2.Impact of COVID-19 pandemic on the management of imported malaria in China.
Y LIU ; D WANG ; Z HE ; T ZHANG ; H YAN ; W LIN ; X ZHANG ; S LU ; Y LIU ; D WANG ; J LI ; W RUAN ; S LI ; H ZHANG
Chinese Journal of Schistosomiasis Control 2023;35(4):383-388
		                        		
		                        			OBJECTIVE:
		                        			To examine the impact of COVID-19 pandemic on the epidemic status of imported malaria and national malaria control program in China, so as to provide insights into post-elimination malaria surveillance.
		                        		
		                        			METHODS:
		                        			All data pertaining to imported malaria cases were collected from Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 through December 31, 2021. The number of malaria cases, species of malaria parasites, country where malaria parasite were infected, diagnosis and treatment after returning to China, and response were compared before (from January 1, 2018 to January 22, 2020) and after the COVID-19 pandemic (from January 23, 2020 to December 31, 2021).
		                        		
		                        			RESULTS:
		                        			A total of 2 054 imported malaria cases were reported in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 to December 31, 2021, and there were 1 722 cases and 332 cases reported before and after the COVID-19 pandemic, respectively. All cases were reported within one day after definitive diagnosis. The annual mean number of reported malaria cases reduced by 79.30% in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region after the COVID-19 pandemic (171 cases) than before the pandemic (826 cases), and the number of monthly reported malaria cases significantly reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region since February 2020. There was a significant difference in the constituent ratio of species of malaria parasites among the imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 146.70, P < 0.05), and P. falciparum malaria was predominant before the COVID-19 pandemic (72.30%), while P. ovale malaria (44.28%) was predominant after the COVID-19 pandemic, followed by P. falciparum malaria (37.65%). There was a significant difference in the constituent ratio of country where malaria parasites were infected among imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 13.83, P < 0.05), and the proportion of malaria cases that acquired Plasmodium infections in western Africa reduced after the COVID-19 pandemic that before the pandemic (44.13% vs. 37.95%; χ2 = 4.34, P < 0.05), while the proportion of malaria cases that acquired Plasmodium infections in eastern Africa increased after the COVID-19 pandemic that before the pandemic (9.58% vs. 15.36%; χ2 = 9.88, P = 0.02). The proportion of completing case investigation within 3 days was significantly lower after the COVID-19 pandemic than before the pandemic (96.69% vs. 98.32%; χ2= 3.87, P < 0.05), while the proportion of finishing foci investigation and response within 7 days was significantly higher after the COVID-19 pandemic than before the pandemic (100.00% vs. 98.43%; χ2 = 3.95, P < 0.05).
		                        		
		                        			CONCLUSIONS
		                        			The number of imported malaria cases remarkably reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region of China during the COVID-19 pandemic, with a decreased proportion of completing case investigations within 3 days. The sensitivity of the malaria surveillance-response system requires to be improved to prevent the risk of secondary transmission of malaria due to the sharp increase in the number of imported malaria cases following the change of the COVID-19 containment policy.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Pandemics
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Incidence
		                        			;
		                        		
		                        			COVID-19/epidemiology*
		                        			;
		                        		
		                        			Malaria/prevention & control*
		                        			;
		                        		
		                        			Malaria, Falciparum/epidemiology*
		                        			
		                        		
		                        	
3.Human leukocyte antigen polymorphism of HIV infected persons without disease progress for long-term in Henan province, 2011-2016.
X J XUE ; J Z YAN ; D CHENG ; C H LIU ; J LIU ; Z LIU ; S A TIAN ; D Y SUN ; B W ZHANG ; Z WANG
Chinese Journal of Epidemiology 2019;40(1):89-92
		                        		
		                        			
		                        			Objective: To understand the disease progression and human leukocyte antigen (HLA) gene polymorphism of HIV-infected persons without disease progress for long term, also known as long-term non-progressors (LTNPs), in Henan province. Methods: A retrospective study was conducted in 48 LTNPs with complete detection and follow-up information during 2011-2016 in Henan. Changes of CD(4)(+)T cells counts (CD(4)) and viral load (VL) during follow-up period were discussed. Polymerase chain reaction-sequence-specific oligonucleotide probe (PCR-SSOP) was used for the analyses of HLA-A, HLA-B and HLA-DRB1 alleles between LTNPs and healthy controls. Results: From 2011 to 2016, forty-eight LTNPs showed a decrease of the quartile (P(25)-P(75)) of CD(4) from 601.00 (488.50-708.72)/μl to 494.00 (367.00-672.00)/μl, and the difference was significant (P<0.05). The increase of the quartile (P(25)-P(75)) of log(10)VL from 3.40 (2.87-3.97) to 3.48 (2.60-4.37), but the difference was not significant (P>0.05). HLA polymorphism analysis revealed that HLA-B*13:02 and HLA-B*40:06 were more common in LTNPs (P<0.05), while HLA-B*46:01 and HLA-DRB1*09:01 were more common in healthy controls (P<0.05). Conclusions: The CD(4) of LTNPs in Henan showed a downward trend year by year. HLA-B*13:02 and B*40:06 might be associated with delayed disease progression for HIV infected persons in Henan.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Alleles
		                        			;
		                        		
		                        			Asian People/genetics*
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Disease Progression
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			HIV
		                        			;
		                        		
		                        			HIV Infections/virology*
		                        			;
		                        		
		                        			HIV-1/immunology*
		                        			;
		                        		
		                        			HLA-B Antigens/genetics*
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Polymorphism, Genetic
		                        			;
		                        		
		                        			Retrospective Studies
		                        			;
		                        		
		                        			Viral Load
		                        			
		                        		
		                        	
4.Exposure to bisphenol A during maternal pregnancy and the emotional and behavioral impact on their preschool children.
X CHEN ; H H BAO ; W K WU ; S Q YAN ; J SHENG ; Y Y XU ; C L GU ; K HUANG ; H CAO ; P Y SU ; F B TAO ; J H HAO
Chinese Journal of Epidemiology 2018;39(2):188-193
		                        		
		                        			
		                        			Objective: To explore the long-term effects of maternal pregnancy bisphenol A (BPA) exposure on emotional and behavioral problems appeared in their preschool children. Methods: The study sample was a subset of the China-Anhui Birth Cohort Study (C-ABCS). A unified questionnaire was used to collect basic information on both pregnant women and their children. Free BPA concentration in maternal serum was determined by high-performance liquid chromatographytandem mass spectrometry (HPLC-MS/MS). The parent-report version of the Strengths and Difficulties Questionnaire (SDQ) was used to estimate the emotional and behavioral problems in preschool children. A total of 1 713 pairs of mothers and children were included in this study. Association between BPA exposure during pregnancy and the emotional and behavioral problems in preschool children was evaluated with multinomial logistic regression model. Results: Prevalence rates in 1 713 preschool children appeared as: 6.48% of emotional problems, 8.11% for conduct problems, 8.35% for hyperactivity/inattention, 2.86% for peer problems, 11.38% for prosocial behaviors and 7.94% for total difficulties. Subjects were divided according to the degrees of exposure and the results showed as: low exposure group (≤0.120 ng/ml), medium exposure group (0.120
		                        		
		                        			Benzhydryl Compounds/toxicity*
		                        			;
		                        		
		                        			Child Behavior Disorders/etiology*
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Cohort Studies
		                        			;
		                        		
		                        			Emotions/physiology*
		                        			;
		                        		
		                        			Environmental Exposure
		                        			;
		                        		
		                        			Environmental Pollutants
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Gas Chromatography-Mass Spectrometry
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Maternal Exposure
		                        			;
		                        		
		                        			Mothers
		                        			;
		                        		
		                        			Phenols/toxicity*
		                        			;
		                        		
		                        			Pregnancy
		                        			;
		                        		
		                        			Prenatal Exposure Delayed Effects
		                        			;
		                        		
		                        			Prevalence
		                        			;
		                        		
		                        			Risk Factors
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			;
		                        		
		                        			Tandem Mass Spectrometry
		                        			
		                        		
		                        	
5.Willingness and influencing factors related to "centralized slaughtering, fresh poultry listing and marketing" strategy among the household chefs in Guangzhou.
W H LIU ; Y MA ; J Y LU ; H C YAN ; J H ZHOU ; X L LIAO ; J H ZENG ; W Q LIN ; D WU ; Z B ZHANG ; Z C YANG ; Z Q CHEN ; J D CHEN ; T G LI
Chinese Journal of Epidemiology 2018;39(2):204-207
		                        		
		                        			
		                        			Objective: To study the willingness and influence factors related to "centralized slaughtering, fresh poultry listing and marketing" strategy, among the household chefs, and provide reference for government to adjust and optimize the strategy on avian influenza prevention. Methods: According to the geographical characteristics and regional functions, 6 'monitoring stations' were selected from 12 residential districts of Guangzhou, respectively. Another 21 meat markets which selling live poultry, were selected in each station and 5 household chefs of each market were invited to attend a face to face interview. Basic information, personal cognitive, willingness and influencing factors to the policy were under study. Univariate and multivariate logistic regression methods were used. Results: A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering, fresh poultry listing and marketing" strategy was 44.6% (296/664). Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618, 95% CI: 1.156-2.264, P=0.005), having received higher education (OR=1.814, 95% CI: 1.296-2.539, P=0.001), or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918, 95% CI: 1.341-2.743, P<0.001) were factors at higher risk. These household chefs also intended to avoid the use of live poultry stalls (OR=1.666, 95%CI: 1.203-2.309, P=0.002) and accept the "centralized slaughtering, fresh poultry listing and marketing" strategy. Conclusion: Detailed study on this subject and, setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the 'freezing-fresh poultry' policy.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Attitude to Health
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Influenza A Virus, H7N9 Subtype
		                        			;
		                        		
		                        			Influenza in Birds
		                        			;
		                        		
		                        			Influenza, Human/prevention & control*
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Marketing
		                        			;
		                        		
		                        			Meat-Packing Industry
		                        			;
		                        		
		                        			Multivariate Analysis
		                        			;
		                        		
		                        			Pilot Projects
		                        			;
		                        		
		                        			Poultry/virology*
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			
		                        		
		                        	
6.Associations of obesity and physical activity with cognition in people aged 50 and above in Shanghai.
Z Z HUANG ; Y C ZHANG ; Y ZHENG ; Y F GUO ; Y RUAN ; S Y SUN ; Y SHI ; S N GAO ; J H YE ; Y J YAN ; K WU ; R F XU ; F WU
Chinese Journal of Epidemiology 2018;39(3):273-279
		                        		
		                        			
		                        			Objective: To investigate the associations of obesity and physical activity with cognition in the elderly. Methods: A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai. The subjects' body weight, body height, waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR), and the data on self-reported physical activity level were collected through questionnaire survey. A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions, including verbal recall, forward digit span (FDS), backward digit span (BDS), and verbal fluency (VF). General linear model was used to examine the associations of BMI, WHR and physical activity with cognition. Results: A total of 7 913 participants were included, with a median age of 60 years. Age, sex, education level, income level, BMI, WHR and physical activity level were significantly associated with cognitive scores in univariate analysis. After adjusted for age, sex, education level and income level, BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P>0.01). WHR was significantly associated with VF score (P<0.01). Abdominally obese participants had lower VF score than non-abdominally obese participants (P<0.01). Physical activity level was significantly associated with all cognitive functions (P<0.01). Compared with participants with moderate physical activity level, participants with low physical activity level had lower scores in all cognitive functions (P<0.01). Conclusion: Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly, suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
		                        		
		                        		
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Body Height
		                        			;
		                        		
		                        			Body Mass Index
		                        			;
		                        		
		                        			Body Weight
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Cognition/physiology*
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Exercise
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Obesity
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			;
		                        		
		                        			Waist Circumference
		                        			;
		                        		
		                        			Waist-Hip Ratio
		                        			
		                        		
		                        	
7.Epidemiological characteristics and molecular typing of typhoid and paratyphoid in China, 2009-2013.
Y CAO ; Y Y HAN ; F F LIU ; Q H LIAO ; J LI ; B W DIAO ; F X FAN ; B KAN ; M Y YAN
Chinese Journal of Epidemiology 2018;39(3):337-341
		                        		
		                        			
		                        			Objective: To understand the epidemiological and molecular characteristics of typhoid and paratyphoid in China from 2009 to 2013, and provide evidence for the prevention and control of typhoid and paratyphoid, the development and improvement of surveillance strategies. Methods: Epidemiological analysis was conducted on the incidence data of typhoid and paratyphoid, and related public health emergencies in China during 2009-2013. Pathogen isolation and culture, serologic test were conducted for the typhoid and paratyphoid cases from 13 national surveillance sites. The isolates were subjected to antimicrobial susceptibility testing. Pulsed-field gel electrophoresis (PFGE) was performed for the molecular typing of these isolates. Results: The average incidence of typhoid and paratyphoid in China during this period was 1.03/100 000. The reported case number and incidence decreased with year. The provinces reporting high case numbers were Yunnan, Guizhou, Guangxi, Hunan, Zhejiang, Guangdong and Xinjiang. The incidence of age group 0-4 years was highest. The proportion of farmers and children outside child care settings showed an increasing tendency over time. The annual incidence peak was during July-August. Twenty five outbreaks occurred during 2009-2013. The results of pathogen isolation and culture showed that the positive rate was 3.00% (940/31 322), among the positive isolates, the proportion of Salmonella paratyphi A accounted for higher proportion (68.19%, 641/940) compared with Salmonella typhi (31.60%, 297/940). The drug resistances of Salmonella typhi and Salmonella paratyphi varied, but their resistances to nalidixic acid were highest (50.22% and 85.33%) respectively. A certain amount of Salmonella typhi isolates showed the resistance to the 3rd generation cephalosporins. PFGE analysis showed divergent patterns of Salmonella typhi compared with limited patterns of Salmonella paratyphi A. Conclusion: The epidemic level of typhoid and paratyphoid in China was relatively low, but the outbreak occurred occasionally. It is necessary to enhance the laboratory-based surveillance, particularly the capability of etiological diagnosis, outbreak investigation, response and antibiotic resistance monitoring, and conduct risk factor investigation in provinces with high incidences in recent years.
		                        		
		                        		
		                        		
		                        			Child
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Disease Outbreaks
		                        			;
		                        		
		                        			Drug Resistance, Bacterial/genetics*
		                        			;
		                        		
		                        			Electrophoresis, Gel, Pulsed-Field
		                        			;
		                        		
		                        			Epidemics
		                        			;
		                        		
		                        			Farmers
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Incidence
		                        			;
		                        		
		                        			Infant
		                        			;
		                        		
		                        			Molecular Typing
		                        			;
		                        		
		                        			Paratyphoid Fever/microbiology*
		                        			;
		                        		
		                        			Population Surveillance
		                        			;
		                        		
		                        			Salmonella paratyphi A/isolation & purification*
		                        			;
		                        		
		                        			Salmonella typhi/isolation & purification*
		                        			;
		                        		
		                        			Typhoid Fever/microbiology*
		                        			
		                        		
		                        	
8.Effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes in China.
X N LIU ; Q H XIA ; H FANG ; R LI ; Y Y CHEN ; Y J YAN ; P ZHOU ; B D YAO ; Y JIANG ; W G ROTHMAN ; Wanghong XU
Chinese Journal of Epidemiology 2018;39(3):357-362
		                        		
		                        			
		                        			Objective: To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China. Methods: In this cluster randomized controlled trial, a total of 799 T2DM patients with most recent hemoglobin A1c (HbA1c) ≥ 7.5% (or fasting plasma glucose level ≥10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai, and randomized into a health literacy intervention group, an exercise intervention group, a comprehensive intervention group and a control group. After baseline survey and examination, a one-year intervention and 3 times (at 3(rd), 6(th), and 12(th) month) follow-up surveys were conducted. Results: The follow-up rates for all the subjects were 99.4%, 98.4% and 95.2%, respectively, at 3(rd), 6(th) and 12(th) month. Patients in intervention groups were more likely to achieve a goal HbA1c level (HbA1c <7.0%) than those in control group, with the highest glycemic control rate (25.3%) observed in comprehensive intervention group at 3(rd) month and then in exercise intervention group (25.3% and 34.6%) respectively, at 6(th) month and 12(th) month. The average levels of HbA1c in three intervention groups were lower at each follow-up time point than those at baseline survey. However, the decreases in HbA1c were obvious only at 6(th) month (P<0.001), with ls-mean (95%CI) of -0.48% (-0.71%, -0.25%), -0.33% (-0.55%, -0.11%) and -0.70% (-0.92%, -0.48%), respectively, in comprehensive, health literacy and exercise intervention groups, but it increased slightly by 0.03% (-0.19%, 0.25%) in control group. Compared with control group, the interventions were significantly associated with the decrease of HbA1c level, with the most improvement observed in comprehensive group (β=-0.47, 95% CI: -0.73, -0.20) at 3(rd) month, and in exercise intervention group at 6(th) month (β=-0.73, 95%CI: -0.98, -0.47) and at 12(th) month (β=-0.75, 95%CI: -1.05, -0.45) of follow-up. Stratified analyses showed that patients with lower health literacy level could benefit from any intervention, while those with higher numeracy skill benefited more from exercise intervention. Conclusion: Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM, which would be helpful in reducing the risks of complications and deaths in diabetes patients.
		                        		
		                        		
		                        		
		                        			Blood Glucose/analysis*
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Diabetes Mellitus, Type 2/therapy*
		                        			;
		                        		
		                        			Disease Management
		                        			;
		                        		
		                        			Exercise
		                        			;
		                        		
		                        			Follow-Up Studies
		                        			;
		                        		
		                        			Glycated Hemoglobin/analysis*
		                        			;
		                        		
		                        			Health Literacy
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Patient Education as Topic
		                        			;
		                        		
		                        			Self Care
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			;
		                        		
		                        			Treatment Outcome
		                        			
		                        		
		                        	
9.Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age.
S S SHAO ; K HUANG ; S Q YAN ; Y YOU ; W J PAN ; X CHEN ; H CAO ; P ZHU ; J H HAO ; F B TAO
Chinese Journal of Epidemiology 2018;39(6):826-829
		                        		
		                        			
		                        			Objective: To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age. Methods: Based on a prospective cohort study design, we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire. Subjects under study were classified into three groups, 1) those with pregnancy- related anxiety during both trimesters, 2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester. When their children were 18 months, autism-like behaviors (ALB) were evaluated, using the part A of Checklist for Autism in Toddlers-23, and then classified into three groups as non-ALB group, minor ALB group and major ALB group. Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors. Results: Compared with non-ALB group, children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk, RR=2.43, 95% CI: 1.21-4.86, P=0.012), major factors as pregnant women's IQ and gestational diabetes mellitus, premature delivery and education levels of fosterers on these pregnant women were under control. Our results from the stratified analysis showed: when in the subgroup that mother was the main fosterer of the child, there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22, 95%CI: 1.73-10.32, P=0.002). Conclusion: The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.
		                        		
		                        		
		                        		
		                        			Anxiety/psychology*
		                        			;
		                        		
		                        			Autistic Disorder/epidemiology*
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Logistic Models
		                        			;
		                        		
		                        			Mothers/psychology*
		                        			;
		                        		
		                        			Pregnancy
		                        			;
		                        		
		                        			Pregnancy Complications/psychology*
		                        			;
		                        		
		                        			Pregnancy Trimester, Third
		                        			;
		                        		
		                        			Pregnancy Trimesters/psychology*
		                        			;
		                        		
		                        			Pregnant Women/psychology*
		                        			;
		                        		
		                        			Prospective Studies
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			
		                        		
		                        	
10.A novel prognostic index for oral cancer in Fujian province.
J F WU ; L S LIN ; F CHEN ; F Q LIU ; L J YAN ; X D BAO ; J WANG ; R WANG ; L K LIN ; Y QIU ; X Y ZHENG ; Z J HU ; L CAI ; B C HE
Chinese Journal of Epidemiology 2018;39(6):841-846
		                        		
		                        			
		                        			Objective: To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC). Methods: From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups: modeling group (modeling dataset, n=318) and validation group (validation dataset, n=316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on β value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability. Results: Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22, 95%CI: 1.45-3.39), poor oral hygiene (HR=2.12, 95%CI: 1.27-3.54), first diagnosis of lymph node metastasis (HR=5.78, 95%CI: 3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43, 95%CI: 1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53, 95%CI: 1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3). Conclusion: Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.
		                        		
		                        		
		                        		
		                        			Carcinoma, Squamous Cell/therapy*
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Lymphatic Metastasis
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Mouth Neoplasms/therapy*
		                        			;
		                        		
		                        			Prognosis
		                        			;
		                        		
		                        			Proportional Hazards Models
		                        			;
		                        		
		                        			Risk Factors
		                        			;
		                        		
		                        			Survival Rate
		                        			;
		                        		
		                        			Treatment Outcome
		                        			
		                        		
		                        	
            
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