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Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics. Methods A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis. Results Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ≥35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (≤ 200 cells/µL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death. Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors on tuberculosis (TB) in four provinces in the eastern and central parts of China., Methods: From Nov. 2009 to Feb. 2011, three population-based field surveys were conducted among the resident population in several townships/streets in Guangdong, Hunan and Jiangsu provinces and Shanghai municipality to collect TB-related information. 474 sputum smear positive TB patients and 1896 controls were randomly selected from the population under study and each case was matched by province, age and sex using a frequency matching method. Single-variable and multiple non-conditional logistic regression modeling were applied for data analysis, and odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated., Results: Data from Single-variable analysis showed that TB history, history of exposure to TB, DM history, immigrant population and per-capita living space were risk factors for TB, and high level of education was protective factors., Results: from multiple logistic regression showed that the risk factors of TB would include the following items: history of having had TB (OR = 52.356, 95%CI: 18.956 - 144.607), living space over 50 m(2)per-capita (OR = 8.742, 95%CI: 1.107 - 69.064), history of exposure to TB (OR = 6.083, 95%CI: 2.336 - 15.839) and being immigrants (OR = 3.306, 95%CI: 1.907 - 5.734), while having had high degree of education as the protective factor of TB (OR = 0.284, 95%CI: 0.110 - 0.733)., Conclusion: Control programs targeting those ever having TB patients and contacts to TB patients as well as immigrants should be strengthened.

Objective: To study the tuberculosis clustering areas and the changing trend, from 2008 to 2010, so as to provider the reference for tuberculosis control., Methods: Global spatial autocorrelation and SaTScan methods were used to detect and analyse the spatial clustering of total tuberculosis notification rate and the new smear-positive pulmonary tuberculosis notification rate, at the provincial level from 2008 to 2010., Results: The spatial clustering (SC) phenomenon was significant on total notification rate and new smear-positive pulmonary tuberculosis notification rate from 2008 to 2010 (P < 0.01). The coverages of clustering areas on total notification rate showed a reduction from 19 provinces to 14 provinces, distributed in the south, west and north-east areas of China. The coverages of clustering areas on new smear-positive pulmonary tuberculosis notification rate concentrated in 14 provinces which covered the south and north-east of China., Conclusion: The disease burden and the risk of transmission in the clustering areas of tuberculosis both located in the south and the north-east of China. The disease burden of tuberculosis was high in the west of China, but not the areas with high risk of transmission.

Objective: To evaluate the precision of Intraocular Lens (IOL) power calculation using a new optical low-coherence reflectometry biometer (Lenstar) and compare the results with those obtained with IOLMaster., Methods: It was a prospective controlled study. Biometry measurements in 157 eyes of 98 cataract patients were performed by the same examiner with Lenstar and IOLMaster. Axial length (AL), corneal keratometry readings (Km), and anterior chamber depth (ACD) were obtained. Correlation and differences of biometry measurements obtained with two biometers were made. Intraocular Lens power were calculated using 4 formulas and the corresponding IOL constants, the target was emmetropia. Then statistical analysis was proceeded., Results: Axial length were (23.65 ± 1.17) mm and (23.65 ± 1.16) mm respectively, Km (44.15 ± 1.58) D and (44.17 ± 1.58) D respectively by Lenstar and IOLMaster and no statistical differences were found (P > 0.05). ACD were (3.09 ± 0.41) mm and (3.05 ± 0.41) mm respectively by Lenstar and IOLMaster and there was statistical difference between them (P = 0.001). All biometry measurements showed good linear correlation (r > 0.9, P < 0.001). IOL power calculations with biometry values between Lenstar and IOLMaster using the 4 formulas showed good agreement. The least difference was obtained with formula SRK/T and the most with formula Haigis., Conclusions: Lenstar can provide precise and noncontact biometry measurements easily and safely, which are welcome by patients. Providing precise and reliable biometry measurements of cataract patients for Intraocular Lens power calculation, it shows good agreement with IOLMaster and the two biometers can be interchanged.

Objective: To establish the surveillance and warning index system corresponding with the epidemic characteristics of tuberculosis, in China., Methods: Literature review and expert meeting were conducted to formulate the preliminary index system frame. Delphi method was used for screening the index and determining the weight of each index., Results: Two-round Delphi consultations were performed. The activity coefficients were 87.0%, 90.0% respectively, with means of authority coefficient as 0.850±0.055 and 0.917±0.017, respectively. Mean scores of the index were 7.063±1.435, 8.156±0.611 respectively, with the means of coefficient of variation as 0.352±0.161 and 0.170±0.057 respectively. The harmony coefficients were 0.322 (χ2=499.472, P<0.05) and 0.393 (χ2=241.126, P<0.05) respectively. After the two-round consultation, the tuberculosis monitoring and warning index system was developed, including 4 first-class indicators, 9 second-class indicators and 48 third-class indicators., Conclusion: An index system was established for tuberculosis monitoring and early warning that could provide evidence for tuberculosis prevention and control as well as for the forecasting and warning model of the disease.

Objective: To analyze the notification status on new sputum-smear positive pulmonary tuberculosis (TB) over the recent years in China, and identify the clusters to address the related reasons., Methods: To spatially and temporally scan the data regarding notification, and to display the results via geographic information system., Results: (1) Spatial analysis identified 6 clusters and their relative risks ranged from 1.03 to 1.83 with statistical significance; (2) Temporal analysis identified there were clusters between 2005 and 2007 in terms of notification on new sputum-smear positive pulmonary TB, and the relative risk was 1.27 (P = 0.001); (3) Spatial and temporal analysis identified 2 clusters and the relative risks of the first class cluster and the second class cluster were 1.35 and 1.49 respectively with statistical significance. Provinces included in the first class cluster were basically the same as these in spatial analysis., Conclusion: Distribution of the notification on new sputum-smear positive pulmonary TB was not stochastic at space, time and space-time, and clusters did exist in China.

Objective: To analyze the results of surveillance for new smear positive pediatric tuberculosis (TB) cases at the age of 0 to 14 years in China, to understand the trend of prevalence and finding of the new smear positive pediatric cases with TB, to illuminate the significance of surveillance for pediatric TB in TB epidemiology and to explore how to prevent and control pediatric TB with the modern TB control strategy (directly observed treatment, short-course, DOTS)., Methods: According to the register of new smear positive pediatric TB cases at the age of 0 to 14 years in the National Annual Surveillance Reporting from 1992 - 2004, the proportion of new smear positive pediatric TB cases among all the new smear positive TB cases in China, the notification rate of new smear positive pediatric TB, the case detection rate of new smear positive TB in the eastern, central and west parts of China, in Beijing, Tianjin and Shanghai municipalities and 13 provinces where the modern TB control strategies have been implemented in 1992 and 15 provinces where the strategies have not been implemented except Beijing, Tianjin and Shanghai municipalities, were analyzed., Results: From 1992 to 2004, 31,358 new smear positive pediatric cases with TB at the age of 0 to 14 years were registered, among whom 14,727 were males (47%) and 16,631 were females (53%). The proportion of new smear positive pediatric TB cases among all the new smear positive TB cases was 1.26%, while the proportion among males was 0.89% and among females was 2.03%. The proportion among females was higher than that among males (P < 0.01). The notification rate of new smear positive pediatric cases with TB was between 0.42/100,000 and 1.08/100,000. Among the new smear positive pediatric TB cases, 44.9% were from western parts of China, followed by central and eastern parts of China and only 0.9% were from Beijing, Tianjin and Shanghai municipalities. Excluding Beijing, Tianjin and Shanghai municipalities, 13 provinces where DOTS was implemented since 1992 were compared with the other 15 provinces. The notification rate of new smear positive TB was respectively 75% and 25%. Western region of China was listed on the top in the proportion of new smear positive pediatric TB cases among all the new smear positive TB cases in every year., Conclusion: Among the registered new smear positive pediatric cases with TB, the number of females was higher than that among females and the proportion among males was also higher than that among males. The number of new smear positive pediatric TB cases in western parts of China was higher than that in central and eastern parts of China and the number in DOTS area was higher than that in non-DOTS area, which meant that the case detection of pediatric TB was associated with TB epidemic and DOTS strategy. Thus, in the implementation of DOTS, strengthening the prevention and control of pediatric TB, tracing the infection source of pediatric TB has certain impact on the TB epidemiological status.

Objective: To study the current status of geriatric tuberculosis (TB) and its impact on TB control program under the directly observed treatment short-course (DOTS) strategy in China., Methods: Using the prevalence information regarding the epidemiology of geriatric TB from the National Random Survey in 2000, a case-control study was carried out to analyze the case detection, treatment and management of geriatric TB patients between DOTS area and non-DOTS area., Results: The prevalence of sputum smear positive (SS+) in the age group of 65 or above was 440/100 000 which was 3.6 times of the average prevalence of SS+ of all age groups. Geriatric SS+ patients took up 28.8% of all the TB patients in 13 provinces with implementation of DOTS and 28.9% in 15 provinces without. The population of TB case in the age group 65 or above occupied 11.4% of all the newly registered SS+ case in 13 DOTS provinces from 1992 to 2000., Conclusion: The prevalence of geriatric SS+ was high. In both DOTS and non-DOTS areas, the proportion of geriatric SS+ was high but the registration rate of new SS+ was low among all the age groups. Both high prevalence and low case detection rate of geriatric TB became main issues to be under concern in the TB control strategy in China.