Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention.

BACKGROUND AND AIMS: Current practice on Helicobacter pylori infection mostly focuses on individual-based care in the community, but family-based H. pylori management has recently been suggested as a better strategy for infection control. However, the family-based H. pylori infection status, risk factors and transmission pattern remain to be elucidated. METHODS: From September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-based H. pylori infection, related factors and transmission pattern. All family members were required to answer questionnaires and test for H. pylori infection. RESULTS: Among all participants, the average individual-based H. pylori infection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1-7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05). CONCLUSION: Familial H. pylori infection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes from H. pylori individual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

Perceptions and Behavioral Adoptions of the Preventive Strategies from Person-to-Person Transmission of COVID-19 Among the Public in China: An Online Cross-Sectional Survey (preprint)

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.

Perceptions and Behavioral Adoptions of the Preventive Strategies from Person-to-Person Transmission of COVID-19 among the Public in China: An Online Cross-Sectional Survey (preprint)

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.

The Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude As Well As Four Non-pharmaceutical Interventions (NPIs) During the Late Period Of The COVID-19 Epidemic In China An Online Cross-sectional Survey of 8158 Adults (preprint)

BackgroundSo far, there has been no published population study on the relationship between COVID-19 infection and publics risk perception, information source, knowledge, attitude and four non-pharmaceutical interventions(NPI: hand washing, proper coughing habits, social distancing and mask wearing) during the COVID-19 outbreak in China. MethodsAn online survey of 8158 Chinese adults between 22 February to 5 March 2020 was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. ResultsOf 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (99.2%), positive risk perception (99.9%) and high knowledge levels that were among the strongest predictors of four highly adopted NPIs (hand washing:96.8%; proper coughing: 93.1%; social distancing:87.1%; mask wearing:97.9%). There was an increased risk of COVID-19 infection for those who not washing hands (2.28% vs 0.65%; RR=3.53: 95%CI: 1.53-8.15; P<0.009); not practicing proper coughing (1.79% vs 0.73%; RR=2.44: 95%CI: 1.15-5.15;P=0.026); not practicing social distancing (1.52% vs 0.58%; RR=2.63:95%CI:1.48 - 4.67; P=0.002); and not wearing a mask (7.41% vs 0.6%; RR=12.38:95%CI:5.81-26.36; P<0.001). For those who did practice all other three NPIs, wearing mask was associated with significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; p=0.035). Similarly, for those who did not practice all or part of the other three NPIs, wearing mask was also associated with significantly reduced risk of infection. In a penalised logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among four NPIs (OR=7.20; 95%CI:2.24-23.11; p<0.001). ConclusionsWe found high levels of risk perception, positive attitude, desirable knowledge as well as a high level of adopting four NPIs. The relevant knowledge, risk perception and attitude were strong predictors of adapting the four NPIs. Mask wearing, among four personal NPIs, was the most effective protective measure against COVID-19 infection with added preventive effect among those who practised all or part of the other three NPIs.