The Temporal Lagged Relationship Between Meteorological Factors and Scrub Typhus With the Distributed Lag Non-linear Model in Rural Southwest China.

Background: Meteorological factors can affect the emergence of scrub typhus for a period lasting days to weeks after their occurrence. Furthermore, the relationship between meteorological factors and scrub typhus is complicated because of lagged and non-linear patterns. Investigating the lagged correlation patterns between meteorological variables and scrub typhus may promote an understanding of this association and be beneficial for preventing disease outbreaks. Methods: We extracted data on scrub typhus cases in rural areas of Panzhihua in Southwest China every week from 2008 to 2017 from the China Information System for Disease Control and Prevention. The distributed lag non-linear model (DLNM) was used to study the temporal lagged correlation between weekly meteorological factors and weekly scrub typhus. Results: There were obvious lagged associations between some weather factors (rainfall, relative humidity, and air temperature) and scrub typhus with the same overall effect trend, an inverse-U shape; moreover, different meteorological factors had different significant delayed contributions compared with reference values in many cases. In addition, at the same lag time, the relative risk increased with the increase of exposure level for all weather variables when presenting a positive association. Conclusions: The results found that different meteorological factors have different patterns and magnitudes for the lagged correlation between weather factors and scrub typhus. The lag shape and association for meteorological information is applicable for developing an early warning system for scrub typhus.

Spatial and temporal clusters of avian influenza a (H7N9) virus in humans across five epidemics in mainland China: an epidemiological study of laboratory-confirmed cases.

BACKGROUND: Avian influenza A (H7N9) virus was first reported in mainland China in 2013, and alarming in 2016-17 due to the surge across a wide geographic area. Our study aimed to identify and explore the spatial and temporal variation across five epidemics to reinforce the epidemic prevention and control. METHODS: We collected spatial and temporal information about all laboratory-confirmed human cases of A (H7N9) virus infection reported in mainland China covering 2013-17 from the open source. The autocorrelation analysis and intensity of cases were used to analyse the spatial cluster while circular distribution method was used to analyse the temporal cluster. RESULTS: Across the five epidemics, a total of 1553 laboratory-confirmed human cases with A (H7N9) virus were reported in mainland China. The global Moran's I index values of five epidemic were 0.610, 0.132, 0.308, 0.306, 0.336 respectively, among which the differences were statistically significant. The highest intensity was present in the Yangtze River Delta region and the Pearl River Delta region, and the range enlarged from the east of China to inner provinces and even the west of China across the five epidemics. The temporal clusters of the five epidemics were statistically significant, and the peak period was from the end of January to April with the first and the fifth epidemic later than the mean peak period. CONCLUSIONS: Spatial and temporal clusters of avian influenza A (H7N9) virus in humans are obvious, moreover the regions existing clusters may enlarge across the five epidemics. Yangtze River Delta region and the Pearl River Delta region have the spatial cluster and the peak period is from January to April. The government should facilitate the tangible improvement for the epidemic preparedness according to the characteristics of spatial and temporal clusters of patients with avian influenza A (H7N9) virus.

Health-related quality of life (HRQoL) associated with echinococcosis patients in Tibetan communities in Shiqu County, China: a case-control study.

PURPOSE: Echinococcosis is a chronic neglected zoonotic disease with high endemic in western China. The aim of the study was to evaluate the Health-related Quality of Life (HRQoL) in patients with echinococcosis in Tibetan communities for investigating the physical and mental health challenges faced by the echinococcosis patients and meeting community health needs. METHODS: The HRQoL was measured with 36-Item Short Form Health Survey (SF-36) questionnaire in the case-control study. Analysis of variance (ANOVA) method was used to analyze the data. RESULTS: 50 echinococcosis patients were collected in study group and divided into three subgroups by the duration of staying on albendazole tablets. 52 healthy individuals were collected in control group. In physical quality of life, the duration of staying on albendazole tables influenced the PF (F = 6.661, P < 0.001), RP (F = 3.130, P = 0.029), and GH (F = 4.105, P = 0.008). In mental quality of life, the duration of staying on albendazole tables influenced the SF (F = 10.764, P < 0.001) and RE (F = 5.573, P = 0.001). The income level was the important confounder in PF (F = 11.515, P = 0.001), GH (F = 10.315, P = 0.002), VT (F = 5.984, P = 0.016), and MH (F = 5.565, P = 0.020). CONCLUSIONS: The HRQoL in people with echinococcosis is reduced in comparison with the healthy individuals. It is necessary to shorten the duration of treatment and adopt the special methods adapting the local culture to improve the health-related quality of life in Tibetan communities. Meanwhile, the economic improvement is the foundation.

The epidemic potential of avian influenza A (H7N9) virus in humans in mainland China: A two-stage risk analysis.

BACKGROUND: From 2013 to 2017, more than one thousand avian influenza A (H7N9) confirmed cases with hundreds of deaths were reported in mainland China. To identify priorities for epidemic prevention and control, a risk assessing framework for subnational variations is needed to define the epidemic potential of A (H7N9). METHODS: We established a consolidated two-stage framework that outlined the potential epidemic of H7N9 in humans: The Stage 1, index-case potential, used a Boosted Regression Trees model to assess population at risk due to spillover from poultry; the Stage 2, epidemic potential, synthesized the variables upon a framework of the Index for Risk Management to measure epidemic potential based on the probability of hazards and exposure, the vulnerability and coping capacity. RESULTS: Provinces in southern and eastern China, especially Jiangsu, Zhejiang, Guangzhou, have high index-case potential of human infected with A (H7N9), while northern coastal provinces and municipalities with low morbidity, i.e. Tianjin and Liaoning, have an increasing risk of A (H7N9) infection. Provinces in central China are likely to have high potential of epidemic due to the high vulnerability and the lack of coping capacity. CONCLUSIONS: This study provides a unified risk assessment of A (H7N9) to detect the two-stage heterogeneity of epidemic potential among different provinces in mainland China, allowing proactively evaluate health preparedness at subnational levels to improve surveillance, diagnostic capabilities, and health promotion.

[Attitude of elementary and middle school students and their parents toward children affected by HIV/AIDS and its determinants].

OBJECTIVE: To describe the attitude of elementary and middle school students and their parents toward children affected by HIV/AIDS and to analyze the determinants of such attitude. METHODS: A cross-sectional study with the stratified cluster sampling method was conducted to interview elementary and middle school students and their parents, and questionnaires were distributed to collect information about the basic characteristics, HIV/AIDS knowledge and attitude toward children affected by HIV/AIDS. Student's t-test, ANOVA and multilevel model were used to analyze the data. RESULTS: A total of 732 students and their parents finished the questionnaires. The students' and parents' awareness rates were 77.56% (95% CI: 63.08% - 92.05%)and 81.76% (95% CI: 72.33% - 91.20%), respectively. Questions with the lowest proportion of positive attitude included separating the children affected by HIV/AIDS and not studying with those children in the same class. Gender (b =-1.15, P =0.016) and knowledge (b =1.26, P <0.001) of students, as well as attitude (b =0.40, P <0.001) of parents were associated with the students' attitude, while parents' knowledge (b =0.93, P <0.001) was associated with parents' attitude. CONCLUSION: Discrimination towards children affected by HIV/AIDS exists among students and their parents. HIV/AIDS knowledge education helps to improve the students' and parents' caring and supporting attitude toward children affected by HIV/AIDS.

Reduced stratifin expression can serve as an independent prognostic factor for poor survival in patients with esophageal squamous cell carcinoma.

UNLABELLED: Stratifin plays an important role in cancer biology by interfering with intracellular signalling pathways and cell-cycle checkpoints. Decreased expression of stratifin gene has been reported to be a poor prognostic indicator in a variety of human malignant tumors. AIM: To clarify the role and prognostic significance of stratifin in esophageal squamous cell carcinoma (ESCC). METHODS: The alteration of stratifin messenger RNA (mRNA) and protein was analyzed by reverse-transcription and quantitative real-time polymerase chain reaction (QRT-PCR) and Western blotting in 20 paired ESCC and nonneoplastic esophageal mucosa tissues, respectively. Then, immunohistochemistry (IHC) was used to evaluate expression of stratifin in tissues of 148 ESCC patients (including the former 20 pairs of tissues) and correlate it with clinicopathological parameters and prognosis of ESCC patients. RESULTS: The stratifin level of mRNA and protein was markedly downregulated in ESCC tissue compared with in corresponding nonneoplastic esophageal epithelium (P<0.05). Similarly, the positive rate of stratifin protein expression was lower in the esophageal cancer than in paired nonneoplastic esophageal epithelium as detected by IHC (P=0.007). Statistically, the downregulation of stratifin expression was correlated with tumor infiltration depth (P=0.003), lymph node metastasis (P=0.008), distant metastasis (P=0.013), and lymphovascular invasion (P=0.007) of ESCC. Furthermore, the reduced stratifin expression was associated with shorter 5-year survival rate of ESCC patients after curative surgery (P<0.0001). On the basis of univariate and multivariate Cox regression analysis, we found that reduced stratifin expression, T4 stage, lymph node metastasis, and distant metastasis were independent risk factors for worse prognosis in ESCC patients. CONCLUSION: The present report indicates that stratifin could be a useful indicator for prognosis of this disease, as well as a potential target for more effective therapy.

Increased expression of prohibitin and its relationship with poor prognosis in esophageal squamous cell carcinoma.

Prohibitin, a potential tumor suppressor, has been shown to be an anti- proliferative protein, a regulator of cell-cycle progression and in apoptosis. Recently, it was found to be over-expressed in breast cancer and gastric cancer, and it has been suggested as a biomarker in those diseases. To clarify the role and the prognostic significance of prohibitin expression in esophageal squamous cell carcinoma (ESCC), we analyzed the expression in ESCC and their corresponding nonneoplastic epithelia tissues by immunohistochemistry(IHC), Western blotting and real-time quantitative reverse transcription polymerase chain reaction(QRT-PCR).The relationship between prohibitin expression and clinicopathological variables was examined by statistical analysis. The findings suggested the up-regulation of prohibitin play an important role in the carcinogenesis of ESCC. The over-expression of prihibitin was significantly correlated with the depth of tumor, lymph node metastasis, distant metastasis, lymphatic invasion and vascular invasion of ESCC. These results suggested that prohibitin(+), lymph node metastasis and distant metastasis could be the independent risk factors for worse prognosis in ESCC patients.