50 years (ORs=1.39,95% CI:1.22～1.57) and oral contraceptive use (Adjusted ORs=2.12,95% CI:1.24～3.62) were associated with increase in breast cancer risk while the summary OR based on number of full-term pregnancy ≥1 (Adjusted ORs=0.63,95% CI:0.60～0.68) and breastfed (ORs=0.76,95% CI:0.64～0.90) indicated no association with breast cancer risk. Conclusions Decreasing benign breast disease, advocating breastfed and examining high risk population will be the effective measures to control breast cancer in women.

Objective To observe the effect of alteplase intra-arterial thrombolysis combined with continuous monitoring of transcranial Doppler (TCD) in patients with acute cerebral infarction. Methods Fifty-four patients with acute cerebral infarction were divided into TCD group and control group by random digits table method. The patients of 2 groups were given alteplase intra-arterial thrombolysis, and the patients of TCD groups were combined with continuous monitoring of TCD. The degree of clinical neurologic impairment was evaluated by National Institutes of Health stroke scale (NIHSS) and Barthel index (BI). The condition of vascular recanalization was evaluated by the change of blood flow signal of TCD. CT was performed within 1 d after thrombolysis to detect intracranial hemorrhage and other adverse reaction. The degree of clinical neurologic impairment, blood vessel recanalization rate after thrombolysis and recanalization time and incidence of intracranial hemorrhage and other adverse reaction were compared between 2 groups. Results There were no statistical difference in NIHSS score before thrombolysis and 1 h after thrombolysis between 2 groups (P>0.05). The NIHSS scores 7 and 30 d after thrombolysis in TCD group were significantly lower than those in control group:(8.1 ± 4.9) scores vs. (12.1 ± 4.2) scores and (6.9 ± 3.1) scores vs. (10.9 ± 3.9) scores, there were statistical differences (P<0.05). The BI scores 7 and 30 d after thrombolysis in TCD group were significantly higher than those in control group: (78.5 ± 13.8) scores vs. (60.8 ± 12.4) scores and (82.6 ± 13.5) scores vs. (63.2 ± 12.9) scores, and there were statistical differences (P<0.05). The blood vessel recanalization rate 24 h after thrombolysis in TCD group was significantly higher than that in control group: 70.4% (19/27) vs. 44.4% (12/27), the recanalization time after thrombolysis was significantly shorter than that in control group: (36.4 ± 9.5) min vs. (58.5 ± 12.4) min, and there were statistical differences (P<0.05). No adverse reaction like intracranial hemorrhage and so on was found by CT detection within 1 d after thrombolysis in the 2 groups. Conclusions Alteplase intra-arterial thrombolysis combined with continuous monitoring of TCD in acute cerebral infarction has good curative effect, and no obvious adverse reaction.

This study explored a novel systemic community-based model for detecting and managing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were interviewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Counseling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some existing problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the community-based VCT/PITC through 4 paths. Then we establish the community HIV health care center constituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.

CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai, Queshan, Shenqiu and Weishi) were included in the study. Pearson correlation and receiver operating characteristic (ROC) were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (P<0.01). An overall positive correlation was noted between TLC and CD4 count (pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001). The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm(3) could predict CD4 < 200 cells/mm(3) with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count < 200 cells/mm3 was a TLC ≤ 1300 cells/mm(3), with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change (r=0.77, P=0.0001) at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm(3). TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.

This study explored a novel systemic community-based model for detecting and managing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were interviewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Counseling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some existing problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the community-based VCT/PITC through 4 paths. Then we establish the community HIV health care center constituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.
Acquired Immunodeficiency Syndrome ; diagnosis ; drug therapy ; China ; Community Health Services ; HIV Infections ; diagnosis ; drug therapy ; Health Knowledge, Attitudes, Practice ; Humans

Objective:To determine the reliability and validity of the Chinese version of Fagerstrom Test for Nicotine Dependence (FrND) scale among smoking male inpatients with schizophrenia.Methods:Two hundred and twenty smoking male inpatients,who met criteria for schizophrenia of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ),were consecutively included.FTND scale and Russell's Reasons for Smoking Questionnaire (RRSQ) were used to assess subjects'severity of nicotine dependence and addiction score of the dimension of reason for smoking,respectively.According to the principle of voluntariness,37 subjects were selected and re-assessed with FTND scale after two-week interval.Reliability,correlation and factor analyses were used to examine the reliability and validity.Results:The Cronbach α (internal consistency) and two-week re-test reliability coefficients of FTND scale were 0.68 and 0.72 (P ＜0.01),respectively.The criterion related validity coefficient with addiction score of RRSQ was 0.53 (P ＜0.01).Two common factors were abstracted from the scale factor analysis,accounting for 52.4％ of the total variance.There were statistically significant differences between patients with different duration of illness,number of hospitalizations and age of smoking initiation (P ＜0.05).Conclusion:The Chinese version of FTND scale for smoking male inpatients with schizophrenia has a relatively low internal consistency and good re-test reliability,criterion related validity,construct validity and empirical validity.

CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression,but it is not widely available in resource-limited settings.This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART,and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART.A retrospective study was performed,and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai,Queshan,Shenqiu and Weishi) were included in the study.Pearson correlation and receiver operating characteristic (ROC) were used.TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (P＜0.01).An overall positive correlation was noted between TLC and CD4 count (pre-HAART,r=0.73,P=0.0001; follow-up HAART,r=0.56,P=0.0001).The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm3 could predict CD4 ＜ 200 cells/mm3 with a sensitivity of 71.12％,specificity of 66.35％at pre-HAART.After 12-month HAART,the optimum prediction for CD4 count ＜ 200 cells/mm3 was a TLC ≤ 1300 cells/mm3,with a sensitivity of 63.27％,and a specificity of 74.84％.Further finding indicated that TLC change was positively correlated to CD4 change (r=0.77,P=0.0001) at the time point of 12- month treatment,and the best prediction point of TLC change for CD4 increasing was 135 cells/mm3.TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.

Objective To assess the clinical value of lung ultrasound (LUS) B-lines in diagnosis of rheumatoid arthritis (RA) associated interstitial lung diseases (RA-ILD).Methods Forty-five consecutive patients with RA who underwent a high resolution computed tomography (HRCT) scan of the chest,were also examined by LUS for detection of B-lines(within 1 month independently in all patients).The B-lines score was obtained by summing the number of total 50 inter-costal spaces (ICSs) of chest wall.Pulmonary fibrosis was quantified by HRCT as previously described by the 30-point Warrick score.Results B-lines score significantly correlated with the Warrick score [(r=0.778,95％CI(0.627,0.872),P＜0.05].Receiver operating characteristic (ROC) curve confirmed that B-lines cut-off point 77[sensitivity of 100％,specificity of 64.3％ respectively,area under curve [AUC] =0.86,95％CI(0.724,0.945)] and 108[sensitivity of 90％,specificity of 88.6％ respectively,AUC=0.879,95％CI(0.747,0.957)] had an optimal power to discriminate mild (Warrick score＜8) and severe fibrosis (Warrick score＞15):Conclusion The data confirm that LUS is a useful technique to identify ILD in RA.In RA-ILD,B-lines correlate significantly with HRCT and are able to identify mild and severe degree of fibrosis.LUS is a promising non-invasive and non-ionizing strategy for screening RA-ILD.

Objective To understand the prevalence of domestic violence and the correlation between domestic violence and posttraumatic stress disorder (PTSD) so as to improve the mental health status of women in Wuhan city of China.Methods A cross-sectional study was conducted in the community health service center in Wuhan.Participants were women who came to the center for gynecological examination.Data on general condition,social support,injury,epidemiological characteristics of domestic violence and PTSD were gathered.Chi-square,student-t and CochranArmitage trend tests were employed to compare the distribution of each characteristic variable between PTSD and non-PTSD group.Binary logistic regression was used to analyze the correlation between domestic violence and PTSD.Results A total of 1 015 women were effectively surveyed.The life-time incidence rates of events related to domestic,psychological,physical and sexual violence were 29.36％,28.28％,6.60％ and 3.55％,respectively.The overall prevalence rate of PTSD was 4.73％.Women who suffered from domestic violence had higher risk of PTSD (OR=2.11,95％ CI:1.04-4.29) than those who never experiencing domestic violence.Women who suffered from psychological or physical violence were 5.06 times more likely to suffer from PTSD (OR=5.06,95％CI:1.91-13.42).Conclusion A strong correlation between domestic violence and PTSD was seen.Victims who suffered from domestic violence should be provided with psychological counseling to reduce the risk of PTSD.

OBJECTIVETo analyze the prevalence and characteristics of childhood adverse experiences among adults aged 18-59 years and understand the association between childhood adverse experiences and risk of chronic diseases in adulthood.

METHODSA cross-sectional study was conducted with a questionnaire among adults aged 18-59 years selected through cluster random sampling from 3 communities in Macheng, Hubei province. Uinivariate and multivariate logistic regression analyses were conducted to evaluate the association between adverse experiences in childhood and the risk of chronic diseases in adulthood.

RESULTSA total of 1 767 adults aged 18-59 years were surveyed and 1 501 valid questionnaires were returned. The average age was (36.32± 10.20) years for males and (35.72±9.08) years for females. The prevalence rate of childhood adverse experiences was 66.22%. The risk of chronic disease in adults increased with the increase of the score indicating childhood adverse experiences (Z=-5.902 1, P<0.000 1). Multivariate logistic regression analysis showed that being physically abused (OR=1.93, 95% CI: 1.41-2.64), substance abuse in family (OR=2.82, 95% CI: 1.16-6.80), being bullied (OR=2.59, 95% CI: 1.39-4.80) and parents separation/divorce (OR=1.51, 95% CI: 1.09-2.09) were significantly associated with risk of chronic diseases in adulthood.

CONCLUSIONThe prevalence of adverse childhood experiences was high in adults aged 18-59 years, which was significantly associated with the risk of chronic diseases in adulthood. Early prevention of chronic diseases should be conducted in childhood.