Socioeconomic status moderates the association between patient satisfaction with community health service and self-management behaviors in patients with type 2 diabetes: A cross-sectional survey in China.

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors.The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed.The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.

Prevalence of Anemia and its Risk Factors among Children under 36 Months Old in China.

This study aims to evaluate the prevalence and sociodemographic factors of anemia in children <36 months old in China. In this study, data of 24 235 children were investigated from 32 primary health care (PHC) facilities in 11 province-level regions. Pearson χ2-test and logistic regression model were used to estimate potential risk factors associated with anemia. The overall prevalence of anemia was 24.4%, and 32.8% children from rural areas were anemic, but no statistically significant difference was observed between male and female. Predictors of anemia are different regions of China, cesarean delivery, premature birth and neonatal asphyxia. We also found that education level and income of children's parents are important determinants of childhood anemia. In additional, feeding practice would affect anemia among children aged 6-12 months. Our results could provide some insights for prevention and control of childhood anemia in PHC facilities.

[Acceptability status of early antiretroviral therapy among HIV-positive men who have sex with men].

OBJECTIVE: To assess the acceptability and influence factors of early antiretroviral therapy (ART) among HIV-positive men who have sex with men (MSM) . METHODS: From June to August 2012, through convenience sampling, HIV-positive MSM who were willing to cooperate with the survey were selected from the Hangzhou and Ningbo AIDS prevention and control database. A total of 280 HIV-positive MSM who did not receive ART participated in the study.Using self-designed questionnaire, general demographic information, awareness of AIDS knowledge, sexual behavior, use of condom, current physical condition, awareness and attitude towards early ART were investigated.Excluding 60 HIV-infected MSM whose CD4(+)T count didn't meet the inclusion criteria, a total of 220 subjects were included in the analysis. Chi-square was used to compare the difference of early ART acceptance among subjects with different characteristics.Non-conditional logistic regression was used to analyze the influence factors of the acceptability of early ART. RESULTS: The acceptance rate of early ART among HIV-infected MSM was 62.7% (138/220). Delaying the disease development, preventing partners from infection, not worrying others to suspect them of having HIV, and partners unknowing the HIV-infected status were the factors which had a relatively higher acceptance rate of early ART. Correspondingly, the acceptance rate was 68.8% (130/189), 68.7% (103/150), 78.4% (69/88) and 72.5% (74/102) respectively and the acceptance rate among subjects with opposite opinions or characteristics was 24.1% (7/29) , 50.0% (30/60), 52.7% (68/129) and 45.8% (58/107) respectively (chi-square values were 21.46, 6.43, 14.84 7.55, all P values <0.05).Logistic regression analysis showed that delaying the disease development (OR = 11.50, 95%CI:3.29-40.22) and preventing partners from infection (OR = 3.72, 95%CI:1.53-9.03) were inclined to the acceptance of early ATR.While concerning others' suspection of them having HIV (OR = 0.19, 95%CI:0.08-0.48) and partners knowing the HIV-infected status were inclined to unacceptance of ART(OR = 0.31, 95%CI:0.13-0.70). CONCLUSION: The acceptability of early ART among HIV-positive MSM is high. The recognition of early ART and concern of privacy leak are the major influence factors which can stimulate the acceptance of early ART.

[Cost-effectiveness analysis of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou].

OBJECTIVE: To evaluate the cost effectiveness of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou. METHODS: According to the HIV test strategy costs and the number of HIV patients found in Guangzhou, following aspects were calculated as the total cost of HIV testing strategy in hospitals from 2006 to 2010 of Guangzhou, the cost of finding each HIV patient, and the cost of obtaining one quality adjusted life year (QALY) using Markov model. RESULTS: The total HIV test strategy costs increased from 11 106.98 thousand Yuan to 25 105.58 thousand Yuan, and 4599 HIV positive patients were found due to this strategy. The cost-effectiveness of HIV testing were different in hospitals from 2006 to 2010 in Guangzhou. The lowest cost-effectiveness ratio of HIV testing strategy was 11 810 Yuan per HIV positive patient, the highest was 23 510 Yuan, and the average was 16 070 Yuan. According to the Markov model result, 7.2855 QALYs could be gained per HIV patient on average via HIV testing strategy in 113 hospitals in Guangzhou, and the cost of obtaining one QALY was 2210 Yuan. CONCLUSION: The cost effectiveness ratio of HIV testing strategy in hospitals in Guangzhou was significantly lower than the standard of WHO recommended, and it was cost-effective to carry out the HIV testing strategy in Guangzhou.

[Gender and its impact on condom use among HIV male serodiscordant couples].

OBJECTIVE: To study the gender-based factors which influence the condom use among the HIV serodiscordant couples in selected regions of China. METHODS: Based on the analysis of the existing case reporting database and convenient sampling in the cross-sectional study, a total of 481 female HIV-negative spouses completed an interviewer-administered questionnaire regarding demographic characters, the knowledge, behaviors and the gender-based factors in five sites of four provinces Sichuan (Zhaojue), Yunnan (Dali), Henan (Weishi) and Guangxi (Lingshan and Luzhai), during June-September 2011. χ(2) analysis and logistic regression were used to study the gender-based factors influencing condom use among the participants. RESULTS: Among the 481 female HIV-negative spouses, the average age was (35.1 ± 6.7) years, and the proportion of Han and Yi nationality were high, 43.5% (209/481) and 41.8% (201/481), respectively. The awareness of knowledge related to HIV spousal transmission was high (≥ 79.6%). A total of 86.9% (418/481) used condom more frequently after informed the status of HIV infection of their spouses, and the condom use consistency was 56.6% (272/481). A total of 57.6% (277/481) reported low sexual relationship power; 34.5% (166/481) experienced forced sex in the past 1 year. And the proportion of condom use self-efficacy from 0 to 3 scores were 12.7% (61/481), 23.9% (115/481), 8.7% (42/481) and 54.7% (263/481), respectively (median = 3). Han and other nationality were significantly more likely to use condom consistently than Yi, with odds ratio (95%CI) of 0.01 (0.00 - 0.03) and 0.01 (0.00 - 0.04), and the female spouses with higher condom use self-efficacy used condom more consistently than the lower ones, with odds ratio (95%CI) of 0.20(0.11 - 0.34). CONCLUSION: The female spouses with higher condom use self-efficacy were more likely to use condom consistently after excluding the confounding effect of nationality.

Apoptosis contributes to testicular toxicity induced by two isomers of bromopropanes.

The aim of this study was to investigate the different testicular toxicity and the role of apoptosis in the possible mechanism induced by the two isomers of bromopropanes (BPs) in the same dosage. Following the 14-day treatment with a single dose of 1-BP and 2-BP (1 g/kg), male rats were killed and a series of experiments were performed. 1-BP and 2-BP both significantly decreased the epididymal sperm count, while only 2-BP induced an increase in sperms with abnormal heads. Morphological evaluation showed that 1-BP did not cause morphological changes in seminiferous epithelium, but 2-BP treatment resulted in the disappearance of spermatogonia, atrophy of the seminiferous tubules and degeneration of germ cells. 2-BP significantly increased the TUNEL-positive cells and the activation of caspase-3 and decreased the genes and proteins expression of Bax, Bcl-2 and p53. In contrast, there were no significant changes in the expression of apoptosis-related genes and proteins in 1-BP group, though the TUNEL-positive cells were significantly increased. Taken together, this study indicated that those two isomers both have toxicity in male rats, however, the testicular toxicity and the role of apoptosis in the toxic mechanism induced by 1-BP and 2-BP may be different.

Melatonin pretreatment attenuates 2-bromopropane-induced testicular toxicity in rats.

2-Bromopropane (2-BP) was used as an alternative for ozone-depleting solvents, which caused reproductive disorders in male workers and laboratory animals. A recent study indicated that 2-BP impaired antioxidant cellular defences and enhanced lipid peroxidation (LPO). Melatonin is a powerful endogenous antioxidant. We hypothesized that reactive oxygen species (ROS) and lipid peroxidation are involved in 2-BP-induced testicular toxicities. To test the hypothesis, we investigated the effects of melatonin on 2-BP-induced testicular toxicities. Rats were intraperitoneally injected with 2-BP (1g/kg) with or without melatonin (5mg/kg), then sacrificed on 7th day after 2-BP injection. Epididymal and testicular tissues were examined for biochemical and histopathological changes. Apoptotic cells in testis were detected by TUNEL staining and immunohistochemistry for active caspase-3. Exposure to 2-BP significantly decreased epididymal sperm count and morphological normal sperms. 2-BP also induced vacuolation and atrophy of the seminiferous tubules, reduction of spermatogonia and apoptosis of germ cells. 2-BP significantly increased TBARS levels in plasma and epididymis, and decreased GSH content in testis and epididymis. Pretreatment with melatonin counteracted 2-BP-induced oxidative stress, ameliorated apoptosis in testis and attenuated histopathological damage in testis. In addition, pretreatment with melatonin significantly attenuated 2-BP-induced sperm morphological changes. We conclude that pretreatment with melatonin attenuates 2-BP-induced testicular toxicity through its ROS scavenging and anti-apoptotic effects.