Assessment on the Effects of Hepatitis B Prevention and Control Measures in Western China: A Comparison of Three Population-based Serosurveys.

OBJECTIVE: Despite the remarkable progress in efforts to control disease spread, the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus (HBV) infection in Western China. This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement. METHODS: Susceptible population vaccination, health education, professional training of doctors, and other prevention and control measures have been implemented in Wuwei city since 2010. Data were obtained from three representative cross-sectional serosurveys conducted in 2010, 2013, and 2015. The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers: HBV surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). Estimates of variance were determined using Taylor series linearization methods. RESULTS: The three serosurveys revealed decreases in the prevalence of HBsAg (7.19% in 2010 vs. 6.51% in 2013 vs. 5.87% in 2015) and anti-HBc positivity (43.89% vs. 32.87% vs. 28.46%) and an increase in the prevalence of anti-HBs positivity (49.07% vs. 53.66% vs. 53.72%) over time. From 2010 to 2015, the legally reported incidence of hepatitis B in Wuwei city decreased from 686.53/100,000 to 53.72/100,000. Notably, persistently high HBsAg-positive rates (above 5.40%) were observed among subjects aged 20-69 years old in the three serosurveys; the prevalence of HBsAg was above 1% among children younger than 10 years old. Furthermore, rural subjects had higher rates of HBsAg and anti-HBc positivity than their urban counterparts (6.04% vs. 4.83% and 30.26% vs. 20.35%, respectively) in 2015 but had a lower rate of anti-HBs positivity (49.68 vs. 55.18%). Multivariate regression analysis showed that age, urban and rural areas, and education level were the main factors affecting HBV infection. CONCLUSION: Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time, the hepatitis B infection rate in children younger than 10 years was still higher than the national average level. Therefore, the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.

Efficacy of cognitive behavioural therapy with medication for patients with obsessive-compulsive disorder: A multicentre randomised controlled trial in China.

BACKGROUND: Meta-analyses support the efficacy of cognitive behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in Western cultures. However, there are no adequately powered multicentre studies in China. This study aimed to compare the effectiveness of treatment with CBT combined with medication and medication alone in OCD patients in China. METHODS: OCD patients (N = 167) were recruited from outpatient clinics at three large tertiary psychiatric hospitals and one general hospital in China. Participants were randomly allocated to receive either CBT combined with medication (n = 92) or medication alone (n = 75) for a 24-week treatment period. Participants' symptoms and social functioning were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF) and Clinical Global Impression Scale for Severity (CGI-S) at 0, 4, 8, 12 and 24 weeks, and the effectiveness of the two treatments compared using linear mixed-effects models. RESULTS: At 24 weeks, both groups showed large within-group effects in all measures. Significantly more patients receiving combined therapy than medication alone had a decrease in symptom severity of at least 35% (based on Y-BOCS total score). The CGI-S and GAF scores decreased in both groups, and significant differences were found between the groups. LIMITATIONS: Study limitations included lack of consideration of medication types and dosages, and the absence of a CBT-only arm. CONCLUSIONS: CBT combined with medication may be effective in alleviating symptoms and social functioning impairment associated with OCD, and is more effective than medication alone in China, particularly for the treatment of compulsive behaviours.

Survey on the use of mental health services and help-seeking behaviors in a community population in Northwestern China.

There is little research into the patterns of mental health services use, related factors, and barriers in help-seeking behaviors among the community population in northwestern China. We conducted a community-based survey among the general population in Xi'an City with the stratified two-stage systematic selection scheme using the World Health Organization Composite International Diagnostic Interview version 3.0 computer-assisted personal interview (CIDI-CAPI 3.0). We interviewed 2447 individuals aged 16 years or older. The lifetime prevalence estimate of mental disorders was 21%. However, the lifetime use rate of mental health services of the 2447 responding subjects was 2.45% and 4.67% among those subjects who reported a mental disorder. Several variables were associated with lower use of mental health services: rural residence and divorced or unmarried. Among the group with mental disorders, 15/21 sought help from non-mental health specialty services such as a general physician (13/21). The high prevalence rate of mental disorders but low rate of mental health services use raises a significant public health issue in northwestern China. Reduction in the resource gap and encouraging people to seek treatment remain a challenge to the mental health services system.

SP600125 blocks the proteolysis of cytoskeletal proteins in apoptosis induced by gas signaling molecule (NO) via decreasing the activation of caspase-3 in rabbit chondrocytes.

NO plays a key role in the pathological mechanisms of articular diseases. As cytoskeletal proteins are responsible for the polymerization, stabilization, and dynamics of the cytoskeleton network, we investigated whether cytoskeletal proteins are the intracellular pathological targets of NO. We aimed at clarifying whether the cytoskeleton perturbations involved in apoptosis are induced in rabbit articular chondrocytes by NO, which can be liberated by sodium nitroprusside (SNP) treatment. The first passage rabbit articular chondrocytes were cultured as monolayer for the experiments, and the effects of NO were tested in the presence of JNK-specific inhibitor, SP600125. SNP treatment of cultured chondrocytes caused significant apoptosis in a concentration-dependent manner (time and dose), as evaluated by TUNEL assay and Annexin V flow cytometry, while the apoptosis was reduced by the SP600125 addition 30 min before SNP treatment. Besides, SP600125 decreased significantly the protein expression of total caspase-3 and the intracellular gene expression of caspase-3, measured by Western blot analysis and PCR. SP600125 also increased the cytoskeletal protein expressions. These results suggested that JNK pathway plays a critical role in the NO-induced chondrocyte apoptosis, and SP600125 treatment blocks the dissolution of the cytoskeletal proteins via activation of caspase-3 pathways.

Epidemiological studies of esophageal cancer in the era of genome-wide association studies.

Esophageal cancer (EC) caused about 395000 deaths in 2010. China has the most cases of EC and EC is the fourth leading cause of cancer death in China. Esophageal squamous cell carcinoma (ESCC) is the predominant histologic type (90%-95%), while the incidence of esophageal adenocarcinoma (EAC) remains extremely low in China. Traditional epidemiological studies have revealed that environmental carcinogens are risk factors for EC. Molecular epidemiological studies revealed that susceptibility to EC is influenced by both environmental and genetic risk factors. Of all the risk factors for EC, some are associated with the risk of ESCC and others with the risk of EAC. However, the details and mechanisms of risk factors involved in the process for EC are unclear. The advanced methods and techniques used in human genome studies bring a great opportunity for researchers to explore and identify the details of those risk factors or susceptibility genes involved in the process of EC. Human genome epidemiology is a new branch of epidemiology, which leads the epidemiology study from the molecular epidemiology era to the era of genome wide association studies (GWAS). Here we review the epidemiological studies of EC (especially ESCC) in the era of GWAS, and provide an overview of the general risk factors and those genomic variants (genes, SNPs, miRNAs, proteins) involved in the process of ESCC.

Epidemiology of Hepatitis B Virus Infection in China: Current Status and Challenges.

The prevalence of hepatitis B is high in China. Based on the National Disease Supervision Information Management System of China, the mean reported incidence of hepatitis B was 84.3 per 100,000 in China between 2005 and 2010. There are differences in population distribution based on region and ethnic group. Here, risk factors, virological characteristics, and prophylaxis of hepatitis B in China are reviewed. Although the prevalence of HBV infection is gradually declining, there are many challenges in HBV infection control, including higher prevalence in floating population, poor compliance of antiviral therapy, and high disease burden.

[Study on the quality of life and its related factors on patients with multiple myeloma].

OBJECTIVE: To evaluate the quality of life and influencing factors on patients with multiple myeloma (MM). METHODS: 227 MM cases were selected at 5 hospitals in Xi'an from August, 2010 to March, 2013. QLQ-C30 was used to evaluate the quality of life of MM patients, and their norms were as control. Factors which influencing the quality of life were investigated and analyzed with SPSS 17.0 software. RESULTS: The total score of quality of life in MM patients was 49.0±21.7 which was lower than the norms (60.7±23.4). The scores on fatigue, nausea, vomiting, pain, short of breath, disturbance on sleeping, losing appetite, constipation, other symptoms and financial difficulty were significantly higher than data of the norms (P < 0.05). Factors as being elderly (especially those older than 70), under higher proportion of medical costs on their own expense or financial difficulty etc., had major influences on the quality of life (P < 0.05) of MM patients who in particular having worse quality of life when in worsening clinical ISS stage (P < 0.05). Low level of hemoglobin, high level of serum calcium and globulin all significantly reduced the quality of life of the MM patients (P < 0.05). CONCLUSION: The quality of life of MM patients was significantly lower than the normal people or patients with other tumors. Fatigue, pain, and financial difficulty were main influencing factors on the quality of life of MM patients. The assessment on the effects of treatment should relate to the improvement of hemoglobin, serum calcium and globulin, which could all improve the quality of life of MM patients.

Mother-to-infant transmission of hepatitis B virus: a Chinese experience.

Over 90% of infants infected with hepatitis B virus (HBV) caused by mother-to-infant transmission will evolve to carrier status, and this cannot be prevented until widespread administration of the HB vaccine and hepatitis B immune globulin (HBIG) is implemented. This prospective study of 214 infants born to HBsAg-positive mothers was carried out to determine if either perinatal or intrauterine HBV transmission could be effectively prevented with HBIG and the HB vaccine. Peripheral blood was collected from mothers and from newborns before they received HBIG and the HB vaccine, as well as at 0, 1, 7, 24, and 36 months after birth. Infants born with an ratio of signal to noise(S/N) value of >5 for HBsAg (ABBOTT Diagnostic Kit) were defined as mother-to-infant transmission cases, those with an S/N between 5 and 50 were classified as perinatal transmission cases, and those with an S/N >50 were considered intrauterine transmission cases. Mother-to-infant transmission occurred in approximately 4.7% (10/214) of the infants; the perinatal transmission and intrauterine transmission rates were 3.7% (8/214) and 0.9% (2/214), respectively. The risk of mother-to-infant transmission increased along with maternal HBeAg or HBVDNA levels. After 36 months of follow-up, all perinatal cases became HBsAg-negative, whereas all intrauterine transmission cases evolved into carrier status. These results indicate that infants infected via intrauterine transmission cannot be effectively protected by HBIG and HB vaccine.

High conservation of hepatitis B virus surface genes during maternal vertical transmission despite active and passive vaccination.

OBJECTIVE: Our purpose was to explore the relationship between hepatitis B virus (HBV) gene heterogeneity and maternal vertical transmission. METHODS: HBsAg-positive mothers and their neonates were selected and classified into a vertical infection neonate group (group N), a vertical infection mother group (group M) and a control group (group C). Serum HBsAg and HBeAg were examined. HBV gene fragments, including the pre-S1, and pre-S2 and S coding regions, were amplified and sequenced, and the genotype and serotype of the sequences were identified. Mutation sites and frequency of mutations were then compared between group N and group C. RESULTS: A total of 104 HBV clone sequences were obtained. All obtained sequences belonged to genotype C and serotype adr. Upon comparing sequences between group N and group C, 4 nonsynonymous mutations were found with significant difference in mutation frequency (p < 0.05). When the mothers were both HBsAg and HBeAg positive, 10 nonsynonymous mutations were found. The frequencies of these mutations were significantly lower in group N than in group C (p < 0.05). CONCLUSION: The 10 HBV mutations were negatively associated with vertical transmission when maternal HBeAg was positive. Furthermore, the species that were vertically transmitted to the fetus were mainly wild-type.

[The mechanism of HBV infection of human trophoblast cell].

OBJECTIVE: To observe the changes of human trophoblast cells after infected with hepatitis B virus. METHODS: HBV positive serum was used to infect human trophoblast cells in vitro. HBsAg in cell culture medium were detected by ELISA method and HBV DNA in cell culture medium and cells were detected by PCR method. HBV fluorescence polymerase chain reaction diagnose kit were used to detect the HBV DNA concentration. Ultra structure of trophoblast cells were observed with transmission electron microscopy (TEM). RESULTS: HBsAg could be detected in infection group by ELISA. Infection group cell culture medium and infection group cells were HBV DNA positive. HBV DNA concentrations in HBV infection cell culture medium in 0, 12, 36, 60, 84 h after extensively PBS washed were < 10(3), 3 x 10(4), 6 x 10(5), 5 x 10(5), 3 x 10(5) copies/mL. HBV infected trophoblast cells were found many forms of endosomes, some of which contents virus like particle. CONCLUSION: HBV might take advantage of clathrin-mediated endocytosis to enter trophoblast cell, which might lead to cell infection or across the cell bar by transcytosis.

[Evaluation on the indirect economic burden of stroke using combination of disability-adjusted life years and human capital method].

OBJECTIVE: Using the indirect economic burden of stroke in a rural population to develop rational allocation of future health resources, in Hanzhong area. METHODS: Cluster sampling which involved 53 natural villages with a total number of 75,000 people selected from the 'stroke monitoring base' of rural population was adopted in this study in the Hanzhong area. All of the 164 stroke cases were studied through a self-designed questionnaire. In calculating disability-adjusted life years (DALYs), fixed value was used in accordance with the value of GBD. The disability assessment was simplified in DALYs calculation and modified Barthel's ADL was used in disability assessment of stroke patients. In indirect economic burden analysis, the human capital method combined with DALYs was adopted with the formula as: indirect economic burden = GNP per capita x DALYs x productivity weight. RESULTS: The total DALYs were 598.88, with an average DALY of stroke as 3.65 per case. The total indirect economic burden of stroke patients in rural areas was 1,993,977.8 RMB and the average of indirect economic burden of stroke was 12,158.4 RMB per case with the largest seen in the 45-59 age group, accounted for 74.4%. CONCLUSION: In our study, the use of method in combining the human capital with DALYs was the first time being adopted in calculation of the indirect economic burden of stroke in rural population in China. The burden seemed to be much lower than literature cited from other countries. It was reasonable to evaluate indirect economic burden of stroke using method in integrating DALYs with human capital, but it was difficult to calculate the DALYs.

[A follow-up study on the efficacy of hepatitis B immunoglobulin combining hepatitis B vaccine in infants born to HBsAg positive mothers].

OBJECTIVE: To study the efficacy of hepatitis B immunoglobulin (HBIG) combining hepatitis B vaccine in high risk infants born to HBsAg positive mothers through a follow-up study program. METHODS: 184 infants (4 twin pairs) born to HBsAg carrier mothers who were consecutively recruited from December 2002 to August 2004 were followed. Major HBV serologic markers in all infants were detected by enzyme-linked immunosorbent assay (ELISA) when they were at birth, at 7th, at 24th and at 36th months. RESULTS: 7 of the 184 infants were HBsAg positive at birth, making the transplacental intrauterine infection rate of HBV as 3.80% (7/184). 125 infants were followed up at 7th months and 108 infants were followed up at 24th and 36th months. Only 2 of the 7 infants born to HBsAg-positive and HBeAg-positive mothers were persistently sera positive for HBsAg, making the chronic infection rate of HBV as 28.57%. The other 140 infants were HBsAg negative during t he follow-up period. The rate o f detectable anti-HBs i ninfants was 7.02% at birth. After infants were immunized by HBIG combining hepatitis B vaccine, the anti-HBs-positive rate reached 92% at 7th months, and gradually descended thereafter. 72.04% of the infants at 24th and 60% at 36th months showed detectable levels of anti-HBs. There was significant correlation between the produce of anti-HBs in infants and HBsAg-positive at birth while HBsAg-positive and HBeAg-positive in mothers did not relate to the produce of anti-HBs in their infants. Of 39 infants born to HBsAg-positive and HBeAg-positive mothers, 25 showed detectable levels of HBeAg. During the follow-up peirod, HBeAg was still detectable in 2 infants who were also HBsAg positive and the others all became HBeAg-negative but no infant became HBeAg-positive. CONCLUSION: The efficacy of HBIG combining hepatitis B vaccine in high risk infants was fine.

[A retrospective study on the survival rate and risk factors of mortality among 617 inpatients with ischemic stroke].

OBJECTIVE: The purpose of this study was to describe survival status and risk factors of mortality on inpatients with ischemic stroke. METHODS: 617 patients with continuous ischemic stroke cases were collected from January 2002 to June 2005 retrospectively in the Department of Neurology, Xijing Hospital, Fourth Military Medical University. In order to perceive relevant information on survival and the cause of death. All patients were followed through phone calls or mailing. The follow-up program was completed in January 2006. Kaplan-Meier methods were used for survival description. Monovariant and multivariant Cox's proportional hazard regression model were used to analyze prognostic factors on mortality. RESULTS: The longest time in the follow-up program was 47 months with 59 dropped-out cases, making the dropout rate as 9.5%. Of these patients, 80 cases died during the period of study(60 for ischemic stroke,3 for cerebral hemorrhage, 10 for cardiac disease, 7 for other cause). The median survival time was 42. 16 months. The survival rates of one-year, two-year and three-year period were 91.9%, 89.4% and 85.3%, respectively. Monovariant and multivariant Cox's proportional hazard regression model showed that the risk factors associated with mortality were old age (RR = 1.043, 95% CI: 1.013-1.074), lower Glasgow scores (RR = 0.855, 95% CI: 0.742-0.985) ,poor conscious levels(RR = 4.085, 95% CI: 2.128-7.844) and having complication (RR = 1.765, 95% CI: 1.108-2.812). CONCLUSION: The results of this study suggested that the risk factors were old age, lower Glasgow scores, poor conscious levels and having complication on mortality of ischemic stroke.

Screening cellular proteins binding to the core region of hepatitis C virus RNA genome with digoxin-labeled nucleic acids.

OBJECTIVE: To screen and identify cellular proteins binding to the core region of hepatitis C virus (HCV) RNA genome. METHODS: The plasmid pHCV core was constructed to generate in vitro transcripts of the core region of HCV RNA genome. Ultraviolet (UV) cross-linking experiment and competition analysis were performed to screen HepG2 cellular proteins, which interact with digoxin-labeled transcripts of the core region of HCV RNA genome. RNA-binding proteins were separated by immunoprecipitation, analyzed by electrophoresis on SDS-PAGE and detected by immunoblotting with anti-digoxingenin-AP. After being excised from SDS-PAGE, the proteins bands were analyzed by MALDI-TOF-MS. RESULTS: Several cellular proteins of hepG2 cell specifically bound to the core region of HCV RNA genome. The binding of cellular proteins to digoxin-labeled HCV core RNA was competed out in proportion to the increasing amount of unlabeled RNA. One of the HCV RNA-binding proteins was the B (brain) isozyme of human phosphoglycerate mutase (PGAM-B) identified by MALDI-TOF-MS. CONCLUSION: PGAM-B could specifically bind to the core region of HCV RNA genome in vitro.

Maternal hepatitis B virus (HBV) DNA positivity and sexual intercourse are associated with HBV intrauterine transmission in China: a prospective case-control study.

BACKGROUND AND AIM: Hepatitis B virus (HBV) intrauterine transmission from infected mothers contributes significantly to the persistence of the high number of HBV carriers. The aim of this study was to identify potential risk factors for HBV intrauterine transmission. METHODS: A case-control study was performed on pregnant women tested positive for HBsAg at Shaanxi Maternal and Neonatal Health Hospital, Xi'an, China, from September 2002 to October 2004. Serum samples were taken from infected women and their newborn infants and used for the detection of HBsAg. A structured standard questionnaire was used to collect demographic, medical and maternal data, and maternal HBV DNA, HBeAg, anti-hepatitis C virus and anti-hepatitis D virus were also assessed. Ten neonates validated as having HBV intrauterine transmission were selected as cases and others as controls. RESULTS: The univariate analysis indicated that maternal HBeAg positivity (odds ratio [OR] = 5.96, 95% confidence interval [CI]: 1.61-22.12), HBV DNA positivity (OR = 12.09, 95% CI: 2.97-40.17) and sexual intercourse in the second trimester (OR = 9.15, 95% CI: 1.08-202.99) were significantly associated with an increased risk for HBV intrauterine transmission, whereas contraceptive measures before pregnancy (OR = 0.21, 95%CI: 0.04-0.99) were associated with a decreased risk. The multivariate analysis, however, identified maternal HBV DNA positivity (OR = 19.18, 95%: CI: 3.26-118.73) and sexual intercourse in the second trimester (OR = 1.29, 95%: CI: 1.00-1.66) as the only independent risk factors for HBV intrauterine transmission. CONCLUSIONS: The risk of HBV intrauterine transmission increased with increased frequency of sexual intercourse. Therefore, it is concluded that maternal HBV DNA positivity and sexual intercourse in the second trimester are independent risk factors for HBV intrauterine transmission.

[Hepatitis B immunoglobulins blocking hepatitis B virus infection of trophoblast cell culture in vitro].

OBJECTIVE: To determine the role of hepatitis B Immunoglobulins (HBIG) in blocking hepatitis B virus (HBV) infection of trophoblast cell culture in vitro. METHODS: Trophoblast cells were placed in the six-well cluster dishes and incubated with 10% fetal calf serum/Dubecco's modified Eagle's Medium (10% FCS DMEM) at 37 degrees C with 5% CO2 in air. At 24 h after plating cells were subjected to experiment. Group A: cells were cultured with 0.5 ml HBV positive serum plus 3 ml 2% FCS DMEM; Group B: cells were cultured with 3 ml 2% FCS DMEM plus 0.5 ml HBV positive serum pretreated with 80 U HBIG for 30 min at 37 degrees C; Group C: cells were cultured with 3 ml 2% FCS DMEM plus 0.5 ml HBV positive serum pretreated with 40 U HBIG for 30 min at 37 degrees C; Group D: cells were cultured with 3 ml 2% FCS DMEM plus 40 U HBIG for 30 min before 0.5 ml HBV positive serum was added; Group E: cells were cultured with 40 U HBIG plus 3 ml 2% FCS DMEM; Group F: cells were cultured with HBV negative serum plus 3 ml 2% FCS DMEM. Twenty-four hours later the inoculums were removed, and the cells were extensively washed with 0.01 mol/L phosphate-buffered saline (PBS). After PBS washing, 4 ml 2% FCS DMEM was added to each well and the medium was collected every 12 hours. Enzyme-Linked Immunosorbent Assay (ELISA) method was used to detect HBsAg in culture medium (absorption value, A). HBV DNA in cell culture medium was detected by polymerase chain reaction (PCR). RESULTS: Before PBS washing, the A value of groups A, B, C, D, E, F were 2.697, 0.040, 0.102, 0.198, 0.036, 0.040 respectively. The cell culture medium in groups of A, B, C, and D were HBV DNA positive, groups of E, F were HBV DNA negative. From 12 hours to 84 hours, the average A value of groups A, B, C, D, E and F was 1.55 +/- 0.27, 0.032 +/- 0.016, 0.100 +/- 0.087, 0.052 +/- 0.044, 0.034 +/- 0.020, 0.034 +/- 0.022 respectively. The A value of groups A was significantly higher than those of other groups (P < 0.01). Cell culture medium at 84 hours of group A was HBV DNA positive and those of group B, C, D, E, F were HBV DNA negative. CONCLUSION: HBIG could effectively block HBV infection of trophoblast cell culture in vitro.

[An 18-year follow-up study on the risk factors of deaths regarding chronic obstructive pulmonary disease in Xi'an, China].

OBJECTIVE: To examine risk factors of chronic obstructive pulmonary disease (COPD) deaths in Chinese military elderly men. METHODS: A cohort analytic study was carried out in Xi'an, China. A total of 1268 retired military males aged 55 or older were examined in 1987 and followed for 18 years. Main outcome measures were all causes and COPD deaths. RESULTS: The total person-years of follow-up from 1987 until June 2005 was 18 766.28. The mean follow-up time was 14.35 years; A total of 491 had died, with 748 alive and 29 lost of follow-up. COPD was the second cause of death in all deaths (16.90%). Results Univariate analysis of Cox model showed that age, number of smoking cigarettes per day, duration of smoking, negative affairs and existing COPD were risk factors of COPD deaths and the relative risks [95% confidence intervals (CI)] were 1.13 (1.09-1.17), 1.04 (1.02-1.06), 1.03 (1.01-1.04), 1.81 (2.85-6.77) and 4.39 (2.85-6.77) respectively. Data from Multivariate analysis of Cox model showed that age, number of smoking cigarettes per day and existing COPD were risk factors of COPD death with relative risks [95% confidence intervals (CI)] as 1.10 (1.06-1.15), 1.03 (1.01-1.06) and 3.07 (1.90-4.98) respectively. The risks for deaths increased significantly with increasing amount and duration of smoking resulting from all causes and COPD. Compared with current smokers, former smokers had lower risks of total mortality(excess risk reduction of 66.67%). CONCLUSION: COPD was the second cause among all deaths in this cohort. Age, number of smoking cigarettes per day and existing COPD were the risk factors of COPD deaths which called for further survey to examine the relationship between quitting smoking and COPD deaths in this cohort.

[Analysis on direct economic burden of stroke in the rural population of Hanzhong, Shaanxi Province].

OBJECTIVE: To analyze the direct economic burden of stroke in rural areas of Hanzhong. METHODS: Plan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income. RESULTS: The median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05). CONCLUSION: In this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.