Publications by authors named "Shixue Li"

28 Publications

  • Page 1 of 1

Appraisal of China's Response to the Outbreak of COVID-19 in Comparison With SARS.

Front Public Health 2021 7;9:679540. Epub 2021 Jul 7.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019 and has since become a pandemic. The COVID-19 containment measures were comparable to those used with severe acute respiratory syndrome (SARS), although these were stricter and more organized, and were initiated earlier and on a larger scale. Based on the lessons learned from SARS, the Chinese government acted aggressively in response to COVID-19, through a unified and effective commanding system, using law-based and science-driven strategies, and coordinated deployment of medical resources. Additionally, the application of high-tech measures, traditional Chinese medicine, and hierarchical medical systems also played an important role in control measures. Despite the remarkable performance, the initial delay in response suggests that the coordination between public health and medical services, reserve and coordination of emergency materials, and capacity for disease control and prevention need to be strengthened.
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http://dx.doi.org/10.3389/fpubh.2021.679540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292770PMC
July 2021

The Effects of Social Support and Morbidities on Self-Rated Health among Migrant Elderly Following Children to Jinan, China.

Healthcare (Basel) 2021 Jun 7;9(6). Epub 2021 Jun 7.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

Social support has been demonstrated to be associated with the health status of old adults, but no study has clarified the relationship between social support, morbidities and self-rated health among the migrant elderly following children (MEFC) to new cities. This study aimed to explore the effect of social support and morbidities on self-rated health among MEFC to Jinan, China. A total of 656 MEFC were included in this study by using multi-stage cluster random sampling. Social support was measured by the Social Support Rating Scale. Correlation analysis and multivariable logistic regression analysis were employed to clarify the association between social support, morbidities and self-rated health among the MEFC. Approximately 75.9% of the MEFC rated their health as good. Logistic regression analysis showed that MEFC who lived with family were more likely to have a higher level of self-rated health. In addition to social support, body mass index (BMI), monthly income, one-year living style, the presence of an elevator, heart disease, stroke, duration of chronic disease, and outpatient service attendance were also associated with the self-rated health of MEFC. Social support and morbidities were significantly associated with self-rated health among MEFC. Targeted policies should be made to improve social support status and lower the morbidities in MEFC.
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http://dx.doi.org/10.3390/healthcare9060686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228491PMC
June 2021

Prevalence and risk factors of depression symptoms among Chinese seafarers during the COVID-19 pandemic: a cross-sectional study.

BMJ Open 2021 06 23;11(6):e048660. Epub 2021 Jun 23.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China

Background: To curb the spread of COVID-19, most countries have adopted measures such as banning shore leave at ports and placed restrictions on crew change. Seafarers may bear an excess pressure during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors associated with depression symptoms among Chinese seafarers during the COVID-19 pandemic.

Design: Cross-sectional study.

Methods: This field survey-based study was conducted at Rongcheng Port, Shandong Province, China, from 10 June 2020 to 25 July 2020. Sociodemographic and occupational characteristics and health-related behaviours were collected through a face-to-face questionnaire. The Self-Rating Depression Scale was used to evaluate depression status during the preceding week. Logistic regression models were used to explore factors related to depression.

Results: 441 male Chinese seafarers were enrolled. Overall, the proportions of seafarers with low, moderate and severe depression symptoms were 23.35%, 9.30% and 9.07%, respectively. Compared with those with good self-rated health (SRH), seafarers with poor SRH had higher odds of depression (OR, 2.24, 95% CI 1.22 to 4.11). Less leisure time or physical exercise was associated with more severe self-reported depression symptoms (1-3 per week vs ≥4 per week: OR, 1.72, 95% CI 0.71 to 4.14; none vs ≥4 per week: OR, 3.93, 95% CI 1.67 to 9.26). Poor sleep quality was associated with higher likelihood of reporting severe depression (fair vs good: OR, 2.78, 95% CI 1.54 to 5.01; poor vs good: OR, 4.30, 95% CI 1.65 to 11.24). The more frequent seafarers worked overtime a week, the higher the likelihood of reporting severe depression symptoms (1-2 per week vs none: OR, 1.82, 95% CI 1.04 to 3.18; ≥3 per week vs none: OR, 2.49, 95% CI 1.05 to 5.92). Also, high perceived work stress was linked to higher odds of being depressed (intermediate vs low: OR, 2.06, 95% CI 0.78 to 5.46; high vs low: OR, 3.83, 95% CI 1.35 to 10.90).

Conclusions: There is a high burden of depression associated with COVID-19 among seafarers. Special interventions that protect the mental health of seafarers are more critical than ever in the context of the pandemic.
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http://dx.doi.org/10.1136/bmjopen-2021-048660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230921PMC
June 2021

Effects of Living Conditions, Subjective Integration, and Social Networks on Health-Related Quality of Life among the Migrant Elderly Following Children in Jinan, China.

Healthcare (Basel) 2021 Apr 2;9(4). Epub 2021 Apr 2.

Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

With accelerated urbanization in China, an increasing number of the migrant elderly following children (MEFC) have appeared. This study aims to explore the effects of living conditions, subjective integration, and social networks on the health-related quality of life (HRQOL) of MEFC in Jinan, China. HRQOL was assessed by the 12-item Short-Form Health Survey, which included the mental component summary (MCS) and the physical component summary (PCS). Univariate analyses and binary logistic regression were used to investigate the association between the above indicators and HRQOL. A total of 656 MEFC were selected by multi-stage cluster random sampling, 25.2% and 25.0% of whom were defined as poor MCS and poor PCS, respectively. Those who understood the local dialect, could trust others, and connected with friends were more likely to have good MCS; those with a nanny, faulty elevator, and no support from their spouse were the reverse. MEFC who were trans-city, had no elevator or a faulty elevator, and went to the hospital alone were more likely to have poor PCS; those who approved of living conditions in their hometowns were the reverse. Results indicated that better living conditions, stronger subjective integration, and wider social networks led to higher HRQOL of MEFC. Implications of the government, communities, and families of MEFC were given to improve their HRQOL.
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http://dx.doi.org/10.3390/healthcare9040414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066240PMC
April 2021

Ambient PM and Related Health Impacts of Spontaneous Combustion of Coal and Coal Gangue.

Environ Sci Technol 2021 05 4;55(9):5763-5771. Epub 2021 Apr 4.

Key Laboratory for Semi-Arid Climate Change of the Ministry of Education, College of Atmospheric Sciences, Lanzhou University, Lanzhou 730000, P. R. China.

Coal and coal gangue spontaneous combustion (CGSC) occurs globally, causing significant environmental pollution. However, its emissions are poorly quantified and are overlooked in global or regional air pollutant emission inventories in previous studies, resulting in the underestimation of its impacts on climate, environment, and public health. This study quantified the emissions of various air pollutants originating from CGSC in Wuhai, a city in China, investigated emission characteristics, and estimated the contribution of CGSC emissions to fine particulate matter (PM) air pollution and related health impacts on a regional scale. The results revealed that the CGSC-related PM emissions were approximately 4643 t a (95% confidence interval (95% CI): 721; 10447), accounting for 26.3% of the total PM emissions. Alkanes, alkenes, and aromatics accounted for 69.4, 17.9, and 2.9%, respectively, of the total emissions of volatile organic compounds (VOCs). Due to CGSC emissions, the ambient PM concentration in Wuhai increased by 5.7 μg m on average, while the nitrate concentration decreased. The number of premature deaths caused by exposure to ambient PM associated with CGSC reached 381 (95% CI: 290; 452) in Wuhai and surrounding cities in 2017. Urgent control strategies and engineering techniques are needed to mitigate CGSC to protect public health.
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http://dx.doi.org/10.1021/acs.est.1c00150DOI Listing
May 2021

The association of liver function biomarkers with internal exposure of short- and medium-chain chlorinated paraffins in residents from Jinan, China.

Environ Pollut 2021 Jan 1;268(Pt A):115762. Epub 2020 Oct 1.

Environmental Research Institute, Shandong University, Binhai Road 72, Qingdao, 266237, China. Electronic address:

Chlorinated paraffins (CPs) are pervasive environmental pollutants which have been reported to be hepatotoxic by laboratory cell and animal studies. However, the related epidemiological reports on their hepatotoxic effects to humans are sparse. In this study, we evaluated the associations between six liver enzymes and serum short-chain CP (SCCP) or medium-chain CP (MCCP) concentrations of 197 residents in Jinan, China. Serum S/MCCPs were detected by quadrupole time-of-flight high-resolution mass spectrometry coupled with atmospheric pressure chemical ionization source (APCI-QTOF-HRMS), and quantified by pattern deconvolution method. The associations between total serum S/MCCP concentrations (ΣS/MCCPs) and continuous liver enzyme levels were assessed by linear regression. Odds ratios (ORs) for the effects of serum ΣS/MCCPs concentrations on liver function biomarkers dichotomized by clinical reference intervals were predicted by logistic regression, either treating ΣS/MCCPs as continuous or categorical dependents. After multivariable adjustment, linear regression results illustrated that 1-ln unit increase in serum ΣSCCPs was negatively associated with male PA levels [-6.08, 95% confidence interval (CI): -11.90, -3.25, p < 0.05], positively associated with male TB levels (1.80, 95% CI: 0.28, 3.31, p < 0.05), and positively associated with female AST levels (1.39, 95% CI: 0.07, 2.70, p < 0.05). One-ln unit increase in serum ΣMCCPs was negatively associated male PA levels (-7.56, 95% CI: -17.15, -4.03, p < 0.05). Logistic regression results suggested that male serum ΣSCCPs were associated with increased prevalence of abnormal PA (OR = 1.47 per 1 ln-unit increase, CI = 1.18, 1.82) and TB (OR = 1.75, 95% CI = 1.12, 2.76) levels, and male serum ΣMCCPs were significantly associated with increased prevalence of abnormal PA (OR = 1.43, 95% CI = 1.03, 1.97) levels. In addition, male participants with concentrations above the median ΣS/MCCPs were associated with increased risk for abnormal PA levels [SCCPs, 2.11-fold (95% CI = 1.15, 3.87); MCCPs, 1.94-fold (95% CI = 1.24, 3.03)]. Male participants with concentrations above the median ΣSCCPs were also associated with increased risk for abnormal TB levels (OR = 1.75, 95% CI = 1.12, 2.76). Conclusively, our results revealed that CP internal exposure was associated with disturbed liver biomarker levels, suggesting the hepatotoxicity of both SCCPs and MCCPs to humans.
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http://dx.doi.org/10.1016/j.envpol.2020.115762DOI Listing
January 2021

The association of liver function biomarkers with internal exposure of short- and medium-chain chlorinated paraffins in residents from Jinan, China.

Environ Pollut 2021 Jan 1;268(Pt A):115762. Epub 2020 Oct 1.

Environmental Research Institute, Shandong University, Binhai Road 72, Qingdao, 266237, China. Electronic address:

Chlorinated paraffins (CPs) are pervasive environmental pollutants which have been reported to be hepatotoxic by laboratory cell and animal studies. However, the related epidemiological reports on their hepatotoxic effects to humans are sparse. In this study, we evaluated the associations between six liver enzymes and serum short-chain CP (SCCP) or medium-chain CP (MCCP) concentrations of 197 residents in Jinan, China. Serum S/MCCPs were detected by quadrupole time-of-flight high-resolution mass spectrometry coupled with atmospheric pressure chemical ionization source (APCI-QTOF-HRMS), and quantified by pattern deconvolution method. The associations between total serum S/MCCP concentrations (ΣS/MCCPs) and continuous liver enzyme levels were assessed by linear regression. Odds ratios (ORs) for the effects of serum ΣS/MCCPs concentrations on liver function biomarkers dichotomized by clinical reference intervals were predicted by logistic regression, either treating ΣS/MCCPs as continuous or categorical dependents. After multivariable adjustment, linear regression results illustrated that 1-ln unit increase in serum ΣSCCPs was negatively associated with male PA levels [-6.08, 95% confidence interval (CI): -11.90, -3.25, p < 0.05], positively associated with male TB levels (1.80, 95% CI: 0.28, 3.31, p < 0.05), and positively associated with female AST levels (1.39, 95% CI: 0.07, 2.70, p < 0.05). One-ln unit increase in serum ΣMCCPs was negatively associated male PA levels (-7.56, 95% CI: -17.15, -4.03, p < 0.05). Logistic regression results suggested that male serum ΣSCCPs were associated with increased prevalence of abnormal PA (OR = 1.47 per 1 ln-unit increase, CI = 1.18, 1.82) and TB (OR = 1.75, 95% CI = 1.12, 2.76) levels, and male serum ΣMCCPs were significantly associated with increased prevalence of abnormal PA (OR = 1.43, 95% CI = 1.03, 1.97) levels. In addition, male participants with concentrations above the median ΣS/MCCPs were associated with increased risk for abnormal PA levels [SCCPs, 2.11-fold (95% CI = 1.15, 3.87); MCCPs, 1.94-fold (95% CI = 1.24, 3.03)]. Male participants with concentrations above the median ΣSCCPs were also associated with increased risk for abnormal TB levels (OR = 1.75, 95% CI = 1.12, 2.76). Conclusively, our results revealed that CP internal exposure was associated with disturbed liver biomarker levels, suggesting the hepatotoxicity of both SCCPs and MCCPs to humans.
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http://dx.doi.org/10.1016/j.envpol.2020.115762DOI Listing
January 2021

Distribution of Haemaphysalis longicornis and associated pathogens: analysis of pooled data from a China field survey and global published data.

Lancet Planet Health 2020 08;4(8):e320-e329

Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China. Electronic address:

Background: Haemaphysalis longicornis, a vector of various pathogens with medical and veterinary importance, is native to eastern Asia, and recently reached the USA as an emerging disease threat. In this study, we aimed to identify the geographical distribution, hosts, and associated pathogens of H longicornis.

Methods: Data were collected from multiple sources, including a field survey, reference book, literature review, and related websites. The thematic maps showing geographical distribution of H longicornis and associated pathogens were produced by ArcGIS. Hosts of H longicornis and positive rates for H longicornis-associated pathogens were estimated by meta-analysis. Ecological niche modelling was used to predict potential global distribution of H longicornis.

Findings: H longicornis was found to be present in ten countries, predominantly in eastern Asia, the USA, Australia, and New Zealand. The tick was known to feed on a variety of domestic and wild animals, and humans. At least 30 human pathogens were associated with H longicornis, including seven species of spotted fever group rickettsiae, seven species in the family of Anaplasmataceae, four genospecies in the complex Borrelia burgdorferi sensu lato, two Babesia species, six species of virus, and Francisella, Bartonella, Coxiella, and Toxoplasma, which were mainly reported in eastern Asia. The predictive modelling revealed that H longicornis might affect more extensive regions, including Europe, South America, and Africa, where the tick has never been recorded before.

Interpretation: H longicornis is relatively common in the world, and is associated with various human and animal pathogens. Authorities and health-care workers should be aware of the threat of the tick species to public health and veterinary medicine. Surveillance and further investigations should be enhanced globally.

Funding: National Natural Science Foundation of China and National Key Research and Development Program of China.
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http://dx.doi.org/10.1016/S2542-5196(20)30145-5DOI Listing
August 2020

Short and medium-chain chlorinated paraffins in serum from residents aged from 50 to 84 in Jinan, China: Occurrence, composition and association with hematologic parameters.

Sci Total Environ 2020 Aug 19;728:137998. Epub 2020 Apr 19.

School of Environmental Science and Engineering, Shandong University, Binhai Road 72, Qingdao, 266237, China. Electronic address:

Human exposure to chlorinated paraffins (CPs) has been expected and assessed by external pathways considering their pervasive environmental occurrence. However, the deficiency of external exposure assessment in characterizing human burden is unavoidable. In addition, the associations between health outcomes and CP contents in human biospecimen are rarely assessed. In this study, we reported the occurrence and homologue profiles of short-chain chlorinated paraffins (SCCPs) and medium-chain chlorinated paraffins (MCCPs) in serum samples from 145 residents aged from 50 to 84 in Jinan, Shandong Province of China using quadrupole time-of-flight high-resolution mass spectrometry coupled with atmospheric pressure chemical ionization source operated in negative ion mode (APCI-qTOF-HRMS). The associations between serum CP concentrations and hematologic parameters were further analyzed by linear regression. We identified high level of ∑SCCPs (median = 107 ng/g wet weight, ww; 13,800 ng/g lipid, lw), ∑MCCPs (median = 134 ng/g ww; 15,200 ng/g lw) and elevated ∑MCCPs/∑SCCPs (median = 1.12) in serum of the studied population. C-CPs and C-CPs were the most abundant SCCP and MCCP groups, respectively. While the predominant chlorine homologues among SCCPs and MCCPs were Cl-CPs. ∑SCCPs, ∑MCCPs, ∑MCCPs/∑SCCPs and the homologue patterns presented no significant variance among age, sex and BMI groups. Further explorations suggested that perturbation of hematologic homeostasis could be induced by CP exposure in a sex-specific way, reflected by significant negative associations of serum SCCP and MCCP concentrations in lipid weight basis with sex-specific hematologic parameters. This study suffered from some limitations and should be interpreted with caution. However, the CP burdens of residents in China and the subsequent health risks must be underscored.
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http://dx.doi.org/10.1016/j.scitotenv.2020.137998DOI Listing
August 2020

Association between Socioeconomic Status, Physical Health and Need for Long-term Care among the Chinese Elderly.

Int J Environ Res Public Health 2019 06 15;16(12). Epub 2019 Jun 15.

School of Ethnology and Sociology, Minzu University of China, Beijing 100081, China.

The aim of this study was to explore the relationship between socioeconomic status (SES), physical health and the need for long-term care (NLTC) of the Chinese elderly, and further, to provide evidence-based advice for establishing an LTC system in China. A cross-sectional survey was conducted in Shandong Province, China in 2017 by using multi-stage random sampling method. Data were collected from elderly individuals aged 60 years and older by self-designed questionnaires through face-to face interviews. A total of 7070 participants were finally included in the database (40.3% male, 59.7% female). Chi-square test analysis and structural equation modeling (SEM) were conducted to clarify the association between SES, physical health and NLTC among the Chinese elderly men and women in Shandong Province. The results of the SEM analysis showed that physical health exerted a strong and negative effect on the NLTC for both genders, with a slightly stronger effect found among the elderly men. SES was found to be significantly and negatively related to the NLTC among the elderly women, while no statistical significance was found for the association between SES and NLTC for elderly men. A significant and positive association between SES and physical health was observed among the elderly men and women, with a slightly stronger effect among the elderly women. Implications for lowering the NLTC and developing an LTC system were addressed based on the findings above.
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http://dx.doi.org/10.3390/ijerph16122124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617196PMC
June 2019

The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province-A Cross-Sectional Study.

Int J Environ Res Public Health 2019 02 13;16(4). Epub 2019 Feb 13.

Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.

This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results.
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http://dx.doi.org/10.3390/ijerph16040526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406556PMC
February 2019

Correction to: Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option.

BMC Infect Dis 2018 09 27;18(1):487. Epub 2018 Sep 27.

School of Public Health, Shandong University, Jinan, China.

After the publication of our article [1] we have been made aware of a number of mislabelling and reporting errors, which were introduced in the preparation of the manuscript. The conclusions are not affected by these errors and thus remain unchanged.
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http://dx.doi.org/10.1186/s12879-018-3370-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161355PMC
September 2018

A DREB-Like Transcription Factor From Maize (), ZmDREB4.1, Plays a Negative Role in Plant Growth and Development.

Front Plant Sci 2018 4;9:395. Epub 2018 Apr 4.

State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China.

The DREB (dehydration-responsive element binding)-type transcription factors are classified into six subgroups, named A-1 to A-6. The members of DREB A-1 and A-2 subgroups have been reported to be involved in response to various abiotic stresses. However, there were only a few genes belonging to A-3 to A-6 subgroups to be reported. In this study, we cloned a DREB A-4 subgroup gene from maize (), , and analyzed its characteristics and functions. was expressed in roots, stems, and leaves at very low levels. It was not induced by any biotic or abiotic treatment. ZmDREB4.1 was located in the nucleus, could directly bind to the DRE element and functioned as a transcriptional activator. The constitutive expression of in tobacco ( L.) repressed leaf extension and hypocotyl, petiole and stem elongation. In maize, overexpression of repressed calli growth and regeneration. Further analysis showed that the smaller leaves of transgenic tobacco resulted from inhibition of cell division. The contents of cytokinin and auxin in transgenic leaves were severely decreased. The shorter hypocotyls, stems and petioles of transgenic tobacco were caused by inhibition of cell elongation. The transgenic hypocotyls, stems and petioles contained reduced gibberellin levels. Application of exogenous GA3 rescued the shorter hypocotyls, stems and petioles, but not the smaller leaves. These results demonstrated that plays an important role in the negative regulation of plant growth and development.
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http://dx.doi.org/10.3389/fpls.2018.00395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893645PMC
April 2018

Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009-2016.

Sci Rep 2017 08 21;7(1):8900. Epub 2017 Aug 21.

Shandong Universities Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases, Taishan Medical College, Taian, Shandong, China.

In the past decade, hand, foot, and mouth disease (HFMD) has posed a serious threat to childhood health in China; however, no epidemiological data from large HFMD epidemics have been described since 2013. In the present study, we described the epidemiological patterns of HFMD in Shandong province during 2009-2016 from a large number of symptomatic cases (n = 839,483), including >370,000 HFMD cases since 2013. Our results revealed that HFMD activity has remained at a high level and continued to cause annual epidemics in Shandong province from 2013 onwards. Although the incidence rate was significantly higher in urban areas than in rural areas, no significantly higher case-severity and case-fatality rates were found in urban areas. Furthermore, the seventeen cities of Shandong province could be classified into three distinct epidemiological groups according to the different peak times from southwest (inland) to northeast (coastal) regions. Notably, a replacement of the predominant HFMD circulating agent was seen and non-EVA71/Coxsackievirus A16 enteroviruses became dominant in 2013 and 2015, causing approximately 30% of the severe cases. Our study sheds light on the latest epidemiological characteristics of HFMD in Shandong province and should prove helpful for the prevention and control of the disease in Shandong and elsewhere.
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http://dx.doi.org/10.1038/s41598-017-09196-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567189PMC
August 2017

Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011.

Int J Equity Health 2017 03 14;16(1):50. Epub 2017 Mar 14.

The Second Hospital of Shandong University, Jinan, People's Republic of China.

Background: China has experienced a rapid increase in hypertension over the past decade, especially in rural. Therefore, the aim of this research is to examine the dynamic trends in urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese adults from 1993 to 2011.

Methods: Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in hypertension prevalence, detection and medication use. Multiple logistic regressions were used to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011, after controlling for health-related behaviors, BMI, demographic variables and socioeconomic characteristics. Blinder-Oaxaca decomposition technique was also used to calculate the extent to which urban-rural disparities reflect an endowments effect or a coefficients effect.

Results: Hypertension prevalence, detection, and medication use among rural adults were significantly lower than urban adults, with the significant level at p < 0.001. The urban-rural gaps in hypertension prevalence and medication use gradually narrowed during the period 1993-2011, whereas the gaps in hypertension detection grew wider. After controlling for confounding variables, urban adults were about 24.5, 49.4, and 89.5% more likely to be hypertensive, detected, and medicated than their rural counterparts (p < 0.01), respectively. The Blinder-Oaxaca decomposition suggested that approximately 22 and 26% of the urban-rural gap in hypertension detection and medication use could be attributed to coefficient difference, respectively.

Conclusions: Although hypertension prevalence among rural adults was comparable to that of urban adults, hypertension detection and medication use of rural adults were still suboptimal. Unusually large urban-rural gaps and an expanding trend in hypertension detection deserve the attention of health policymakers and researchers.
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http://dx.doi.org/10.1186/s12939-017-0545-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348878PMC
March 2017

Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011.

Int J Equity Health 2017 03 14;16(1):50. Epub 2017 Mar 14.

The Second Hospital of Shandong University, Jinan, People's Republic of China.

Background: China has experienced a rapid increase in hypertension over the past decade, especially in rural. Therefore, the aim of this research is to examine the dynamic trends in urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese adults from 1993 to 2011.

Methods: Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in hypertension prevalence, detection and medication use. Multiple logistic regressions were used to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011, after controlling for health-related behaviors, BMI, demographic variables and socioeconomic characteristics. Blinder-Oaxaca decomposition technique was also used to calculate the extent to which urban-rural disparities reflect an endowments effect or a coefficients effect.

Results: Hypertension prevalence, detection, and medication use among rural adults were significantly lower than urban adults, with the significant level at p < 0.001. The urban-rural gaps in hypertension prevalence and medication use gradually narrowed during the period 1993-2011, whereas the gaps in hypertension detection grew wider. After controlling for confounding variables, urban adults were about 24.5, 49.4, and 89.5% more likely to be hypertensive, detected, and medicated than their rural counterparts (p < 0.01), respectively. The Blinder-Oaxaca decomposition suggested that approximately 22 and 26% of the urban-rural gap in hypertension detection and medication use could be attributed to coefficient difference, respectively.

Conclusions: Although hypertension prevalence among rural adults was comparable to that of urban adults, hypertension detection and medication use of rural adults were still suboptimal. Unusually large urban-rural gaps and an expanding trend in hypertension detection deserve the attention of health policymakers and researchers.
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http://dx.doi.org/10.1186/s12939-017-0545-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348878PMC
March 2017

Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option.

BMC Infect Dis 2016 Nov 15;16(1):677. Epub 2016 Nov 15.

School of Public Health, Shandong University, Jinan, China.

Background: Rotavirus infection causes considerable disease burden of acute gastroenteritis (AGE) hospitalization and death among children less than 5 years in China. Although two rotavirus vaccines (Rotarix and RotaTeq) have been licensed in more than 100 countries in the world, the Lanzhou Lamb rotavirus vaccine (LLR) is the only vaccine licensed in China. This study aims to forecast the potential impacts of the two international vaccines compared to domestic LLR.

Methods: An economic evaluation was performed using a Markov simulation model. We compared costs at the societal aspect and health impacts with and without a vaccination program by LLR, Rotarix or RotaTeq. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from literature review. The model incorporated the impact of vaccination on reduction of incidence of rotavirus infection and severity of AGE indicated by hospitalization, inpatient visits and deaths. Outcomes are presented in terms of quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio (ICER) compared to status quo.

Results: In a hypothetical cohort of 100,000 infants, the two international vaccines showed very good cost-effectiveness, with ICER of Rotateq and Rotarix shifting from LLR of $1715.11/QALY and $2105.66/QALY, respectively. Rotateq and Rotarix had significantly decreased incidence compared to LLR, particularly among infants aged 6 months to 2 years.

Conclusions: RotaTeq is expected to introduce in the national routine immunization program to reduce disease burden of rotavirus infection with universal coverage.
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http://dx.doi.org/10.1186/s12879-016-2013-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111341PMC
November 2016

ZmDof3, a maize endosperm-specific Dof protein gene, regulates starch accumulation and aleurone development in maize endosperm.

Plant Mol Biol 2017 Jan 5;93(1-2):7-20. Epub 2016 Oct 5.

State Key Laboratory for Agrobiotechnology, College of Biological Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing, 100193, China.

Key Message: To explore the function of Dof transcription factors during kernel development in maize, we first identified Dof genes in the maize genome. We found that ZmDof3 was exclusively expressed in the endosperm of maize kernel and had the features of a Dof transcription factor. Suppression of ZmDof3 resulted in a defective kernel phenotype with reduced starch content and a partially patchy aleurone layer. The expression levels of starch synthesis-related genes and aleurone differentiation-associated genes were down-regulated in ZmDof3 knockdown kernels, indicating that ZmDof3 plays an important role in maize endosperm development. The maize endosperm, occupying a large proportion of the kernel, plays an important role in seed development and germination. Current knowledge regarding the regulation of endosperm development is limited. Dof proteins, a family of plant-specific transcription factors, play critical roles in diverse biological processes. In this study, an endosperm-specific Dof protein gene, ZmDof3, was identified in maize through genome-wide screening. Suppression of ZmDof3 resulted in a defective kernel phenotype. The endosperm of ZmDof3 knockdown kernels was loosely packed with irregular starch granules observed by electronic microscope. Through genome-wide expression profiling, we found that down-regulated genes were enriched in GO terms related to carbohydrate metabolism. Moreover, ZmDof3 could bind to the Dof core element in the promoter of starch biosynthesis genes Du1 and Su2 in vitro and in vivo. In addition, the aleurone at local position in mature ZmDof3 knockdown kernels varied from one to three layers, which consisted of smaller and irregular cells. Further analyses showed that knockdown of ZmDof3 reduced the expression of Nkd1, which is involved in aleurone cell differentiation, and that ZmDof3 could bind to the Dof core element in the Nkd1 promoter. Our study reveals that ZmDof3 functions in maize endosperm development as a positive regulator in the signaling system controlling starch accumulation and aleurone development.
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http://dx.doi.org/10.1007/s11103-016-0543-yDOI Listing
January 2017

National equity of health resource allocation in China: data from 2009 to 2013.

Int J Equity Health 2016 Apr 19;15:68. Epub 2016 Apr 19.

Department of Social Medicine and Health Management, College of Public Health, Shandong University, 44 Culture Road, Li Xia District, Jinan, 250012, Shandong Province, China.

Background: The inequitable allocation of health resources is a worldwide problem, and it is also one of the obstacles facing for health services utilization in China. A new round of health care reform which contains the important aspect of improving the equity in health resource allocation was released by Chinese government in 2009. The aim of this study is to understand the changes of equity in health resource allocation from 2009 to 2013, and make a further inquiry of the main factors which influence the equity conditions in China.

Methods: Data resources are the China Health Statistics Yearbook (2014) and the China Statistical Yearbook (2014). Four indicators were chosen to measure the trends in equity of health resource allocation. Data were disaggregated by three geographical regions: west, central, and east. Theil index was used to calculate the degree of unfairness.

Results: The total amount of health care resources in China had been increasing in recent years. However, the per 10, 000 km(2) number of health resources showed a huge gap in different regions, and per 10, 000 capita health resources ownership showed a relatively small disparities at the same time. The index of health resources showed an overall downward trend, in which health financial investment the most unfair from 2009 to 2012 and the number of health institutions the most unfair in 2013. The equity of health resources allocation in eastern regions was the worst except for the aspect of health technical personnel allocation. The regional contribution rates were lower than that of the inter-regional contribution rates which were all beyond 60 %.

Conclusion: The equity of health resource allocation improved gradually from 2009 to 2013. However, the internal differences within the eastern region still have a huge impact on the overall equity in health resource allocation. The tough issues of inequitable in health resource allocation should be resolved by comprehensive measures from a multidisciplinary perspective.
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http://dx.doi.org/10.1186/s12939-016-0357-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837535PMC
April 2016

Microtubule-Associated Protein SBgLR Facilitates Storage Protein Deposition and Its Expression Leads to Lysine Content Increase in Transgenic Maize Endosperm.

Int J Mol Sci 2015 Dec 12;16(12):29772-86. Epub 2015 Dec 12.

State Key Laboratory for Agro-Biotechnology, College of Biological Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China.

Maize (Zea mays) seed is deficient in protein and lysine content. Many studies have been made to improve the nutritional quality of maize seeds. Previously, we reported the role of a natural lysine-rich protein gene SBgLR in increasing protein and lysine content. However, how the SBgLR improves lysine and protein content remains unclear. Here, the reasons and possible mechanism for SBgLR in protein and lysine improvement have been analyzed and discussed. Through seed-specific expression of SBgLR, we obtained transgenic maize with the simultaneously increased lysine and protein contents. High-protein and high-lysine characters were stably inherited across generations. The expression of SBgLR in maize kernels increased the accumulation of both zeins and non-zein proteins. Transmission electron microscopy showed that the number of protein bodies (PBs) was increased obviously in SBgLR transgenic immature endosperms with the morphology and structure of PBs unchanged. The proteinaceous matrix was more abundant in transgenic mature endosperms under scanning electron microscopy. The stabilities of zein and lysine-rich non-zein genes were also increased in transgenic endosperms. Finally, the potential application of SBgLR in maize nutrient improvement was evaluated. This study shows that a cytoskeleton-associated protein has potential applicable value in crop nutrient improving, and provided a feasible strategy for improvement of maize grain quality.
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http://dx.doi.org/10.3390/ijms161226199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691142PMC
December 2015

The assessment on impact of essential drugs policy on primary health care system in rural areas of Shandong Province policy and regulation division of the Health Department of Shandong Province.

Technol Health Care 2015 ;23 Suppl 1:S169-76

Shandong Institute of Pharmaceutical Research, Shandong, China.

At present, China has achieved an initial establishment and gradual implementation of a framework for national essential drugs policy. With the further implementation of the national essential drugs policy, it is not clear how the policy works, whether it achieves the original intention of essential drugs policy, and what impact essential drugs policy exerts on the primary health care system. In view of it, we conducted a field research on sample areas of Shandong Province to understand the conditions of the implementation of the essential drugs policy in Shandong Province. From three perspectives of medical institutions, patients and medical staff, this thesis analyzes the impact of essential drugs policy on village-level and township-level health service system, summarizes the effectiveness of implementing essential drugs policy, discovers the problems of various aspects and conducts an in-depth analysis of the causes, and puts forward feasible suggestions to provide reference for improving the essential drugs policy. The assessment results show that the implementation of essential drugs policy in Shandong Province has played a positive role in promoting the sound development of the primary health care system, changed the situation of covering hospital expenses with medicine revenue in the past, contributed to the return of medical institutions to public welfare, and reduced the patient's economic burden of disease. But there emerge many problems as follows: impact on the doctor's diagnosis and treatment due to incompleteness of drug types, and distribution not in place, patient loss and operational difficulty of village clinic. Thus, this thesis makes recommendations of drugs catalog formulation, drug procurement, sales and use, and meanwhile points out that the supporting financial compensation policy and performance appraisal policy and other measures in place are a prerequisite for a positive role of essential drugs policy.
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http://dx.doi.org/10.3233/thc-150951DOI Listing
July 2016

Mapping and Analyzing Stakeholders in China's Essential Drug System by Using a Circular Model: Who We Should Deal with Next?

Value Health Reg Issues 2015 May 16;6:111-117. Epub 2015 May 16.

School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. Electronic address:

Objectives: To predict the prospects of the essential drug system by using the Stakeholder Impact Index (SII) and evaluate the current performance of each main stakeholder and suggested dangerous stakeholders and dormant stakeholders.

Methods: A Delphi method was used, involving 36 experts with experience in implementation and evaluation of the essential drug policy, to construct the circular model as well as evaluate the performance of each stakeholder.

Results: The central government was a dominant stakeholder of the whole essential drug system. The provincial governments were definitive stakeholders, whereas local governments and medical institutions were dependent stakeholders. Furthermore, media and drug stores were dormant stakeholders and pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders. Patients, community residents, and medical insurance programs were discretionary stakeholders. The SII for the essential drug system was positive (SII = 2.72).

Conclusions: The overall anticipation of the essential drug policy is optimistic. Letting definitive stakeholders (provincial governments) having more autonomy can efficiently accelerate the pace of implementation of the essential drug policy in the current situation. Central government, however, also needs to construct an experience exchange platform with the aim of building versatile methods for running the essential drug system in all provinces. Pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders for the essential drug policy. Because of their potential threat to the implementation of the policy, the central government should motivate them to support the construction of the essential drug system spontaneously. In that case, provincial governments need to construct a fair, balanced, and self-stabilized bidding platform.
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http://dx.doi.org/10.1016/j.vhri.2015.03.007DOI Listing
May 2015

Dose-response meta-analysis on coffee, tea and caffeine consumption with risk of Parkinson's disease.

Authors:
Hui Qi Shixue Li

Geriatr Gerontol Int 2014 Apr 23;14(2):430-9. Epub 2013 Jul 23.

Department of Social Medicine and Health Administration, School of Public Health, Shandong University, Jinan, China; Department of Teaching Affaires, Qingdao University, Qingdao, China.

Aims: A dose-response meta-analysis was carried out between Parkinson's disease (PD) risk, and coffee, tea and caffeine consumption.

Methods: A comprehensive search was carried out to identify eligible studies. The fixed or random effect model was used based on heterogeneity test. The dose-response relationship was assessed by restricted cubic spline.

Results: A total of 13 articles involving 901 764 participants for coffee, eight articles involving 344 895 participants for tea and seven articles involving 492 724 participants for caffeine were included. A non-linear relationship was found between coffee consumption and PD risk overall, and the strength of protection reached the maximum at approximately 3 cups/day (smoking-adjusted relative risk: 0.72, 95% confidence interval 0.65-0.81). A linear relationship was found between tea and caffeine consumption, and PD risk overall, and the smoking-adjusted risk of PD decreased by 26% and 17% for every two cups/day and 200 mg/day increments, respectively. The association of coffee and tea consumption with PD risk was stronger for men than that for women, and the association of caffeine consumption with PD risk was stronger for ever users of hormones than that for never users of hormones among postmenopausal women. The aforementioned associations were weaker for USA relative to Europe or Asia.

Conclusions: A linear dose-relationship for decreased PD risk with tea and caffeine consumption was found, whereas the strength of protection reached a maximum at approximately 3 cups/day for coffee consumption overall. Further studies are required to confirm the findings.
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http://dx.doi.org/10.1111/ggi.12123DOI Listing
April 2014

Improved nutritive quality and salt resistance in transgenic maize by simultaneously overexpression of a natural lysine-rich protein gene, SBgLR, and an ERF transcription factor gene, TSRF1.

Int J Mol Sci 2013 Apr 29;14(5):9459-74. Epub 2013 Apr 29.

State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, No. 2 Yuanmingyuan West Road, Haidian District, Beijing 100193, China.

Maize (Zea mays L.), as one of the most important crops in the world, is deficient in lysine and tryptophan. Environmental conditions greatly impact plant growth, development and productivity. In this study, we used particle bombardment mediated co-transformation to obtain marker-free transgenic maize inbred X178 lines harboring a lysine-rich protein gene SBgLR from potato and an ethylene responsive factor (ERF) transcription factor gene, TSRF1, from tomato. Both of the target genes were successfully expressed and showed various expression levels in different transgenic lines. Analysis showed that the protein and lysine content in T1 transgenic maize seeds increased significantly. Compared to non-transformed maize, the protein and lysine content increased by 7.7% to 24.38% and 8.70% to 30.43%, respectively. Moreover, transgenic maize exhibited more tolerance to salt stress. When treated with 200 mM NaCl for 48 h, both non-transformed and transgenic plant leaves displayed wilting and losing green symptoms and dramatic increase of the free proline contents. However, the degree of control seedlings was much more serious than that of transgenic lines and much more increases of the free proline contents in the transgenic lines than that in the control seedlings were observed. Meanwhile, lower extent decreases of the chlorophyll contents were detected in the transgenic seedlings. Quantitative RT-PCR was performed to analyze the expression of ten stress-related genes, including stress responsive transcription factor genes, ZmMYB59 and ZmMYC1, proline synthesis related genes, ZmP5CS1 and ZmP5CS2, photosynthesis-related genes, ZmELIP, ZmPSI-N, ZmOEE, Zmrbcs and ZmPLAS, and one ABA biosynthesis related gene, ZmSDR. The results showed that with the exception of ZmP5CS1 and ZmP5CS2 in line 9-10 and 19-11, ZmMYC1 in line 19-11 and ZmSDR in line 19-11, the expression of other stress-related genes were inhibited in transgenic lines under normal conditions. After salt treatment, the expressions of the ten stress-related genes were significantly induced in both wild-type (WT) and transgenic lines. However, compared to WT, the increases of ZmP5CS1 in all these three transgenic lines and ZmP5CS2 in line 9-10 were less than WT plants. This study provides an effective approach of maize genetic engineering for improved nutritive quality and salt tolerance.
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http://dx.doi.org/10.3390/ijms14059459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676793PMC
April 2013

Sharps injuries and job burnout: a cross-sectional study among nurses in China.

Nurs Health Sci 2012 Sep 13;14(3):332-8. Epub 2012 Jun 13.

Institute of Social Medicine and Health Service Management, School of Public Health of Shandong University, Ji'nan, Shandong, China.

The present study investigated the relationship between sharps injuries and job burnout in nurses. Sharps injury questionnaires and the Maslach Burnout Inventory (MBI) questionnaires were used to investigate and analyze job burnout among 468 nurses, of which 458 effective questionnaires were collected, for a response rate of 97.86%. A total of 292 nurses had at least one sharps injury (63.76% of the 458 nurses). The dimension scores were higher for injured nurses compared with non-injured nurses. The difference between the dimensions of emotional exhaustion and depersonalization for nurses with sharps injuries was statistically significant (P < 0.05). A rank correlation analysis showed that these two dimensions had a positive correlation with sharps injuries (r = 0.69-0.78). The prevalence of sharps injuries in nursing is associated with depersonalization, as measured by the MBI. Nursing administrators should pay more attention to clinically burned-out nurses, and provide more opportunity to nurses for training and education to reduce the prevalence of sharps injuries.
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http://dx.doi.org/10.1111/j.1442-2018.2012.00697.xDOI Listing
September 2012

Health resource allocation and productive efficiency of Chinese county hospitals: data from 1993 to 2005.

Biosci Trends 2010 Oct;4(5):218-24

Institute of Social Medicine and Health Services Management, School of Public Health, Shandong University, Ji'nan, Shandong, China.

This study aims to assess trends in the productive efficiency of China's county hospitals during the economic transition using data from 1993 to 2005. A data envelopment analysis (DEA) framework was used to calculate the efficiency score of county hospitals in all 31 provinces. A C²R model and a BC² model were devised to respectively calculate overall and scale efficiency and pure technical efficiency at the hospital's current scale. Models included four inputs (number of medical staff; number of beds; value of fixed capital; and hospital expenditures) and three outputs (outpatient and emergency visits, number of inpatients, and hospital revenue) in total. As the results, geographical disparities in health resource allocation and county hospital productivity were noted. From 1993 to 2005, the number of county hospitals increased and their inputs, e.g. fixed capital in particular, grew rapidly. However, the amount of both outpatient and inpatient services declined somewhat especially in the middle and the western regions. The overall efficiency at the national level decreased slightly. County hospitals in the eastern region tended to have better overall, scale, and technical efficiency in comparison to the middle and the western regions. In conclusion, county hospitals are inefficient due to their enlarged scale and the reduced amount of health care services they provide. This issue should be addressed especially in the middle and the western regions, where health resources are far more limited and yet wasted. The effects of ongoing health sector reform on the productivity of county hospitals must be monitored and evaluated.
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October 2010

HIV infection and mental health of "money boys": a pilot study in Shandong Province, China.

Southeast Asian J Trop Med Public Health 2010 Mar;41(2):358-68

Shandong Province Center of Disease Control and Prevention, Shandong University, Jinan, China.

A pilot study was conducted in eight cities of Shandong Province, China to examine the seroprevalence of HIV and syphilis infection, and the mental health of "money boys" who were recruited by respondent-driven sampling and interviewed using a semi-structured questionnaire. The prevalence of the HIV-positive among money boys was 5.1%. Factors associated with the infection were having sex with women in the past 6 months (p < 0.05) and suffering STD-like symptoms (p < 0.01). The prevalence of syphilis was 10.2%. There were 77.2% participants engaged in such an occupation for economic survival. The prevalence of anxiety and depression among money boys was 46.6% and 68.1%, respectively. Heterosexual money boys were more likely to suffer from such mental symptoms. This study revealed the urgent need for interventions for HIV/AIDS control, together with mental counseling, targeting this vulnerable population.
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March 2010

Prevalence of HIV infection and HIV-related sex risk behaviors in men who have sex with men in Shandong Province, China.

Biosci Trends 2008 Jun;2(3):97-100

Shandong Province Center for Disease Control and Prevention, Ji'nan, China.

Recently, men who have sex with men (MSM) have become a population at high risk ofHIV infection in China, and more investigations of and intervention programs targeting this hidden population are urgently needed. The objective of this study was to assess the prevalence of HIV-positive individuals, HIV-related knowledge, and sex risk behaviors in MSM in large and middle-sized cities. Subjects were 1,617 interviewees who were selected by snowball sampling in 8 cities of Shandong Province and who were interviewed using a structured questionnaire. Their serological specimens were tested in a laboratory to confirm infection with HIV. Results indicated a prevalence of HIV infection of 1.3%, which is low when compared to that in metropolitan areas worldwide, although the prevalence of unsafe sexual behaviors was relevantly high and there was a lack of accessibility to HIV/STD testing and peer education. This study revealed the urgent need to make intervention programs universal, effective, and much more accessible to MSM in typical large and middle-sized cities in China.
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June 2008
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