INTRODUCTIONThis study aimed to examine the attendance rates of post-discharge supervised rehabilitation as recommended by the multidisciplinary team at discharge among subacutely disabled adults and the barriers preventing adherence.

MATERIALS AND METHODSPatients were from a community hospital, aged 40 years or older. They had been assessed by a multidisciplinary team to benefit from rehabilitation after discharge, were mentally competent and communicative. We used a sequential qualitative-quantitative mixed methods study design. In the initial qualitative phase, we studied the patient-perceived barriers to adherence to rehabilitation using semi-structured interviews. Emerging themes were then analysed and used to develop a questionnaire to measure the extent of these barriers. In the subsequent quantitative phase, the questionnaire was used with telephone follow-up at 3, 6, 9 and 12 months after discharge.

RESULTSQualitative phase interviews (n = 41) revealed specific perceived financial, social, physical and health barriers. At the start of the quantitative phase (n = 70), 87.1% of the patients viewed rehabilitation as beneficial, but overall longitudinal attendance rate fell from 100% as inpatient to 20.3% at 3 months, 9.8% at 6 months, 6.3% at 9 months and 4.3% at 12 months. The prevalence of physical and social barriers were high initially but decreased with time. In contrast, the prevalence of financial and perceptual barriers increased with time.

CONCLUSIONAttendance of post-hospitalisation rehabilitation in Singapore is low. Self-perceived barriers to post-discharge rehabilitation attendance were functional, social, financial and perceptual, and their prevalence varied with time.

Adult ; Aged ; Aged, 80 and over ; Female ; Health Services Accessibility ; Hospitals, Community ; Humans ; Male ; Middle Aged ; Patient Compliance ; Patient Discharge ; Qualitative Research ; Rehabilitation ; Self Concept ; Surveys and Questionnaires ; Time Factors

Being an undisputed risk factor of cancer, air pollution is posing a huge threat to the health on human beings. In this article, we introduced the composition of air pollution, and the standards on air quality which was set by both World Health Organization and the Chinese government. We also summarized the most recent research findings on the association between air pollution and the risk of lung, breast, bladder and other major cancers.
Air Pollutants/toxicity* ; Air Pollution/adverse effects* ; Humans ; Neoplasms/epidemiology* ; Prevalence ; Research/trends* ; Risk Factors

Objective: To understand the spatial-temporal distribution of enterovirus infection in Macao Special Administrative Region, China, from 2011 to 2016. Methods: The incidence data of enterovirus infections in child care settings and primary schools in Macao during this period, which were confirmed by the Health Bureau, were used for the spatial-temporal analysis. Bernoulli model was used as probability model. Software SPSS 20.0 was used for descriptive statistics of the study cases, and software SaTScan 9.4.4 was used for spatial and temporal scanning. Finally, software Google Earth was used for visualization of geographical information. Results: A total of 330 enterovirus infection events were reported in Macao from 2011 to 2016. The infection event number was highest in 2014 (101, 30.6%), the infections mainly occurred during May to June. A case clustering area with a radius of 0.7 km (high rates) was observed in northeast of Macao from 2011 to 2013 (log likelihood rate=13.4, P<0.001, RR=1.4). Conclusion: The annual prevention of enterovirus infection and related health education should be started in February and March in Macao, and the key area is the northeast of Macao island.
Child ; Child Health ; China/epidemiology* ; Cluster Analysis ; Enterovirus Infections/epidemiology* ; Geography ; Humans ; Incidence ; Probability ; Software ; Spatio-Temporal Analysis

Objective: To understand the prevalence of major human parasitic diseases and related factors in Henan province. Methods: This stratified sampling survey was carried out according to the requirement of national survey protocol of major human parasitic diseases, 2014-2015. The prevalence of soil-transmitted helminths infection, taeniasis and intestinal protozoiasis were surveyed in 104 sites selected from 35 counties (districts) and the prevalence of clonorchiasis was surveyed in 62 sites selected from 37 townships. In each survey spot, 250 persons were surveyed. A total of 26 866 persons and 15 893 persons were surveyed. Modified Kato-Katz thick smear was used to detect the eggs of intestinal helminthes. Tube fecal culture was used to identify the species of hookworm. The Enterobius eggs were detected in children aged 3 to 6 years by using adhesive tape. The cyst and trophozoite of intestinal protozoa were examined with physiological saline direct smear method and iodine stain method. Results: The overall infestation rate of intestinal parasites was2.02% in Henan, and the worm infection rate was higher than protozoa infection rate. Fourteen kinds of intestinal parasites were found, including nematode (5 species), trematode (2 species), and protozoan (7 species). The infection rate of Enterobius vermicularis was highest, and Qinba Mountain ecological area had the highest infestation rate of intestinal parasites in 4 ecological areas of Henan. There was no significant difference in intestinal parasite infection rate between males and females (χ(2)=3.630, P=0.057), and the differences in intestinal parasite infection rate among different age groups had significance (χ(2)=124.783, P=0.000 1). The infection rate reached the peak in age group ≤9 years and the major parasite was Enterobius vermicularis. Furthermore the overall human infection rate of parasite showed a downward trend with the increase of educational level of the people (χ(2)=70.969, P=0.000 1), the differences had significance (χ(2)=120.118, P=0.000 1). For different populations, the infection rate of intestinal parasites was highest among preschool children. The infection of intestinal helminth was mainly mild, only 2 severe cases were detected. The infection rate of Clonorchis sinensis in urban residents was only 0.006%. Logistic regression analysis showed that being preschool children (χ(2)=15.765, P=0.000 1) and drinking well water (χ(2)=45.589, P=0.000 1) were the risk factors for intestinal parasite infection, and annual income per capita of farmers was the protective factor against intestinal parasite infection. The infection rates of protozoa and intestinal parasites decreased sharply compared with the results of previous two surveys, and the rate of intestinal helminth infection also dropped sharply compared with the second survey. The numbers of protozoa, helminth and intestinal parasites detected in this survey were all less than the numbers found in the previous two surveys. Conclusions: Compared the results of three surveys in Henan, the infection rate of protozoa and intestinal parasites showed a downward trend. The prevention and treatment of Enterobius vermicularis infection in children should be the key point of parasitic disease control in the future.
Animals ; Child ; Child, Preschool ; Clonorchiasis/epidemiology* ; Farmers ; Feces/parasitology* ; Female ; Helminthiasis/epidemiology* ; Helminths ; Humans ; Intestinal Diseases, Parasitic/parasitology* ; Male ; Prevalence ; Protective Factors ; Risk Factors ; Rural Population ; Soil Microbiology ; Surveys and Questionnaires ; Taeniasis/epidemiology* ; Trematode Infections/parasitology* ; Urban Population ; Water Wells

Objective: To understand the epidemiological and etiological characteristics of mumps in Fujian province, 2005-2017. Methods: All the reported mumps cases were collected through the National Notifiable Disease Information Management System, 2005-2017. Active search and interviews were conducted to collect the information on vaccination of mumps. Throat swab specimens were collected for cells culture, genotyping and gene sequence analysis on mumps virus (MuV). Results: A total of 83 959 cases of mumps were reported in Fujian province from 2005 to 2017, with an average annual incidence of 17.6 per 100 000. Since 2007, the incidence appeared increasing but then decreasing, reaching the lowest level (7.5 per 100 000), after the setup of a monitoring program. Annually, the onset time of mumps showed an obvious two seasonal peaks, one from April to July, with a weakening trend, and the other from October to January with a rising trend. Most of the mumps cases occurred among students, kindergarten and scattered children (89.2%, 5 814/6 517), children aged 5-9 years (38.8%, 2 527/6 517), with cases reported from every region. Program from the pathogen surveillance showed that the transmission chain of G genotype mumps virus did exist in Fujian. Data from the sequence analysis revealed that mutations in the nucleotide of G genotype strain in 2015 had led to mutation of 6 amino acid sites in the SH gene coding region, resulting in the differences appearing in both nucleotide and amino acid homology with type A vaccine strain. Conclusions: The incidence of mumps decreased annually, in Fujian. Prevention programs should focus on primary and secondary school students. In Fujian province, we also noticed the transmission chain of mumps G genotype with some amino acid mutations in the SH gene coding region. Monitor programs on both epidemiologic and etiology, should be strengthened.
Child ; Child, Preschool ; China/epidemiology* ; Genotype ; Humans ; Incidence ; Mumps/epidemiology* ; Mumps virus/pathogenicity* ; Phylogeny ; Sequence Analysis

Evidence-Based Medicine ; methods ; trends ; Humans

Humans ; Carcinoma, Mucoepidermoid/pathology* ; Thyroid Neoplasms/pathology* ; Eosinophilia/pathology*

Objective: Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs. We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data. Methods: The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province. The generalized estimation model was established by the GENMOD module of SAS, with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors, such as age, having insurance, HBV infection status, and history of anti-TB drug intake, as independent variables. Results: In this study, the probability of drug resistance at baseline level was 20.26%. Age, insurance, whether being co-infected with HBV, and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance. The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance. Conclusion: The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes, and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.
Antitubercular Agents/therapeutic use* ; Drug Resistance, Multiple, Bacterial ; Humans ; Models, Statistical ; Mycobacterium tuberculosis/drug effects* ; Risk Factors ; Sputum/microbiology* ; Surveys and Questionnaires ; Tuberculosis/epidemiology* ; Tuberculosis, Multidrug-Resistant

Objective: To estimate the incidence and mortality of kidney cancer in China in 2014, based on the cancer registration data. Data was collected through the National Central Cancer Registry (NCCR). Methods: All together, 449 cancer registries submitted required data on incidence and deaths of kidney cancer occurred in 2014, to the NCCR. After evaluation on the quality of data,339 registries were accepted for analysis and stratified by areas (urban/rural) and age groups. Combined with data from the National population in 2014, the nationwide incidence and mortality of kidney cancer were estimated. Data from the 2000 National census was used, and with Segi's population used for the rates of age-standardized incidence/mortality. Results: The qualified 339 cancer registries covered a total population of 288 243 347, with 144 061 915 in urban and 144 181 432 in rural areas. The percentage of morphologically verified cases and cases with only available death certificates were 72.70% and 1.27%, respectively. The mortality to incidence ratio was 0.37. The estimates of new cases were around 68 300 in whole China, in 2014, with a crude incidence rate as 4.99/100 000 (95%CI: 4.95/100 000-5.03/100 000). The age-standardized incidence rates of kidney cancer, estimated by China standard population (ASR China) and world standard population (ASR world) were 3.43/100 000 (95%CI: 3.40/100 000-3.46/100 000) and 3.40/100 000 (95%CI: 3.37/100 000- 3.43/100 000), respectively. The cumulative incidence rate of kidney cancer was 0.40% in China. The crude and ASR China incidence rates for males appeared as 6.09/100 000 (6.03/100 000-6.15/100 000) and 4.32/100 000 (4.28/100 000-4.36/100 000), respectively, whereas those were 3.84/100 000 (3.79/100 000-3.89/100 000) and 2.54/100 000 (2.50/100 000-2.58/100 000) for females. The crude and ASR China incidence rates in urban areas appeared as 6.60/100 000 (95%CI: 6.54/100 000-6.66/100 000) and 4.25/100 000 (95%CI: 4.21/100 000-4.29/100 000), respectively, whereas those were 3.05/100 000 (95%CI: 3.01/100 000-3.09/100 000) and 2.29/100 000 (95%CI: 2.25/100 000-2.33/100 000) in rural areas. The estimates of kidney cancer deaths were around 25 600 in the country, in 2014, with a crude mortality rate of 1.87/100 000 (95%CI: 1.85/100 000-1.89/100 000). The ASR China and ASR world mortality rates appeared as 1.16/100 000 (95%CI: 1.14/100 000-1.18/100 000) and 1.16/100 000(95%CI: 1.14/100 000-1.18/100 000), respectively, with a cumulative mortality rate (0-74 years old) of 0.12%. The crude and ASR China mortality rates were 2.31/100 000 (95%CI: 2.27/100 000- 2.35/100 000) and 1.52/100 000 (95%CI: 1.50/100 000-1.54/100 000) for males, respectively, whereas those were 1.41/100 000 (95%CI: 1.38/100 000-1.44/100 000) and 0.81/100 000 (95%CI: 0.79/100 000- 0.83/100 000) for females. The crude and ASR China mortality rates were 2.49/100 000 (95%CI: 2.45/100 000-2.53/100 000) and 1.42/100 000 (95%CI: 1.40/100 000-1.44/100 000) in urban areas, respectively, whereas those were 1.12/100 000 (95%CI: 1.09/100 000-1.15/100 000) and 0.78/100 000 (95%CI: 0.76/100 000-0.80/100 000) in the rural areas. Conclusions: Both the incidence and mortality of kidney cancer seemed low, in China. However, the incidence of kidney cancer had greatly increased. Our findings suggested that prevention and control strategies for kidney cancer should be focused on males in the urban areas.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China/epidemiology* ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Kidney Neoplasms/mortality* ; Male ; Middle Aged ; Registries ; Rural Population ; Urban Population ; Young Adult

Objective: To investigate the expression of MSI1 and HER2 in mammary Paget's disease, and the correlation between the expression levels of MSI1 and HER2 and the clinicopathologic characteristics and prognosis of the patients. Methods: Clinical data and paraffin-embedded specimens of 34 pairs of mammary Paget's disease and underlying breast cancer were collected at the Department of Pathology, Affiliated Lianyungang Oriental Hospital of Xuzhou Medical University from March 2011 to December 2019. Immunohistochemistry was used to detect the expression of MSI1 and HER2 in mammary Paget's disease and the accompanying breast cancer, and to analyze the correlation between the expression levels of MSI1 and HER2 and their clinicopathologic features, as well as their influence on prognosis. Results: In mammary Paget's disease, the positive rate of MSI1 was 91.2% (31/34) and the positive rate of HER2 was 88.2% (30/34); the expression of MSI1 and HER2 was positively correlated (P=0.001, r=0.530). The expression of MSI1 was positively correlated with menopausal status (r=0.372, P=0.030) and lymph node metastasis (r=0.450, P=0.008). HER2 expression was positively correlated with menopausal status (r=0.436, P=0.010), and negatively correlated with ER expression (r=-0.365, P=0.034). The co-expression of MSI1 and HER2 was positively correlated with age (r=0.347, P=0.044) and menopausal status (r=0.496, P=0.003), and negatively correlated with ER expression (r=-0.461, P=0.006). Conclusions: MSI1 and HER2 are highly expressed in mammary Paget's disease and their expression levels are positively correlated. The correlation analysis between clinicopathological features and prognosis suggests that both of them may be involved in the occurrence and development of mammary Paget's disease and are potential therapeutic targets for mammary Paget's disease.
Humans ; Female ; Paget's Disease, Mammary/pathology* ; Breast Neoplasms/pathology* ; Prognosis ; Lymphatic Metastasis ; Nerve Tissue Proteins/metabolism* ; RNA-Binding Proteins