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An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

Background: The incidence of cervical cancer in Uyghur women ranks first among those in Han and other ethnic minority groups. We aimed to understand the natural history of HPV in Uyghur women. Methods: A longitudinal cohort study on the natural history of HPV infection in rural Uyghur women in China was conducted between May 2013 and May 2014. A total of 11000 women from South Xinjiang underwent HPV screening by careHPV and liquid-based cytology. Ultimately, a total of 298 women with positive HPV and normal biopsy results or CIN1 were enrolled to participate in a study including follow-up HPV testing for two years. Results: The HPV infection rate in Uyghur women was 9.15%. Among the participants, the careHPV test showed that 298 women were HPV-positive, and histology showed CIN1 or normal results for these women at baseline. Among these patients, after 24 months of initial recruitment, 92 (30.87%) patients had persistent HPV infections, and 206 (69.13%) had cleared HPV infection. Univariate analysis showed that persistent HPV infection was associated with age and shower frequency (P < 0.001 and P = 0.047, respectively). Conclusions: Our results suggest that women over the age of 50 years who have been infected with HR-HPV for more than 1 year should be regularly screened and monitored for HPV. In addition, education should be strengthened to improve poor health habits in these women. [ABSTRACT FROM AUTHOR]

Background: Paying attention to the health-related quality of life (HRQOL) of rural residents in poverty-stricken areas is an important part of China's poverty alleviation, but most studies on health-related quality of life have focused on rural residents, elderly individuals, and patients; evidence on the HRQOL of rural minority residents is limited. Thus, this study aimed to assess the HRQOL of rural Uighur residents in remote areas of Xinjiang, China, and determine its influencing factors to provide policy opinions for realizing a healthy China strategy. Methods: A cross-sectional study was performed on 1019 Uighur residents in rural areas. The EQ-5D and self-administered questionnaires were used to assess HRQOL. We applied Tobit and binary logit regression models to analyse the factors influencing HRQOL among rural Uighur residents. Results: The health utility index of the 1019 residents was − 0.197,1. The highest proportion of respondents reporting any problem was for mobility (57.5%), followed by usual activity (52.8%). Low levels of the five dimensions were related to age, smoking, sleep time, Daily intake of vegetables and fruit per capita. Gender, age, marital status, physical exercise, sleep duration, daily intake of cooking oil per capita, daily intake of fruit per capita, distance to the nearest medical institution, non-infectious chronic diseases (NCDs), self-rated health score, and participation in community activities were correlated with the health utility index of rural Uighur residents. Conclusions: HRQOL was lower for rural Uyghur residents than for the general population. Improving health behavioural lifestyles and reducing the incidence of poverty (return to poverty) due to illness are effective means of promoting the health in Uyghur residents. The region must fulfil the health poverty alleviation policy and focus on vulnerable groups and low-income residents to improve the health, ability, opportunity, and confidence of this population to live well. [ABSTRACT FROM AUTHOR]

Malus sieversii (Ldb.) Roem. is the original species of modern cultivated apple and a key national essential conservation plant in China. In recent years, degradation and death of wild apple has been exacerbated by imbalances in the rhizosphere micro-ecosystems of wild apple forests due to soil nutrient loss, grazing, climate change and pest and disease outbreaks. However, the structure, diversity and response to environmental factors of wild apple rhizosphere microbial communities are so far unclear. In this study, the rhizosphere bacterial and eukaryotic communities of M. sieversii (Ldb.) Roem. in eight regions of the Yili River were analyzed using 16S/18S rDNA high-throughput sequencing technology. The results indicated that the bacterial operational taxonomic units (OTUs), Shannon index, and community composition were significantly lower in regions A, E, and F than in other regions. By contrast, the dominant eukaryotic communities in all regions were relatively similar in composition and differed less than the relative abundance of bacterial communities. Geographical and climatic distance were found to be key factors influencing the composition and diversity of wild apple rhizosphere microbial communities through mantel analysis. Moreover, these factors above were more correlated with bacterial diversity than with eukaryotes. This study identified the structure of wild apple rhizosphere microbial communities in Xinjiang and their interaction mechanisms under geographical and environmental gradients. It provides guidance for the sustainable management and ecological construction of wild apple forests in China. [ABSTRACT FROM AUTHOR]

Background: Xinjiang is an economically underdeveloped area in China, but the obesity rate of children and adolescents is increasing year by year. Physical fitness and body mass index (BMI) are very important factors for healthy development, whereas few studies focus on the relationship between them in this region. This study aimed to explore the relationship between physical fitness and BMI of children and adolescents aged 7 to 18 in Xinjiang.Method: A total of 17,356 children and adolescents aged 7-18 years were involved. BMI was divided into five levels by percentiles, from very low to very high. Physical fitness was evaluated by five indicators: grip strength, standing long jump, sit-and-reach, 50 m dash, and endurance running. Single-factor analysis of variance was used to compare the Z-scores of the five physical fitness indicators among different BMI levels for the four age groups by gender. A nonlinear quadratic regression model was used to evaluate the relationship between BMI and each indicator in the four age groups.Result: There is a significant correlation between the five health-related indicators (grip strength, standing long jump, sit and reach, 50 m dash, endurance run) at two age groups (13-15 yrs., 16-18 yrs) of children and adolescents in Xinjiang, China. The range of the Pearson coefficient is 0.048 ~ 0.744. For the other two age groups (7-9 yrs., 10-12 yrs.,) significant correlations are found only in some indicators, and the Pearson coefficient ranges from 0.002 to 0.589. The relationship between BMI and physical fitness presents an U-shaped or inverted U-shaped curve in most age groups(R2 ranges from - 0.001 to 0.182. Children and adolescents with normal BMI score higher on physical fitness tests, and boys (R2 ranges from - 0.001 to 0.182) are more pronounced than girls (R2 ranges from 0.001 to 0.031).Conclusion: Children and adolescents with a BMI above or below the normal ranges have lower physical fitness than those with normal BMI. BMI and physical fitness have an U-shaped or inverted U-shaped curve relationship, and the impact is more evident in boys than girls. Targeted actions such as improving the quality of physical education classes, advocating students to keep a balanced diet and physical exercise should be taken designedly. [ABSTRACT FROM AUTHOR]

Background: China has a unique cotton planting pattern. Cotton is densely planted in alternating wide and narrow rows to increase yield in Xinjiang, China, causing the difficulty in the accurate estimation of cotton yield using remote sensing in such field with branches occluded and overlapped. Results: In this study, unmanned aerial vehicle (UAV) imaging and deep convolutional neural networks (DCNN) were used to estimate densely planted cotton yield. Images of cotton fields were acquired by the UAV at an altitude of 5 m. Cotton bolls were manually harvested and weighed afterwards. Then, a modified DCNN model (CD-SegNet) was constructed for pixel-level segmentation of cotton boll images by reorganizing the encoder-decoder and adding dilated convolutions. Besides, linear regression analysis was employed to build up the relationship between cotton boll pixels ratio and cotton yield. Finally, the estimated yield for four cotton fields were verified by weighing harvested cotton. The results showed that CD-SegNet outperformed the other tested models, including SegNet, support vector machine (SVM), and random forest (RF). The average error in yield estimates of the cotton fields was as low as 6.2%. Conclusions: Overall, the estimation of densely planted cotton yields based on low-altitude UAV imaging is feasible. This study provides a methodological reference for cotton yield estimation in China. [ABSTRACT FROM AUTHOR]

Background: Ticks are ectoparasites that feed on blood of a broad taxonomical range of terrestrial and flying vertebrates and are distributed across a wide range of environmental settings. To date, the species identity, diversity, and relationships among the ticks on lizards in China have been poorly understood. Methods: In this study, 30 ticks, collected from the multi-ocellated racerunner (Eremias multiocellata) lizard in the Tarim Basin and adjacent Yanqi Basin of the Xinjiang Uygur Autonomous Region in China, were identified by morphological observation and confirmed by DNA-based techniques. The mitochondrially encoded 12S rRNA, 16S rRNA, and COI gene fragments of ticks were amplified and sequenced. To understand the genetic polymorphisms, 47 ticks collected from hedgehogs and 1 from brushwood in the Tarim Basin were also included. Species identification was based on both morphological and molecular characters. The median-joining network approach was used to evaluate the intraspecific genealogies of the ticks and their relatedness with the geographical origin or hosts. Results: The sequence similarity analysis confirmed that the 30 ticks belong to three genera and three species including 11 individuals of Hyalomma asiaticum, 3 of Rhipicephalus turanicus, and 16 of Haemaphysalis sulcata. A network approach revealed paraphyletic populations of R. turanicus and Hy. asiaticum at the intraspecies level regarding geographical origin and low host specificity. For R. turanicus and Hy. asiaticum, common ancestry was observed between COI sequences from lizards and other sequence types from different hosts and countries. Conclusions: To our knowledge, our study is the first to conduct a molecular survey of ticks from lizards in the arid regions of Xinjiang, China. Eremias multiocellata is an atypical host of the three tick species. Notably, two species of ticks, Hy. asiaticum and R. turanicus, have been collected and identified from lizards in China for the first time. Star-like networks suggest both of them might have experienced recent population expansion. The discoveries are closely related to the geographical environments in Xinjiang and will provide information for the control of ticks and tick-borne pathogens in Northwest China. [ABSTRACT FROM AUTHOR]

Background: To effectively provide public health care for rural residents, the Ministry of Health formally unveiled the contract service policy in rural China in April 2013. As the counterpart to family medicine in some developed countries, the contract service established a compact between village doctors and local governments and a service agreement between doctors and their patients. This study is a rare attempt to explore the perspectives of health providers on the contract service policy, and investigate the demand side's attitude toward the public health services delivered under the contract policy. This evidence from Xinjian County, Jiangxi Province, the first and most representative pilot site of the contract service, could serve as a reference for policymakers to understand the initial effects of the policy, whereby they can regulate and amend some items before extending it to the whole country. Methods: Official documents were collected and semi-structured interviews with human resources and villagers in Xinjian County were conducted in September 2013. A purposive sampling method was used, and eight towns from the total 18 towns in Xinjian County were selected. Ultimately, eight managers (one in each township health center), 20 village doctors from eight clinics, and 11 villagers were interviewed. A thematic approach was used to analyze the data, which reflected the people's experiences brought about by the implementation of the contract service policy. Results: While the contract service actually promoted the supply side to provide more public health services to the villagers and contracted patients felt satisfied with the doctor-patient relationship, most health providers complained about the heavy workload, insufficient remuneration, staff shortage, lack of official identity and ineffective performance appraisal, in addition to contempt from some villagers and supervisors after the implementation of the contract service. Conclusions: Contract service is a crucial step for the government to promote public health services in rural areas. To inspire the positive perspective and optimal work performance of the health workforce, it is imperative for the Chinese government to fortify financial support to health providers, adopt an advanced management model and escalate administrative capacity. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is one of the commonest causes of cancer-related deaths worldwide. The prevalence rate of cervical cancer in Uyghur women in Xinjiang Autonomous Region of China has been remarkably higher than the ethnic groups living in the same region. This study aimed to assess the knowledge level and attitude of cervical cancer and its issues among the Uyghur women in Xinjiang province of China. Methods: A cross-sectional interview-based survey of 5,000 Uyghur women was developed from 2013 to 2014 in Xinjiang autonomous region, to assess their knowledge and perception of cervical cancer and its issues. The collection of data was based on the questionnaire items. Results: According to the questionnaire items, we collected a data for 5,000 participants. A very small proportion of participants had heard of the cervical cancer, human papillomavirus (HPV), and HPV vaccine, that is, 27.0%, 13.0% and, 6.0%, respectively. According to the demographic characteristics, women aged 31 to 40 years were more aware of the knowledge of cervical cancer (32.9%), HPV (17.8%), and HPV vaccine (9.1%), and women with undergraduate or higher educational level had more knowledge of cervical cancer (30.0%), HPV (21.0%), and HPV vaccine (9.7%). Conclusions: From our study, we concluded that Uyghur women need more information about cervical cancer and its risk factors. Lack of the related knowledge about cervical cancer may be one of the important factors for high incidence rate of cervical cancer in Uyghur population. In order to reduce the incidence rate and mortality of cervical cancer in Uyghur women and to make extensive health education to raise awareness of cervical cancer and HPV is strongly needed than prophylactic vaccination. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis (VL) was once a severe parasitic disease in China. Thanks to the great efforts of integrated control, VL was eliminated in most epidemic areas, except for certain western provinces (autonomous region) at the end of 1950s. From then on, VL gained less attention and has seemed to spread, especially in the last 15 years. Infants are the most important population threatened by VL. However, there have been few studies on the endemic characteristics of infantile VL in China. Methods: Infantile VL cases were collected from the online National Infectious Diseases Reporting System (NIDRS). Statistical description and inference was used to reveal the endemic characteristics in gender, age group, time and regionalism. Spatial analysis was carried out to explore the high risk area for infantile VL in China. Results: A total of 1093 infantile VL cases were reported from 2006 to 2012. There was no statistically significant difference in gender over time. The minimum, maximum and mean age of these cases was 1.1, 35.9 and 13.8 months, respectively. Among them 86.92% were under 2 years of age, and there was a statistically significant difference among age groups over time. An incidence peak appeared in 2008-2009, most cases were distributed in the months September to December, and there was a tail-raising effect in the coming two months of the next year. More than 98% of cases were reported in Xinjiang Uygur Autonomous Region, Gansu Province and Sichuan Province, accounting for 61.02%, 32.75% and 4.57%, respectively. A total of 56 counties reported infantile VL cases, with the cumulative incidence ranging from 0.02 to 24.57%. There were two main zones of high endemicity for infantile VL in China. The monthly incidence clearly coincides with the number of towns where infantile VL cases were reported. Three fatalities were reported during the study period, the case fatality rate was 2.75‰. Conclusions: The endemic situation of infantile VL is serious, and there are several active foci of infantile VL prevalence in China. VL has emerged as a severe threat to infants of endemic regions in China. [ABSTRACT FROM AUTHOR]

Background: The prevalence of population-wide hypertension, obesity and dyslipidemia has not been well studied in the pasture area of Xinjiang. The present epidemiological study was performed to determine the prevalence of hypertension, obesity and dyslipidemia in minority populations from the pasture area of Xinjiang and to discuss the potential risk factors for hypertension.Methods: A population-based, cross-sectional study in the Xinjiang pasture area was performed which included 2251 participants aged over 30 years (90.33% participation rate) of whom 71.26% were Kazaks. Several risk factors were considered: hypertension (defined as systolic or diastolic blood pressure or both of at least 140/90 mmHg measured on one occasion or treatment for hypertension) overweight/obesity (body mass index > or = 25 kg/m2) alcohol intake, smoking/tobacco use and dyslipidemia. Outcomes were prevalence of hypertension, obesity and dyslipidemia and the associated risk factors of hypertension detected by multivariate logistic regression analysis taking into account various metabolic and lifestyle characteristics.Results: The prevalence of hypertension, overweight/obesity and dyslipidemia in all participants from the pasture area of Xinjiang was 51.9%, 47.9% and 49.2% respectively. Independently, the prevalence and awareness of hypertension was 52.6% and 15.3% among Kazaks (n = 1604), 54.6% and 14.1% among Uygurs (n = 418), 39.5% and 16.1% among Mongolians (n = 81) and 43.9% and 18.2% among non-Xinjiang-born Han immigrants (n = 148). The prevalence of overweight/obesity in Kazaks, Uygurs, Mongolians and Han immigrants was 46.7%, 48.9%, 62.5% and 50.3%, respectively. The prevalence of dyslipidemia in the four ethnic groups mentioned was 53.5%, 34.8%, 49.3% and 47.3%, respectively. The mean blood pressure in all participants was 136/86 mmHg (pre-hypertensive), the mean BMI was 24.7 kg/m2. Based on multiple logistic regression analysis, the significant risk factors for hypertension were age [1.07(1.06-1.09), P < 0.0001], overweight/obesity [overweight: 1.61(1.22-2.13), p = 0.0007; obesity: 1.95 (1.33-2.87), p = 0.0007], hypercholesterolemia [1.30(1.15-1.47), p < 0.0001] and an alcohol intake of over 30 g/day [2.22(1.43-3.45), p = 0.0004].Conclusions: The considerably high prevalence of hypertension, overweight/obesity and dyslipidemia among the minority population aged over 30 from the pasture area of Xinjiang calls for effective preventive measures. Age, increased body mass index, hypercholesterolemia and > or =30 g/d alcohol intake can be counted as risk factors for hypertension, but further genetic or environmental clarification would be desirable to explain the unusually high prevalence of the conditions mentioned above. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a complex disease influenced by multiple genetic and environmental factors. The Kazakh ethnic group is characterized by a relatively high prevalence of hypertension. Previous research indicates that the FURIN gene may play a pivotal role in the renin-angiotensin system and maintaining the sodiumelectrolyte balance. Because these systems influence blood pressure regulation, we considered FURIN as a candidate gene for hypertension. The purpose of this study was to systematically investigate the association between genetic variations in the FURIN gene and essential hypertension in a Xinjiang Kazakh population. Methods: We sequenced all exons and the promoter regions of the FURIN gene in 94 hypertensive individuals to identify genetic variations associated with the disorder. Genotyping was performed using the TaqMan polymerase chain reaction method for four representative common single nucleotide polymorphisms (SNPs, -7315C > T, 1970C > G, 5604C > G, 6262C > T) in 934 Kazakh Chinese people. One SNP (1970C > G) was replicated in 1,219 Uygur Chinese people. Results: Nine novel and seven known single nucleotide polymorphisms were identified in the FURIN gene. The results suggest that 1970C > G was associated with a hypertension phenotype in Kazakh Chinese (additive model, P = 0.091; dominant model, P = 0.031, allele model, P = 0.030), and after adjustment with logistic regression analysis, ORs were 1.451 (95%CI 1.106-1.905, P = 0.008) and 1.496 (95% 1.103-2.028, P = 0.01) in additive and dominant models, respectively. In addition, the association between 1970C > G and hypertension was replicated in Uygur subjects (additive model, P = 0.042; dominant model, P = 0.102; allele model, P = 0.027) after adjustment in additive and dominant models, ORs were 1.327 (95% 1.07-1.646), P = 0.01 and 1.307 (95%CI 1.015-1.681, P = 0.038), respectively. G allele carriers exhibited significant lower urinary Na+ excretion rate than non-carriers in the Kazakh Chinese population (152.45 ± 76.04 uM/min vs 173.33 ± 90.02 uM/min, P = 0.007). Conclusion: Our results suggest that the FURIN gene may be a candidate gene involved in human hypertension, and that the G allele of 1970C > G may be a modest risk factor for hypertension in Xinjiang Kazakh and Uygur populations. [ABSTRACT FROM AUTHOR]

Background: HPV has been found repeatedly in esophageal carcinoma tissues. However, reported detection rates of HPV DNA in these tumors have varied markedly. Differences in detection methods, sample types, and geographic regions of sample origin have been suggested as potential causes of this discrepancy. Methods: HPV L1 DNA and HPV genotypes were evaluated in 435 esophageal carcinoma specimens collected from four geographic regions with different ethnicities including Anyang in north China, Shantou in south China, Xinjiang in west China, and the United States. The HPV L1 fragment was detected using SPF1/GP6+ primers. HPV genotyping was performed using genotype specific PCR. Results: Two hundred and forty four of 435 samples (56.1%) tested positive for HPV L1. Significant differences in detection rate were observed neither among the three areas of China nor between China and the US. HPV6, 16, 18, 26, 45, 56, 57, and 58 were identified in L1 positive samples. HPV16 and 57 were the most common types in all regions, followed by HPV26 and HPV18. Conclusions: HPV infection is common in esophageal carcinoma independent of region and ethnic group of origin. Findings in this study raise the possibility that HPV is involved in esophageal carcinogenesis. Further investigation with a larger sample size over broader geographic areas may be warranted. [ABSTRACT FROM AUTHOR]

Background: Although visceral leishmaniasis (VL), a disease caused by parasites, is controlled in most provinces in China, it is still a serious public health problem and remains fundamentally uncontrolled in some northwest provinces and autonomous regions. The objective of this study is to explore the spatial and temporal characteristics of VL in Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region in China from 2004 to 2018 and to identify the risk areas for VL transmission. Methods: Spatiotemporal models were applied to explore the spatio-temporal distribution characteristics of VL and the association between VL and meteorological factors in western China from 2004 to 2018. Geographic information of patients from the National Diseases Reporting Information System operated by the Chinese Center for Disease Control and Prevention was defined according to the address code from the surveillance data. Results: During our study period, nearly 90% of cases occurred in some counties in three western regions (Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region), and a significant spatial clustering pattern was observed. With our spatiotemporal model, the transmission risk, autoregressive risk and epidemic risk of these counties during our study period were also well predicted. The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. Conclusions: The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. Our findings will strengthen the VL control programme in China. [ABSTRACT FROM AUTHOR]