Relationship between vitamin D receptor gene polymorphism and preterm birth / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the relationship between vitamin D receptor (VDR) gene pol-ymorphisms at Fok I site and the risk of preterm birth for potential intervention of of preterm birth or threatened premature delivery.</p><p><b>METHODS</b>Fifty-seven women with preterm birth and 84 with full-term birth were included in this analysis. Polymerase chain reaction-restriction frag-ment length polymorphism (PCR-RFLP) was performed to identify VDR gene Fok I geno-types.</p><p><b>RESULTS</b>No significant difference was found in age, D-dimer (DDI), fibrinogen (Fg), serum calcium (Ca), leukocyte count or glycosylated hemoglobin (HbA1c) level between the women in the preterm and full-term birth groups (P>0.05). The two groups differed signifi-cantly in the distribution of VDR gene Fok I site genotypes and allele frequency of F/F (P<0.05).The frequency of FF genotype was significantly higher in the preterm group than in the full-term group. Compared with Ff and ff genotypes, FF genotype was associated with an in-creased risk of preterm delivery (χ=9.701, P=9.701, OR=3.320, 95% CI [1.560, 7.066]). In the preterm group, the maternal age, DDI, Fg, serum Ca, leukocyte count or HbA1c did not differ significantly between the genotypes (P>0.05).</p><p><b>CONCLUSION</b>VDR gene Fok I site geno-types are related with preterm birth, and the FF genotype may serve as a potential risk factor for preterm birth.</p>

Effect of aluminum hydroxide adjuvant on the immunogenicity of the 2009 pandemic influenza A/H1N1 vaccine: multi-level modeling of data with repeated measures / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate the effect of the aluminum hydroxide (Al-OH) adjuvant on the 2009 pandemic influenza A/H1N1 (pH1N1) vaccine.</p><p><b>METHODS</b>In a multicenter, double-blind, randomized, placebo-controlled trial, participants received two doses of split-virion formulation containing 15 μg hemagglutinin antigen, with or without aluminum hydroxide (Al-OH). We classified the participants into six age categories (>61 years, 41-60 years, 19-40 years, 13-18 years, 8-12 years, and 3-7 years) and obtained four blood samples from each participant on days 0, 21, 35, and 42 following the first dose of immunization. We assessed vaccine immunogenicity by measuring the geometric mean titer (GMT) of hemagglutination inhibiting antibody. We used a two-level model to evaluate the fixed effect of aluminum Al-OH and other factors, accounting for repeated measures.</p><p><b>RESULTS</b>The predictions of repeated measurement on GMTs of formulations with or without Al-OH, were 80.35 and 112.72, respectively. Al-OH significantly reduced immunogenicity after controlling for time post immunization, age-group and gender.</p><p><b>CONCLUSION</b>The Al-OH adjuvant does not increase but actually reduces the immunogenicity of the split-virion pH1N1 vaccine.</p>

A norovirus-borne outbreak caused by contaminated bottled spring water in a school, Zhejiang province / 中华流行病学杂志

Objective To study a local hospital reported acute gastroenteritis in a boarding school on its source of infection, mode of transmission and risk factors of the infection. Methods A suspected case was defined as who had developed diarrhea (≥3 times/day) or vomiting among teachers or students of the school, during April 19-30, 2010. A confirmed case was from a probable case plus tested positive for norovirus in stool specimens by using RT-PCR. Stool specimens of cases and environmental specimens were collected for laboratory diagnosis. In a ease-control study, we compared exposures to sources of bottled water, consumption of bottled water, and hygienic habits of 220 probable or confirmed cases from April 21-23 in the peak of the outbreak, together with another 220 controls, with frequency-matched by school grade. Results 20.3% of the 1536 students but none of the teachers developed the disease. 98.6% of the cases (n=217) and 85.5% (n=188) of the controls had drunk bottled water in the classroom (ORM-H= 12.3,95%CI: 3.7-40.9). 47.9% (n= 104)of the cases and 41.5% (n=78)of the controls had drunk unboiled bottled water in classroom (ORM-H=3.8,95%CI: 1.5-9.6). 47.9% (n=104) of the cases and 48.4% (n=91) of the controls had drunk bottled mixed water (boiled and unboiled) in the classroom (ORM-H=2.8, 95%CI: 1.1-7.0).Stool specimens from 3 cases and one bottle of uncovered bottled water in classroom showed positive of having norovirus genotype Ⅱ. Coliforms was cultured much higher rates than standard deviations in the bottled water. The factory making the bottled water was not licensed or having strict disinfection facilities. Conclusion Bottled spring water contaminated by norovirus was responsible for this outbreak.

A hepatitis A outbreak caused by contaminated well water in a primary school of Jiangxi province, China, 2009 / 中华流行病学杂志

Objective A hepatitis A outbreak in a primary school was reported by Gan County Center for Disease Control and Province (CDC) and an investigation was conducted to identify the possible source of infection and risk factors for transmission.Methods A probable case was defined as having onset of jaundice (yellow urine,sclera or skin) or a 2-fold increase in Alanine aminotransferase with 2 or more,of the followings symptoms:anorexia,disgust of oil,abdominal pain,nausea,fatigue,vomiting,in students and staff of the primary school between 1 November 2008 and 14 February 2009.A confirmed case was IgM positive for hepatitis A,added on a probable case.We searched for cases through reviewing medical records in the township hospital and village clinics and conducting symptom screening among students or teachers.We also conducted a case-control study to compare the exposure histories of 19 cases and 53 anti-HAV-IgM negative controls randomly selected from those asymptomatic students in the same grade.Results 21 cases from all the students was identified,with the attack rate as 3.5％.The epidemic curve showed the two peaks of the outbreak were 28 days apart,both indicating that they were related to the exposure of the source of origin.74％of the case-students drank the unboiled Well B water,compared to 42％ of control-students (OR=4.0,95％CI:1.1-15).The total bacterial count was 600 cfu/ml and the total coliform was 23 MPN/100 ml in one sample collected from the well water.Conclusion This hepatitis A outbreak was caused by drinking contaminated water in Well B.We recommended that all the schools should use chlorinated municipal pipe water.Public health authorities should strengthen the supervision of quality of water in schools.

Compliance on hand-hygiene among healthcare providers working at secondary and tertiary general hospitals in Chengdu / 中华流行病学杂志

Objective To evaluate the compliance on hand-hygiene and related factors among healthcare providers working at secondary and tertiary hospitals in Chengdu.Methods On-site observations regarding hand-hygiene compliance and facilities were conducted in 6 hospitals in Chengdu.Doctors and nurses were asked and recorded about their knowledge regarding hand hygiene.Results Of 1535 activities where hand-hygiene was deemed necessary,under observating healthcare providers would perform hand-hygiene procedures 17.8％ of the time (12.8％ of the time before touching a patient,21.0％ of the time before touching objects around a patient,27.3％ of the time after touching a patient,and 31.5％ of the time after removing gloves).Only 2.2％ of the treating rooms were equipped with foot-operated or automatic faucets; of these only 24.5％ had soap or alcohol-based hand-sanitizer,and 6.3％ had paper towel or other hand-drying equipments.92.8％ of the healthcare providers knew of the six-step method on hand-washing.More than 90.0％ of the healthcare providers knew that both palm and back of the hands as well as the front and back of the fingers should be washed.However,only 22.8％ knew that the hand-washing procedure should last ≥15 seconds.Rates on hand hygiene among chief or more senior physicians (14.6％),attending physicians (9.2％) and junior doctors (15.6％),nurses in chief (25.0％),senior nurses (26.3％) and junior nurses (20.5％) showed no significant differences (P＞0.05).Similarly,scores on related knowledge between chief or senior physicians (12.4 ± 3.2),attending physicians (13.6 ± 3.3) and junior doctors ( 13.4 ± 2.9),nurses in charge ( 15.2 ± 2.0),senior nurses ( 14.8 ± 2.1 ) and junior nurses (14.3 ± 2.6) also showed no significant differences (P＞0.05).Rate on hand hygiene among nurses (22.7％) was significantly higher than that of the doctors ( 13.6％ ).Rate of hand hygiene among 50-59 years old healthcare providers (7.4％) was significantly lower than those of all the other age groups ( 17.1％-25.0％ ) ; rate of female health care providers ( 19.5％ ) was significantly higher than that of males ( 13.8％ ).Similarly,the nurse' s knowledge score ( 14.7 ± 2.3) was significantly higher than that of the doctors ( 13.2 ± 3.1 ).Among 50-59 years old healthcare providers,the rate was ( 12.2 ± 3.8) significantly lower than that of 20-29 ( 14.0 ± 2.6),30-39 ( 14.3 ± 2.9) and 40-49 year olds ( 13.8 ± 2.7).Again,the knowledge score of females ( 14.5 ± 2.5 ) was significantly higher than that of males (12.7 ± 3.2) (P＜0.05).Conclusion The high-level knowledge on hand-hygiene among healthcare providers in this area did not translate into good practices.Also,most of the hospitals had poor hand-hygiene equipments.We recommend that training and periodic monitoring be conducted,and hand-hygiene equipment be improved to facilitate hand-hygiene practices among healthcare providers.

An outbreak of human orf disease caused by introduced black goats / 中华流行病学杂志

Objective To identify risk factors for a human orf disease outbreak in a village in Chongqing city. Methods Standardized case-definition was set and a case-finding program was conducted among all the residents of the village. All the patients were interviewed using a standardized questionnaire and collected fluids in the skin rash for laboratory testing. A retrospective cohort investigation was conducted among all the village residents who introduced the black goats to analyze the risk of orf infection, in relation to the mode and frequency of contacts to the infected goats. Results We found 18 cases (including 16 suspected cases and 2 confirmed cases) among the members of 10 families that introduced the black goats. Village residents who had ever used their legs to grip the goats were nearly five times as likely to develop orf disease as those who did not (RR=4.98, 95％CI: 1.34-75.27). Village residents who had ever washed and wiped the goats were three times as likely to develop orf disease as those who had not (RR = 3.09,95％CI: 0.98-45.38). The frequency of contacts with the infected goats was associated with the risk of developing orf disease in a dose-response fashion (x2 test for trends: P= 0.006).Frequently wearing long trousers when dealing with the goats appeared as a protective factor (RR=0.30,95％CI: 0.15-0.78). Conclusion This outbreak was caused by the introduced black goats which carried and infected by the orf virus. Direct physical contact with infected goats but without wearing protective clothing were risk factors for the development of human orf disease.

The use of antiviral drugs in treating novel influenza A(H1N1)inpatients in Suzhou city,Jiangsu province,China,2009-2010 / 中华流行病学杂志

Objective To explore the use of antiviral drugs in treating the hospitalized patients of novel influence A(H1N1)in Suzhou city during the 2009-2010 influenza pandemic,so as to make the proper use of antiviral drugs during influenza epidemics.Methods We selected 3municipal hospitals and reviewed the medieal records of hospimlized patients suffered from novel influence A(H1N1)during June 2009 to March 2010,to gather antiviral use and other related information.Results 98%(222/226)of the hospitalized patients received antiviral treatment.Among them,92%(205/222)were given the neuraminidase inhibitor oseitamivir.However,only 18% of the patients who received oseltamivir were given the treatment within 2 days after the onset of the illness.Amantadine and rimantadinc were not used for any of the hospitalized patients.Through interview on the physicians,we identified that delay in seeing care,misdiagnosis,delay in laboratory diagnosis were factors affecting the timely use of oseltamivir.Conclusion The majority of the hospitalized patients suffered from novel influence A(H1N1)in the three municipal hospitals received oseltamivir treatment.However,in most occasions the drug was not used timely.Techniques of rapid detection and diagnosis for novel influenza A(H1N1)virus should be developed,and the diagnostic capabilities of the physicians improved,to increase the effectiveness of these antiviral drugs.

Study on an outbreak of food poisoning caused by Salmonella blegdam / 中华流行病学杂志

objective To identify the bacterial pathogen in food and the source of infection that might be responsible for a food poisoning outbreak.Methods All the probable cases that had attended the banquet in a villige of Sichuan province who had developed fever(≥37.5℃),diarrhea (≥3 times/dav)and vomiting since August 1,2009,were identified.A case-control study was conducted to identify the foods that might be responsible for this food poisoning event.50 cases were randomly selected from the probable cases and 50 controls were randomly selected from those without the symptoms.Results The attack rate of this food poisoning event was 43.4%(132/304).86.0%(43/50)of the cases and 34.0%(17/50)of the controls had eaten pork-mixed-vermicelli(OR=12.0,95%CI:4.4-32).Data from further tests showed that dose-effect relation existing between eating pork mixing vermicelli behavior and the incidence rates(Chi-square trend:x2=21.06,P=0.00)of the disease.94.0%(47/50)of the cases and 68.0%(34/50)of the controls had eaten mushroom braising chicken(OR=7.4.95%CI:2.0-27).Data from the crossover analysis showed that there appeared an effect modification between behaviors of eating pork-mixed-vermicelli and eating mushroom braising chicken.Three cases were detected carrying Salmonella blegdam from their anus swabs and the same bacteria type was also detected in the pork-mixed-vermicelli. Conclusion This outbreak of salmonellosis was caused by Salmonella blegdam contaminated pork-mixed-vermicelli or mushroom braising chicken during food processing.

Non-airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members, China, June 2009 / 中华流行病学杂志

Objective During June 2-8, 2009, 11 cases of the novel influenza A (H1N1)occurred in Sichuan Province, China. We investigated this outbreak to identify the source of infection,mode of transmission and risk factors for infection. Methods The primary case, a U.S. citizen,developed disease on June 2. From June 3 to 5, she joined Tour Group A for a trip to Jiuzhaigou. We telephoned passengers of the three flights on which the primary case had traveled in China, and members of Tour Group A. We asked whether they had any influenza-like symptoms during May 27 to June 12. Health authorities placed passengers whose seats were within three rows of the primary case on flights and members of Tour Group A on medical observation, and isolated individuals if they developed symptoms. We used real-time RT-PCR to test the throat swabs from symptomatic persons for the novel influenza virus and defined a confirmed case as one with influenza-like symptoms and laboratory confirmation. A retrospective cohort investigation to identify the risk factors for infection was conducted. We interviewed all members of Tour Group A about their detailed contact history with the primary case. Results During June 5 to 6, 9 (30%) of the primary case' s 30 fellow tour group members developed disease, compared with none of her 87 fellow passengers to Jiuzhaigou and 1 of her 87 fellow passengers on the returning trip (when several of the members of Tour Group A were symptomatic). 56% of the tourists who had talked with the primary case in close range ( ＜2 m) for ≥2 minutes developed disease, whereas none of the 14 other tour group members developed disease (RR= ∞; exact 95%CI: 2.0- ∞ ). Having conversed with the primary case for ≥ 10 minutes (vs. 2-9 minutes) increased the risk by almost five fold (RR=4.8, exact 95%CI: 1.3-180). Conversely, other kinds of contact, such as dining at the same table, receiving chewing gum from the primary case and sharing bus rides or planes with the primary case played no roles during this outbreak. Conclusion This novel influenza A (H1N1) outbreak was caused by an imported case, and transmitted mainly via droplet transmission when the primary case was talking with her fellow tourists during a tour. These findings highlight the importance of preventing droplet transmission during a pandemic.

Outbreak of cholera associated with consumption of soft-shelled turtles, Sichuan province, China, 2009 / 中华流行病学杂志

Objective Vibrio cholera was extremely rare in Sichuan province (no cases in 2008). Any outbreak could indicate contamination through the food supply system. In July 2009, a hospital reported a cluster of 7 diarrhea patients; all attended the same banquet. One patient was confirmed to have Vibrio cholera (O139). We conducted this investigation to identify the source of this possible cholera outbreak. Methods We defined a suspect case as any banquet attendee with diarrhea ( ≥3 times/day). A confirmed case was a suspect case with a positive Vibrio cholera culture. We took stool samples or rectal swabs from all attendees for cholera culture and interviewed 272 banquet attendees about foods they ate at the banquet and kitchen workers about food preparation. Results 7.1% (24/337) of attendees developed cases within an average of 65 hours after eating. Three meals were served. All patients had the lunch whereas no patients only ate breakfast and/or dinner. Of 180 attendees who ate turtle meat 12% were case-patients, compared to 3.3% of 92 attendees who did not (RR=3.6,95%CI: 1.1-12). Of the 150 attendees who ate peanuts 13% were cases compared to 4.1%of 122 attendees who did not eat peanuts (RR=3.1,95%CI: 1.2-8.0). During preparation, the same utensil was used for fresh turtle meat and peanuts without washing in-between the process. Turtle meat and peanuts were stored for ＞ 16 hours at room temperature after cooking before consumption. All 33 turtles originated from commercial production in another province. Conclusion This outbreak was likely caused by poor food handling of commercially produced turtles. We proposed that to improve microbiologic monitoring of aquatic food animals, and raise the awareness of good handling practices at mass gathering in rural China.

Study on the score criteria of severe hand, foot and mouth disease cases / 中华流行病学杂志

Objective To explore the score criteria of severe hand, foot and mouth disease (HFMD) cases and to provide evidence for unified criteria and treatment on severe HFMD cases.Methods All severe cases and partial mild cases reported by two designated hospitals of HFMD in Fuyang during March to June, 2008 were scored by the methods of criteria constructed in advance.ROC curve was adopted to evaluate the score criteria and the gold standard was defined according to ICU, intubation and clinical outcomes, etc. Sensitivity, specificity and Youden' s index were used to determine the division scores on critical, severe and mild cases. Results 97% of the cases (34 cases) were scored less than 6 points. 88% of cases (24 cases) who were intubated or mechanical ventilated had the scores of 6 points or higher. 79% of deaths (11 cases) were scored 10 points or higher. The area of receiver operation characteristic (ROC) curve was 0.90 (95% CI: 0.83-0.98)between severe and mild cases and the area of ROC curve was 0.95 (95%CI: 0.92-0.98) between critical and severe, mild cases. When comprehensively considering the sensitivity and specificity,severe cases were best judged when score was 4 points (sensitivity, specificity and Youden' s index were 0.94, 0.68 and 0.62 respectively). When score was 6 points, critical cases were judged very well (sensitivity, specificity and Youden' s index were 0.92, 0.84 and 0.76 respectively). Conclusion Score criteria could be quantified to determine the degree of seriousness and with high-value for diagnosis on HFMD.

An outbreak of gastroenteritis caused by contaminated well water in a village, Henan province / 中华流行病学杂志

Objective To identify the cause and mode of transmission of a gastroenteritis outbreak in a village, Henan province. Methods Gastroenteritis patients were identified through family visits, interviewing the village doctors and reviewing diagnosis and prescription records at the village health clinic. Cases were defined as onset of one of the four symptoms from the village resident during July 20 to August 12,2010. The symptoms would include diarrhea ( ≥ 3 times/day), abdominal pain, nausea or vomiting. A retrospective cohort study was conducted to assess the association between drinking raw well water or eating noodles rinsed by raw well water and gastroenteritis. Stools or vomits of the ease-patients and the well water samples were tested for bacterial pathogens. Results Data for 60 case-patients were collected. All cases occurred in the northern part of the village. Persons who used water from a public well in the northern part of the village had an attack rate of 55%, which was 3.5 times of those who did not use the well water (16%) (RR=3.5,95%CI: 1.2-10). Results from the retrospective cohort study showed that drinking un-boiled water from the well was a risk factor (RR=1.7,95%CI: 1.3-2.3). Laboratory testing showed that total coliform and E. coli both greatly exceeded the limit considered safe for drinking, indicating there was fecal contamination in the well water. No bacterial pathogens were detected in the patients' stools or vomits. Conclusion The outbreak was mainly caused by drinking contaminated water from the public well in the northern part of the village.

Observation on therapeutic effect of electroacupuncture therapy for promoting consciousness of patients with coma / 中国针灸

<p><b>OBJECTIVE</b>To observe the promoting consciousness effect of electroacupuncture therapy on the patients with long-term coma caused by severe craniocerebral trauma.</p><p><b>METHODS</b>Twenty-nine cases with coma more than 3 weeks and Glasgow Coma Scales (GCS) of 8 or less were divided into an observation group (n=15) and a control group (n=14). They were treated with the same western medicine. In addition to ordinary treatment, the observation group was treated with electroacupuncture at Baihui (GV 20), Shuigou (GV 26), Yongquan (KI 1) etc. for 30 min and the needles were retained for 30 min, once each day.</p><p><b>RESULTS</b>The average awake time and awake rate were 40.1 days and 73.3% (11/15) respectively in the observation group, which were higher than 51.8 days and 28.6% (4/14) in the control group.</p><p><b>CONCLUSION</b>Electroacupuncture therapy combine with western medicine is more effective in improving consciousness of patients in coma caused by severe craniocerebral trauma.</p>

Personal protective and healthcare seeking behaviors urban residents before and during an influenza pandemic in Beijing / 中华流行病学杂志

Objective To provide evidence-based recommendations to the government on strategies for reducing the impact of the imminent influenza pandemic, we conducted a survey on the personal protective and healthcare seeking behaviors of Beijing residents in the wake of the worldwide epidemic of the novel 2009 H1N1 influenza virus, and potential changes in these behaviors during a full-blown pandemic. Methods We used a two-stage Mitofsky-Waksberg telephone survey to collect information for Beijing residents ≥ 18 years of age and weighted the sample by the census estimate of Beijing population for 2008. A structured questionnaire was used to collect information about the respondents' knowledge regarding the novel influenza virus, current personal protective and healthcare seeking behaviors during a full-blown influenza pandemic. Results 286 Beijing urban residents were interviewed during May 15 to 18 (response rate: 62%). 77%(95%CI: 71%-82%) of the residents that they would cover their sneezes at home, and 93%(95%CI: 89%-96%) would do so in a public place. Of the residents would cover their sneezes at home, 66% (95%CI: 57%-74%) would covered their sneezes by hand, 33% (95%CI:25%-42%) by facial tissue, and only 0.4% (95%CI: 0.1%-2.9%) by sleeves. Similarly, of the residents would cover their sneezes at a public place, 64% (95%CI: 56%-71%) would cover their sneezes by hand, 33%(95%CI: 26%-41%) by facial tissue and 0% by sleeves. 46% (95% CI: 32%-59%) of the residents would wash their hands after covering their sneezes with hand in public places, and 77% (95%CI: 64%-89%) would do so at home. Higher percentages of residents would wear a mask (63%, 95% CI: 56%-70%) and get vaccinated (43%, 95% CI: 37%-50%) during a pandemic than under currently situation (3.5%, 95% CI: 1.7%-7.0% for wearing a mask; 13%, 95% CI: 9.8%-18% for getting vaccinated). 86% (95% CI: 81%-89%) of the residents would visit a doctor for an influenza-like illness during a pandemic, similar to the percentage currently seen (76%, 95%CI: 70%-81%). 71%(95%CI: 63%-78%) of the residents would visit a doctor for influenza-like illness and would choose a tertiary medical center; with percentage (74% , 95% CI: 66%-80%) similar to the one during a pandemic. Conclusion Beijing residents need to be aware of the proper ways to cover their noses when sneezing (especially using their sleeves more), and to wash their hands. An effective plan to triage patients should be immediately established to efficiently utilize the limited healthcare resources, which would likely be further strained during a pandemic.