Clinical and radiographic predictors in diagnosing sputum smear-negative pulmonary tuberculosis in HIV-negative patients: a cross-sectional study in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In county-level tuberculosis (TB) dispensaries in China, the accurate diagnosis of sputum smear-negative pulmonary tuberculosis (SNPT) needs to be improved by developing and validating clinical and radiographic predictors.</p><p><b>METHODS</b>The study was conducted simultaneously in three counties per province in Chongqing Municipality and Liaoning Province in China between May 2005 and May 2006. A total of 432 new SNPT patients who are HIV-negative and more than 15 years old diagnosed by expert panels in county-level TB dispensaries were recruited. Their sputum samples were collected for culture before anti-TB treatment, and the treatment outcomes (changes of X-rays) were followed up at the end of the 6th month.</p><p><b>RESULTS</b>Of the 432 SNPT patients, sputum culture positive (9.7%) or culture negative with good changes of X-rays at the end of the 6th month (73.6%) was validated as SNPT. Four predictive variables were associated with validated SNPT in the multivariate logistic regression model: age ≤55 years old (odds ratio (OR) 5.66; 95% CI 2.69-11.91), >60 days of cough (OR 3.73; 95% CI 1.10-12.65), ≥10% of pulmonary consolidation in the lungs (OR 5.40; 95% CI 2.90-10.06), and pulmonary consolidation in the upper lobe anterior segment (OR 3.00; 95% CI 1.57-5.72). The area under the receiver operating characteristic curve of the model was 0.77 (95% CI 0.71-0.83).</p><p><b>CONCLUSION</b>Four predictors of clinical and radiological characteristics that had a good diagnostic performance of SNPT deserve to be recommended as index indicators of SNPT diagnosis in county-level TB dispensaries in China.</p>

Geographical distribution regarding the prevalence rates of pulmonary tuberculosis in China in 2010 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the geographical distribution regarding the prevalence rates of pulmonary tuberculosis (TB) in 2010, to provide reference for eliminating the regional unbalance of TB prevalence in China.</p><p><b>METHODS</b>Thiessen Polygon Method, dealing with spatial analysis in geographical information system, was used to analyze data from the 5th national TB epidemiological survey.</p><p><b>RESULTS</b>The prevalence rates of active pulmonary TB(PAPT), Mycobacterium-positive pulmonary TB (PMPT) and smear-positive pulmonary TB (PSPT) were 62-548/100 thousand population (OHTP),0-120/OHTP and 0-68/OHTP, which were all relatively lower in most parts of Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang and Shandong than in other areas. PAPT (549-1656/OHTP), PMPT (121-366/OHTP) and PSPT (69-181/OHTP) were relatively higher in most parts of Guangxi, Sichuan, Guizhou, Yunnan, Xizang, Qinghai and Xinjiang than in other areas, in which PAPT, PMPT and PSPT of some areas could be seen as high as 1657-2646/OHTP, 367-625/OHTP and 182-285/OHTP, respectively. PAPT, PMPT and PSPT manifested jigsaw pattern distribution between 320-548/OHTP adn 549-919/OHTP, among 67-120/OHTP, 121-207/OHTP and 208-366/OHTP, and among 38-68/OHTP, 69-115/OHTP and 116-181/OHTP, respectively, in the rest of the provinces or autonomous regions.</p><p><b>CONCLUSION</b>The geographical distribution for TB prevalence significantly presented the fact that it was relatively low in the eastern parts and high in the western parts, and a jigsaw transition pattern between the low and high rates, in the central part of the country.</p>

Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005 - 2006 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Men who have sex with men (MSM) have become one of the most risky populations for HIV infection in China. Though several cross-sectional sero-prevalence studies have been conducted, the annual HIV incidence remains unknown in this population.</p><p><b>METHODS</b>We applied IgG-capture BED-enzyme immunoassay (BED-CEIA) to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.</p><p><b>RESULTS</b>Overall, 1067 MSM samples were collected, including 526 samples in the year 2005 and 541 in 2006. In 2005, of 17 HIV seropositive samples, 7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year (95% CI, 0.8% - 5.0%). In 2006, of 26 HIV seropositive samples, 9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% (95% CI, 1.3% - 5.9%), which was 0.7% higher than that in 2005. Individuals engaging in male group sexual intercourse (5.17% vs 0.87%, P = 0.019) and having receptive anal sexual intercourse more than five times (2.79% vs 0.33%, P = 0.047) in the past 6 months significantly increase the risk of being infected by HIV-1.</p><p><b>CONCLUSIONS</b>A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend. The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population.</p>

Factors associated with retention in a community-based methadone maintenance treatment among drug users in Urumqi, Xinjiang Uigur Autonomous Region / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the factors associated with retention in a community-based methadone maintenance treatment(MMT) among drug users in Urumqi.</p><p><b>METHODS</b>With national MMT guideline( drift) for heroine addicted drug users, local heroine-dependent people were admitted to community-based MMT program affiliated to Xinjiang Uigur Autonomous Region Center for Mental Health. Data on outpatients' social-demo characteristics, baseline behaviors on drug use and daily stabilized dose of drugs were entered to MMT database.</p><p><b>RESULTS</b>Up to 10, Feb. , 2006,353 persons withdrew MMT treatment among 709 heroin dependant drug users. Between 11, Aug., 2005 and 10, Feb., 2006, with median duration as 77 days, cumulative drop-out rate of 90 days and 180 days after first dose of MMT were 73.8% among 455 and 99.4% among 355 drug users, respectively. The incidence of drop-outs was 29.8 per 100 person-month. The median length of stay (days) in MMT was 68.0 (95% CI: 59.0- 78.0). Correlates of retention were found as: Being Uigur(HR = 1.35;95% CI :1.09-1.67), duration of drug use (HR =0.74; 95% CI:0.55-0.99) and stabilized dose(HR = 0.60;95% CI: 0.48-0.74) was found in multiple Cox proportional hazard regression model.</p><p><b>CONCLUSION</b>Retention of MMT among drug users in Urumqi was low. Uigur people should be given individual counseling to help them increase the compliance rate. Within the ranges of clinic dosage, adjustment of the methadone dose on an individual base might serve as an appropriate approach to increase the effectiveness of the program.</p>