OBJECTIVETo evaluate the vulnerability to floods in Guangdong province at district level.

METHODSData were collected from the sixth census, the 2010 Statistical Yearbook of Guangdong, the 2010 Health Statistics Yearbook of Guangdong and China Disease Prevention and Control information systems, etc. The weight of each indicator was determined based on subjective method and objective method respectively; and finally the results of the two methods were compared.

RESULTS13 indicators were selected for the assessment of vulnerability to floods, including 6 sensitivity indicators, 5 adaptability indicators and 2 exposure indicators. Indicators with large weight (subjective weight/objective weight) were the proportion of population older than 65 years old (0.31/0.30), the proportion of population older than 65 years old (0.16/0.23), infant mortality rate (0.18/0.20), the total Gross Domestic Product (GDP) per capita (0.33/0.21), the proportion of illiterate in the population older than 15 years old (0.19/0.28), history frequency of floods (0.75/0.75). The mean vulnerability index (VI) calculated by subjective method was 0.35 with the standard deviation of 0.10; the mean vulnerability index calculated by objective method was 0.31 with the standard deviation of 0.08. The two weighting methods showed consistent results of vulnerability index (ICC = 0.975, P < 0.01). VI of most districts dropped in the interval of 0.30 - 0.39. Districts with subjective VI > 0.50 or objective VI > 0.40 should pay more attention to floods, including parts of the coastal areas, Beijiang River Basin, the eastern tributary area of Dongjiang River and the northern part of Pearl River Delta. Dapu district of Meizhou (0.55/0.45), Dianbai district and Maogang district of Maoming (0.54/0.48) were most vulnerable. Districts of Heyuan, Dongguan, Zhaoqing and Huizhou were less vulnerable, Yuancheng district of Heyuan showed least vulnerable to floods (0.15/0.12) followed by Dongguan (0.18/0.16), Duanzhou district (0.18/0.16) and Guangning (0.17/0.15) district of Zhaoqing. The score of indicators differed among different level of vulnerability (P < 0.05).

CONCLUSIONDifferent regions of Guangdong province showed different vulnerability to floods, vulnerable areas should be priority in the prevention and control of floods.

China ; Climate ; Demography ; Disasters ; Floods ; Humans ; Risk Assessment ; Rivers

OBJECTIVETo study the characteristics of the effect of different temperatures on mortality of different cities through analyzing the relationship between mortality and meteorology of five Chinese cities.

METHODSWe get the demography and climate data of Beijing, Tianjin, Shanghai, Nanjing and Changsha cities from National Center of Disease Control and Prevention and Climate net respectively. Then we applied the R software and Distributed Lag Non-linear Models (DLNM) package to analyze our data and find the nonlinear and lag effects on mortality using DLNM.

RESULTSThe city of Beijing and Tianjin are located in the temperate zone. And the climate of Shanghai, Nanjing, Changsha belong to subtropical monsoon climate. When the daily mean temperature arrived 30°C and on lag 0 day, the values of relative risk of effect of high mean temperature on mortality in Nanjing (1.31, 95%CI: 1.21 - 1.41) and Changsha (1.25, 95%CI: 1.13 - 1.39) are larger than that in Beijing (1.18, 95%CI: 1.12 - 1.25), Tianjin (1.18, 95%CI: 1.10 - 1.26) and Shanghai(1.15, 95%CI: 1.06 - 1.24). While the relative risk of effect of low mean temperature on mortality is lower and lasts for a longer lag time. During the whole lag time, the relative risk of effect of the lowest daily mean temperature of each city on mortality in Tianjin, Changsha, Beijing, Nanjing, and Shanghai is 3.41, 95%CI: 1.60 - 7.27, 2.15, 95%CI: 1.11 - 4.15, 2.24, 95%CI: 1.12 - 4.48, 2.80, 95%CI: 1.75 - 4.48, 1.53, 95%CI: 1.12 - 2.03, respectively. The cumulative effect of mean temperature on mortality appears like a U-shape. When on lag 0-1 day, the value of relative risk of effect of extremely high temperature and the highest mean temperature on mortality is larger than 1. While the effect of low temperature on mortality becomes obvious after lag 2 days.

CONCLUSIONDepending on this research, extremely low temperature and the lowest mean temperature has a more obvious impact on mortality in the northern area than in the south. Extremely high temperature and the highest daily mean temperature is on the contrary. Meanwhile, different temperatures have different impacts on mortality in the same city: high temperature has an acute impact while there is a longer lag time in low temperature.

China ; Climate ; Humans ; Mortality ; Nonlinear Dynamics ; Temperature ; Urban Population

OBJECTIVETo analyze the incidence and mortality trends of female breast cancer in urban and rural areas of Beijing from 2004 to 2008.

METHODSThe incidence and mortality data of female breast cancer from 2004 to 2008 were sorted from Beijing Cancer Registry Database, including 15 527 new diagnosed cases and 3219 deceased cases in total, covering population 29 351 258 person years; among which 11 065 new cases and 2378 deceased cases were from urban areas, covering 17 877 128 person years and 4462 new diagnosed cases and 841 deceased cases were from rural areas, covering 11 474 130 person years. The incidence cases aged 25 and above were divided into 13 age groups by 5 years. The cases under 49 years (≤ 49) and over 49 years (> 49) were separately defined as premenopausal group and postmenopausal group. Incidence and mortality rates in each year, age-specific incidence and mortality rates in urban and rural areas in Beijing were calculated. The annual standard incidence and mortality rates were adjusted by world population constitution; and the incidence rates ratio in different years related to the place of residence, urban or rural were calculated. JoinPoint software was applied to analyze the incidence trend and calculated the annual percentage of changing (APC).

RESULTSThe age of female breast cancer patients in urban Beijing in 2004 was (55.83 ± 13.01), while it changed to (56.10 ± 12.80) in 2008, increasing by 0.27 years old. The proportion of the patients who were under 49 years declined from 38.32% (732/1910) in 2004 to 34.02% (894/2628) in 2008. While the average age of the patients in rural areas have improved 0.21 year old, from (52.15 ± 11.33) years old in 2004 to (52.36 ± 11.59) years old in 2008; and the proportion of the patients under 49 years also declined from 45.44% (314/691) in 2004 to 43.40% (454/1046) in 2008. From 2004 to 2008, the incidence and mortality rate of female breast cancer in urban areas of Beijing separately rose from 55.43/100 000 (1910/3 445 812) and 10.65/100 000 (367/3 445 812) to 70.70/100 000 (2628/3 717 436) and 15.01/100 000 (558/3 717 436). And in rural areas, those rates separately rose from 30.60/100 000 (691/2 257 953) and 5.54/100 000 (125/2 257 953) in 2004 to 44.78/100 000 (1046/2 336 040) and 7.49/100 000 (175/2 336 040) in 2008. After adjusting by world population constitution, the difference showed no statistical significance in mortality trend of female breast cancer in rural areas of Beijing (P > 0.05). In year 2004, the female breast cancer incidence rate ratio of urban to rural areas in Beijing fluctuated between 1.34 and 4.47, with the average ratio value at 1.81. In year 2008, the ratio value fluctuated between 1.15 and 2.37, with the average ratio value at 1.57. During 2004 and 2008, the peak age group of the female breast cancer incidence in urban areas was in 60 - 64 years old group, with the rate of 126.92/100 000 (998/786 300) whereas the mortality rate was increasing within aging. In rural areas the peak age groups of the incidence and mortality were separately in 50 - 54 and 80 - 84 years old groups, with the rate of 80.63/100 000 (793/983 516) and 29.17/100 000 (40/137 132) respectively.

CONCLUSIONThe incidence and mortality of breast cancer in urban areas in Beijing, as well as the incidence of breast cancer in rural areas in Beijing showed increasing trend annually. The gap in breast cancer incidence between rural and urban areas in Beijing was narrowing, while the incidence rate among different aging groups and the peak mortality rate showed significant difference between urban and rural areas in Beijing.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; epidemiology ; mortality ; China ; epidemiology ; Female ; Humans ; Incidence ; Middle Aged ; Survival Rate

OBJECTIVETo understand the characteristics of HIV/AIDS patients with late diagnosis and find the factors associated with late HIV detection.

METHODSHIV late diagnosed patients and early diagnosed patients, which were identified and classified by definition in advance, were selected from the case reporting database of HIV/AIDS Comprehensive Response Information Management System in eight counties of four provinces (Zhumadian, Nanyang, and Zhoukou of Hennan province; Liuzhou and Lingshan county of Guangxi autonomous region; Guangzhou and Shenzhen of Guangdong province; Dehong of Yunnan province) between January 1, 2009 and June 30, 2010. A total of 3912 eligible patients were investigated, including 2496 late diagnosis and 1416 early diagnosis. The structured questionnaires were used to obtain information on behaviors, HIV detection history and reason of late detection for all eligible HIV/AIDS patients. Late diagnosed patients were defined by CD4 T-cell counts less than 200 cells/mm(3) or diagnosis as AIDS within the reported year after the first HIV positive test. The univariate and multivariate logistic regression methods were used to analyze the characteristics of HIV/AIDS late diagnosed patients.

RESULTSOnly 14.2% (350/2469) of them have ever had the awareness of "to go for HIV testing", 68.8% (150/218)of which did not put it into practice within one month because of discrimination and stigma. Among those HIV late diagnosed patients without the awareness of "to go for HIV testing", the proportions of "never worried about HIV infection" or "never heard of AIDS" were 69.7% (1476/2116) and 18.1% (383/2116), respectively. When those HIV late diagnosed patients visited health settings because of AIDS related symptoms, only 40.0% (590/1475) of them received the HIV testing service. Furthermore, 54.5% (322/590) of those received HIV testing were not informed the results. Compared with early diagnosed patients, patients with late diagnosis were over 50 years old (OR = 4.14, 95%CI: 3.09 - 5.55), primary school education (OR = 1.29, 95%CI: 1.10 - 1.52) and illiteracy (OR = 2.15, 95%CI: 1.25 - 2.82), Routes of transmission from former illegal blood or plasma (OR = 2.91, 95%CI: 2.27 - 3.74) and transfusion of blood/blood products (OR = 2.79, 95%CI: 2.11 - 3.68). Late diagnosed patients were identified mainly from voluntary counseling and testing (45.4%, 1130/1528) and medical institutions (38.3%, 954/1469).

CONCLUSIONThe main reasons for late diagnosis of HIV infection are low initiative of HIV testing and discrimination and stigma. Furthermore, the low awareness of medical institutions to actively provide HIV testing affects the early diagnosis of HIV infections.

Acquired Immunodeficiency Syndrome ; diagnosis ; epidemiology ; Adult ; China ; epidemiology ; Counseling ; Delayed Diagnosis ; Female ; HIV Infections ; diagnosis ; epidemiology ; Humans ; Male ; Mass Screening ; Middle Aged ; Risk Factors

OBJECTIVETo investigate the effectiveness of psychosocial services provided by social workers in reducing dropout rate and increasing treatment dosage in methadone maintenance treatment (MMT) users.

METHODSFrom May in 2009 to April in 2010, 300 MMT users were recruited from three MMT clinics in Guangzhou, and were randomly allocated into the intervention group and the control groups. The control group (152 cases) received standard MMT services while the intervention group (148 cases) received additional services provided by social workers. Methadone dosage, dropout rate, perceptions toward MMT etc. were compared between the two groups.

RESULTSThe 1-month dropout rate of the control and intervention groups were 19.7% (30/152) and 6.8% (10/148) (P < 0.05) respectively; the 6-month dropout rate of the control and intervention groups were 75.5% (115/152) and 50.7% (75/148) (P < 0.05) respectively. The intervention group had higher average treatment dosage than the control group ((56.0 ± 21.2) vs (64.4 ± 23.1) ml/d, (58.0 ± 24.0) vs (66.1 ± 26.6) ml/d, P < 0.05). At 1-month and 6-month, the intervention group had higher scores of MMT-related perception ((1.26 ± 0.68) vs (1.84 ± 0.95), (1.55 ± 0.83) vs (2.44 ± 1.23), P < 0.05), self-efficacy of maintenance ((3.68 ± 1.33) vs (4.20 ± 1.05), (3.80 ± 1.38) vs (4.43 ± 0.79), P < 0.05) and satisfaction toward MMT((4.08 ± 0.54) vs (4.15 ± 0.60), (4.01 ± 0.67) vs (4.31 ± 0.64), P < 0.05) as compared to the control group. The reverse was true for the score of negative experiences ((1.05 ± 0.86) vs (0.96 ± 0.92), (1.46 ± 0.87) vs (1.11 ± 1.07), P < 0.05).

CONCLUSIONThe psychosocial interventions provided by social workers were effective in reducing dropout rate, increasing treatment dosage and improving cognitions of MMT users.

Adult ; Female ; Heroin Dependence ; drug therapy ; Humans ; Male ; Methadone ; administration & dosage ; therapeutic use ; Opiate Substitution Treatment ; Patient Compliance ; Social Work ; Substance Abuse Treatment Centers ; Treatment Outcome

OBJECTIVETo describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients.

METHODSThis study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients.

RESULTSOf the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05).

CONCLUSIONIllicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients' continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.

Adult ; Female ; Humans ; Longitudinal Studies ; Male ; Methadone ; administration & dosage ; therapeutic use ; Patient Compliance ; statistics & numerical data ; Substance-Related Disorders ; drug therapy ; Treatment Outcome

OBJECTIVETo study the prevalence of primary HIV drug resistance in antiretroviral therapy (ART) areas of Henan province.

METHODSA total of 121 drug-naive long-term infected individuals and 154 patients with newly diagnosed from January 2011 to March 2012 were recruited, the questionnaires were surveyed and whole blood were collected to analyze the CD4(+)T cell counts and viral load. In-house method for genotypic resistance test was determined in those with viral load > 1000 copies/ml samples, the differences of demographic characteristics, immunological parameters and primary drug resistance were compared between the two groups.

RESULTSA total of 121 cases of long-term individuals who had infected (12.50 ± 3.21) years were mainly previous paid blood donors, and the age was (46.61 ± 9.32) years old. The infection route of the newly diagnosed were diversity, including blood, sexual transmission and others, the cases were 73, 73, 8, respectively, the confirmatory year was (0.91 ± 0.28) years, and average age was (22.21 ± 3.11) years old. The difference were statistically significant in the route of transmission, age and infection time from demographic analysis of the two groups (P < 0.05). The absolute M(P(25)-P(75)) counts of CD4(+)T lymphocytes of long-term group was 322 (217 - 422) cell/µl, which was lower than the newly diagnosed was 434(308 - 578) cell/µl (P < 0.05), and viral load was 4.0 (2.96 - 4.64) copies/ml, 3.77 (2.94 - 4.53) copies/ml, the difference was not significant (P > 0.05). The prevalence of primary drug resistance in long-term group and newly diagnosed was 5.79% (7/121), 9.09% (14/154), respectively, and the difference was statistically different (P < 0.05), and one PI-resistant strain was found in the newly diagnosed group.

CONCLUSIONThe primary drug resistant strains in untreated patients were found in Henan province of ART areas, and there was difference in degree of resistance between long-term infected individuals and newly diagnosed.

Adult ; Anti-HIV Agents ; pharmacology ; therapeutic use ; China ; epidemiology ; Drug Resistance, Viral ; Female ; HIV Infections ; drug therapy ; epidemiology ; virology ; Humans ; Male ; Middle Aged ; Viral Load

OBJECTIVETo analyze the molecular epidemiological characteristics of HIV-1 subtype CRF01_AE strains being prevailed among HIV/AIDS in Zhejiang province in 2009.

METHODSA total of 303 subjects were identified by stratified random sampling among HIV infected individuals in Zhejiang province in 2009. Gag fragments of the HIV-1 strains were amplified by nested polymerase chain reaction from the DNA extracted from whole blood of HIV-1 infected individuals. PCR products were sequenced and analyzed by phylogenetic method.

RESULTSA total of 132 HIV-1 subtype CRF01_AE sequences were identified from the 225 samples that sequenced successfully, accounting for 58.67% (132/225). A total of 90.91% (120/132) CRF01_AE strains infected HIV/AIDS were transmitted mainly by sexual contacts. A total of 65.91% (87/132) of the cases infected by heterosexual route and 25.00% (33/132) by homosexual route. There were three main clusters in the phylogenetic tree. Pairwise DNA distance within three groups was 0.037 ± 0.011, 0.034 ± 0.008 and 0.047 ± 0.010, which has statistical significance (P < 0.05). Distribution of the sequence of homosexual behavior infected individuals was relatively concentrated in clusters one (96.97%, 32/33), and crossed with heterosexual behavior infectors, and presented the close relations with strains from Jiangsu province, Zhengzhou of Henan province, Liaoning province, Shijiazhuang of Hebei province.

CONCLUSIONThe CRF01_AE strains were the dominant subtypes among HIV infected individuals. The majority of the CRF01_AE infected cases had high risk sexual behavior. The heterosexual infected cases were more than homosexual cases. The circulating status of CRF01_AE strains in homosexual population was relatively independent, but also had evidence of transmission from man who have sex with man to heterosexual population.

Acquired Immunodeficiency Syndrome ; epidemiology ; virology ; Adolescent ; Adult ; China ; epidemiology ; Female ; Genetic Variation ; HIV-1 ; classification ; genetics ; Humans ; Male ; Middle Aged ; Molecular Epidemiology ; Phylogeny ; Young Adult

OBJECTIVETo investigate drug resistance status in patients with highly active antiretroviral therapy (HAART) in Shandong province.

METHODSA total of 758 patients were separated from the anticoagulatory whole blood during May and October in 2011. The entire protease gene and part of the reverse transcriptase gene were amplified by RT-PCR and nest-PCR in the samples with viral load larger than 1000 copies/ml, then sequenced the gene fragments. Mutation of drug resistant gene and drug susceptibility was analyzed by the online tool HIV db program developed by Stanford University.

RESULTSThe rate of virologic failure in patients was 9.1% (69/758). A total of 53 gene sequences that acquired were used for genotypic resistance analysis. A total of 23 patients were indicated drug resistance with the total of 3.1% (23/742). Drug resistance rates of nucleotide reverse transcriptase inhibitor (NRTI) and non-NRTI(NNRTI) were 2.4% (18/742) and 3.0% (22/742), respectively, and the primary mutation types of drug resistance were M184V and Y181C for NRTI and NNRTI, with no resistance to protease inhibitor (PI). In the 23 patients indicated drug resistance, 78.3% (18/23) were NRTI resistance, 95.7% (22/23) were NNRTI resistance and 73.9% (17/23) dual NRTI and NNRTI resistance.

CONCLUSIONThe presence of drug resistant gene in HIV strains among AIDS patients with HAART in Shandong province was at low level, but mutation diversity was found in drug resistant gene.

Acquired Immunodeficiency Syndrome ; drug therapy ; virology ; Adolescent ; Adult ; Aged ; Antiretroviral Therapy, Highly Active ; Drug Resistance, Viral ; genetics ; Female ; Genes, Viral ; Genotype ; HIV-1 ; drug effects ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Sequence Analysis ; Viral Load ; Young Adult

OBJECTIVETo investigate the sexual partners and sexual behaviors among HIV-infected men who have sex with men (MSM) and to examine the factors related with high risky sexual behaviors.

METHODSA total of 200 HIV-positive MSM participants were recruited using "snowballing" sampling from June to December in 2010 in Shanghai. Participants completed the questionnaire which included social demographic characteristics, sexual behaviors with male and female sexual partners in the past 6 months, alcohol consumption, alkyl nitrite use, illegal substances use and depression and anxiety symptoms, etc.

RESULTSOf the 200 HIV-positive MSM participants, 45.0% (90/200) of participants' ages ranged from 26 to 35, and 30.0% (60/200) of the respondents were married. Participants living with a male partner and living with a female partner accounted for 17.0% (34/200) and 9.0% (18/200), respectively. A total of 57.5% (115/200) had anal sex with male and 13.5% (27/200) had sex with female in the past 6 months. The percentage of participants who had 2 or more male anal sexual partners was 36.5% (73/200). During last six months, participants who didn't use condom consistently during anal sexes with men and vaginal sexes with women accounted for 16.0% (32/200) and 3.5% (7/200), respectively. The rate of risky sexual behaviors (any unprotected sex with male or female) during past 6 months was 17.5% (35/200). Factors associated with risky sexual behaviors included getting drunk before last sex (OR = 4.270, 90%CI: 1.676 - 10.881), using alkyl nitrite (OR = 3.397, 90%CI: 1.564 - 7.377) and having casual male partners (OR = 2.951, 90%CI: 1.278 - 5.252) during past six months, getting HIV infection diagnosis in half year (OR = 4.181, 90%CI: 1.939 - 9.013).

CONCLUSIONThere were high rates of unprotected anal sex with men and vaginal sex with women among HIV positive MSM and alcohol and substance use before sex could increase the risk of having unprotected sex.

Adult ; China ; epidemiology ; HIV Infections ; epidemiology ; psychology ; Homosexuality, Male ; Humans ; Male ; Risk Factors ; Risk-Taking ; Surveys and Questionnaires ; Unsafe Sex ; statistics & numerical data