Showing papers by "Chinese Center for Disease Control and Prevention published in 2007"

Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China.

Abstract: Over the past two decades, China has enjoyed impressive economic development, and her citizens have experienced many remarked changes in their lifestyle. These changes are often associated with an increase in obesity and chronic disease. In this meta-analysis, based on nationally representative data, we studied the current prevalence of obesity and the trends in obesity, mortality and morbidity in China. Between 1992 and 2002, the prevalence of overweight and obesity increased in all gender and age groups and in all geographic areas. Using the World Health Organization body mass index cut points, the combined prevalence of overweight and obesity increased from 14.6 to 21.8%. The Chinese obesity standard shows an increase from 20.0 to 29.9%. The annual increase rate was highest in men aged 18–44 years and women aged 45–59 years (approximately 1.6 and 1.0% points, respectively). In general, male subjects, urban residents, and high-income groups had a greater increase. With the increase in overweight and obesity, obesity-, and diet-related chronic diseases (e.g., hypertension, cardiovascular disease (CVD), and type 2 diabetes) also increased over the past decade and became a more important preventable cause of death. Hypertension increased from 14.4% in 1991 to 18.8% in 2002 in adults; in older adults aged 35–74 years, it increased from 19.7 to 28.6%. Between 1993 and 2003, the prevalence of CVD increased from 31.4 to 50.0%; diabetes increased from 1.9 to 5.6%. During 1990–2003, although total mortality rate (per 100 000) decreased, overall the mortality rate and contribution (as percentages) to total death of obesity-related chronic disease increased, in particular, in rural areas. Mortality rate (per 100 000) of CVD increased from 128 to 145 and its contribution to total death, 27 to 32%, in rural areas; the figures decreased slightly in urban areas. The mortality rate of ‘nutrition, endocrinology and metabolism-related disease’ (NEMD) increased in both rural and urban areas between 1990 and 2000, 8.0 to 10.6 and 4.9 to 5.3, respectively. The current prevalence of hypertension, dyslipidaemia, metabolic syndrome, and diabetes among Chinese adults is approximately 20, 20, 15, and 3%, respectively. The prevalence of overweight and obesity and obesity-related chronic diseases have increased in China in the past decade. Our findings provide useful information for the projection of future trends and the formulation of national strategies and programmes that can address the challenges of the growing obesity and chronic disease epidemic.

Surveillance of Resistance to Adamantanes among Influenza A(H3N2) and A(H1N1) Viruses Isolated Worldwide

Abstract: Our previous reports demonstrated an alarming increase in resistance to adamantanes among influenza A(H3N2) viruses isolated in 2001-2005. To continue monitoring drug resistance, we conducted a comprehensive analysis of influenza A(H3N2) and A(H1N1) viruses isolated globally in 2005-2006. The results obtained by pyrosequencing indicate that 96.4% (n=761) of A(H3N2) viruses circulating in the United States were adamantane resistant. Drug resistance has reached 100% among isolates from some Asian countries. Analysis of correlation between the appearance of drug resistance and the evolutionary pathway of the hemagglutinin (HA) gene suggests at least 2 separate introductions of resistance into circulating populations that gave rise to identifiable subclades. It also indicates that resistant A(H3N2) viruses may have emerged in Asia in late 2001. Among A(H1N1) viruses isolated worldwide, resistance reached 15.5% in 2005-2006; in the United States alone, it was 4.0%. Phylogenetic analysis of the HA and M genes indicates that the acquisition of resistance in A(H1N1) viruses can be linked to a specific genetic group and was not a result of reassortment between A(H3N2) and A(H1N1) viruses. The results of the study highlight the necessity of close monitoring of resistance to existing antivirals as wells as the need for new therapeutics.

Streptococcus suis infections in humans: the Chinese experience and the situation in North America.

Abstract: Infections caused by Streptococcus suis are considered a global problem in the swine industry. In this animal species, S. suis is associated with septicemia, meningitis, endocarditis, arthritis and, occasionally, other infections. Moreover, it is an agent of zoonosis that afflicts people in close contact with infected pigs or pork-derived products. Although sporadic cases of S. suis infection in humans have been reported, a large outbreak due to S. suis serotype 2 emerged in the summer of 2005 in Sichuan, China. A similar outbreak was observed in another Chinese province in 1998. Symptoms reported in these two outbreaks include high fever, malaise, nausea and vomiting, followed by nervous symptoms, subcutaneous hemorrhage, septic shock and coma in severe cases. The increased severity of S. suis infections in humans, such as a shorter incubation time, more rapid disease progression and higher rate of mortality, underscores the critical need to better understand the factors associated with pathogenesis of S. suis infection. From the 35 capsular serotypes currently known, serotype 2 is considered the most virulent and frequently isolated in both swine and humans. Here, we review the epidemiological, clinical and immunopathological features of S. suis infection in humans.

In Vitro and In Vivo Activities of Synthetic Trioxolanes against Major Human Schistosome Species

Abstract: Schistosomiasis is a parasitic disease that remains of considerable public health significance in tropical and subtropical environments. Since the mainstay of schistosomiasis control is chemotherapy with a single drug, praziquantel, drug resistance is a concern. Here, we present new data on the antischistosomal properties of representative synthetic 1,2,4-trioxolanes (OZs). Exposure of adult Schistosoma mansoni for 24 h to a medium containing 20 μg/ml OZ209 reduced worm motor activity, induced tegumental alterations, and killed worms within 72 h. While exposure of S. mansoni to OZ78 had no apparent effect, addition of hemin reduced worm motor activity and caused tegumental damage. Administration of single 200-mg/kg of body weight oral doses of OZ78, OZ209, and OZ288 to mice harboring a juvenile S. mansoni infection resulted in worm burden reductions of 82.0 to 95.4%. In the adult infection model in mice, single 400-mg/kg doses of these compounds resulted in a maximum total worm burden reduction of 52.2%. High worm burden reductions (71.7 to 86.5%) were observed after administration of single 200-mg/kg doses of OZ78 and OZ288 to hamsters infected with either juvenile or adult S. mansoni. A single 200-mg/kg dose of OZ78 to hamsters infected with adult Schistosoma japonicum resulted in total and female worm burden reductions of 94.2 to 100%. Our results, along with the low toxicity, metabolic stability, and good pharmacokinetic properties of the OZs, indicate the potential for the development of novel broad-spectrum antischistosomal OZ drug candidates.

Health Effects of Exposure to Natural Arsenic in Groundwater and Coal in China: An Overview of Occurrence

Abstract: Between 2001 and 2005, 21,155 of 445,638 wells in 20,517 villages in 292 counties in 16 provinces from China, or 5% of wells, were found to contain > 50 μg/L arsenic (As) by field testing with the Merck As kit. We achieved quality assurance of analysis of at least 10% of the wells containing > 50 μg/L As using hydride generation atomic fluorescence spectrometry and silver dithiodicarbomate spectrometry. Our best estimate of the population exposed to > 50 μg/L As in drinking water was 582,769. This is probably an underestimate for China because of the limited area surveyed. In a survey of 135,492 individuals in eight provinces, we used the National Diagnosis Standard for Endemic Arsenicosis and identified 10,096 cases of arsenicosis with various degrees of skin lesions. The arsenicosis occurrence rate of 7.5% is likely an overestimate, because the survey focused more on known and suspected endemic areas of arsenicosis. The occurrence of arsenicosis correlates positively with the percentage of wells containing > 50 μg/L As, or at a ratio of 1 to 5%. Based on both the amount of As in well water and the rate of occurrence of arsenicosis, Shanxi province, Inner Mongolia autonomous region, and Jilin province are the top three areas in China as of 2005 for exposure to endemic As from drinking water. Our survey also identified exposure to high levels of As from wells in several provinces and from the indoor burning of coal containing high levels of As in Shaanxi province. These areas, however, have not had any reports of previous arsenicosis endemics. In the endemic areas, the average rate of occurrence of arsenicosis at advanced stages was 1.2%, possibly because of a long exposure time of > 20 years; the rate of occurrence increased to 2.7% when we included a high dose of As exposure from the indoor burning of coal. Mitigation to reduce As exposure remains a challenge in rural China.

The Chinese free antiretroviral treatment program: challenges and responses

Abstract: To respond to the HIV/AIDS epidemic in China, the National Center for AIDS/STD Control and Prevention established the Division of Treatment and Care in late 2001 The pilot for the National Free ART Program began in Henan Province in 2002, and the program fully began in 2003 Treatment efforts initially focused on patients infected through illicit blood and plasma donation in the mid-1990s and subsequently expanded to include HIV-infected injection drug users, commercial sex workers, pregnant women, and children The National Free ART Database was established in late 2004, and includes data on current patients and those treated before 2004 Over 31 000 adult and pediatric patients have been treated thus far Challenges for the program include integration of drug treatment services with ART, an under-resourced health care system, co-infections, stigma, discrimination, drug resistance, and procurement of second-line ART The merging of national treatment and care, epidemiologic, and drug resistance databases will be critical for a better understanding of the epidemic, for earlier identification of patients requiring ART, and for improved patient follow-up The Free ART Program has made considerable progress in providing the necessary care and treatment for HIV-infected people in China and has strong government support for continued improvement and expansion

VFDB 2008 release: an enhanced web-based resource for comparative pathogenomics

Abstract: Virulence factor database (VFDB) was set up in 2004 dedicated for providing current knowledge of virulence factors (VFs) from various medical significant bacterial pathogens to facilitate pathogenomic research. Nowadays, complete genome sequences of almost all the major pathogenic microbes have been determined, which makes comparative genomics a powerful approach for uncovering novel virulence determinants and hidden aspects of pathogenesis. VFDB was therefore upgraded to present the enormous diversity of bacterial genomes in terms of virulence genes and their organization. The VFDB 2008 release includes the following new features; (i) detailed tabular comparison of virulence composition of a given genome with other genomes of the same genus, (ii) multiple alignments and statistical analysis of homologous VFs and (iii) graphical comparison of genomic organizations of virulence genes. Comparative analysis of the numerous VFs will improve our understanding of the nature and evolution of virulence, as well as the development of new therapeutic and preventive strategies. VFDB 2008 release offers more user-friendly tools for comparative pathogenomics and it is publicly accessible at http://www.mgc.ac.cn/VFs/.

Selenium Level and Cognitive Function in Rural Elderly Chinese

Abstract: Selenium is a trace element associated with antioxidant activity and is considered to be a protective agent against free radicals through enhanced enzyme activity. Studies on selenium and cognitive function or Alzheimer's disease have yielded inconsistent results. A cross-sectional survey of 2,000 rural Chinese aged 65 years or older from two provinces in the People's Republic of China was conducted from December 2003 to May 2005 by use of the Community Screening Instrument for Dementia, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test, the Indiana University Story Recall Test, the Animal Fluency Test, and the Indiana University Token Test. Over 70% of the study participants have lived in the same village since birth. Nail samples were collected and analyzed for selenium contents. Analysis-of-covariance models were used to estimate the association between quintile selenium levels measured in nail samples and cognitive test scores, with adjustment for other covariates. Lower selenium levels measured in nail samples were significantly associated with lower cognitive scores (p < 0.0087 for all tests) except the Animal Fluency Test (p = 0.4378). A dose-response effect of selenium quintiles was also seen for those significant associations. Results in this geographically stable cohort support the hypothesis that a lifelong low selenium level is associated with lower cognitive function.

Effectiveness of first eight methadone maintenance treatment clinics in China

Abstract: Objective: To evaluate the effectiveness of the first phase of eight methadone maintenance treatment (MMT) clinics in China. Design: Repeated cross-sectional surveys. Methods: Three surveys of clients attending the first phase of eight MMT clinics were carried out at entry, and 6 and 12 months after enrolment. Drug using behaviours, drugrelated criminal activity, and relationships with families were compared for the three periods. Blood specimen were collected and tested for HIV for each client at entry, and HIV-negative clients were re-tested after 12 months. Results: A total of 585, 609 and 468 clients participated in the first, second and third surveys,respectively. The proportion of clients who injecteddrugs reduced from 69.1to 8.9 and 8.8%, and the frequency of injection in the past month had reduced from 90 times per month to twice per month, employment increased from 22.9 to 43.2 and 40.6%, and self-reported criminal behaviours reduced from 20.7 to 3.6 and 3.8% in the three surveys. By the third survey, 65.8% of clients reported a harmonious relationship with families, an increase from 46.8% at entry, and 95.9% of clients were satisfied with MMT services. Eight HIV seroconversions were found among 1153 clients during 12 months. Conclusion: The study demonstrated that the first phase MMT contributed to a reduction in drug use, drug injecting behaviours, drug-related criminal behaviours, HIV infections, and improved relationships within families among heroin users who participated in the MMT programme. MMT needs to be scaled up nationwide rapidly with improved services. 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occurrence of Strongyloides stercoralis in Yunnan Province, China, and Comparison of Diagnostic Methods

Abstract: Background Strongyloides stercoralis is a neglected soil-transmitted helminth species, and there is a lack of parasitologic and epidemiologic data pertaining to this parasite in China and elsewhere. We studied the local occurrence of S. stercoralis in a village in Yunnan province, China, and comparatively assessed the performance of different diagnostic methods. Methodology/Principal Findings Multiple stool samples from a random population sample were subjected to the Kato-Katz method, an ether-concentration technique, the Koga agar plate method, and the Baermann technique. Among 180 participants who submitted at least 2 stool samples, we found a S. stercoralis prevalence of 11.7%. Males had a significantly higher prevalence than females (18.3% versus 6.1%, p = 0.011), and infections were absent in individuals <15 years of age. Infections were only detected by the Baermann (highest sensitivity) and the Koga agar plate method, but neither with the Kato-Katz nor an ether-concentration technique. The examination of 3 stool samples rather than a single one resulted in the detection of 62% and 100% more infections when employing the Koga agar plate and the Baermann technique, respectively. The use of a mathematical model revealed a ‘true’ S. stercoralis prevalence in the current setting of up to 16.3%. Conclusions/Significance We conclude that S. stercoralis is endemic in the southern part of Yunnan province and that differential diagnosis and integrated control of intestinal helminth infections needs more pointed emphasis in rural China.

Setting international standards for verbal autopsy

Abstract: In many countries most deaths occur at home. Such countries often have civil registration systems that are limited or non-existent and therefore most deaths go unrecorded. Countries that cannot record the number of people who die or why they die cannot realize the full potential of their health systems. Health systems need reliable numbers and causes of death to function properly. But in these circumstances – in the absence of a complete picture of the population’s health – there are tools and techniques that can be used to obtain a fairly accurate representation of mortality trends. It takes a long time for countries to achieve a fully functioning civil registration system with medical certification of cause of death. In the meantime, more and more countries are using verbal autopsies (VA) to meet the information needs of their health systems.1 Verbal autopsy is a method of ascertaining probable causes of a death based on an interview with primary caregivers about the signs, symptoms and circumstances preceding that death. Different institutions have been researching and developing all aspects of the verbal autopsy process over the past two decades. We have also been working on this process, particularly to improve the questionnaire and the methods of analysing the resulting information. However, this has been a largely uncoordinated effort and one that has not reached consensus on what to cover in the interview and how to analyse the results, despite previous attempts to promote standard tools.2–4 The main consequence of this failure to agree on a standard approach is that now we cannot compare results from different countries. Currently, 36 Demographic Surveillance Sites (DSS) in 20 countries, the Sample Registration System (SRS) sites in India, and the Disease Surveillance Points (DSP) in China regularly use VA on a large scale, primarily to assess the causes-of-death structure of a defined population.1 Despite such a widespread use of verbal autopsy, we are unable to assess how consistent and reliable the data are. We are also unable to replicate procedures used to assign cause of death. Because verbal autopsy data sets are not widely shared, it is impossible to independently assess the quality of the assignment. Really useful validation studies are rare and verbal autopsy research is often done on small and non-representative samples of the population. The Millennium Development Goals (MDG) have put pressure on countries to track their progress in terms of population health. But to track that progress, countries need reliable numbers. In other words, they need a strong empirical basis for cause-specific mortality data. This is essential for evaluating the impact of disease control programmes and major global health initiatives. One way of dealing with incomplete information is to use models of mortality patterns. But cause-of-death information predicted by such models is not suitable for monitoring progress on what works and what does not.5 That leaves verbal autopsy as the only practical option in these countries and one that will play a key role in tracking progress towards the MDGs. Agreement on a core set of verbal autopsy tools (including technical standards and guidelines for their use) and their widespread adoption is needed now. To tackle this challenge, WHO led an expert group of researchers, data users, and other stakeholders, with sponsorship from the Health Metrics Network (HMN), in developing the necessary standards. The expert group systematically reviewed, debated, and condensed the accumulated experience and evidence from the most widely-used and validated procedures. This synthesis was done to achieve a high degree of consistency and comparability across verbal autopsy data sets. WHO has now published the results of this collaboration as: Verbal autopsy standards: ascertaining and attributing cause of death. The new standards include: Verbal autopsy questionnaires for three age groups (under four weeks; four weeks to 14 years; and 15 years and above); Cause-of-death certification and coding resources consistent with the International Classification of Diseases and Related health Problems, tenth revision (ICD-10); and A cause-of-death list for verbal autopsy prepared according to the ICD-10. The content is freely available on the WHO web site (www.who.int) and will be distributed in print; and incorporated into HMN’s resource kit. This is an important publication, but it is not the last word on verbal autopsy methods. Research is needed to validate these standard core procedures in several countries with different patterns of mortality. Other areas of research include further development of items included in questionnaires, and automated methods for assigning causes of death from verbal autopsy that remove human bias, while producing replicable and valid results.6 Operational issues need addressing: sampling methods and size when using verbal autopsy tools in research demographic surveillance sites; sample or sentinel registration; censuses; and household surveys. Research is also required when adapting these questionnaires to specific situations in different countries, taking into account relevant cultural, epidemiological and administrative considerations. WHO is working with partners to do this research and develop guidelines on these issues. With time, this guidance and experience will better inform the users of verbal autopsy, and improve the comparability and consistency of its results. For the present, we urge that these new international consensus standards become the foundation of verbal autopsy practices wherever possible. ■

Trends in the distribution of body mass index among Chinese adults, aged 20–45 years (1989–2000)

Abstract: To describe body mass index (BMI, in kg/m2) distribution patterns and trends among Chinese adults, aged 20–45 years (1989–2000). A descriptive, population-based study of BMI change. Chinese provinces (eight in 1989 and 1997; nine in 2000), representative of the household-based surveys (the China Health and Nutrition Survey, 1989–2000) using multistage, random cluster sampling, supplemented with annual household consumption survey data of the State Statistical Bureau (SSB). A total of 4527, 4507 and 4046 adults, aged 20–45 years, in 1989, 1997 and 2000, respectively. BMI (underweight: BMI<18.5 kg/m2 and overweight: BMI⩾25 kg/m2). Percentile curves for BMI in 1989 and 2000 were constructed by gender and age using the LMS (lambda, mu, sigma) method. Compared with 1989, the 2000 BMI distribution curves flattened at higher levels of BMI (men and women). There was a 13.7% increase in the proportion of men and a 7.9% increase of women who were overweight or obese with a resulting greater change in the annualized prevalence rate for men. This increase in the prevalence of overweight and obesity was far greater than the decrease (2.1% for men; 2.2% for women) in that of underweight. Age–gender-specific percentile curves showed BMI increases mainly among women, aged 35–45 years, and among men at all age groups. Chinese BMI dynamics show much greater rates of change among men, aged 20–45 years, than among women, with the increase among women concentrated between ages 35 and 45 years. These changes portend large shifts in other diet-related non-communicable diseases in China over the following decades. Controlling the increasing trends of BMI, especially in men, is an important public health problem facing China.

Safety and immunogenicity from a phase I trial of inactivated severe acute respiratory syndrome coronavirus vaccine.

Abstract: Background Emergence of severe acute respiratory syndrome (SARS) from the winter of 2002 to the spring of 2003 has caused a serious threat to public health. Methods To evaluate the safety and immunogenicity of the inactivated SARS coronavirus (SARS-CoV) vaccine, 36 subjects received two doses of 16 SARS-CoV units (SU) or 32 SU inactivated SARS-CoV vaccine, or placebo control. Results On day 42, the seroconversion reached 100% for both vaccine groups. On day 56, 100% of participants in the group receiving 16 SU and 91.1% in the group receiving 32 SU had seroconverted. The geometric mean titre of neutralizing antibody peaked 2 weeks after the second vaccination, but decreased 4 weeks later. Conclusion The inactivated vaccine was safe and well tolerated and can elicit SARS-CoV-specific neutralizing antibodies.

Molecular epidemiological analysis of Japanese encephalitis virus in China

Abstract: Sixty-two new Japanese encephalitis virus (JEV) isolates were obtained from mosquitoes, biting midges, human cerebrospinal fluid and human blood samples in China during 2002-2005. The E and prM genes were sequenced and phylogenetic analyses were performed with 38 JEV other isolates from China and 36 JEV strains from other countries. Phylogenetic trees based on the E and prM gene sequences were similar. The results indicate that: (i) recent JEV isolates from China are divided into two genotypes, genotype 1 and genotype 3; (ii) recent JEV isolates from China are grouped into the same clusters within genotypes 1 and 3; and (iii) genotype 1 JEV strains have been isolated in China since 1979, whilst genotype 3 JEV strains were isolated before the 1970s. The results suggest that genotype 1 JEV was introduced to China around 1979 and that JEV strains belonging to genotypes 1 and 3 circulate in China.

Phytate intake and molar ratios of phytate to zinc, iron and calcium in the diets of people in China

Abstract: To assess the phytate intake and molar ratios of phytate to calcium, iron and zinc in the diets of people in China. 2002 China Nationwide Nutrition and Health Survey is a cross-sectional nationwide representative survey on nutrition and health. The information on dietary intakes was collected using consecutive 3 days 24 h recall by trained interviewers. The data of 68 962 residents aged 2–101 years old from 132 counties were analyzed. The median daily dietary intake of phytate, calcium, iron and zinc were 1186, 338.1, 21.2 and 10.6 mg, respectively. Urban residents consumed less phytate (781 vs 1342 mg/day), more calcium (374.5 vs 324.1 mg/day) and comparable amounts of iron (21.1 vs 21.2 mg/day) and zinc (10.6 vs 10.6 mg/day) than their rural counterparts. A wide variation in phytate intake among residents from six areas was found, ranging from 648 to 1433 mg/day. The median molar ratios of phytate to calcium, iron, zinc and phytate × calcium/zinc were 0.22, 4.88, 11.1 and 89.0, respectively, with a large variation between urban and rural areas. The phytate:zinc molar ratios ranged from 6.2 to 14.2, whereas the phytate × calcium/zinc molar ratios were from 63.7 to 107.2. The proportion of subjects with ratios above the critical values of phytate to iron, phytate to calcium, phytate to zinc and phytate × calcium/zinc were 95.4, 43.7, 23.1 and 8.7%, respectively. All the phytate/mineral ratios of rural residents were higher than that of their urban counterparts. The dietary phytate intake of people in China was higher than those in Western developed countries and lower than those in developing countries. Phytate may impair the bioavailability of iron, calcium and zinc in the diets of people in China.

Acceptance of and barriers to voluntary HIV counselling and testing among adults in Guizhou province, China

Abstract: Objectives To find and compare the levels of acceptance of and barriers to voluntary counselling and testing (VCT) among adults in two different counties of Guizhou province, China, one in which the China CARES project was operating and the other in which it was not. Design A longitudinal design with two-stage cluster sampling was employed. Methods A total of 1012 participants were recruited in the two counties. All participants were interviewed, then given a coupon for free VCT after the interview. Participants were paid for returning the coupon within 2 months, whether tested or not. The uptake of VCT was measured within 2 months after the interview. Results The study found that the levels of HIV/AIDS knowledge and acceptability of VCT among the adults in both counties were low. Although 459 participants (43.5%) expressed an intent to use the VCT services, only 193 (16.5%) actually visited the VCT facilities, and only 42 (3.7%) actually took an HIV test within 2 months after the interview. The use of VCT was related to occupation, age, transportation difficulties, health status, ethnicity, and high-risk behaviors. The main barriers to HIV testing included perceiving oneself as low risk, fear of unsolicited disclosure, and fear of stigma and discrimination that would result from taking the test. Conclusion Education about HIV/AIDS and VCT needs to be improved, and levels of stigma and discrimination reduced, in order to enhance the uptake of VCT services, an essential step for the initiation of treatment.

Relationship Between Syphilis and HIV Infections Among Men Who Have Sex With Men in Beijing, China

Abstract: Little is known about risk of HIV and other STDs among men who have sex with men (MSM) in China. The objective was to survey the prevalence and risk factors of HIV and syphilis and evaluate correlation of two infections among MSM in the Chinese capital city. A community-based sample of 526 MSM was recruited in 2005 through Internet advertising community outreach and peer referring. Interviewer-administered interviews were conducted to collect information on demographics and sexual and other risk behaviors and blood samples were collected to test for syphilis and HIV infections. Seventeen (3.2%) participants were HIV seropositive and 59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants who did not have Beijing residence. Forty percent had >10 lifetime male sex partners and 28.8% reported having ever had sex with women. Consistent condom use with primary male sex partners ranged from 21% to 24% with nonprimary male sex partners from 35% to 42% and with female partners around 33%. Illicit drug use was not common; only 2.5% reported using Ecstasy or ketamine in the past 6 months. Multivariate logistic regression analyses demonstrated that >10 lifetime male sex partners were independently associated with seropositivity of both syphilis (OR 1.9; 95% CI 1.1-3.4) and HIV (OR 4.3; 95% CI 1.4 -13.6). In addition HIV infection is significantly associated with syphilis seropositivity (OR 3.8; 95% CI 1.3-10.8). High mobility multiple sexual partners and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM. (authors)

Cross-sectional surveys and subtype classification of human Blastocystis isolates from four epidemiological settings in China

Abstract: The prevalence and geographical distribution of the intestinal protozoa Blastocystis in humans across China is unknown, and the relative importance of different subtypes has yet to be investigated. We assessed the community prevalence and relative frequencies of different Blastocystis subtypes in four epidemiological settings in China, i.e., Shanghai municipality, Yongjia county (Zhejiang province), Eryuan county, and Menghai county (both Yunnan province). Blastocystis infection was detected with the culture method, and the subtype was identified with polymerase chain reaction using a set of subtype-specific primers. The prevalence at the four study settings was 1.9, 5.9, 18.4, and 32.6%, respectively. People aged greater than or equal to 60 years had a higher prevalence in the former two settings, Shanghai and Yongjia, whereas the highest infection rate was found among individuals aged 10-17 years in the latter two settings, Eryuan and Menghai. A higher prevalence was found in men in the former two settings but in women in the latter two settings. Five different Blastocystis subtypes were identified from the 192 isolates. Subtype 3 was the predominant type, followed by subtype 1. In conclusion, the epidemiology of Blastocystis varies across China.

Determinants of childhood overweight and obesity in China

Abstract: In order to investigate the determinants of childhood overweight and obesity in China, the prevalence of overweight (including obesity) was compared according to different dietary and physical activity patterns and parental body weight status. A total of 6826 children aged 7-17 years from the 2002 China National Nutrition and Health Survey were included in the study. Information for dietary intake was collected using three consecutive 24-h recalls by trained interviewers. The amounts of cooking oil and condiments consumed were weighed. An interview-administered 1-year physical activity questionnaire was used to collect physical activity information. The results showed that the heavier the parental bodyweight, the higher the overweight prevalence in children. The prevalence ratio increased if parent(s) were overweight and/or obese, up to 12.2 if both parents were obese. Overweight children consumed significantly more dietary energy, protein and fat, but less carbohydrate than their normal weight counterparts. On average, overweight children spent 0.5 h less on moderate/vigorous activities and 2.3 h more on low intensity activities per week. The following prevalence ratios were statistically significant: walking to and from school (0.6); moderate/vigorous activities > or =45 min/d (0.8); low intensity physical activities >2 h/d (1.3); the consumption of > or =25 g/d cooking oil (1.4); > or =200 g/d meat and meat products consumption (1.5); > or =100g/d dairy products (1.8). After adjustment for parental body weight status and socioeconomic status, only cooking oil consumption and walking to and from school remained significantly related to child overweight. In conclusion, parental weight status is an import-ant determinant. Fat intake, low intensity activities and active transport to/from school may be suitable entry points for overweight prevention among Chinese school children.

Factors associated with adherence to antiretroviral therapy among HIV/AIDS patients in rural China.

Abstract: Objective To assess the levels of adherence to antiretroviral therapy in a sample of HIV-infected patients from rural areas in China and to determine the factors associated with suboptimal adherence. Design A cross-sectional study was conducted on HIV-infected adults receiving free antiretroviral therapy (ART) in two project sites of China's Comprehensive AIDS Response program (China CARES). Methods Data on socio-demographic characteristics, ART regimens, HIV/AIDS knowledge, side effects, reasons for missing doses, substance abuse, self-efficacy, doctor-patient relations and health services information was collected through face-to-face interview. The adherence rate was calculated as the number of doses taken divided by the number prescribed over the past three days. Results A total of 181 patients participated in the study and 81.8% of them reported > or = 95% adherence on the previous three days. The most frequently reported reasons for missing doses were forgetfulness, being busy and antiretroviral drug side effects. In the multivariate analysis, patients' knowledge about side effects [odds ratio (OR) = 8.08, 95% confidence interval (CI) 2.63-24.81], belief towards ART (OR = 3.20, 95% CI: 1.24-8.26), having developed reminder tools of taking medication (OR = 3.49, 95% CI: 1.36-8.96) and patient' trust and confidence in his/her doctor (OR = 7.79, 95% CI: 1.26-48.95) were independently associated with adherence. Conclusion Regular ART adherence education and counseling, improved training on medication self-management skills, improved adherence monitoring and health care services should be priority strategies for improving adherence to ART among HIV/AIDS patients who receive free ART in rural China.