infected mothers / 中华传染病杂志

Objective:To investigate the causes of anemia in newborns delivered by human immunodeficiency virus (HIV) infected mothers.Methods:This was a retrospective study. Forty-two newborns delivered by HIV infected mothers during January 2010 and May 2019 in Beijing Ditan Hospital Affiliated to Capital Medical University were selected. According to the hemoglobin levels of newborns on the days of their birth, newborn cases were divided into two groups, anemia group and non-anemia group. The clinical data including gestational ages, birth weight, maternal anemia status during pregnancy, using of antiviral drugs during pregnancy, percentages of HIV RNA positivity in early pregnancy/pre-treatment and before delivery, maternal percentage of different CD4 + T lymphocyte counts in early pregnancy/pre-treatment and before delivery between two groups were compared. The efficacies of relative indicators for prediction of anemia in newborns were evaluated by the area under receiver operating characteristic curve (AUROC). Differences between groups were compared by chi-square test. Results:Among 42 cases of newborns, 14 cases were in anemia group and 28 cases in non-anemia group. There were no statistical differences in gestational ages, birth weight, maternal anemia status during pregnancy and positive percentage of HIV RNA before delivery between two groups ( χ2=2.211, 1.025, 1.362 and 3.783, respectively, P=0.283, 0.763, 0.181 and 0.092, respectively). In anemia group, 11 mothers took zidovudine during pregnancy, which was 12(42.86%) in non-anemia group. The difference was statistically significant ( χ2=4.359, P=0.037). Eight cases of mothers with HIV RNA positive in early pregnancy/pre-treatment in the anemia group, which was 11(39.29%) in the non-anemia group. The difference was statistically significant ( χ2=6.490, P=0.011). The number of CD4 + T lymphocyte count ≤500/μL was 13 in early pregnancy/pre-treatment in anemia group, which was 20(71.43%) in the non-anemia group. The difference was statistically significant ( χ2=16.396, P<0.01). The number of CD4 + T lymphocyte ≤0.28 was 13 in early pregnancy/pre-treatment in the anemia group, which was 19(67.86%) in the non-anemia group ( χ2=19.908, P<0.01). The number of CD4 + T lymphocyte count ≤500/μL was 14 before delivery, which was 15(53.37%) in the non-anemia group ( χ2=9.536, P=0.008). The number of CD4 + T lymphocyte ≤0.28 before delivery was 14 in anemia group, which was 15(53.37%) in the non-anemia group ( χ2=9.750, P=0.006). According to the receiver operating characteristic curve results, the AUROC, optimal cut-off value, sensitivity and specificity of CD4 + T lymphocyte count before delivery in predicting neonatal anemia were 0.708, 476.0/μL, 100.0% and 50.0%, respectively. The AUROC, optimal cut-off value, sensitivity and specificity of maternal CD4 + T lymphocyte percentage before delivery in predicting neonatal anemia were 0.719, 0.275, 100.0% and 53.6%, respectively. Conclusion:Low CD4 + T lymphocyte level in HIV-infected mothers before delivery, HIV positive in early pregnancy/pre-treatment and using of zidovudine during pregnancy may be associated with neonatal anemia.

Coronavirus Disease 2019 Influenza A in Children: An Observational Control Study in China / 生物医学与环境科学（英文）

This study aimed to understand the differences in clinical, epidemiological, and laboratory features between the new coronavirus disease 2019 (COVID-2019) and influenza A in children. Data of 23 hospitalized children with COVID-19 (9 boys, 5.7 ± 3.8 years old) were compared with age- and sex-matched 69 hospitalized and 69 outpatient children with influenza A from a hospital in China. The participants' epidemiological history, family cluster, clinical manifestations, and blood test results were assessed. Compared with either inpatients or outpatients with influenza A, children with COVID-19 showed significantly more frequent family infections and higher ratio of low fever ( 39 °C), nasal congestion, rhinorrhea, sore throat, vomiting, myalgia or arthralgia, and febrile seizures. They also showed higher counts of lymphocytes, T lymphocyte CD8, and platelets and levels of cholinesterase, aspartate aminotransferase, lactate dehydrogenase, and lactic acid, but lower serum amyloid, C-reactive protein, and fibrinogen levels and erythrocyte sedimentation rate, and shorter prothrombin time. The level of alanine aminotransferase in children with COVID-19 is lower than that in inpatients but higher than that in outpatients with influenza A. Pediatric COVID-19 is associated with more frequent family infection, milder symptoms, and milder immune responses relative to pediatric influenza A.

An ultra-sensitive and easy-to-use assay for sensing human UGT1A1 activities in biological systems / 药物分析学报

The human UDP-glucuronosyltransferase 1A1 (UGT1A1), one of the most essential conjugative enzymes, is responsible for the metabolism and detoxification of bilirubin and other endogenous substances, as well as many different xenobiotic compounds. Deciphering UGT1A1 relevance to human diseases and characterizing the effects of small molecules on the activities of UGT1A1 requires reliable tools for probing the function of this key enzyme in complex biological matrices. Herein, an easy-to-use assay for highly-selective and sensitive monitoring of UGT1A1 activities in various biological matrices, using liquid chromatography with fluorescence detection (LC-FD), has been developed and validated. The newly developed LC-FD based assay has been confirmed in terms of sensitivity, specificity, precision, quanti-tative linear range and stability. One of its main advantages is lowering the limits of detection and quantification by about 100-fold in comparison to the previous assay that used the same probe substrate, enabling reliable quantification of lower amounts of active enzyme than any other method. The precision test demonstrated that both intra- and inter-day variations for this assay were less than 5.5％. Further-more, the newly developed assay has also been successfully used to screen and characterize the regu-latory effects of small molecules on the expression level of UGT1A1 in living cells. Overall, an easy-to-use LC-FD based assay has been developed for ultra-sensitive UGT1A1 activities measurements in various biological systems, providing an inexpensive and practical approach for exploring the role of UGT1A1 in human diseases, interactions with xenobiotics, and characterization modulatory effects of small mole-cules on this conjugative enzyme.

Spatio-temporal distribution and correlation of reported cases of hepatitis C and HIV/AIDS in China, 2012-2017 / 中华流行病学杂志

Objective To compare the time and spatial distribution of hepatitis C and HIV/AIDS cases and its correlation,in China from 2012 to 2017.Methods Data on reported hepatitis C and HIV/AIDS cases was gathered from the Direct Reporting System of Infectious Diseases Information Network in China,2012 to 2017 while annually collected provincial data was based on the date of review and current address.Correlation of the data was analyzed,using both simple correlation and linear regression methods.Results The number of reported cases of hepatitis C remained stable in China,in 2012-2017,with the number of annual reported cases as 201 622,203 155,202 803,207 897,206 832 and 214 023,respectively.The number of reported cases on HIV/AIDS showed a steady growing trend,from 82 434,90 119,103 501,115 465,124 555 to 134 512.However,the numbers of hepatitis C and HIV/AIDS cases were in the same,top six provinces:Henan,Guangdong,Xinjiang,Guangxi,Hunan and Yunnan.Results from the simple correlation analysis indicated that there was a positive correlation (r＞0.5,P＜0.01) existed between the above-said two kinds of cases at the provincial level in China,in 2012-2017.Again,results from the linear regression analysis also showed that the correlation coefficient r,and year was strongly correlated (r=0.966) while rs had been linearly increasing with time.Conclusions Our data showed that there were temporal and spatial correlations existed between the reported cases of hepatitis C and HIV/AIDS at the provincial level,suggesting that relevant prevention and control programs be carried out in areas with serious epidemics.Combination of the two strategies should be encouraged,especially on prevention and treatment measures related to blood transmission.

Sentinel surveillance for viral hepatitis C in China, 2016-2017 / 中华流行病学杂志

Objective To understand the prevalence of hepatitis C virus (HCV) infection in 5 populations in China during 2016-2017 and provide evidence for the estimation of prevalence trend of hepatitis C and evaluation on the prevention and control effect.Methods A total of 87 national sentinel surveillance sites for hepatitis C were set up in 31 provinces (autonomous regions and municipalities) of China to obtain the information about HCV infection prevalence in 5 populations,including volunteer blood donors,people receiving physical examination,patients receiving invasive diagnosis and treatment,patients receiving hemodialysis,and clients visiting family planning outpatient clinics.From April to June,2016 and 2017,cross-sectional surveys were repeatedly conducted in the 5 populations and blood samples were collected from them for HCV antibody detection.Results In 2016,86 sentinel sites completed the surveillance (one sentinel site was not investigated),and 115 841 persons were surveyed.The overall HCV positive rate was 0.38％ (442/115 841,95％CI:0.23％-0.53％).In 2017,all the 87 sentinel sites completed the surveillance,and 120 486 persons were surveyed.The overall HCV positive rate was 0.37％ (449/120 486,95％CI:0.23％-0.52％).In 2016 and 2017,the anti-HCV positive rates were 4.46％ (223/5 005,95％CI:2.18％-6.73％) and 4.39％ (216/4 919,95％ CI:2.29％-6.50％) respectively in hemodialysis patients,0.85％ (44/5 200,95％ CI:0.27％-1.42％) and 0.70％ (36/5 150,95％ CI:0.15％-1.24％) respectively in patients receiving invasive diagnosis and treatment and remained to be ≤0.25％ in volunteer blood donors,people receiving physical examination and clients visiting family planning outpatient clinics.Results for the comparison of the anti-HCV positive rates in the 5 populations indicated that the differences were significant (F=23.091,P＜0.001 in 2016 and F=20.181,P＜0.001 in 2017).Conclusions Data from the sentinel surveillance of HCV infection on prevalence in China showed that the anti-HCV positive rates varied in the 5 populations during 2016-2017.The anti-HCV positive rate appeared the highest in the hemodialysis patients,followed by that in the patients receiving invasive diagnosis and treatment,and the prevalence of HCV infection in other 3 populations were at low levels.

Spatio-temporal distribution and correlation of reported cases of hepatitis C and HIV/AIDS in China, 2012-2017 / 中华流行病学杂志

Objective To compare the time and spatial distribution of hepatitis C and HIV/AIDS cases and its correlation,in China from 2012 to 2017.Methods Data on reported hepatitis C and HIV/AIDS cases was gathered from the Direct Reporting System of Infectious Diseases Information Network in China,2012 to 2017 while annually collected provincial data was based on the date of review and current address.Correlation of the data was analyzed,using both simple correlation and linear regression methods.Results The number of reported cases of hepatitis C remained stable in China,in 2012-2017,with the number of annual reported cases as 201 622,203 155,202 803,207 897,206 832 and 214 023,respectively.The number of reported cases on HIV/AIDS showed a steady growing trend,from 82 434,90 119,103 501,115 465,124 555 to 134 512.However,the numbers of hepatitis C and HIV/AIDS cases were in the same,top six provinces:Henan,Guangdong,Xinjiang,Guangxi,Hunan and Yunnan.Results from the simple correlation analysis indicated that there was a positive correlation (r＞0.5,P＜0.01) existed between the above-said two kinds of cases at the provincial level in China,in 2012-2017.Again,results from the linear regression analysis also showed that the correlation coefficient r,and year was strongly correlated (r=0.966) while rs had been linearly increasing with time.Conclusions Our data showed that there were temporal and spatial correlations existed between the reported cases of hepatitis C and HIV/AIDS at the provincial level,suggesting that relevant prevention and control programs be carried out in areas with serious epidemics.Combination of the two strategies should be encouraged,especially on prevention and treatment measures related to blood transmission.

Sentinel surveillance for viral hepatitis C in China, 2016-2017 / 中华流行病学杂志

Objective To understand the prevalence of hepatitis C virus (HCV) infection in 5 populations in China during 2016-2017 and provide evidence for the estimation of prevalence trend of hepatitis C and evaluation on the prevention and control effect.Methods A total of 87 national sentinel surveillance sites for hepatitis C were set up in 31 provinces (autonomous regions and municipalities) of China to obtain the information about HCV infection prevalence in 5 populations,including volunteer blood donors,people receiving physical examination,patients receiving invasive diagnosis and treatment,patients receiving hemodialysis,and clients visiting family planning outpatient clinics.From April to June,2016 and 2017,cross-sectional surveys were repeatedly conducted in the 5 populations and blood samples were collected from them for HCV antibody detection.Results In 2016,86 sentinel sites completed the surveillance (one sentinel site was not investigated),and 115 841 persons were surveyed.The overall HCV positive rate was 0.38％ (442/115 841,95％CI:0.23％-0.53％).In 2017,all the 87 sentinel sites completed the surveillance,and 120 486 persons were surveyed.The overall HCV positive rate was 0.37％ (449/120 486,95％CI:0.23％-0.52％).In 2016 and 2017,the anti-HCV positive rates were 4.46％ (223/5 005,95％CI:2.18％-6.73％) and 4.39％ (216/4 919,95％ CI:2.29％-6.50％) respectively in hemodialysis patients,0.85％ (44/5 200,95％ CI:0.27％-1.42％) and 0.70％ (36/5 150,95％ CI:0.15％-1.24％) respectively in patients receiving invasive diagnosis and treatment and remained to be ≤0.25％ in volunteer blood donors,people receiving physical examination and clients visiting family planning outpatient clinics.Results for the comparison of the anti-HCV positive rates in the 5 populations indicated that the differences were significant (F=23.091,P＜0.001 in 2016 and F=20.181,P＜0.001 in 2017).Conclusions Data from the sentinel surveillance of HCV infection on prevalence in China showed that the anti-HCV positive rates varied in the 5 populations during 2016-2017.The anti-HCV positive rate appeared the highest in the hemodialysis patients,followed by that in the patients receiving invasive diagnosis and treatment,and the prevalence of HCV infection in other 3 populations were at low levels.

Effects and associated factors of HIV/AIDS anti-retroviral therapy in Liangshan Yi Autonomous Prefecture, Sichuan Province / 中华预防医学杂志

Objective@#To evaluate the effectiveness and to explore the releated factors of antiretroviral therapy among HIV/AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan Province.@*Methods@#The method of convenience sampling was adopted in July 2017 to select the research objects who were accepted antiretroviral therapy (ART) over 6 months, older than 18 years and had HIV viral load in 2016, totally 400 cases. A retrospective study was used to collect the data, including social demography, medicine use, information of medical service acquisition, their own behaviors and cognition. 395 questionnaires were effectively recovered. χ2 test and logistic regression were performed to examine relationships between factors and effects.@*Results@#All of the 395 respondents were Yi-nationality. The average age of all cases was (39.23±7.52) years old and 223 were male (56.5%). Among 395 cases patients who were detect Viral load in 2016, 221 cases were under the number of 400 copies, thze effective rate of ART was 55.9%. Multivariate analysis showed that HIV/AIDS patients who missed the medication during the antiviral therapy had poor antiviral effects. Compared to those who adhered to medication, the treatment-ineffective OR (95%CI) of the patients missing the medication during the therapy was 7.06 (3.67-13.58); Compared to those who had adverse reactions that affect the therapy, the treatment-ineffective OR (95%CI) of the patients with mild adverse reactions that did not affect the therapy was 0.45 (0.23-0.87); Compared to the patients who used drugs during the treatment, the treatment-ineffective OR (95%CI) value of the antiretroviral therapy effect of non-drug users was 0.39 (0.16-0.91);Compared to the patients who have a correct cognition that insisting on taking medicine correctly can extend their life expectancy as a common person, the treatment-ineffective OR (95%CI) values for those who hold the view that could be prolonged by 10-20 years and not/unknown were 4.18 (1.59-10.99) and 6.64 (2.67-16.53).@*Conclusion@#The HIV/AIDS patients who receive ART were less effective in Liangshan, Prefecture. Missings drugs is one of the main influencing factors for the ineffective treatment.

Influence of shift work in nursing on sleep and circadian blood pressure and rhythm / 心血管康复医学杂志

Objective: To explore influence of shift work in nursing on sleep and circadian blood pressure and rhythm. Methods: A total of 29 shift nurses, who worked in our hospital for a long period, were enrolled as shift nurse group. Another 32 day shift nurses were regarded as day shift nurse control group（control group）. Both groups received Pittsburgh sleep quality index (PSQI) assessment and 24h ambulatory blood pressure monitoring (ABPM). Results: Compared with control group, PSQI assessment showed that most factor scores and PSQI total score [(8.67±2.16) scores vs. (11.98±3.30) scores] significantly increased in shift nurse group（P<0.05~0.01）; 24h ABPM showed that mean nighttime SBP [(106.51±12.94) mmHg vs. (115.74±13.72) mmHg] and nighttime DBP [(71.23±9.76) mmHg vs. (74.96±10.68) mmHg] significantly rose in shift nurse group, P<0.05; Mean SBP decreasing rate [(7.84±1.52)% vs. (3.66±1.47)%] and mean DBP decreasing rate [(6.55±1.39)% vs. (2.83±0.51)%], SBP dipper percentage (59.38% vs. 31.03%) and DBP dipper percentage (68.75% vs. 27.59%) significantly reduced, SBP non-dipper percentage (40.63% vs. 68.97%) and DBP non-dipper percentage (31.25% vs. 72.41%) significantly rose in shift nurses group, P<0.05~0.01.Conclusions: There exists definite somnipathy and significant change of circadian blood pressure and rhythm in shift nurses.

A case-control study on the causes of new HIV infection among heroin addicts attendees at the methadone maintenance treatment clinics / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the routes and factors associated with HIV new infection of heroin addicts who had been attending the methadone maintenance treatment (MMT) program.</p><p><b>METHODS</b>A 1 : 1 nested case-control study was implemented with the cases (new HIV infections) and controls (HIV negative) selected from the treatment cohort of China MMT clients. Questionnaire was developed to collect information on demographic characters, behaviours on drug use, sexual behaviour, daily dosage of methadone intake, adherence to MMT, and psychological problems. Univariate analysis and multivariate condition logistic regression were used to identify factors associated with HIV infection.</p><p><b>RESULTS</b>108 (54 paired) clients on MMT were recruited, with 76 males and 32 females. Among them, 95 were Han Chinese and 13 were minorities, with average time of drug use as 12.1 ± 5.0 years. Among 54 new HIV infections, 33 were infected through sharing needles, 12 were through sexual contact and 9 unidentified. Results from multivariate condition logistic regression indicated that having longer duration of heroin use before on MMT (More than 10 years vs. less than 10 years,OR = 20.9, 95% CI:1.62-269.34, P = 0.02), shared needles in the last 6 months (OR = 276.7, 95%CI:5.65-> 999.99, P < 0.01) were risk factors while better adherence (More than 0.5 vs. less than 0.5,OR = 0.07, 95%CI:0.42-0.87, P = 0.04) and living with families (OR = 0.002, 95% CI:0.001-0.94, P < 0.01) were protective factors.</p><p><b>CONCLUSION</b>Sharing needles was the main route of HIV new infection among those clients that were on MMT. Factors as having received more support from both family and community, improvement of adherence to MMT, reducing the frequency of injection etc., could reduce the risk of HIV infection among those MMT clients.</p>

Current situation related to antiretroviral therapy and related influential factors on HIV infected injection drug users in the methadone maintenance treatment clinics / 中华流行病学杂志

<p><b>OBJECTIVE</b>To find out the current coverage of antiretroviral therapy (ART) among HIV positive subjects and to identify the major influential factors associated with the participation in ART among them.</p><p><b>METHODS</b>291 HIV positive subjects from 6 methadone maintenance treatment (MMT) clinics in Guangxi and Yunnan province were surveyed by questionnaires.</p><p><b>RESULTS</b>217 males (74.6%) and 74 females (25.4%) were under investigation, with the average age of 38.4 +/- 5.9. Most of them received less than senior high school education, married and unemployed. Results from the single factor logistic regression analysis showed that: working status, living alone, self-reported history of drinking alcohol in the last month, negative attitude towards MMT among family members,poor self-reported compliance to MMT in the last month,lack of incentives in the MMT clinics, reluctance on disclosure of their own HIV status, good self-perception on their health status, lack of communication on ART related topics among family members in the last 6 months, lack of correct attitude and knowledge on ART etc. appeared as the main factors that influencing the participation in ART program among the patients. Data from the multivariate logistic regression analysis showed that factors as: living alone, unwilling to tell others about the status of HIV infection, poor self-perception on HIV infection, lack of discussion of ART related topics within family members in the last 6 months and poor awareness towards ART among the family members etc., were associated with the low participation rate of ART. Conclusion Strengthening the publicity and education programs on HIV positive patients and their family members at the MMT clinics seemed to be effective in extending the ART coverage. Attention should also be paid to increase the family support to the patients.</p>

Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program / 中华流行病学杂志

Objective To study the factors that associated with the mortality of overdose on methadone maintenance treatment (MMT) among HIV-positive patients.Methods A 1 ∶ 1 matched case-control design was used to identify the relationship between factors related to demography,drug use,characteristics of treatment and the mortality of overdose.110 HIV-positive patients who died of drug overdose from March 2004 to September 2012 were defined as cases.Controls were another 110 patients who were still alive and paired with the cases,according to the same gender,similar date of MMT initiation and from the same clinics.Results Multivariate conditional logistic regression analyses indicated that risk factors as sharing needles before enrolled in the MMT program (OR=5.19,95％ CI:1.39-19.33),HIV infection because of injecting drug-use (OR=3.08,95％ CI:1.16-8.21),and off from the treatment before the end point of the program (OR=2.54,95％CI:1.23-5.23) were associated with mortality caused by overdose.Higher adherence (OR=0.31,95％CI:0.10-0.95) appeared to be associated with lower mortality when compared with the control group.Conclusion In order to reduce the mortality rate,comprehensive intervention could be introduced to improve the compliance of retention on MMT among patients.Intervention efforts should be focused on those patients who shared needle / syringes.

Study on the incidence and risk factors of HCV infection among heroin addicts who were on methadone maintenance treatment in Dehong prefecture,Yunnan province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the incidence and risk factors of HCV infection among heroin addicts who were receiving methadone maintenance treatment(MMT)in Dehong prefecture, Yunnan province.</p><p><b>METHODS</b>All heroin addicts who were HCV negative at the initiation of MMT in June 2005 through March 2012, in Dehong prefecture, were included in this cohort analysis. HCV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.</p><p><b>RESULTS</b>A total of 2390 MMT clinic attendants were qualified for this cohort study by March 2012. 731(30.6%) of them had never received any follow-up HCV testing so were recognized as loss to follow-up. The other 1659 (69.4%) participants had received at least one follow-up HCV testing and were observed for a total of 3509.12 person-years(py). During this period 99 new HCV infections or HCV sero-converters were identified. The overall HCV incidence was 2.82/100 py and was 3.62/100 py for 2006, 5.36/100 py for 2007, 6.71/100 py for 2008, 2.56/100 py for 2009, 1.90/100 py for 2010, and 0.44/100 py for 2011, respectively. Results from multiple regression analysis, using Cox proportional hazard model, indicated that after controlling for confounding variables, those who were unemployed, being injecting drug users(IDUs)or HIV positive at entry into the MMT program were more likely to be newly infected with HCV or HCV sero-converted during the follow-up period than those who were peasants, non-IDUs or HIV negative at entry into the MMT program(HR = 2.02, 95% CI:1.18-3.48; HR = 9.05, 95% CI:5.49-14.93; HR = 2.12, 95% CI: 1.37-3.56), respectively.</p><p><b>CONCLUSION</b>The incidence of HCV infection among MMT clinic attendants was decreasing since 2009 in Dehong prefecture. Those who were unemployed, injecting drug users and HIV positive were at higher risk of HCV infection.</p>

Evaluation on the long-term effectiveness among the first set eight methadone maintenance treatment clinics in China / 中华流行病学杂志

Objective To evaluate the long-term effectiveness of the first set 8 methadone maintenance treatment (MMT) clinics in China. Methods Repeated cross-sectional surveys were conducted on the first month after the enrollment and 5 years later,among drug users who received MMT,using a standard questionnaire.Data on demographic characteristics,HIV-related high-risk bchaviors,criminal records associatcd with drug use and related family/social functions were collected and analyzed.Results There were 252 and 195 participants being interviewed at the baseline and the 5-year surveys,respectively,.Of them,66 participants were involved in both surveys.There was no significant differences on factors as ethnicity,level of education,working status,marital status and living status (P＞0.05) between the baselinc and the 5-year surveys.Compared with data from the baseline survey,participants' behavior on drug abuse (100.0％ vs.24.1％,P＜0.001 ),needle sharing behavior ( 19.4％ vs.0.0％,P ＜ 0.001 ),and exchanging sex for drugs ( 34.5 ％ vs.0.0％,P＜0.001 ) had significant decreases at the 5-year survey.Rates on condom use ( 10.6％ vs.25.0％,P=0.004),and having jobs (27.8％ vs.47.7％,P＜0.001 ) had been improved significantly,while self-reported criminal cases related to drug use (15.1％ vs.1.5％,P＜0.001) and the contacts with drug users (88.9％ vs.31.3％,P＜0.001) had been significantly reduced after joining the MMT program.Conclusion MMT could play an active role in reducing the HIV-related high-risk behaviors,criminal cases associated with drug abuse as well as enhancing the family and social functions of the MMT patients.Providing high quality service to the MMT clinic and trying to keep the drug users stick to the program remain difficult.It was also important to improve the training programs for staff working at the MMT clinics.

Characteristics and associated factors of long-term retention for methadone maintenance treatment patients / 中华预防医学杂志

<p><b>OBJECTIVE</b>To describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients.</p><p><b>METHODS</b>This study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients.</p><p><b>RESULTS</b>Of the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05).</p><p><b>CONCLUSION</b>Illicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients' continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.</p>

Study on the prevalence of HIV and AIDS-related risky sexual behaviors among male university students who have sex with men in Beijing,China / 中华流行病学杂志

Objective To assess the prevalence of HIV and risky sexual behaviors among university students who have sex with men(MSM)in Beijing.Methods MSM students in the universities were mainly recruited via internet.Questionnaires were self-administered to collect social demographic information and AIDS-related risky sexual behaviors.After completing the questionnaire,blood sample was collected to determine HIV infection through serological testing.X2 test and logistic regression were employed for univariate and multivariate analysis,respectively.Results A total of 157 students were recruited with mean age of 22.7±2.8 years old,12.1%of them were minorities and 77.7% were self-identified as homosexual.98.1% had engaged in anal intercourse(AI)in their lifetime and 73.9%reported that AI was common sexual behavior they often practised.In the past 6 months,58.6% had ever had unprotected anal intercourse(UAI),58.0% never used condoms during oral intercourse,and 59.2% had multiple sex partners(≥2).Nearly half of them believed that they were at low or no risk of contracting HIV and the prevalence of HIV infection was 2.5%.Data from logistic regression analysis showed that ever having had sex with a casual partner in a lifetime (OR=13.10).understanding that serving an insertive role had less risk than being receptive during the AI (OR=3.37),and ever having been to a gay bar(OR=2.49)was independently related to having multiple sex partners in the past 6 months.Conclusion Despite the extensive programs on education,behaviors regarding UAI and ever having had multiple sex partners were silll commonly seen among university MSM students.Interventions were needed to prevent HIV transmission in this population.

Study on incidence of HIV infection among heroin addicts receiving methadone maintenance treatment in Dehong prefecture, Yunnan province / 中华流行病学杂志

Objective To determine the incidence and risk factors of HIV infection among heroin addicts receiving methadone maintenance treatment(MMT)in Dehong prefecture,Yunnan province.Methods All heroin addicts who were HIV negative at the initiation of MMT in June 2005 and through June 2011,in Dehong prefecture were included in the cohort analysis.HIV incidence was calculated and related risk factors determined by using Cox proportional hazard regression model.Results A total of 3154 MMT clinic attendants were qualified for this cohort study.By June 2011,1023(32.4％)of them had never received any follow-up HIV testing so were thus referred as loss to follow-up.The other 2131(67.6％)members had received at least one follow-up HIV testing and were observed for a total of 4615.86 person-years.During the period,22 new HIV infections or seroconverters were identified,making the overall HIV incidence as 0.48/100 person-years.The HIV incidence was higher among those who were unemployed,never married,self-reported being injecting drug users(IDUs)and HCV positive at entry into the MMT program.None of those who were always negative on follow-up-urine-testing of morphine was discovered as HIV newly infected during the follow-up period.Data from multiple regression analysis under Cox proportional hazard model indicated that after controlling for confounding variables,non-IDUs at the entry point for the MMT program,were less likely to be HIV newly-infected or seroconverted than IDUs(HR=0.29,95％CI:0.11-0.76).Conclusion MMT prograqm in Dehong prefecture was demonstrated to be fairly effective in reducing HIV transmission through drug use.Those HIV negative attendants at the MMT clinic who were IDUs or keep using drugs during the treatment,were at higher risk of HIV seroconvertion.More efforts were needed to improve the follow-up and HIV testing programs for the MMT clinic attendants.