The spatial variation in the effects of air pollution on cardiovascular mortality in Beijing, China.

Owing to lack of data from multiple air quality monitoring stations, studies about spatial association between concentrations of ambient pollutants and mortality in China are rare. To investigate the spatial variation of association between concentrations of particulate matter less than 10 µm in aerodynamic diameter (PM10), nitrogen dioxide (NO2) and carbon monoxide (CO) and cardiovascular mortality in Beijing, China, we collected data including daily deaths, concentrations of PM10, NO2 and CO, and meteorological factors from 1 January 2009 to 31 December 2010 in all 16 districts of Beijing. Generalized additive model (GAM) and generalized additive mixed model (GAMM) were used to examine the citywide and district-specific effects of PM10, NO2 and CO on cardiovascular mortality. The citywide effect derived from GAMM was lower than that derived from GAM, and the strongest effects were identified for 2-day moving average lag 0-1. The interquartile increases in concentrations of PM10, NO2 and CO were associated with 2.46 (95% confidence interval (CI), 1.22-3.72), 4.11 (95%CI, 2.82-5.42) and 2.23 (95%CI, 1.14-3.33) percentage increases in daily cardiovascular mortality by GAMM, respectively. The relative risk of each district compared with reference district was generally statistically significant. The death risk associated with air pollutants varies across different geographic districts in Beijing. The data indicate that the risk is high in suburban areas and rural counties. We found significant and spatially varied adverse effects of air pollution on cardiovascular deaths across the rural and urban areas in Beijing.

Acute Effects of Nitrogen Dioxide on Cardiovascular Mortality in Beijing: An Exploration of Spatial Heterogeneity and the District-specific Predictors.

The exploration of spatial variation and predictors of the effects of nitrogen dioxide (NO2) on fatal health outcomes is still sparse. In a multilevel case-crossover study in Beijing, China, we used mixed Cox proportional hazard model to examine the citywide effects and conditional logistic regression to evaluate the district-specific effects of NO2 on cardiovascular mortality. District-specific predictors that could be related to the spatial pattern of NO2 effects were examined by robust regression models. We found that a 10 µg/m3 increase in daily mean NO2 concentration was associated with a 1.89% [95% confidence interval (CI): 1.33-2.45%], 2.07% (95% CI: 1.23-2.91%) and 1.95% (95% CI: 1.16-2.72%) increase in daily total cardiovascular (lag03), cerebrovascular (lag03) and ischemic heart disease (lag02) mortality, respectively. For spatial variation of NO2 effects across 16 districts, significant effects were only observed in 5, 4 and 2 districts for the above three outcomes, respectively. Generally, NO2 was likely having greater adverse effects on districts with larger population, higher consumption of coal and more civilian vehicles. Our results suggested independent and spatially varied effects of NO2 on total and subcategory cardiovascular mortalities. The identification of districts with higher risk can provide important insights for reducing NO2 related health hazards.

Prevalence of Obesity and Related Factors among Bouyei and Han Peoples in Guizhou Province, Southwest China.

OBJECTIVE: To investigate the prevalence of general and abdominal obesity and associated factors in Bouyei and Han peoples. DESIGN: A cross-sectional study was carried out in Guizhou province, southwest China in 2012, with multi-stage sampling to enroll 4551 participants aged 20 to 80 years. General and abdominal obesity were defined by World Health Organization (WHO) for Chinese. A design-based analysis was performed to evaluate prevalence of obesity and its related factors. RESULTS: Bouyei people had a significantly lower prevalence of general obesity (4.8% vs. 10.9%, p < 0.05) and abdominal obesity (13.6% vs. 26.8%, p < 0.05) than that in Han people. Prevalence of obesity increased with age until middle-age period and declined thereafter. Men aged 40-49 years group and women aged 50-59 years group have the highest prevalence of general obesity. Prevalence of abdominal obesity was higher than that of general obesity. Middle-age, Higher income, Han people were significantly associated with an increased risk of General/abdominal obesity. CONCLUSIONS: Bouyei people had a lower prevalence of general and abdominal obesity than the Han people. Etiological studies should be conducted to determine underlying genetic factors and dietary factors.

Multi-site time series analysis of acute effects of multiple air pollutants on respiratory mortality: a population-based study in Beijing, China.

In large cities in China, the traffic-related air pollution has become the focus of attention, and its adverse effects on health have raised public concerns. We conducted a study to quantify the association between exposure to three major traffic-related pollutants - particulate matter < 10 µm in aerodynamic diameter (PM10), carbon monoxide (CO) and nitrogen dioxide (NO2) and the risk of respiratory mortality in Beijing, China at a daily spatiotemporal resolution. We used the generalized additive models (GAM) with natural splines and principal component regression method to associate air pollutants with daily respiratory mortality, covariates and confounders. The GAM analysis adjusting for the collinearity among pollutants indicated that PM10, CO and NO2 had significant effects on daily respiratory mortality in Beijing. An interquartile range increase in 2-day moving averages concentrations of day 0 and day 1 of PM10, CO and NO2 corresponded to 0.99 [95% confidence interval (CI): 0.30, 1.67], 0.89 (95% CI: 0.27, 1.51) and 0.95 (95% CI: 0.29, 1.61) percent increase in daily respiratory mortality, respectively. The effects were varied across the districts. The strongest effects were found in two rural districts and one suburban district but significant in only one district. In conclusion, high level of several traffic-related air pollutants is associated with an increased risk of respiratory mortality in Beijing over a short-time period. The high risk found in rural areas suggests a potential susceptible sub-population with undiagnosed respiratory diseases in these areas. Although the rural areas have relatively lower air pollution levels, they deserve more attention to respiratory disease prevention and air pollution reduction.

Arsenic exposure is associated with DNA hypermethylation of the tumor suppressor gene p16.

BACKGROUND: Occupational and environmental exposure to inorganic arsenic leads to development of cancer and represents a significant health hazard in more than 70 countries. The underlying mechanism for arsenic-induced carcinogenesis remains unclear. Laboratory studies suggest that arsenic is a poor mutagen but may cause epigenetic silencing of key tumor suppressor genes such as p16 through DNA hypermethylation. However, the evidence for an association between human arsenic exposure and abnormal DNA methylation of tumor suppressor genes is lacking. FINDINGS: Paired case-control studies were conducted involving 40 individuals with high arsenic exposure and arsenicosis, 40 individuals with similarly high exposure to arsenic but without arsenicosis, and 40 individuals with normal exposure to arsenic. DNA methylation status of p16 was determined using methylation-specific PCR. Conditional logistic regression analysis showed that DNA hypermethylation of p16 gene was significantly associated with high arsenic exposure (Odds Ratio = 10.0, P = 0.0019) independently of the development of arsenicosis (Odds Ratio = 2.0, P = 0.1343). CONCLUSIONS: High exposure of arsenic in human is positively linked to DNA hypermethylation of p16 gene, suggesting that epigenetic silencing of key tumor suppressor may be an important mechanism by which arsenic promotes cancer initiation.

The association between ambient air pollution and daily mortality in Beijing after the 2008 olympics: a time series study.

In recent decades, ambient air pollution has been an important public health issue in Beijing, but little is known about air pollution and health effects after the 2008 Beijing Olympics. We conduct a time-series analysis to evaluate associations between daily mortality (nonaccidental, cardiovascular and respiratory mortality) and the major air pollutants (carbon monoxide, nitrogen dioxide and particulate matter less than 10 µm in aerodynamic diameter) in Beijing during the two years (2009,2010) after the 2008 Beijing Olympics. We used generalized additive model to analyze relationship between daily mortality and air pollution. In single air pollutant model with two-day moving average concentrations of the air pollutants, increase in their interquartile range (IQR) associated with percent increase in nonaccidental mortality, 2.55 percent [95% confidence interval (CI): 1.99, 3.11] for CO, 2.54 percent (95% CI: 2.00, 3.08) for NO2 and 1.80 percent (95% CI: 1.21, 2.40) for PM10, respectively; increases in the IQR of air pollutant concentrations associated with percent increase in cardiovascular mortality, 2.88 percent (95% CI: 2.10,3.65) for CO, 2.63 percent (95% CI: 1.87, 3.39) for NO2 and 1.72 percent (95% CI: 0.88, 2.55) for PM10, respectively; and increase in IQR of air pollutant concentrations associated with respiratory mortality, 2.39 percent (95% CI: 0.68, 4.09) for CO, 1.79 percent (95% CI: 0.11, 3.47) for NO2 and 2.07 percent (95% CI: 0.21, 3.92) for PM10, respectively. We used the principal component analysis to avoid collinearity of varied air pollutants. In addition, the association stratified by sex and age was also examined. Ambient air pollution remained a significant contributor to nonaccidental and cardiopulmonary mortalities in Beijing during 2009,2010.

Prevalence of dyslipidemia and associated factors in the Yi farmers and migrants of Southwestern China.

There are scant data on serum lipid profile in the Yi people in China. The Yi farmers and migrants provide an unusual opportunity to estimate effects of environmental factors on serum lipid levels. We conducted a cross-sectional study in the Yi people to estimate prevalence of dyslipidemia and associated factors. It was found that prevalence of high total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), abnormal ratio of TC/HDL-C and low high-density lipoprotein-cholesterol (HDL-C) were 1.82%, 5.07%, 1.56%, 9.30% and 39.47%, respectively in the Yi farmers. And those in the Yi migrants were 4.81%, 22.21%, 3.24%, 26.56% and 40.53%. Prevalence of dyslipidemia increased with time period in the Yi farmers after their emigrating to urban areas for less than 25 years, except high TC. It was also found that prevalence of dyslipidemia of the Yi migrants increased with time period before their emigration, including hypertriglyceridemia, low HDL-C and high ratio of TC/HDL-C. Their body mass index (BMI), history of type 2 diabetes mellitus (T2DM), gender, ever alcohol drinking and physical activity all were associated with dyslipidemia, but no factors associated with high LDL-C was found. In conclusion, all these results suggest that the Yi migrants have a higher prevalence of dyslipidemia than the Yi farmers do, which possibly can attribute to their urbanized lifestyles.

Trends of overweight and obesity in Yi people between 1996 and 2007: an Yi migrant study.

OBJECTIVE: To evaluate trends of overweight and obesity prevalence between 1996 and 2007 in Yi farmers and Yi migrants. METHODS: An Yi migrant study was conducted in Liangshan Yi Autonomous Prefecture, Sichuan Province, China from 1996 to 2007. Data were collected with identical methods, including standardized questionnaire and body measurements. RESULTS: Age- and sex-specific body mass index (BMI) significantly increased from 20.02 in 1996 to 22.36 in 2007, among Yi farmers, which was significantly different from those among Yi migrants (23.67 in 2007 and 20.90 in 1996) (P<0.05). Prevalence of obesity rose from 1.21 % in 1996 to 4.55 % in 2007 (OR=1.15, P<0.001) in Yi migrants, while that in Yi farmers from none in 1996 to 0.12 % in 2007 (P>0.05). Prevalence of overweight rose significantly to 26.24 % in 2007 from 17.24 % in 1996 (OR=1.06, P<0.001) in Yi migrants, while that in Yi farmers from 1.29 % in 1996 to 4.45 % in 2007 (OR=1.14, P>0.001). Yi migrants appeared to have a 5.52-fold higher risk on developing overweight and obesity than Yi farmers have. CONCLUSION: The Yi migrants had a steeper increase of overweight with year and consequently caused more obesity. Change in lifestyle may contribute most likely to higher prevalence of overweight and obesity in Yi migrants.

HIV, HCV, and HBV co-infections in a rural area of Shanxi province with a history of commercial blood donation.

BACKGROUND: Unhygienic blood collection in the early 1990s led to blood-borne infections in Central China. This study aimed to estimate human immunodeficiency virus (HIV) co-infection with hepatitis C and B viruses (HCV and HBV) and their risk factors in a rural area of Shanxi Province with a history of commercial blood donation. METHODS: A cross-sectional study was conducted in 2004. All adult residents in the target area were invited to participate in the study. Face-to-face interviews were completed and blood specimens were tested for HIV, HCV, and HBV surface antigen (HBsAg). RESULTS: Prevalence rates of HIV, HCV, and HBsAg were 1.3% (40/3 062), 12.7% (389/3 062), and 3.5% (103/2982), respectively. Of the 40 HIV-positive specimens, 85% were HCV positive and 2.5% were HBsAg positive. The history of commercial blood donation was positively associated with HIV, HCV, and HIV/HCV co-infections, but was negatively associated with HBsAg seropositivity. Migration for employment in the last 5 years was positively related to HIV, HBsAg, and HIV/HCV co-infections. Univariate logistic analysis showed that illegal drug use, number of sex partners, extramarital sex behavior, commercial sex behavior, and condom use rate were not related to anti-HIV, anti-HCV, HBsAg seropositivity or their co-infections. CONCLUSION: The history of commercial blood donation was the main risk factor for HIV, HCV, and HIV/HCV co-infections in this former commercial blood donation area. HIV and HCV prevention and treatment interventions are important in this area.

Validation of the Chinese version of the Functional Performance Inventory Short Form in patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVE: To determine the reliability and validity of the Chinese version of the Functional Performance Inventory Short Form (FPI-SF-C) in patients with chronic obstructive pulmonary disease in Beijing, China. BACKGROUND: The Functional Performance Inventory Short Form (FPI-SF) is a 32-item instrument designed to measure self-reported functional performance of patients with chronic obstructive pulmonary disease. This instrument had not been translated into Mandarin Chinese and tested for use in mainland China. DESIGN: Cross-sectional validation study with a two-week test of reproducibility. METHOD: The FPI-SF was translated using forward and backward translation procedures and administered to 108 stable chronic obstructive pulmonary disease patients from outpatient clinics of three hospitals in Beijing, China. Pulmonary function and six-minute walking distance (6-MWD) tests were performed on the same day or within one week before the FPI-SF-C completion. Thirty of the patients participated in the reproducibility assessment. RESULTS: Cronbach's alpha for the FPI-SF-C total score was 0·89; subscales ranged from 0·70 (Body Care)-0·89 (Spiritual activities). Test-retest reliability (intraclass correlation coefficient) was 0·93 with subscales ranging from 0·73 (Body Care)-0·96 (Household Maintenance). No ceiling or floor effects were observed for total FPI-SF-C score. Total scores correlated significantly (p<0·05) with 6-MWD (r=0·56), modified Medical Research Council Dyspnoea Scale (MMRC) (r=-0·55), BODE index (r=-0·47), forced expiratory volume in one second (FEV(1)) (r=0·41) and FEV(1) % of predicted (r=0·26) and differentiated patients based on GOLD rating of COPD severity (χ(2)=16·22, p<0·001). CONCLUSIONS: Results suggest the FPI-SF-C is a reliable and valid instrument for measuring functional performance in mainland Chinese patients with chronic obstructive pulmonary disease. Further psychometric testing in a wide range of subjects and an evaluation of its utility in clinical practice are warranted. RELEVANCE TO PRACTICE: The FPI-SF-C may be useful for understanding difficulties in functional performance and evaluating the effect of treatment in Chinese patients with chronic obstructive pulmonary disease.

Paraplegia and paraparesis from intrathecal methotrexate and cytarabine contaminated with trace amounts of vincristine in China during 2007.

PURPOSE: The production and administration of drugs used intrathecally requires special care to prevent contamination with neurotoxic agents. In 2007, we investigated a widespread outbreak of paraplegia and paraparesis among Chinese patients who received intrathecal drugs to identify the presumed contaminant and its source to prevent further cases. PATIENTS AND METHODS: We defined a case as onset from January 1 to October 31, 2007, of bilateral flaccid paraparesis or paraplegia or retention and incontinence of stool or urine, in a patient receiving intrathecal drugs. Using a retrospective cohort approach, we selected 12 hospitals from all hospitals that had reported cases. In these hospitals, we identified all 448 patients (including 107 cases) who received intrathecal chemotherapy or chemoprophylaxis in 2007. We calculated attack rates and Mantel-Haenszel adjusted risk ratios for intrathecal drug type and lot. RESULTS: All 12 hospitals used intrathecal methotrexate or cytarabine produced by one pharmaceutical plant. Only two lots of each drug were associated with cases. Lot-specific attack rates ranged from 42% to 100% (risk ratio, ∞; lower confidence bounds, 1.8 to 7.3). Vincristine production had immediately preceded production of the implicated lots on the same equipment. By using ultra performance liquid chromatography, we detected vincristine (0.28 to 18 µg) in unused vials from implicated lots of methotrexate and cytarabine. CONCLUSION: Trace amounts of vincristine that contaminated intrathecal drugs caused a large outbreak of severe neurologic damage. Vincristine and other neurotoxic drugs should not be produced on any equipment that is also used for producing drugs that are to be administered intrathecally.

Association of the renin gene polymorphism, three angiotensinogen gene polymorphisms and the haplotypes with essential hypertension in the Mongolian population.

Renin is a rate-limiting enzyme of the renin-angiotensin system and plays a crucial role in the regulation of blood pressure (BP). Angiotensinogen (AGT) is the precursor of potent vasoactive hormone angiotensin II and the AGT gene has been incriminated as a marker for genetic predisposition to essential hypertension (EH) in some ethnic groups. The purpose of the study is to explore the association of a new genetic marker of renin gene, and AGT gene M235T, A-6G, and A-20C polymorphisms and their haplotypes with EH in the Mongolian population. On the basis of the prevalence survey, 243 hypertensives and 258 normotensives who had no blood relationship with each other were selected as subjects. All the subjects were interviewed with questionnaires and their blood specimens were collected. Renin gene insertion/ deletion (I/D) polymorphism was genotyped by PCR-polyacrylamide gel electrophoresis. AGT gene M235T, A-6G, and A-20C polymorphisms were genotyped by a PCR-restriction fragment length polymorphism and single-strand conformation polymorphism. The frequencies of renin genotype DD and allele D in hypertensives (36.21%, 63.79%, respectively) were significantly higher than those in normotensives (29.84%, 57.17%, respectively, P < 0.05). The odds ratios (OR) of renin genotype ID, DD to renin genotype II on hypertension were 1.98 (OR 95% CI 1.08-3.72) and 2.51 (OR 95% CI 1.33-4.88), respectively. There were no significant differences in the distributions of genotypes and alleles for AGT gene M235T, A-6G, and A-20C polymorphisms and all different haplotypes between the two groups. Renin gene I/D polymorphism is associated with EH, whereas AGT gene M235T, A-6G, and A-20C polymorphisms and the haplotypes are not associated with EH in the Mongolian population.

[Reliability and validity of modified pulmonary functional status and dyspnea questionnaire in Chinese patients with chronic obstructive pulmonary disease].

OBJECTIVE: To determine the reliability and validity of the modified pulmonary functional status and dyspnea questionnaire (PFSDQ-M) Chinese version in patients with chronic obstructive pulmonary disease (COPD) at 2 hospitals in Beijing, China. METHODS: PFSDQ-M has three domains, i.e., change experienced by patient with activities or activity restriction (CA), dyspnea with activities (DA) and fatigue with activities (FA). Sixty-one patients with COPD in stable condition were assessed by interview with PFSDQ-M Chinese version, modified Medical Research Council dyspnea scale (MMRC), respectively, and underwent pulmonary function test (PFT) and 6-minute walking test (6MWT) on the same day or within one week before interview. RESULTS: Cronbach's alpha was 0.84, 0.85 and 0.89 for domains of CA, DA and FA of the PFSDQ-M, respectively. Scores of change in activities, dyspnea and fatigue with activities in patients of COPD correlated to their 6-minute walking distance (r = -0.39 to -0.50), FEV(1) (r = -0.28 to -0.36), FEV(1)/FVC (r = -0.27 to -0.37), FEV(1)% of predicted (r = -0.27 to -0.37), dyspnea score in MMRC (r = 0.59 to 0.66) and BODE index (r = 0.40 to 0.51), respectively (all P < 0.01). Degrees of restriction of activity, dyspnea and fatigue with activities varied significantly in patients with different severity of COPD (chi(2) = 7.35 to 15.21, P < 0.05, P < 0.01, respectively). CONCLUSIONS: Results of 61 patients with COPD interviewed with PFSDQ-M Chinese version suggest its good reliability and validity in discriminating patients with COPD of varied severity and stages.

Silicosis in automobile foundry workers: a 29-year cohort study.

OBJECTIVES: The purposes were to determine the relationship between silicosis among foundry workers and their cumulative exposure to silica dust, and to establish a regression model to predict the risk for developing silicosis by a given length of employment and air concentrations of silica at worksites. METHODS: A 29-year cohort study was conducted, including all those employed for more than one year during January 1, 1980 to December 31, 1996 and all members of the cohort were followed-up to December 31, 2008. In total, 2009 workers of an automobile foundry in Shiyan, Hubei province were recruited in the study, 1300 at eight worksites including sand preparation, cast shakeout, and finishing, melting, moulding, core-making, overhead crane operation and pouring as exposed group, and the other 709 auxiliary workers at the same factory, such as electricians, inspectors, fitters, and so on, as control group. Person-years of observation were calculated by persons observed and years followed-up for each of them. Person-year incidence of silicosis and its relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CI) among the workers were estimated, adjusted for relevant factors with logistic regression model using SPSS version 15.0 software. RESULTS: Totally, 2009 workers were followed-up for 37 151 person-years and 48 cases of silicosis were found, with an overall incidence of 1.34 per thousand, 2.02 per thousand in exposed group, and 0.15 per thousand in control one. Risk of silicosis was significantly higher in the exposed group than that in the control one (RR = 13.13, 95% CI 3.18-54.13), higher in men than that in women (RR = 13.92, 95% CI 1.92-100.93). Risks of silicosis varied by job, highest in those exposed to cast shakeout and finishing (RR = 28.14, 95% CI 6.43-123.11), followed by those exposed to pouring (RR = 22.23, 95% CI 5.01-98.55) in the foundry. Average length of employment at onset of silicosis was 25.94 years, and silicosis incidence increased with length of employment. Average age at onset of silicosis was 47.83 years old. The risk of silicosis in workers with pulmonary tuberculosis was 2.57 folds as those without it (P < 0.01). Ten deaths were recorded in those with silicosis, with a case-fatality rate of 20.83 percent three of them died of lung cancer, three of liver cancer, two of ischemic heart disease, and two of other diseases as their immediate causes of death. Incidence of silicosis in foundry workers positively correlated with their cumulative silica exposure (OR = 3.00, 95% CI 2.34-3.83). Risks of silicosis increased by 4.38 folds with an increase of 1 mg/m3-year of cumulative silica exposure, and by 3.79 folds with smoking, respectively, adjusted for alcohol drinking and age. Based on a logistic regression model fitted, incidence of silicosis is expected to be 44.6 per thousand for those with daily exposure to silica of 4.18 mg/m3 in average for 30 years, and if incidence of silicosis is expected to be less than 1 per thousand, daily exposure to silica should be controlled below 0.2 mg/m3 for those with 20 years of employment, or below 0.1 mg/m3 for those with 30 or 40 years of silica exposure. CONCLUSIONS: At present, foundry workers in China still face high risk of developing silicosis. For lowering occurrence of silicosis in exposed workers, it seems necessary that current occupational exposure limits for silica at worksites in China should be reexamined and silica dust control measures be strengthened.

HIV-1 and STIs prevalence and risk factors of miners in mining districts of Yunnan, China.

OBJECTIVE: To assess HIV/sexually transmitted infection (STI) prevalence and associated risk factors among miners in Yunnan, China. METHODS: A cross-sectional study was conducted among 1798 miners in 2 townships of Gejiu City, Yunnan, from March to May 2006. Standardized interviewer-administered questionnaires were completed and specimens collected for HIV/STI testing. RESULTS: The prevalence of HIV, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, herpes simplex virus-2, and any STIs among all miners was 0.7%, 4.8%, 0.8%, 1.8%, 9.6%, and 14.9%, respectively. One fifth of miners reported patronizing female sex workers (FSWs) at least once, and of these, 72% never used a condom with a FSW. Miners who visited FSWs had a higher prevalence of HIV (1.8% vs. 0.5%) and any STI (23.2% vs. 4.3%), including C. trachomatis (6.9% vs. 4.3%), N. gonorrhoeae (2.1% vs. 0.5%), and herpes simplex virus-2 (14.9% vs. 8.4%), and higher rates of illegal drug use compared with miners who visited no FSWs. CONCLUSIONS: High prevalence of HIV/STIs among miners in Gejiu warrants special attention to this population, and vigorous interventions should address both sexual and drug use-related risk.

[Study on severity, status of awareness and therapy regarding urinary incontinence in elderly people from rural areas in Jixian county, Tianjin].

OBJECTIVE: To understand the prevalence of urinary incontinence (UI) and its severity in rural elderly people, as well as to investigate the awareness on UI in the elderly and health-care service seeking behavior. METHODS: A cross-sectional study was carried out in two townships of Jixian county, Tianjin. A total of 743 people aged 60 years and over were selected under cluster sampling method. All the information was collected with a standardized structured questionnaire by face-to-face interview. Prevalence, severity, the awareness on UI in the elderly and their utilization of health-care service for its diagnosis and treatment were analyzed. RESULTS: Prevalence of UI was 33.38% among people aged 60 years and over in two townships of Jixian, higher in females than in males (43.15% vs. 22.75%, χ(2) = 34.70, P < 0.0001). The prevalence rates of UI in 60- age group, 65- age group, 70- age group, 75- age group, 80- age group, 85 - 95 age group were 28.64%, 32.12%, 34.08%, 35.45%, 47.76%, 30.00%, respectively, and increased with age (for trend χ(2) = 2.19, P = 0.029). Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were mild, while mixed urinary incontinence (MUI) were mainly moderate. The differences of severity of SUI, UUI, MUI between men and women did not show statistical significance (all P > 0.05). In 743 elderly people, more than half of the respondents had never heard of UI (50.20%, 373/743) and only 170(22.88%) elderly people considered UI as a disease. 630 (84.79%) and 665 (89.50%) elderly people in our research group did not know that such condition was curable and preventable. In 248 elderly people with UI, only 12 (4.84%) of them ever seeking community health-care services in the health-care centers or hospitals. For the ones who did visit the centers, the purpose was only to seek for drug treatment. CONCLUSION: Prevalence of UI appeared to be high among the elderly people in rural areas of Jixian county. Most of the elderly people were lack of knowledge about UI that hindered them from seeking for diagnosis and treatment in the clinics, plus the treatment program for UI was not standardized. Knowledge on UI and health care seeking behavior should be popularized and strengthened among elderly people living in the rural areas.

Prevalence and related factors of falls among the elderly in an urban community of Beijing.

OBJECTIVE: To understand the prevalence, consequences and risk factors of falls among urban community-dwelling elderly in Beijing. METHODS: A cross-sectional study was conducted in Longtan Community, Beijing. A total of 1512 individuals aged 60 years or over were selected by stratified cluster sampling. Data regarding the frequency of falls in the previous year, as well as circumstances, consequence and related factors of falls were collected from the elderly through face-to-face interviews with questionnaires in their home. RESULTS: The prevalence of falls was 18.0% on the average among 1512 participants, higher in women (20.1%) than in men (14.9%) (P = 0.006), and increased with age (chi2(for trend) = 10.37, P = 0.001). The total rate of falls-induced injuries among the fallers was 37.7%. Falls usually resulted in soft-tissues bruises (58.7%), fear of repeated episodes of falls (58.8%), loss of independence and confidence in movement (35.7%) and even in hip fracture. In addition to the burden of medical care, falls also generated a big economic burden. Occurrence of falls was significantly associated with both intrinsic and extrinsic factors. The related factors of falls in the elderly included age > or = 60-70 years, femininity, less physical activities, fear of future falls, living alone, severely impaired vision, health problem-impacted activities of daily living, chronic diseases (diabetes, hypertension, postural hypotension, stroke sequela, cataract, arthritis, dementia and depression), medications (psychoactive, anti-diabetic), gait imbalance, high bed and faintly-lighted stairway. CONCLUSION: The prevalence of falls among urban community-dwelling elderly in Beijing is closely associated with significant associated with intrinsic and extrinsic factors. Efforts to prevent falls in the elderly should be made at community level.

Microbicide acceptability among female sex workers in Beijing, China: results from a pilot study.

OBJECTIVES: To explore attitudes toward hypothetical vaginal microbicides and willingness to use them among female sex workers (FSWs) in a district of Beijing, China, and to identify factors likely to affect acceptability and use of microbicides for HIV prevention among this population. METHODS: An exploratory cross-sectional study using convenience sampling was conducted. A total of 54 FSWs were recruited from Shijingshan District in Beijing for a face-to-face interview. Main outcome variables were measured by a microbicide acceptability score, perception of HIV/STI risk and self-reported high-risk sexual behaviors, condom use, HIV/STI history, and self-reported experience of vaginal product use. RESULTS: Mean score of microbicide acceptability in FSWs was 2.73, with a standard deviation (SD) of 0.46 (ranging from 1 to 4). Acceptability score varied by partner types (p = 0.025), history of HIV testing (p = 0.037), and concern about contracting an STI (p = 0.042). Covert use of microbicides in FSWs with various sexual partners was statistically different (p = 0.001). FSWs preferred to pay for microbicides and to use them covertly. CONCLUSIONS: In general, FSWs in Shijinghsan District might have a positive response to microbicides across all hypothetical characteristics. Further study is needed for comprehensive understanding of the contextual factors of microbicide use.

[Acceptability of vaginal microbicides among female sex workers in urban Beijing, China].

OBJECTIVE: To explore the attitudes and willingness towards vaginal microbicides use among female sex workers (FSWs) for HIV/AIDS and sexually transmitted infection (STI) prevention in an urban district of Beijing, China, as well as its related factors. METHODS: A cross-sectional study using convenience sampling was conducted. A total of 54 FSWs were recruited from Shijingshan District in urban Beijing. Main outcome variables were measured by microbicide acceptability score with questionnaire, including high-risk sexual behaviors, self-reported condom use, self-reported HIV/STI history and perception on the risk of HIV/STI. RESULTS: Mean score of microbicide acceptability in FSWs was 2.73 (ranging 1 to 4). Acceptability score varied by the type of their sex partner (P = 0.049), experience of HIV testing (P = 0.037) and concerns about contracting STI (P = 0.042). Willingness to use and covert use of microbicides in FSWs varied significantly with their sex partners (P = 0.001). CONCLUSION: FSWs in Shijingshan district might have a positive response to vaginal microbicides use across all hypothetical characteristics in general. Further study is needed for comprehensive understanding of contextual factors related to it.

[Factors influencing the rate on retention to methadone maintenance treatment program among heroin addicts in Guizhou, China].

OBJECTIVE: To understand the situation of client-retention to methadone maintenance treatment (MMT) program and related factors. METHODS: A cohort study was adopted. In total, 1003 heroin addicts who were treated at 8 local MMT clinics with less than one month period, were recruited under nominal informed consent from Guizhou province, southwest part of China, during June to October 2006. Face-to-face interview and questionnaire administered to collect relevant information from the clients who were also followed until June 2007 to understand the situation on retention. Data were analyzed with Kaplan-Meier method to estimate the retention rate at different time spans while factors related to retention were analyzed with Cox proportional hazard regression model. RESULTS: All the clients were followed-up for 14 months, with an average retention of ten months. The retention rates of the clients were 68.8% and 57.4% at 6th-month and 12th-month of the treatment program, estimated by Kaplan-Meier method. Results of Cox regression analysis showed that factors influencing retention rate on MMT among the clients, including their awareness on MMT, daily dose of methadone intake, and different MMT clinics which they were attached to. Risk influencing the withdrawal from MMT had a 20% decrease along with the increase when the daily dose of methadone intake reached 25 mg, with a hazard ratio of 0.80 (P < 0.01). If the clients were aware that methadone was a life-time treatment when they began the MMT program, the risk for withdrawal would be lower than those who were not and the hazard ratio became 0.66 (P < 0.05). CONCLUSION: Our data showed that about half of the clients who were at the MMT program would still stick to it after 12-months, suggesting that the retention rate was not satisfactory and need to be improved. Factors as the MMT clinics themselves that the clients visited, daily methadone dosage they took, and the awareness on MMT etc. were important predictors to the rate of retention on MMT program.