Adverse Events Associated with Treatment of Multidrug-Resistant Tuberculosis in China: An Ambispective Cohort Study.

BACKGROUND Adverse events are under-appreciated negative consequences that are significant clinical problems for patients undergoing anti-MDR-TB treatment due to longer duration of treatment and more need for concurrent use of multiple second-line drugs. The aim of this study was to determine the incidence of adverse events and their impact on MDR-TB therapy and treatment outcome, and to identify possible drug-event pairs in China. MATERIAL AND METHODS An ambispective cohort study was conducted based on hospital medical records, which included a retrospective study that enrolled 751 MDR-TB patients receiving standardized regimen between May 2009 and July 2013, and a follow-up investigation of treatment outcome conducted in December 2016 in China. Adverse events were determined according to laboratory results or clinical criteria. Cox's proportional hazards regression models were used for evaluating associations. RESULTS There were 681(90.7%) patients experienced at least 1 type of adverse event and 55.2% of them required a changed MDR-TB treatment; 51(6.8%) patients required permanent discontinuation of the offending drug due to adverse events. The occurrence of adverse events was associated with poor treatment outcome (adjusted hazard ratio, 1.54; 95% CI 1.21, 1.87). A total of 10 different drug-event pairs were identified. CONCLUSIONS Adverse events occurred commonly during MDR-TB treatment in China, and often resulted in MDR-TB treatment change. The occurrence of adverse events affected MDR-TB poor outcome after treatment.

The free vaccination policy of influenza in Beijing, China: The vaccine coverage and its associated factors.

BACKGROUND: In order to improve influenza vaccination coverage, the coverage rate and reasons for non-vaccination need to be determined. In 2007, the Beijing Government published a policy providing free influenza vaccinations to elderly people living in Beijing who are older than 60. This study examines the vaccination coverage after the policy was carried out and factors influencing vaccination among the elderly in Beijing. METHODS: A cross-sectional survey was conducted through the use of questionnaires in 2013. A total of 1673 eligible participants were selected by multistage stratified random sampling in Beijing using anonymous questionnaires in-person. They were surveyed to determine vaccination status and social demographic information. RESULTS: The influenza vaccination coverage was 38.7% among elderly people in Beijing in 2012. The most common reason for not being vaccinated was people thinking they did not need to have a flu shot. After controlling for age, gender, income, self-reported health status, and the acceptance of health promotion, the rate in rural areas was 2.566 (95% confidence interval [CI], 1.801-3.655, P<0.010) times greater than that in urban areas. Different mechanisms of health education and health promotion have different influences on vaccination uptake. Those whom received information through television, community boards, or doctors were more likely to get vaccinated compared to those who did not (Odds Ratio [OR]=1.403, P<0.010; OR=1.812, P<0.010; OR=2.647, P<0.010). CONCLUSION: The influenza vaccine coverage in Beijing is much lower than that of developed countries with similar policies. The rural-urban disparity in coverage rate (64.1% versus 33.5%), may be explained by differing health provision systems and personal attitudes toward free services due to socioeconomic factors. Methods for increasing vaccination levels include increasing the focus on primary care and health education programs, particularly recommendations from doctors, to the distinct target populations, especially with a focus on expanding these efforts in urban areas.

Effects of a fruit-vegetable dietary pattern on oxidative stress and genetic damage in coke oven workers: a cross-sectional study.

BACKGROUND: Coke oven workers (COWs) are exposed to high level of genotoxic chemicals that induce oxidative stress and genetic damage. The dietary intake of certain types of foods may reverse these effects. METHODS: We conducted a cross-sectional study with 51 topside COWs, 79 other COWs, and 67 controls, to assess the effects of dietary patterns on oxidative stress and genetic damage. RESULTS: Compared to the controls, both topside and other COWs had significantly higher urinary 1-hydroxypyrene levels, serum oxidant levels [malondialdehyde, (MDA)], and genetic damage [micronucleus (MN) frequency & 8-oxo-2'-deoxyguanosine (8-OH-dG)], but lower antioxidant levels [superoxide dismutase (SOD) and glutathione peroxidase, (GPx)]. The fruit-vegetable (FV) dietary pattern was positively correlated with serum SOD levels and negative correlated with serum MDA, MN frequency, and urinary 8-OH-dG. COWs with an FV patter in the highest quartile (Q4) had significantly increased antioxidant levels (SOD and GPx) and decreased oxidant levels (MDA) and genetic damage (MN frequency and 8-OH-dG) than those with an FV pattern in the lowest quartile (Q1). CONCLUSION: Compared to control subjects, COWs had increased oxidative stress and genetic damage. A FV dietary pattern may reverse oxidative stress and genetic damage in COWs.

[Analysis of vaccination coverage of the elderly influenced by different family structures in Beijing].

OBJECTIVE: To investigate the differences in free influenza vaccination rate among different family structures of the elderly population in Beijing under the free vaccination policy. METHODS: A cross sectional study was conducted by a multi-stage cluster sampling from July to August in 2013. A total of 1 717 individuals were selected to answer a self-designed questionnaire of demographic characteristics and basic information about receiving free influenza vaccination and 1 637 of which were valid. The chi-square test for dichotomous variables was calculated to examine the relationship between vaccine status and family characteristics. Predictor variables were selected as variables for non-conditional logistic regression model to determine potential independent predictors of vaccine uptake. RESULTS: The free influenza vaccination rate in elderly population was 38.8% (634/1 637) in 2013. The rate in the old people who lived alone was the highest which was 47.5% (58/122). The rate in the old people who lived with children and spouse was 34.6% (175/506). There was a significant difference in coverage rate among different family structures (χ(2)=11.57, P=0.009). The rate in the old people who lived with spouse only, lived with children only and other types were 41.5% (322/778) , 34.7% (69/201), and 33.3% (10/30), respectively. In a multi-factor model, there was a significant difference in vaccination rate among different family structures after other confounding factors were controlled. The odds ratios (95% CI) of the people living with spouse only, people living with children only and people living with spouse and children were 0.90 (0.60-1.33) , 0.59 (0.37-0.96) , and 0.63 (0.42-0.96), respectively. CONCLUSION: The vaccination rate in the old people living alone was low. The health education should be conducted not only in the elderly people but also in their family members.

[Social determinants of the life quality among the elderly in Beijing, China].

OBJECTIVE: To verify the association between social determinants and the quality of life (QoL) among the elderly in Beijing. METHODS: A questionnaire household survey was conducted and 1 685 over 60 dwellers in Beijing were interviewed. The EQ-5D scale was used to measure the elderly's QoL and Time Trade-off model was used to calculate the EQ-5D index. Multiple linear regression and Logistic regression were employed to analyze the association between social determinants and the QoL. RESULTS: There was no statistical significant difference in the QoL between the urban and the rural residents (P>0.05). The elderly with higher education level and income or married tended to have higher overall QoL scores and better performance of five dimensions of the QoL (P<0.05). CONCLUSION: More policies should be focused on the elderly with lower social determinants in both urban and rural areas in Beijing.