Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China / 北京大学学报(医学版)

OBJECTIVE@#To explore the discrepancy between behavioral-indicated candidacy and perceived candidacy (behavioral-perceived gap) and its associated factors of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM), so as to identify the focus population of PrEP interventions and to design and implement targeted interventions.@*METHODS@#We recruited a sample of 622 HIV-negative MSM who were regular clients of a community-based organization located in Chengdu, China, from November to December 2021. A cross-sectional questionnaire was used to collect the participants' information on social demographics, PrEP-related knowledge and cognitions, and risk behaviors. In this study, behaviorally eligible for PrEP was defined as performing at least one type of high-risk behavior in the past six months, including inconsistent condom use, sex with an HIV-positive partner, confirmed sexual transmitted infections (STI) diagnosis, substance use, and post-exposure prophylaxis (PEP) experience. Logistic regression models were fitted, and multivariate analyses were adjusted for social demographics.@*RESULTS@#Among the 622 eligible participants, 52.6% (327/622) were classified as behaviorally eligible for PrEP. Only 37.9% (124/327) of the participants perceived themselves as appropriate candidates for PrEP and 62.1% (203/207) had discrepancy between behavioral-indicated and perceived candidacy. 85.9% (281/327) had heard of PrEP, and 14.2% (40/281) accessed PrEP information through health care providers. Of the 327 participants eligible for behavior-indicated PrEP use, about half (47.1%) knew how to obtain PrEP medication and 33.0% had a professional PrEP counseling experience. The majority (93.3%) had no or few friends using PrEP. 54.1% scored eight or above in PrEP knowledge level. 66.7% reported having two or more sexual partners in the past six months. After adjusting for age and recruitment channel, we found six factors that were associated with perceived candidacy for PrEP, including PEP use [adjusted odds ratio (ORA)=2.20; 95% confidence interval (CI): 1.33-3.63], PrEP availability (ORA=1.69; 95%CI: 1.06-2.68), a greater number of PrEP-using friends (ORA=4.92; 95%CI: 1.77-13.65), PrEP know-ledge (ORA=2.21; 95%CI: 1.38-3.56), multiple sexual partnership (ORA=1.77; 95%CI: 1.07-2.94), and perceiving a higher risk of HIV infection (ORA=4.02; 95%CI: 1.73-9.32). Substance use during sex and PrEP information channel were not statistically associated with this beha-vioral-perceived gap.@*CONCLUSION@#We observed a high discrepancy between behavioral-indicated and perceived candidacy for PrEP among Chengdu MSM in China. Future PrEP implementation efforts should be made in skills training in assessing HIV infection risk, increasing PrEP knowledge, providing professional PrEP counselling, and fostering PrEP support environment.

Application of epidemiological methods in health impact assessment / 中华流行病学杂志

Health impact assessment (HIA) system has been listed in the Outline of the Healthy China 2030 Plan and the Law of Basic Health Care and Health Promotion of the People's Republic of China, however, the technique guideline of HIA needs to be established and improved. This paper summarizes the applications of different epidemiological methods in HIA and focus on the introduction of the application of ecology model of health social determinants as theory basis in the establishment of HIA system along with the introduction of HIA cases in the world. The applications of epidemiological methods in domestic HIA research are limited. Therefore, appropriate applications of epidemiological methods should be strengthened in HIA guideline and system development, especially the applications of big health data, mobile health techniques, systems epidemiology and implementation science, to facilitate data collection and potential health hazard evaluation and surveillance for HIA, establishment and improvement of HIA system and the implementation of Healthy China Strategy.

Impact of health literacy on patient experience of outpatients in China and its mechanism / 北京大学学报(医学版)

OBJECTIVE@#To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism.@*METHODS@#The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience.@*RESULTS@#A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P < 0.001), also indirectly affected by health literacy (β=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173.@*CONCLUSION@#The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.

Prediction of 3-mouth glycemic control in type 2 diabetes mellitus based on machine learning algorithm / 中华疾病控制杂志

Objective To evaluate the efficiency of Logistic regression algorithm and random forest algorithm in prediction of blood glucose control in patients with type 2 diabetes mellitus (T2DM) after 3 months, and explore the influencing factors of blood glucose control. Methods The data was extracted from baseline survey and follow-up information of patients with T2DM in Shunyi and Tongzhou Districts. The patient’s 3-month glycosylated hemoglobin which was more than 6.5% was chosen as the outcome categorical variable. The random forest algorithm and Logistic algorithm were used to establish the prediction model. The predictive efficiency was evaluated with the area under receive operating characteristic curve (AUC) and accuracy rate. Results Factors affecting the patient’s glycemic control included baseline fasting plasma glucose(P<0.001), duration of disease(P<0.001), smoking(P=0.026), static activity time(P=0.006), body mass index(overweight P=0.002, obesity P=0.011), bracelet use(P=0.028), and diabetes diet(P=0.002).The Logistic regression prediction model had an AUC of 0.738, a sensitivity of 72.9%, a specificity of 68.1%, and an accuracy of 71.2%. The random forest model had an AUC of 0.756, a sensitivity of 74.5%, a specificity of 69.5%, and an accuracy of 72.8%. Conclusions The efficiency of random forest is better than Logistic regression model, which can be applied to the prediction of blood glucose control and assist the management of diabetic patients.

A comparative study on safe sexual behavior and its intention among college students in Beijing between 2006 and 2016 / 中华疾病控制杂志

Objective To compare the changes of safe sexual behavior and its intention among college students in Beijing between 2006 and 2016, and to provide evidence for reproductive health education for prevention and control of sexually transmitted diseases (STDs). Methods By a stratified random sampling method,a questionnaire survey was conducted among college students in Beijing in 2006 and 2016 respectively. Results The rate of sexual behaviors declined ( 2=81.150,P<0.001), while the percentage of homosexual behavior among respondents in 2016 was higher than that in 2006( 2=12.115,P<0.001). Meanwhile, the age of first sexual intercourse (t=12.009, P<0.001) and the intention of safe sexual behavior declined( 2=10.375,P<0.001). In both surveys, the proportion of risk behaviors among students who ever had sexual behavior was higher than that of students never had sexual behavior. Multivariate linear regression analysis showed that the intention of safe sexual behavior among college students was associated with gender, age, self-efficacy of condom use, UNGASS index, visiting entertainment places and browsing pornographic information on the Internet(all P<0.05).Conclusions Compared with 2006, the safe sexualbehavior, intention and their risk factors among college students in Beijing changed greatly in 2016. The contents and approaches of intervention related to STDs and reproductive health should be changed according to the current situation in order to improve the intention of safe sexual behavior among college students and to control the occurrence of STDs.