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Background There have been few studies on children hospitalized with respiratory syncytial virus (RSV) published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven RSV children hospitalized in Suzhou, China. Methods Testing is routine for RSV for children admitted to the respiratory ward at Suzhou University Children's Hospital. We performed a retrospective study on children with documented RSV infection hospitalized at Suzhou University Children Hospital during 2005-2009 using a structured chart review instrument. Results A total of 2721 hospitalized children (15.0% of those tested) were positive by immunofluorescent assay for RSV during 2005-2009, and 64.0% of them were male. Eighty-seven percentage of the RSV-infected children were 2 years old and younger, and 56.6% were ≤ 6 months of age. The median length of hospital stay was 8 days. Of the RSV-infected children, 92.5% developed pneumonia and 21.8% experienced wheezing. In total, 49 (5.1%) of RSV-positive children were transferred to the ICU. Children ≤ 6 months old and who had congenital heart disease had higher risk of severe RSV disease. The mean cost of each RSV-related hospitalization was US$571.8 (US$909.6 for children referred to ICU and US$565.4 for those cared for on the wards). Multivariable logistic regression showed that compared with the ≤ 6 months children, those aged >6 months old had higher hospitalization cost; children with respiratory distress or with chronic lung diseases tended to have higher hospitalization costs than others. Conclusions RSV infections and severe RSV diseases mostly occurred in early infancy. The direct medical cost was high relative to family income. Effective strategies of RSV immunization of young children in China may be beneficial in addressing this disease burden.

Background. Surveillance for pneumococcal respiratory illness was conducted in children hospitalized at Affiliated Pediatric Hospital of Fudan University in Shanghai from August 2000 to August 2001. Methods. Sputum cultures were obtained from pediatric patients admitted with pneumonia or respiratory distress by tracheal aspirate. Blood cultures were also performed on a subset of patients. All pneumococcal isolates were serotyped and tested for antibiotic susceptibility. In addition clinical information on the patients including prior antibiotic history was abstracted. Streptococcus pneumoniae tracheal isolations were attempted in a total of 1013 pediatric patients hospitalized during this period. Among these samples 112 specimens were S. pneumoniae-positive. These positive isolates underwent serotyping and antibiotic susceptibility testing. Results. Five serotypes (19F, 23F, 6A, 14, 6B) of S. pneumonia accounted for 81% (91 of 112 cases). Other serotypes accounted only for 12% (13 of 112 cases), and 7% (8 of 112 cases) of isolates could not be typed by quelling test. Only one blood culture isolate was positive, probably reflecting the frequent use of antibiotic treatment before hospitalization. Fifty-one and 8.0% of isolates had intermediate and high level penicillin resistance, respectively. Fifty-eight percent were resistant to ampicillin, 6.6% to cefazolin, 25.0% to cefaclor, 6.6% to ceftriaxone, 85.7% to erythromycin, 66.7% to clindamycin and 28.2% to chloramphenicol. Among 66 isolates that were not susceptible to penicillin, serotype 19F was the most common, followed by 23F and 14. Conclusion. S. pneumoniae is a common cause of respiratory illness requiring hospitalization in young children in Shanghai, with antibiotic resistance increasingly common. Five serotypes account for most disease.

OBJECTIVE Our objective was to determine the secular trend in prevalence of type 2 diabetes in Shanghai, China. RESEARCH DESIGN AND METHODS Two consecutive population-based surveys for type 2 diabetes were conducted in randomly selected adults aged 35–74 years in Shanghai in 2002–2003 (n = 12,329) and in 2009 (n = 7,423). Diagnosed type 2 diabetes was determined based on self-report, whereas those undiagnosed were identified by measured fasting and postload glucose according to 2009 American Diabetes Association criteria. RESULTS Age-standardized prevalence of diagnosed and undiagnosed type 2 diabetes increased from 5.1 and 4.6% in 2002–2003 to 7.4 and 5.2% in 2009. The prevalence of type 2 diabetes increased with age and was higher among men and in urban residents in both surveys (P < 0.001). Between the two surveys, the increase in the prevalence was more evident in the rural population (P < 0.001) and appeared more rapid in younger birth cohorts (P < 0.05). CONCLUSIONS Our results suggest that Shanghai has experienced an increasing burden of type 2 diabetes.

To investigate the relationships between hyperuricaemia, serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of Pudong New Area, Shanghai.3326 residents aged 20 - 80 years were randomly selected from Pudong New Area, Shanghai through multistage sampling and interviewed between April and July of 2008. Fasting blood sample and morning ovid urine sample were collected for each participant for testing of SUA, serum creatinine, urinary albumin and creatinine. Both urine albumin to creatinine ratio (ACR) and glomerular filtration rate (GFR) were calculated to estimate the renal function.The overall prevalence of CKD was 16.0% (age standardized 13.2%). The mean values of estimated GFR in participants with CKD and without CKD were (89.19±27.25) and (105.88±98.37) ml×min(-1)×(1.73 m2)(-1), respectively. The prevalence rates of CKD in serum uric acid quartiles: first quartile, less than 4.2 mg/dl; second quartile, 4.2-5.0 mg/dl; third quartile, 5.0-6.0 mg/dl; and fourth quartile, 6.0 mg/dl or more were 13.9%, 15.0%, 15.8%and 19.4% (P0.05) respectively, increasing along with the increase of SUA among both sexes. Compared to the serum uric acid first quartile, the multivariate-adjusted odds for CKD of the second, third and fourth quartiles were 1.19 [95% confidence interval (CI): 0.90-1.58], 1.27 (95%CI: 1.02-1.70), 1.28 (95%CI: 1.10-1.68), respectively.Hyperuricaemia was independently associated with the increased prevalence of CKD among population living in the Pudong New Area, Shanghai.

To observe the compliance of film-coated praziquantel tablets in the schistosomiasis transmission controlled areas, so as to provide the evidence for the establishment of chemotherapy intervention measures in these areas.In the areas of schistosomiasis transmission controlled in Sichuan Province, 234 people were selected as film-coated praziquantel group (FCPG), and 203 people were selected as praziquantel group (PG). A questionnaire survey was implemented and the compliance of chemotherapy of the 2 groups was compared.In PG, all the people indicated that the praziquantel tablets has bad smell, 98.0% of the people had side-effects, such as nausea, headache, 69.5% thought the medicine was harmful to health subjectively, and 99.5% thought that it was too much dose of tablets for taking one time. In FCPG, all the people indicated that the film-coated praziquantel tablets had no bad smell, 18.8% of the people had side-effects, and 74.4% would like to choose film-coated praziquantel tablets. The rates of knowledge of praziquantel of PG and FCPG were 50.7% and 29.1%, respectively ( chi2 = 21.449, P = 0.01).The film-coated praziquantel tablets have no bad smell and lighter side-effects. The compliance of the film-coated praziquantel tablets is high in the areas of schistosomiasis transmission controlled, so the film-coated praziquantel tablets are worth to popularize and apply.

A total of 1,811 individuals from two villages located in the areas of China endemic for Schistosoma japonicum were analyzed by the Kato-Katz parasitologic examination, indirect hemagglutination assay (IHA), and enzyme-linked immunosorbent assay (ELISA). Statistical analysis of the results showed the kappa indices ranged from 0.106 to 0.234 between IHA and the stool examination and ranged from 0.037 to 0.134 between ELISA and the fecal examination. The sensitivity value of the IHA was 83.7% in Village A and 92.3% in Village B; the specificity value of the IHA was 55.8% in Village A and 67.3% in Village B. The sensitivity value of the ELISA was 88.4% in Village A and 96.2% in Village B; the specificity value of the ELISA was 38.4% in both Village A and Village B. A search for a good diagnostic test that can be applied in field situations in China should be given high priority.

Many epidemiologists have agreed that a refined estimate of the incubation period of severe acute respiratory syndrome (SARS) would need a sample size of about 200 cases and appropriate statistical methods enabling the inclusion of cases with defined periods of exposure. However, no such studies have been reported so far. Besides, determinants of the SARS incubation period remain unclear. In this study, 209 probable SARS cases with documented episodes of exposure between March 1 and May 31, 2003, in mainland China were included. A nonparametric method was used to analyze these data with defined periods of exposure to obtain the refined estimate of the SARS incubation period. Furthermore, the authors also explored the influence of various factors on the SARS incubation period by analysis of variance, linear regression analysis, and analysis of covariance. The estimates of mean and variance of the SARS incubation period were 5.29 days and 12.33 days2, respectively; 90% of patients would have an incubation period of less than 11.58 days with a probability of 0.8, and 99% of patients would have an incubation of less than 22.22 days with a probability of 0.9. The affected area showed a highly significant effect on the incubation period (p < 0.001), but the contact pattern, occupation, gender, and age did not.

To explore the consistency among different indices of abdominal ultrasonography for the diagnosis of schistosomiasis japonica related morbidity and the best combination of the indices.Six indices of abdominal ultrasonography were selected to investigate schistosomiasis related morbidity in residents in a village of Hunan Province, and the Kappa coefficients of diagnostic consistency among different indices and Cronbach's alpha coefficients of different combinations of indices were computed.The Kappa coefficients of 'liver parenchymaor = grade II' with 'right midclavicular subcostal' and with 'portal vein diameter' were 0.4131 and 0.4655 respectively, higher than normal level. The degree of their consistency was fair, and others showed poor or almost no consistency. Among the combinations made up of different indices, the Cronbach's alpha coefficient of the combination made up of 'liver parenchymaor = grade II', 'right midclavicular subcostal' and 'portal vein diameter' was 0.6566 which was the highest, showing the strongest internal consistency.The six indices can not be replaced with each other in assessing schistosomiasis related morbidity. Before abdominal ultrasonography is used extensively to assess the morbidity, it is necessary to study the diagnostic consistency of these indices and the best combination of the indices.

This paper presents a statistical method of familial correlation on family data from case-control studies.Marginal mean models of the probands and the relatives conditional on the proband's disease status, as well as the marginal association model of the relatives were modeled integrately. Conditional odds-ratio and marginal odds-ratio were used to measure the familial correlation.The parameter's interpretation in the model was in accordance with sample characteristics. This method is more efficient due to making fully use of information of the probands and relatives. In addition, the method has all advantages of GEE2.The method in this paper efficiently and conveniently analyzes the family data from case-control studies to estimate the familial correlation on disease.

To study the effect of infection control on schistosomasis Japonicum based on selective chemotherapy.Data were derived from national surveillance of schistosomiasis from 2000 to 2002, and random effect model of Meta-analysis was used to analyze the effect of chemotherapy on controlling schistosomiasis infection.One year after chemotherapy was started in the pilot villages where infection rate of schistosomiasis was more than 10%, the infection rates among residents and eggs per gram (EPG) of patients as well as population (geometric mean, GM) significantly reduced by 20.15%, 22.91% and 33.93% with 95% confidence interval (CI) 6.95 - 31.48, 14.69 - 30.34 and 11.69 - 50.68 respectively. In the pilot villages where infection rates were between 6% and 10%, the control measures largely base on chemotherapy significantly reduced the infection rate, by 24.50 (95% CI: 5.35 - 39.83). However the infection rates were no longer reduced in the pilot villages where the infection rate was less than 6%; EPG of patients and residents were maintained at the original level in the pilot villages where infection rate was 10% or less.In China, the rates of schistosomiasis Japonicum infection could be effectively reduced through the control measures largely based on chemotherapy, and they were kept at a relatively low level. However, it was very difficult to interrupt the transmission of schistosomiasis.

To explore the correlation of the ultrasound indices of liver and spleen in schistosomiasis japonica and with infection frequency, infection time and EPG.The canonical correlation was applied to analyze the correlation of the hepatosplenic ultrasound indices in schistosomiasis japonica, and the correlation of the ultrasound indices with infection frequency, infection time and EPG. The proportions of variation related to each other in liver and spleen were analyzed by the redundancy analysis.The correlation coefficients of the first pair correlation canonical variable were 0.7842, 0.5483 and 0.5800, 0.4220, respectively, in males and females without infection, males and females with infection history (P0.01). The correlation coefficients of the first pair correlation canonical variable were 0.6063, 0.5215 and 0.6595, 0.3849, respectively, in male negatives and female negatives, male positives and female positives (P0.01). In groups of males and females without infection, the variations of liver ultrasound indices related with the variation of spleen ultrasound indices were 43.5% and 17.5% respectively, and in groups infection history, they were 22.1% and 11.4% respectively. In male and female negative groups, the variations of liver ultrasound indices related with the variation of spleen ultrasound indices were 26.8% and 16.8% respectively, and in positive groups, they were 27.6% and 10.7% respectively. The infection frequency, infection time and EPG in the stool-positive groups were not significantly related with the canonical variables of liver and spleen ultrasound indices (P0.05).There is a significant canonical correlation between the liver and spleen ultrasound indices in schistosomiasis japonica, especially in males. In groups with infection history, the infection frequency, infection time and EPG of those stool-positives are not relevant to the canonical variables of liver and spleen ultrasound indices.

To identify the trends of endemic situation at the twenty-one national surveillance sites from 2000 to 2002.According to the protocol of the national surveillance system, longitudinal surveillance of endemic situation of schistosomiasis was carried out at the twenty-one surveillance sites since 2000.Relative indexes of endemic situation of schistosomiasis decreased in two surveillance sites annually. The infection rate of Schistosoma japonicum in human population decreased in most surveillance sites. The infection rate of cattle decreased in eight surveillance sites. However, acute cases were found in two sites each year. The density of live snails and infected snails was higher compared with that in 2000 among eight sites and infected snails were found in inner embankment in Junshan surveillance sites. Hunan Province, in 2002 at first time. The snail ridden areas increased significantly in Fengjin sites, Shanghai, where schistosomiasis was eliminated years ago.Current control strategies have some impact on the morbidity of schistosomiasis. However, these strategies should be lasted for longer time and surveillance on snails should be enhanced.

To explore the synthetical index for diagnosing schistosomiasis with ultrasound and to assess the prevalence rate with the index.Ultrasound indexes of schistosomiasis Japonicum were analyzed by principal component analysis, and the synthetical indexes were assessed by ROC curve.Among the abnormal rates of the 6 indexes, the lowest was 1.6% comparing with the highest of 59.5%. Significant difference was noficed among the abnormal rates (chi(2) = 631.1, P0.01). The individual correlation of the six indexes to each other as will as with age distribution was significant (P0.05). The three principal components reflected the degree of pathological changes on liver and spleen. The first principal component was the factor reflecting the degree of liver pathological changes, and the second and third principal components reflected the degree of pathological changes on spleen. The synthetical index D(1) = 0.047X(1) + 0.428X(2) + 1.247X(3) + 0.095X(4) + 0.002X(5) + 0.213X(6) - 12.837 was found by adding the three weight principal components, and it's area under the ROC curve was 0.957. When -1.70 was taken as the critical value, the abnormal rate of population was 66.3%, close to the resident's actual prevalence rate 66.9%.Ultrasonography was considered as a method which could rapidly assessing the resident's prevalence rate in the endemic areas of schisitosomiasis Japonicum, and could also provide powerful information for development of strategy on chemotherapy.

Background Acute lower respiratory infection (ALRI) is a major cause of hospitalization for children in China, while the etiological diagnosis of ALRI remains a challenge. This study was performed to evaluate the utility of the blind Nasotracheal aspiration (NTA) in the pathogen detection in ALRI through an evaluation of the test's specificity. Methodology/Principal Findings A hospital-based study of children ≤3 years was carried out from March 2006 through March 2007 in Suzhou University Affiliated Children's Hospital, including 379 cases with ALRI from the respiratory wards, and 394 controls receiving elective surgery. Nasopharyngeal swabs (NPS) and NTA specimens were taken on admission. S. pneumoniae was isolated from 10.3% of NTA samples from ALRI children, H. influenzae from 15.3%, and M. catarrhalis from 4.7%. The false positive rate—the strains from NTA in control group children—was 8.4% (95% CI: 5.8%–11.4%) for S. pneumoniae, 27.2% (95% CI: 22.7–31.5%) for H. influenzae, and 22.1% (95% CI: 18.0%–26.2%) for M. catarrhalis. The agreement between NPS and NTA in the control group was over 70%. Conclusion/Significance The blind NTA test is not a useful test for etiologic diagnosis of ALRI.

Background Few population-based studies have examined the relationship between glycemic status and chronic kidney disease (CKD) in China. We examined the prevalence of CKD across categories of glycemia [diagnosed diabetes, undiagnosed diabetes (fasting plasma glucose [FPG] ≥ 126 mg/dL), prediabetes (FPG 100–126 mg/dL) and normal glycemia (FPG Methods 5,584 Chinese adults aged 20–79 years were selected from the Pudong New Area of Shanghai through a multistage random sampling. Demographic and lifestyle characteristics, anthropometry and blood pressure were measured. Biochemical assays included FPG, serum creatinine and lipids, urinary creatinine and albumin. Prevalence of albuminuria [urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g], decreased kidney function and CKD (either decreased kidney function or albuminuria) across levels of glycemia were estimated. Results The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P Conclusions As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status. Prevention and control of diabetes and prediabetes should be a high priority in reducing the CKD burden in China.