Search

Background: Preconception care is an opportunity for detecting potential health risks in future parents and providing health behavior education to reduce morbidity and mortality for women and their offspring. Preconception care has been established in maternal and child health hospitals in Shanghai, China, which consists of health checkups, health education and counseling. This study investigated factors associated with the utilization of preconception care, and the role of preconception care on health behavior changes before conception among pregnant women and their partners.Methods: A cross-sectional study was conducted among pregnant women at three maternal and child health hospitals in Shanghai. The participants were invited to complete a self-administered questionnaire on the utilization of preconception care and health behavioral changes before conception.Results: Of the 948 recruited pregnant women, less than half (42.2%) reported that they had utilized preconception care before the current pregnancy. Unplanned pregnancy, unawareness of preconception care and already having a general physical examination were the main reasons for not attending preconception care. The two main sources of information about preconception care were local community workers and health professionals. Younger women and the multipara were less likely to utilize preconception care. Women who utilized preconception care were more likely to take folic acid supplements before conception [Adjusted Odds Ration (aOR) 3.27, 95% Confidence Interval (CI) 2.45-4.36, P < 0.0001]. The partners of pregnant women who had attended preconception care services were more likely to stop smoking [aOR 2.76, 95%CI 1.48-5.17, P = 0.002] and to stop drinking [aOR 2.13, 95%CI 1.03-4.39, P = 0.041] before conception.Conclusions: Utilization of preconception care was demonstrated to be positively associated with preconception health behavior changes such as women taking folic acid supplements before pregnancy, their male partner stopping smoking and drinking before conception. Future studies are needed to explore barriers to utilizing preconception care services and understand the quality of the services. Strategies of promoting preconception care to expectant couples, especially to young and multipara women, should be developed to further improve the utilization of the services at the community level. [ABSTRACT FROM AUTHOR]

Introduction: Falls are currently the top safety problem in long-term care facilities (LTCFs) in China. Due to the increasing number of residents living in LTCFs, more evidence is needed to give a foundation for fall prevention.Objective: This study aimed to explore the epidemiological characteristics of falls in LTCFs in central Shanghai.Methods: The study was conducted in 21 LTCFs in a central district in Shanghai, with a capacity of 3,065 residents. A two-stage sampling method was applied in participant recruitment. Falls were recorded by LTCF staff over a 12-month period. Details of falls were obtained by face-to-face interviews. The χ2 test was used in data analyses.Results: The incidence of falls was 13.5%; 64.0% falls resulted in injuries, with 32.0% involving fractures. Women had a significantly higher incidence of injurious falls than men (χ2 = 4.066, p = 0.044). Residents aged 80-89 years or in level 1 care had the highest incidence of falls with severe consequences. The incidence of falls was significantly higher at small- or medium-sized LTCFs, public LTCFs, and LTCFs with higher environmental risk levels compared to their counterparts. Most falls occurred when walking on a flat floor (28.9%) and rising up or sitting down (24.0%); 40.9% occurred during the night. Of those injured, 54.8% were treated in hospitals, and only 53.7% completely recovered.Conclusions: Though the average incidence of falls in LTCFs in Shanghai was relatively low, great variation was observed between LTCFs, and severe consequences occurred frequently. Fall prevention programmes should be evidence-based with applicable devices and individualized care services and supports. The roles of personal and institutional factors on falls warrant further study. [ABSTRACT FROM AUTHOR]

Background: Anti-tuberculosis therapy requires at least six-month treatment with continuous administration of combined antibiotics, including isoniazid, rifampicin, pyrazinamide, and ethambutol. The long-term exposure to antibiotics could cause consequent changes in gut microbiota, which may alter the gastrointestinal function and drug absorption in patients, thereby affect the outcome of treatment. The study aims to characterize the longitudinal changes of gut microbiota among tuberculosis (TB) patients under standardized first-line treatment and provide an understanding of the association between alterations in gut microbiota composition and unfavorable clinical outcomes.Methods: The study is a multicenter, observational prospective cohort study. Three study sites are purposively selected in the western (Sichuan Province) and eastern (Jiangsu Province and Shanghai) parts of China. Three-hundred patients with bacteriologically confirmed pulmonary TB are enrolled. All eligible patients should be investigated using structured questionnaires before treatment initiation; and be followed up during the treatment at Day-14, Month-2, Month-5, the end of treatment and the sixth month after ending therapy. Stool samples are to be collected at each visit, consisting of six stool samples from each patient. Additionally, 60 healthy volunteers from Sichuan province and Shanghai city will be recruited as healthy controls to form the baseline of patient gut microbiota in the Chinese population. The dynamic changes of gut microbiota in terms of alpha diversity, beta diversity, taxonomic composition are to be illustrated individually from the time at diagnosis until the sixth month after therapy is completed. Furthermore, the diversity and component of gut microbiota will be compared between the groups with and without unfavorable treatment outcome in terms of adverse effect and treatment failure.Discussion: Studies on the clinical manifestations, adverse reactions, and gut microbiota alterations will provide scientifically-sound evidence on the impact of gut microbiota alterations on TB treatment outcomes. The study is not only useful for guiding personalized TB treatment but also sheds light on the effects of continuous antibiotics administration on gut microbiota.Trial Registration: Chinese Clinical Trial Registry, trial ID: ChiCTR1900023369, May 24, 2019. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Summary: Background: There is limited information on the prevalence of latent tuberculosis infection (LTBI) and the risk factors among contacts of pulmonary TB, which might contribute significantly to TB burden and therefore become the major concern for TB control in Shanghai, China. Methods: A total of 45 diagnosed TB patients from each of 7 Shanghai districts were chosen and approximately 3 contacts per case were randomly selected. A structured questionnaire was used to acquire socio-demographic information and to assess the degree of exposure to index cases. LTBI screening was performed by T-SPOT.TB assay. Results: Of 969 enrolled contacts, 39% were men, average age was 45 ± 19.1 years, and 76.3% were household contacts. LTBI was identified in 29.6% of subjects. Those contacting smear-positive TB patients were 2.24 times (95%CI, 1.586–3.162) more likely to develop LTBI than those otherwise; household contact significantly increased the likelihood of LTBI by 1.52 times (95%CI, 1.061–2.180). Furthermore, among household contacts, the risk of LTBI was higher in spouses and first-degree relatives and increased with age and contact duration. Conclusions: A high prevalence of LTBI was observed among the TB contacts in Shanghai, highlighting the need of intervention among the household contacts and those contacting smear-positive TB patients. [ABSTRACT FROM AUTHOR]

The present study aimed to describe the disease progression of chronic hepatitis B patients without or with compensated cirrhosis at baseline, to estimate the risk of progression to decompensated cirrhosis, hepatocellular carcinoma and death, and to determine prognostic factors of disease progression in patients in Shanghai, China. Stored medical records from 322 biopsy-confirmed chronic hepatitis B cases diagnosed between 1981 and 1993 were selected, and the status of patients was tracked in 1999–2000. Among consenting patients, ultrasound examination and laboratory tests were conducted. Person-year incidence rates, Kaplan–Meier analysis, log-rank tests, and Cox regression analysis were conducted. Among chronic hepatitis B patients without compensated cirrhosis, the incidence rates of decompensated cirrhosis, hepatocellular carcinoma, and death were 6.3, 2.8, and 7.6 per 1000 person-years, respectively, while for patients with compensated cirrhosis, the rates were 35.6, 8.2, and 35.2 per 1000 person-years, respectively. The 15-year survival rate was 88% for patients without compensated cirrhosis, compared with 56% for patients with compensated cirrhosis ( P < 0.001). Cox regression analysis demonstrated that increased α-fetoprotein (AFP) ( P < 0.01), γ-globulin ( P < 0.05), and high-level severity of hepatic fibrosis ( P < 0.01) at baseline were risk factors of decompensated cirrhosis. Factors associated with a high risk of death included elevated AFP at baseline ( P < 0.01), severity of hepatic fibrosis ( P < 0.003), and sustained positivity for hepatitis B surface antigen ( P < 0.004). Increased AFP and severity of hepatic fibrosis at baseline were associated with higher risk of decompensated cirrhosis and death. These data provide rare empirical estimates of the negative long-term outcomes for patients with chronic hepatitis B in Shanghai, China. [ABSTRACT FROM AUTHOR]

Mycobacterium kansasii pulmonary disease is frequently misdiagnosed and treated as tuberculosis, especially in countries with high tuberculosis burden. This study aimed to investigate the drug resistance profile of M. kansasii in patients with M. kansasii pulmonary disease in Shanghai and to determine the variations in drug resistance after 2 months of antimycobacterial treatment. All patients with a diagnosis of M. kansasii pulmonary disease from 2017 to 2019 in Shanghai were retrospectively analysed. Whole-genome sequencing was performed, and the minimum inhibitory concentration (MIC) to antimycobacterial drugs was measured using the broth microdilution method. In total, 191 patients had a diagnosis of M. kansasii pulmonary disease. Of them, 24.1% (46/191) had persistent positive culture after 2 months of antimycobacterial treatment. Whole-genome sequencing revealed that the 46 paired isolates had a difference of <17 single nucleotide polymorphisms, thus excluding the possibility of exogenous reinfection. More than 90% of the baseline isolates were sensitive to rifampin, clarithromycin, moxifloxacin, or amikacin, whereas a high resistance to ethambutol (118/191, 61.8%) and 4 μg/mL of isoniazid (32/191, 16.8%) were observed. Two isolates presented high resistance to rifamycin (i.e. a rifampin MIC of >8 μg/mL and a rifabutin MIC of 8 μg/mL) both containing the rpoB mutation (S454L). The increase of MIC to rifampin, ethambutol, and/or isoniazid was identified in 50.0% (23/46) of the patients. A high prevalence of innate resistance to ethambutol and isoniazid was observed among circulating M. kansasii clinical strains in Shanghai. The increase in drug resistance under empirical antimycobacterial treatment highlighted the urgency of definitive species identification before initiating treatment. [ABSTRACT FROM AUTHOR]

• Revealed spatial heterogeneity of NTM-PD, focusing on MKC-PD, MAC-PD, and MABC-PD. • Utilized Bayesian spatial disease mapping to highlight high-risk NTM-PD areas. • Demonstrated distinct demographic and clinical characteristics of NTM-PD patients. • Linked environmental factors to varying NTM-PD distribution patterns. To investigate the spatial heterogeneity of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Shanghai. A population-based retrospective study was conducted using presumptive pulmonary tuberculosis surveillance data of Shanghai between 2010 and 2019. The study described the spatial distribution of NTM-PD notification rates, employing hierarchical Bayesian mapping for high-risk areas and the Getis-Ord Gi* statistic to identify hot spots and explore associated factors. Of 1652 NTM-PD cases, the most common species was Mycobacterium kansasii complex (MKC) (41.9%), followed by Mycobacterium avium complex (MAC) (27.1%) and Mycobacterium abscessus complex (MABC) (16.2%). MKC-PD patients were generally younger males with a higher incidence of pulmonary cavities, while MAC-PD patients were more often farmers or had a history of tuberculosis treatment. MKC-PD hot spots were primarily located in the areas alongside the Huangpu River, while MAC-PD hot spots were mainly in the western agricultural areas. Patients with MKC-PD and MAC-PD exhibited a higher risk of spatial clustering compared to those with MABC-PD. Different types of NTM-PD exhibit distinct patterns of spatial clustering and are associated with various factors. These findings underscore the importance of environmental and host factors in the epidemic of NTM-PD. [Display omitted] [ABSTRACT FROM AUTHOR]

Falls are the most common safety problem among older people living in long-term aged care facilities in China. Unsupportive environments can increase the risk of falls among this population. We aimed to understand the distribution of environmental risk factors in long-term aged care facilities and their associations with falls among residents. The environmental risk factors in 25 long-term aged care facilities in Changning, Shanghai, were investigated on site using a 75-item questionnaire on potential fall-related risk factors. Residents in participating facilities were interviewed and prospectively followed up for 1 year to ascertain the occurrence of falls. Univariate and multivariate analyses were applied to measure the associations between environmental exposures and falls. Between Nov 1, 2017, and Dec 31, 2018, 739 residents were interviewed at baseline and 605 completed 1-year follow-up. 132 (22%) of 605 participants had at least one fall during follow-up. The number of environmental risk factors in each care facility ranged from two to 22 (mean 11 [SD 5]). The three most common factors, which were significantly associated with the occurrence of falls, were inadequate or inappropriate handrails (24 [96%] facilities; risk ratio [RR] for fall occurrence 1·878 [95% CI 1·128–3·126]), unsafe ground (23 [92%]; 2·496 [1·111–5·606]), and insufficient lighting (21 [84%]; 2·008 [1·103–3·656]). Risk factors were most frequently distributed in bedrooms (in 24 [96%] facilities), shared toilets or showers (20 [80%]), and individual toilets or showers (17 [68%]). On univariate analysis, falls were significantly associated with the presence of environmental risk factors in corridors (RR 1·571 [1·058–2·334]), elevators (1·826 [1·224–2·724]), and living rooms (1·843 [1·249–2·720]). After adjusting for demographics and individual risks of falls by Morse Scale, residents in facilities with eight or more environmental factors had significantly increased risk of falls (adjusted RR 2·207 [1·378–3·534]). Environmental risk factors in long-term aged care facilities are associated with increased risk of falls among residents. Improving lighting and ground safety and installing adequate handrails, especially in corridors, elevators, and living rooms, could reduce the incidence of falls. Shanghai Municipal Commission of Health and Family Planning (grant number 201640040), Chinese Center for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]