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Objective:To analyze the influencing factors of dental fluorosis of children in the drinking-water-borne endemic fluorosis (referred to as drinking-water-borne fluorosis) areas with qualified drinking water.Methods:In 2020 and 2021, the cluster sampling method was used to select the children aged 8 to 12 years old from the drinking-water-borne fluorisis areas with qualified drinking water in Tianjin City for water and urine fluoride detection, dental fluorosis examination and questionnaire survey, and logistic regression and classification tree model were used to analyze the influencing factors of dental fluorosis in children.Results:A total of 3 795 cases children aged 8 to 12 years old were investigated, and 1 001 cases of dental fluorosis were detected, and the detection rate of dental fluorosis was 26.38% (1 001/3 795). The results of logistic analysis showed that age [odds ratio ( OR) = 1.193, 95% confidence interval ( CI): 1.115 - 1.277], high urinary fluoride (1.84 - 19.40 mg/L, OR = 1.510, 95% CI: 1.169 - 1.952) and the number of permanent residents at home ≥6 ( OR = 1.377, 95% CI: 1.090 - 1.739) were risk factors of dental fluorosis in children; and the mother's with higher education level (college degree or above, OR = 0.664, 95% CI: 0.441 - 0.999), the years of water improvement ≥5 years (5 - < 10 years, OR = 0.193, 95% CI: 0.157 - 0.238; ≥10 years, OR = 0.254, 95% CI: 0.193 - 0.333) were protective factors of dental fluorosis in children. The results of classification tree model analysis showed that the years of water improvement contributed the most to the prevalence of dental fluorosis among children in the drinking-water-borne fluorisis areas with qualified drinking water, followed by age, number of permanent residents at home and urinary fluoride. The area under the receiver operating characteristic curve (AUC) of logistic regression model and classification tree model were 0.730 (95% CI: 0.711 - 0.748) and 0.721 (95% CI: 0.702 - 0.739), respectively, with good fitting effect. Conclusion:The detection rate of children's dental fluorosis in the drinking-water-borne fluorosis areas with qualified drinking water is mainly related to the years of water improvement, age, the number of permanent residents at home and urinary fluoride.
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Objective:To understand the current status of overweight and obesity, the iodine nutrition level and goiter among children in Tianjin, and explore their relationships, so as to effectively adjust the prevention and control measures.Methods:From January 2019 to December 2020, one primary school was selected from all towns or streets in 16 districts of Tianjin, and non-boarding children aged 8 to 10 (age and gender balanced) were selected from each primary school. The number of children sampled in towns or streets in each district was as even as possible. Every year, 200 children from each district were investigated for height, weight, iodine of household edible salt, urinary iodine and thyroid volume. Body mass index (BMI) was calculated and its relationship with iodine nutrition level and goiter of children was analyzed.Results:A total of 6 552 children were investigated, and the median urinary iodine was 178.95 μg/L, the goiter rate was 2.15% (141/6 552). There was no significant difference in iodine content of household edible salt among children in different BMI groups ( P = 0.835), but the difference in thyroid volume was statistically significant ( P < 0.001). By constructing a restrictive cubic spline model, the risk of goiter in children of different age groups increased with increase of BMI ( P < 0.001 or P = 0.002). Conclusions:The BMI of children is closely related to thyroid volume. The influence of height and weight should be considered in diagnosis of goiter of children.
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Objective To investigate the situation of drinking water fluorosis in Tianjin, to study the benchmark dose of urinary fluoride, and to provide a reference for the formulation of the standard for urinary fluoride. Methods Three fluorosis endemic areas were selected in Tianjin, and three villages in each area were selected in this study. The water fluoride was detected, and the prevalence of dental fluorosis and the urinary fluoride of children aged 8-12 years old were investigated. Results The prevalence of dental fluorosis and urinary fluoride content in children in the villages with water fluoride exceeding the standard were significantly higher than those in the villages with water fluoride qualified, and the difference was statistically significant (χ2=88.821, P＜0.001; Z=6.089, P＜0.001). The analysis of the prevalence of dental fluorosis in children showed that the younger the age, the lower the prevalence and severity of dental fluorosis (χ2trend=14.584, P2trend= 20.525, P2=0.736, P=0.391; χ2=3.649, P=0.456). There were significant differences in urinary fluoride between children with different ages and genders (H=14.768, P=0.011; Z=-2.526, P=0.012). According to the level of urinary fluoride, the children were divided into 5 groups. With the increase of urinary fluoride concentration, the prevalence of dental fluorosis gradually increased and the difference was statistically significant (χ2trend=16.348, P<0.001), showing a dose-effect relationship. Based on the prevalence of dental fluorosis in children, BMDS was used to calculate the BMD and BMDL, which were 2.20 mg/L and 1.54 mg/L, respectively. Conclusion The water reform and fluoride reduction in Tianjin has achieved certain results. There is a dose-effect relationship between urinary fluoride and prevalence of dental fluorosis in children, and the reference dose value is slightly higher than the current standard, suggesting that the current standard can be updated timely.
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Objective To understand the iodine nutrition status of pregnant women in Tianjin from 2015 to 2019, and to provide a theoretical basis for pregnant women's scientific iodine supplement in the future. Methods A total of 6 939 pregnant women were randomly selected from 16 districts in Tianjin. The urine samples and home salt of the pregnant women were collected to test iodine content. Results The iodine content was determined in a total of 6 939 household salt samples of the pregnant women. The coverage rate of iodized salt was 81.78%, the consumption rate of qualified iodized salt was 66.85%, and the median salt iodine content was 25.96 mg/kg. A total of 6,938 urine samples were determined for iodine content. The median urinary iodine of the pregnant women (154.26 µg/L) reached an appropriate level of iodine nutrition, but there was an imbalance in the regional distribution (suburbs < urban areas, pregnant women in the third trimester of suburbs < pregnant women in the third trimester of urban areas, and non-elderly pregnant women in the suburbs < non-elderly pregnant women in the suburban areas). Spearman correlation analysis found that urinary iodine was positively correlated with salt iodine and the coverage rate of iodized salt (all P<0.05). The urinary iodine level in pregnant women who consumed uniodized salt was lower than the level in those who consumed qualified iodized salt (P<0.05). Conclusion The coverage rate of iodized salt and the consumption rate of qualified iodized salt in Tianjin had not yet reached the national standard for eliminating iodine deficiency disorders. Although the median urine iodine level of pregnant women generally reached an appropriate level, the level of pregnant women's urinary iodine in the suburbs was significantly lower than that in urban areas. The urinary iodine level of pregnant women in the first trimester, suburban areas (pregnant women in the first and third trimester) and pregnant women who consumed uniodized salt were still in the iodine deficiency level. Therefore, it is necessary to continue to strengthen the monitoring of pregnant women's iodine nutrition, strengthen the promotion of scientific consumption of qualified iodized salt in key populations, and provide a basis for formulating a scientific iodine supplementation policy for pregnant women.
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Objective To study the iodine nutritional status in the key population in Tianjin before and after the implementation of the new standards of iodized salt content, and to provide a scientific basis for iodine supplementation. Methods According to the method of population proportion sampling, the family edible salt samples, the urinary iodine and goiter of children aged 8-10 years and the urinary iodine level of pregnant women were investigated before the adjustment of salt iodine content (2005, 2011) and after the adjustment (2014, 2017). The results were compared and analyzed. Results The median of salt iodine after the adjustment (26.05mg/kg) was significantly lower than that of before (30.20mg/kg, Z=12.867, P2=221.916, 309.405, 540.148, respectively, P 2=0.196, P=0.658). After stratified analysis based on salt iodine content, it was found that among children who took iodized salt and qualified iodized salt, the median urine iodine after adjustment was lower than that before adjustment, and the difference was statistically significant (Z=2.726, 2.742, all P2=4.769, P=0.029). Conclusion After adjusting the salt iodine content in Tianjin, children's iodine nutrition was optimized from a higher level to an appropriate level, and thyroid goiter rate of children remained at low level. The iodine nutrition of pregnant women was slightly lower than adequate level, but the proportion of pregnant women at the adequate level increased. The new standard of iodine salt was appropriate, but the proportion of children with urine iodine <100μg/L increased, which needs to be monitored. At the same time, the iodized salt coverage rate and the qualified iodized salt consumption rate did not reach the elimination standard of iodine deficiency diseases, and the supervision of the salt industry market should be strengthened.
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Objective To comprehensively evaluate the health education effects of iodine deficiency disorders in different areas of Tianjin, and to provide a reference for improving the quality of iodine deficiency disorders health education. Methods The rank sum ratio method (RSR), TOPSIS and fuzzy combination were used to comprehensively evaluate the effect of health education intervention on iodine deficiency disorders in 16 areas of Tianjin. Results The evaluation results of RSR, TOPSIS and fuzzy combination method ranked N, D, and E areas in the last three places, while G, F, and P areas ranked first, second, and third. Combined with the RSR method, it was shown that in the evaluation of the effects of iodine deficiency health education interventions in 16 areas, the health education effect in G, F and P areas was classified as superior, the health education effect in D ,E and N areas was classified as inferior, and other areas were moderate. Conclusion The fuzzy combined RSR-TOPSIS method avoided the limitation of using either RSR or TOPSIS alone and made the conclusion more objective and accurate, and provided comprehensive quantitative results for the health education of iodine deficiency diseases in different areas of Tianjin. This fuzzy combination method objectively evaluated the intervention effect of health education in different areas, which provides a reference for improving the quality of health education for iodine deficiency disorders.
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Objective The aim of this study was to establish a practical and feasible prevention,and a treatment scheme of cardiovascular toxicity(CVT)induced by chemotherapy in cervical cancer based on known effective measures and to provide scientific guidance and basis for clinical treatment. Methods The risk of pre-chemotherapy CVT and post-chemotherapy CVT were evalua-ted in 164 subjects from November 2016 to January 2018. The Interrupted time series(ITS)model of CVT incidence before and after intervention was established. The CVT biomarkers and results of clinical examination before and after chemotherapy were compared in selected patieds. The effects of measures were evaluated. Results There was no difference in the ITS model of CVT incidence before and after intervention(P>0. 05). Among echocardiography examination results,the E peak velocity of mitral valve and E/A ratio in-creased,and the difference was statistically significant(P<0. 05),LVEF、FS、SV and A peak velocity of mitral valve had no differ-ences(P>0. 05). There were no differences in ECG and double lower extremities arteriovenous ultrasonography results(P>0. 05). The level of sICAM-1,sTM,vWF and h-FABP decreased(P<0. 05),the levels of NO and eNOS increased(P<0. 05);there was no significant difference in the levels of hs-CRP and E-selectin(P>0. 05). Conclusion The comprehensive prevention and treat-ment program established in this study can improve the cervical cancer chemotherapy CVT microscopically, and further research should be carried out by expanding the sample size.
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Objective To explore the spatial distribution clustering and influencing factors of chronic Keshan disease in China,and to provide evidence for prevention and control of Keshan disease.Methods Using non-probability sampling methods,combined with case search and key surveys,data on national detection rate of chronic Keshan disease,on disease influencing factors in 2013-2014 were collected;a spatial database was established,and ArcGIS 9.0 software was used to perform global Moran'sI,local Moran's I,local Getis-Ord Gi and inverse distance weighted interpolation analysis for the detection rate of national chronic Keshan disease.Spatial regression was used to analyze the influencing factors of chronic Keshan disease.Results Global autocorrelation analysis showed that Moran's I =0.03,Z =2.72,P ＜ 0.01,indicating that there was aggregation in the detection rate of Keshan disease.The results of local Moran's Ii showed that there were local high-detection rate clusters in the wards of Keshan disease,and the high-high aggregation areas were mainly concentrated in the wards of Gansu,Inner Mongolia,and Shanxi;the high-low aggregation areas were mainly located in the wards of Heilongjiang,Jilin,Shandong;the low-high aggregation area were mainly located in the wards of Heilongjiang.Getis-Ord Gi autocorrelation results showed that Keshan disease hotspots were mainly located in the wards of Inner Mongolia,Heilongjiang,Gansu,Shandong,Shanxi and Yunnan;the results of reverse distance weighted interpolation showed that the detection rates of the counties in Gansu and Inner Mongolia were higher than that in Heilongjiang,Jilin,Liaoning,Shanxi,Shandong,Shaanxi and Yunnan,the detection rate of wards in other provinces was at a lower level.Spatial regression analysis showed that the spatial distribution of chronic Keshan disease was negatively related to rural per capita net income and annual average temperature in the ward (Z =-2.808,-2.747,P ＜ 0.05).Conclusions Global chronic Keshan disease exists spatial aggregation,the local gathering area is mainly located in the wards of Gansu,Inner Mongolia.The spatial distribution of chronic Keshan disease may be affected by the level of rural per capita net income and annual average temperature in the ward.
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Objective To explore the spatial description of Keshan disease(KD)and to provide a basis for reasonable allocation of health resources and for making precision prevention and control strategies. Methods In 2013 and 2014, the KD's condition, prevention and control measures and their effects were investigated in the diseased affected counties in the provinces through combination of case search and key survey. Results A total of 16(100.0%,16/16)diseased provinces,315(96.0%,315/328)diseased counties were surveyed,and 1 562 people with KD were detected in 281 000 residents, the detection rate was 55.6/10 000. Chronic and latent KD detection rates were 8.9/10 000(250)and 46.7/10 000(1 312),respectively.There were 261(82.9%)diseased counties that had reached the control standards of KD,and 54(17.1%)did not meet the control standards,which mainly distributed in the provinces of Henan, Inner Mongolia, Gansu and Shanxi. Conclusions The detection rate of KD has been at a low level, but in Henan, Inner Mongolia, Gansu, and Shanxi, there are prevalent KD areas that have not yet reached the control level.This part of the areas should be treated as key prevention and control areas of KD.
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Objective To describe the status of prevalence,awareness,treatment,and control of hypertension among the residents in severe historical endemic areas of Keshan Disease in Heilongjiang Province,and to provide scientific evidence for prevention and control of hypertension.Methods In December 2015,Yongjin,Yongli groups of Yongjin Village,and Fengnian,Fengtian,Fengfu groups of Fengnian Village in Fanrong Township,Fuyu County,Qiqihaer City,Heilongjiang Province were selected via the cross-sectional method.The residents aged 18 years or older were surveyed as respondents by cluster sampling.Demography,risk factors,hypertension related information were collected through questionnaire survey.Blood pressure,height and weight were measured through physical examination.Blood pressure measurement was conducted with Omron HEM-1020 electronic sphygmomanometer,the diagnostic criteria was Chinese Guidelines for Prevention and Treatment of Hypertension (revised in 2010).Results Totally 683 residents were surveyed,the valid participants were 669,the prevalence of hypertension was 49.2％ (329/669),the standardized prevalence was 37.9％,the prevalence of men [58.0％ (164/283)] was higher than that of women [42.7％ (165/386),x2 =15.103,P ＜ 0.01],the prevalence increased with increasing age (total,men,women:x2tendency =9.044,4.560,7.789,all P ＜ 0.01).The awareness of hypertensive patients was 60.8％ (200/329),the standardized awareness was 41.2％,the awareness of men [54.3％ (89/164)] was lower than that of women [67.3％ (111/165),x2 =5.836,P ＜ 0.05],the awareness of hypertensive patients increased with increasing age (total,men,women:x2tendency =3.638,2.686,2.419,all P ＜ 0.05).The treatment of hypertensive patients was 51.1％ (168/329),the treatment of men [43.9％ (72/164)] was lower than that of women [58.2％ (96/165),x2=6.711,P ＜ 0.05],the treatment of hypertensive patients increased with increasing age (total,men,women:x2tendency =4.422,2.704,3.633,all P ＜ 0.01).The control rate of hypertensive patients was 5.5％ (18/329),the control rate among the treatment was 10.7％ (18/168).Conclusions The standardized prevalence of hypertension among the residents of the severe historical endemic areas of Keshan disease in Heilongjiang Province is higher than the national average (25.2％),the standardized awareness is lower than the national average (46.5％),the treatment and the control are low.We should pay more attention to the hypertension in the severe historical endemic areas of Keshan disease.