江苏省输入性疟疾初诊时间及影响因素分析

目的　了解江苏省输入性疟疾病例回国后就医行为特征,分析病例初诊时间影响因素,为输入性疟疾病例早期发现、防止重症病例发生及继发传播提供科学依据。方法　在中国疾病预防控制中心传染病报告信息管理系统和寄生虫病防治信息管理系统中,收集2019年江苏省报告的输入性疟疾病例个案信息以及发病及初诊时间信息。对输入性疟疾病例回国后就医行为及流行病学特征进行描述性分析,采用多因素logistic回归分析探索病例回国后初诊时间影响因素。结果　2019年江苏省累计报告输入性疟疾病例244例,病例初诊时间在1～12 d,平均初诊时间（1.53 ± 1.65） d、中位初诊时间1 d。出现首发症状当天就医的病例数最多（76例,31.1%）,68例（27.9%）第2天就医、46例（18.9%）第3天就医、54例（22.1%）3 d后就医,其中3例初诊时间在1周以上。归国时间在1月（14例,5.7%）和12月（13例,5.3%）、年龄在41～50岁（32例,13.1%）的外出务工人员中初诊时间延误者比例较高。多因素logistic回归分析发现,归国时间在3月[比值比（OR）= 0.16, P = 0.03, 95%可信区间（CI）：（0.03,0.85）]及有境外疟原虫感染史者[OR = 0.36, P = 0.001, 95% CI :（0.19, 0.67）]的病例初诊时间相对较短。结论　江苏省输入性疟疾患者主动就医及时性有待提高,有疟原虫感染史者就医更及时。     

Risk factors for malaria infection and anemia for pregnant women in the Sahel area of Bandiagara, Mali

Malaria infection and anemia during pregnancy are the primary causes of maternal and fetal morbidity and mortality. The aims of this study were to identify risk factors for malaria infection and to assess the relationship between malaria infection and anemia in pregnant women. Two cross-sectional surveys were conducted in September 1993 and then again in May 1994 (the end of the rainy and dry seasons respectively). A total of 235 pregnant women were randomly selected from both the rural and urban areas of Bandiagara, Mali. According to results from multivariate analysis, the risk of malaria infection was significantly higher during the rainy season (OR= 4.85, 95% CI 2.42-9.75) the first trimester of gestation (OR= 2.21, 95% CI 1.00-4.87, in younger women (OR= 2.48, 95% CI 1.19-5.16), and in women living in the rural area (2.49, 95% CI 0.99-6.27). The risk of anemia was also higher during the rainy season (OR= 1.93, 95% CI 1.10-3.39, in the rural area (OR= 3.55, 95% CI 1.46-8.62). The risk of anemia was lower during the first trimester of gestational age (OR= 0.45, 95% CI 0.22-0.92). The relationship between malaria infection and anemia also varied with season. During the rainy season, the risk for anemia was similar among malaria-infected and non-infected pregnant women. In contrast, the risk was higher among infected pregnant women during the dry season (OR= 3.43, 95% CI 1.09-10.07). In conclusion, the data suggest, that earlier gestation age, living in the rural area, and young age rather than parity are important risk factors for malaria infection in pregnant women. Further, malaria infection is strongly associated with anemia in pregnant women particularly during the dry season and is most likely the cause of anemia. Thus, control measures against malaria infection should target younger rural women in their first trimester of pregnancy.     

Progress of partial integration of malaria control with other vector borne diseases control in northern Thailand

Thailand partially integrated the malaria program into the provincial and local Public Health system starting in 2003 by adding it to the control of other vector borne diseases and by transferring some activities to the Public Health Department. This study evaluates the results of this transfer on 8 high malaria incidence districts of Mae Hong Son and Chiang Mai Provinces. Indicators were measured for all community hospitals, Vector Borne Disease Control Units, (VBDU), health centers (HC), malaria clinics, and malaria posts in 2003 and 2004 during the first two years of partial integration. The number of Vector Borne Disease Control staff decreased 1.8 - 3%, and their operational budgets decreased 25%. The VBDU staff did all the indoor residual spraying (IRS), insecticide treated net (ITN) work and entomology surveys, they took 80.6% of the blood films, and treated 72% of the patients, while Public Health system did the remainder. The Annual Parasite Incidence (API) (1 - 10/1,000) and IRS coverage (88 - 100%) remained adequate in most areas during the first years after partial integration, but the API increased (to 31.6 - 57.6/1,000) in some populations. The percentage of insecticide treated bed net coverage was adequate in Mae Hong Son (95.4%), but inadequate in Chiang Mai (52.2%). Early diagnosis and prompt treatment (4 - 23 days), hospitals reporting disruption of anti-malarial drugs (3 of 7), and health centers having all needed equipment, training, and drugs for malaria diagnosis (9%) remain inadequate. If the program is allowed to diminish, malaria could spread again among the population. Integration of antimalarial activities into the general Public Health system has only been partially successful. We recommend the integration process and results should be monitored and evaluated to find and mitigate problems as they occur, and modify the integration process if needed.     

云南省腾冲市住院病人溶组织内阿米巴感染情况及影响因素分析

目的　了解云南省腾冲市住院病人溶组织内阿米巴感染情况及其影响因素。方法　2016?07?01–2017?03?31,采用横断面调查方法对云南省腾冲市人民医院住院病例进行问卷调查。无菌采集其粪便样本,通过巢氏PCR检测溶组织内阿米巴感染情况。采用[χ2]检验和多因素logistic回归模型分析溶组织内阿米巴感染的影响因素。结果　共调查507名住院患者,其中10名患者感染溶组织内阿米巴,感染率为1.97%（95% CI：1.07%～3.59%）。溶组织内阿米巴感染者和非感染者身高（Z = -0.40,P = 0.69）、体重（Z = -0.34,P = 0.73）、体重指数（Z = -0.40,P = 0.69）和年龄（Z = -1.48,P = 0.14）差异无统计学意义。慢性腹泻（OR = 21.43,95% CI：5.04～91.23）和日常饮用水（OR = 11.28,95% CI：2.79～45.56）是人感染溶组织内阿米巴的影响因素。溶组织内阿米巴感染和腹胀（OR = 0.70,95% CI：0.09～5.56）、食欲不振（OR =0.50,95% CI：0.06～4.02）、皮肤瘙痒（OR = 0.79,95% CI：0.10～6.38）、肛周瘙痒（OR = 1.74,95% CI：0.21～14.07）及便秘（OR = 0.91,95% CI：0.13～7.33）无统计学关联。结论　云南省腾冲市住院病人溶组织内阿米巴感染率较高,慢性腹泻和饮用未煮沸的水与溶组织内阿米巴感染呈高度相关。     

Sexual behavior and HIV infection among pregnant hilltribe women in northern Thailand

A case-control study was carried out to determine factors associated with HIV infection among pregnant hilltribe women who attended the antenatal clinics of six hospitals in northern Thailand (Mae Suai, Wieng Pa Pao, Mae Sai, Mae Chan, Wieng Kaen, Mae Fa Luang, and Chiang Rai hospitals) between 1 January 2005- 31 May 2007. Data were collected using questionnaires and analysis was by univariate (p-value = 0.100) and multivariate analysis (p-value = 0.050) in the model of unconditional multiple logistic regression. The ratio of cases to controls was 1:4. The sample consisted of 255 subjects; 51 cases and 204 controls. The mean age of the women was 26.9 years (min = 15, max = 52, and SD 7.3). The majority of the women were Lahu (49.8%) or Akha (36.9%). Nearly half the women were Christian (48.2%), followed by Buddhist (42.4%). Most of the women were not educated (60.4%). The largest group for family income was 10,000-49,999 baht/year (62.6%). After controlling for family income, family debt, education, occupation and household members, the findings showed that the "not married to debut partner" group were at greater risk than the "married to debut partner" group by 6.6 times (OR(adj) = 6.6, 95% CI = 2.9-14.9). The "use of alcohol" group were at higher risk by 4.5 times (OR(adj) = 4.5, 95% CI = 2.0-10.3) compared to the no alcohol use group, and a history of genital ulcer group had an increased risk of 6.3 times (OR(adj) = 6.3, 95% CI = 1.2-31.1) the chance of having HIV infection compared to no history of genital ulcers in pregnant hilltribe women.     

Prevalence and predictors of maternal peripheral malaria parasitemia in central Mozambique

Malaria infection during pregnancy (MiP) is heterogeneously distributed even in malaria-endemic countries. Program planners require data to facilitate identification of highest-priority populations for MiP control. Using data from two cross-sectional studies of 5,528 pregnant women in 8 neighboring sites in Mozambique, we described factors associated with maternal peripheral parasitemia by using logistic regression. Principal multivariate predictors of maternal peripheral parasitemia were gravidity (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.60-3.26 for primigravidae and OR = 1.61, 95% CI = 1.29-2.01 for secundigravidae compared with gravidity > or = 3); age (OR = 0.96 per year, 95% CI = 0.94-0.99); study site (OR = 1.45, 95% CI = 1.34-1.56 to 5.32, 95% CI = 4.92-5.75) for comparison with the reference site; and no maternal education (OR = 1.38, 95% CI = 1.15-1.66) compared with any education. Other predictors (in subgroups) were bed net use (OR = 0.49, 95% CI = 0.48-0.50); preventive sulfadoxine-pyrimethamine doses (OR = 0.25, 95% CI = 0.24-0.25); and infection with human immunodeficiency virus (HIV) (OR = 1.49, 95% CI = 1.11-2.00). Programmatic priorities should respond to heterogeneous distribution of multiple risk factors, including prevalence of malaria and infection with HIV, and maternal socioeconomic status.     

Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR

A cross-sectional seroprevalence study on leptospirosis, using microscopic agglutination test (MAT), was conducted in rural villages in Khammouane Province, Lao People's Democratic Republic, in December 2006. The overall prevalence of leptospiral infection among 406 subjects was 23.9% (95% confidence interval [CI] 19.7-28.0%). Independent risk factors for the infection, identified by multivariate logistic regression, were male sex (odds ratio [OR], 1.92; 95% CI: 1.24-2.98), recent flooding on one's own property (OR, 2.12; 95% CI: 1.25-3.58), and collecting wood in the forest (OR, 1.90; 95% CI: 1.17-3.09). Age, occupation, and animal ownership were not associated with seropositivity. Flooding was associated with the risk of infection particularly for women, whose behaviors or activities involving contact with floodwater were presumed to play an important role. This study showed that leptospirosis is endemic in Khammouane Province and that local flooding plays an important role in the transmission of the disease.     

Microgeographical Differences of Plasmodium vivax Relapse and Re-Infection in the Peruvian Amazon

To determine the magnitude of Plasmodium vivax relapsing malaria in rural Amazonia, we carried out a study in four sites in northeastern Peru. Polymerase chain reaction-restriction fragment length polymorphism of PvMSP-3α and tandem repeat (TR) markers were compared for their ability to distinguish relapse versus reinfection. Of 1,507 subjects with P. vivax malaria, 354 developed > 1 episode during the study; 97 of 354 (27.5%) were defined as relapse using Pvmsp-3α alone. The addition of TR polymorphism analysis significantly reduced the number of definitively defined relapses to 26 of 354 (7.4%) (P < 0.05). Multivariate logistic regression modeling showed that the probability of having > 1 infection was associated with the following: subjects in Mazan (odds ratio [OR] = 2.56; 95% confidence interval [CI] 1.87, 3.51), 15–44 years of age (OR = 1.49; 95% CI 1.03, 2.15), traveling for job purposes (OR = 1.45; 95%CI 1.03, 2.06), and travel within past month (OR = 1.46; 95% CI 1.0, 2.14). The high discriminatory capacity of the molecular tools shown here is useful for understanding the micro-geography of malaria transmission.     

Highly endemic hepatitis B infection in rural Vietnam

BACKGROUND AND AIM: Hepatitis B is a major public health problem in Vietnam; however, estimates of the prevalence of hepatitis B virus (HBV) and hepatitis delta virus (HDV), and risk factors in rural Vietnam are limited. The aim of this study was to determine HBV and HDV prevalence, and identify risk factors for HBV infection. METHODS: A cross-sectional seroprevalence study was undertaken in two rural districts in Thai Binh province. The study population was randomly selected using multistage sampling. Demographic and behavioral risk information and serological samples were obtained from 837 participants. RESULTS: Mean age was 42.3 years +/- 15.8 (range, 16-82 years), and 50.8% were female. Prevalence of anti-HBV core antibody (anti-HBc) and hepatitis B virus surface antigen (HBsAg) was 68.2% and 19.0%, respectively, and hepatitis B e antigen HBeAg was detected in 16.4% of the HBsAg-positive group. Prevalence of HDV was 1.3% in the HBsAg-positive group. Factors associated with HBV infection (anti-HBc or HBsAg positive) were age 60 years or older (OR, 3.82; 95% CI, 1.35-10.80; P = 0.01), residence in Vu Thu district (OR, 3.00; 95% CI, 2.16-4.17; P < 0.0001), hospital admission (OR, 2.34; 95% CI, 1.33-4.13; P = 0.003) and history of acupuncture (OR, 2.01; 95% CI, 1.29-3.13; P = 0.002). Household contact with a person with liver disease (OR, 2.13; 95% CI, 1.29-3.52; P = 0.003), reuse of syringes (OR, 1.81; 95% CI, 1.25-2.62; P = 0.002) and sharing of razors (OR, 1.69; 95% CI, 1.03-2.79; P = 0.04) were independent predictors of HBsAg positivity. Alanine aminotransferase (ALT) level was elevated (>40 IU/L) in 43% of the HBsAg-positive group; proportion elevated was higher in HBeAg-positive (65%) compared with HBeAg-negative (39%) individuals in this group (P = 0.02). CONCLUSION: Hepatitis B virus infection is highly endemic in rural Vietnam. Poor infection control activities in health-care settings contribute to high HBV prevalence in this region. Universal HBV infant vaccination and improved infection control procedures are required for improved HBV control in Vietnam.     

云南西双版纳疟疾暴发区疟疾发病危险因素的病例对照调查

目的研究疟疾暴发区疟疾发病的危险因素. 方法采用病例对照的流行病学调查方法,用预先设计的问卷表收集人口学信息、疟疾知识、蚊帐使用、化学预防和流动史等信息. 结果共调查66例病人和57例对照.采用单因素和多因素回归方法分析了33个因素.单因素分析发现6个因素与疟疾发病有关,多因素分析发现2个独立的因素.男性疟疾发病的几率低于女性(OR=8.53,95% CI 0.97～74.24) ,日落后从劳作地回村者的疟疾发病危险度低(OR=0.06,95% CI 0.01～0.68). 结论在暴发流行区,仅有几个因素影响不同人群的的疟疾发病.日落后从劳作地回村者的疟疾发病危险度低,提示控制措施应重点放在控制和预防村内感染和传播方面.     

Intestinal helminths and malnutrition are independently associated with protection from cerebral malaria in Thailand

Although human infection with Ascaris appears to be associated with protection from cerebral malaria, there are many potential socio-economic and nutritional confounders related to helminth infection that need to be considered. In a hospital-based study, 37 cases of cerebral malaria and 61 cases of non-severe malaria with high parasite biomass (i.e. hyperparasitaemia and/or circulating schizonts) answered a structured questionnaire and were screened for intestinal helminths. Logistic regression was then used to adjust for the potential confounders. The adjusted odds ratios (OR) and their 95% confidence intervals (CI) still showed a significant protective association for helminths (OR = 0.24; CI = 0.07-0.78, P = 0.02) and malnutrition (OR = 0.11; CI = 0.02-0.58; P = 0.01), with no evidence of interaction between the two. There was also a significant dose-effect trend for the helminth infections (P = 0.048). These results, despite coming from a hospital-based study, indicate that the apparent association between helminths and protection from cerebral malaria is not the result of socio-economic or nutritional confounders.     

Malaria infection during pregnancy: intrauterine growth retardation and preterm delivery in Malawi

In sub-Saharan Africa, malaria infection in pregnancy contributes to low birth weight through intrauterine growth retardation (IUGR) and preterm delivery (PTD). It was hypothesized that malaria-associated PTD and IUGR have differing etiologies due to timing of infection. In a prospective cohort of primigravid women enrolled at the antenatal clinic of Mangochi District Hospital in Malawi, the associations were investigated between antenatal or delivery parasitemias and IUGR or PTD. Among 178 singleton deliveries, 35% of infants were preterm or had IUGR. Cord blood parasitemia (odds ratio [OR]=3.34; 95% confidence interval [CI], 1.3-8.8], placental parasitemia (OR=2.43; 95% CI, 1.2-5.1), and postdelivery maternal peripheral parasitemia (OR=2.78; 95% CI, 1.3-6.1) were associated with PTD. Parasitemia and/or clinically diagnosed malaria in the antenatal period was associated with IUGR (OR=5.13; 95% CI, 1.4-19.4). Delivery parasitemias had borderline associations with IUGR. The risk patterns observed suggest that the timing and severity of infection influences the occurrence of IUGR or PTD.     

华支睾吸虫病诱发原发性肝细胞癌的危险性评价

目的 探讨华支睾吸虫病与原发性肝细胞癌的关系及其与HBV感染、饮酒的协同致病作用.方法 采用病例对照研究的方法,以444例原发性肝细胞癌患者及同期住院500例非肿瘤患者为研究对象,比较两组间华支睾吸虫病合并状况,评价华支睾吸虫病发生原发性肝细胞癌的危险性以及与HBV感染、饮酒的协同致病作用.结果 病例组华支睾吸虫病合并率为16.44%,对照组合并率为2.40%,两组间差异有统计学意义(χ2=56.58,P＜0.01),有华支睾吸虫病者发生原发性肝细胞癌的OR值为8.00(95% CI:4.34～14.92),其中病程不足10年者并发原发性肝细胞癌的OR值为4.82(95% CI:2.32～10.26),10年及以上者OR值为17.54(95% CI:5.47～57.18).华支睾吸虫病与HBV感染和华支睾吸虫病与饮酒之间呈正相加交互作用,其交互作用超额相对危险度分别是110.43和18.23;交互作用归因比分别是0.80和0.63;交互作用指数分别是5.18和2.84.结论 华支睾吸虫病可能是原发性肝细胞癌的重要危险因素之一;随着华支睾吸虫病病程的延长,华支睾吸虫病者并发原发性肝细胞癌危险性增加;华支睾吸虫病与HBV感染或饮酒在原发性肝细胞癌的发生中可能具有协同致病作用.     

Association of the sickle cell trait and the ABO blood group with clinical severity of malaria in southwest Nigeria

In regions of high Plasmodium falciparum malaria endemicity, certain erythrocyte polymorphisms confer resistance to severe disease. In this study, we evaluate the role of the sickle cell trait (HbS) and ABO blood groups in the clinical manifestations of childhood malaria in Southwest Nigeria. The subjects comprised 3100 children (53% males, median age 39 months), including 1400 children with uncomplicated malaria, 1000 children with asymptomatic malaria and 700 with severe malaria. Haemoglobin (Hb) types were determined using electrophoresis and serum agglutination techniques were used to determine ABO blood groups. Blood group O was the commonest ABO blood group (47.7%) in the study population, the others were A (22.5%), B (25.2%) and AB (4.6%). The frequencies of the HbAS and HbAC were 14.4% and 5.8%, respectively. In regression models adjusting for age, gender, parasite density and blood group, HbAS was associated with a reduced risk of severe malaria OR=0.46 (CI(95%): 0.273-0.773). Among severe malaria subjects, HbAS was associated with significantly lower parasite densities. The protective effect of blood group O was demonstrated with a decreased risk of severe malaria OR=0.743 (CI(95%): 0.566-0.976) after adjusting for age, gender and parasite density and Hb genotype. Blood group B was associated with increased risk of severe malaria OR=1.638 (CI(95%): 1.128-2.380) after adjusting for age, gender, packed cell volume, parasite density and Hb genotype. We have confirmed from this large study of Nigerian children the major protective effective of the sickle cell heterozygous state against both cerebral malaria and severe malarial anaemia. We also show that the B blood group is associated with an increased risk of severe malaria. In conclusion, the sickle cell haemoglobin type and ABO groups modulate the risk of severe malaria in Nigerian children.     

Microscopic and sub-microscopic Plasmodium falciparum infection, but not inflammation caused by infection, is associated with low birth weight

Pregnancy-associated malaria is one of the leading causes of low birth weight in malaria endemic areas. In this study, 145 parturient women residing in areas endemic for Plasmodium falciparum in Lambaréné, Gabon, were recruited into the study after delivery, and the association of maternal P. falciparum infection, inflammatory response, and birth weight was studied. At delivery, 10% (15) of the mothers (12 were positive in both peripheral and placental blood smears, 1 was positive in peripheral blood only, and 2 were positive in placenta blood only) were positive for P. falciparum by microscopy and 23% (30) by real-time polymerase chain reaction (PCR). The level of C-reactive protein (CRP) was significantly elevated in microscopically P. falciparum-positive pregnant women (34 mg/L; 95% CI: 3-458) but not in those with sub-microscopic infections (6 mg/L; 95% CI: 1-40) compared with those free of P. falciparum infection (7 mg/L; 95% CI: 1-43). In a multivariate analysis, the presence of microscopic (adjusted OR = 28.6, 95% CI = 4.8-169.0) or sub-microscopic (adjusted OR = 13.2, 95% CI = 2.4-73.0) P. falciparum infection in pregnant women and age of mothers < 21 years (adjusted OR = 9.7 CI = 1.0-89.7), but not CRP levels, were independent predictors for low birth weight. This finding may have important operational implications and emphasizes the need for appropriate diagnostic methods in studies evaluating the outcome of pregnancy-associated malaria.     

Hepatitis delta virus infection in mongolia: analyses of geographic distribution, risk factors, and disease severity

The prevalence and risk factors for hepatitis delta virus (HDV) infection among Mongolian school children were assessed by detecting the antibody against HDV and HDV RNA, and through structured interviews. The study subjects consisted of 181 children with the past or ongoing hepatitis B virus infection who were investigated during the nationwide serosurvey conducted in 2004. The prevalence of antibody to HDV was 6.1%, with the proportion of 13.6% among hepatitis B surface antigen (HBsAg)-positive subjects, all of whom had HDV RNA. Multivariate logistic regression analyses showed that injections (> 11 times) (odds ratio [OR] = 8.31, 95% confidence interval [CI] = 1.28-54.07) and blood sampling (> 3 times) (OR = 5.34, 95% CI = 1.12-25.53) in health care settings, hospitalization (> 3 times) (OR = 6.20, 95% CI = 1.18-32.71), and cohabitating with patients with chronic hepatitis (OR = 4.57, 95% CI = 1.26-16.55) predicted the seropositivity for antibody to HDV. These results suggest that parenteral exposures in health care settings and household transmission are the main routes of HDV transmission among Mongolian children.     

Ethnic differences in the prevalence and pattern of dementia-related behaviors

OBJECTIVES: To determine the prevalence of dementia-related behaviors in a large, multiethnic sample of community-dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991. MEASUREMENTS: Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self-report. Caregivers were asked if the patient typically demonstrated any of eight dementia-related behaviors. To determine the independent association between ethnicity and dementia-related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics. RESULTS: Overall, 92% of patients had one or more dementia-related behaviors. Sixty-one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering. After multivariate adjustment, black patients were significantly more likely than whites to be constantly talkative (odds ratio (OR)=1.41, 95% confidence interval (CI)=1.11-1.80), to have hallucinations (OR=1.89, 95% CI=1.49-2.40) and episodes of unreasonable anger (OR=1.70, 95% CI=1.34-2.15), to wander (OR=1.40, 95% CI=1.08-1.81), and to wake their caregiver (OR=1.33, 95% CI=1.04-1.69). Latinos had a significantly higher likelihood than whites of having hallucinations (OR=1.49, 95% CI=1.10-2.01), episodes of unreasonable anger (OR=1.59, 95% CI=1.18-2.16), combativeness (OR=1.59, 95% CI=1.17-2.17), and wandering (OR=1.59, 95% CI=1.21-2.26). For most behaviors, these adjusted ORs are similar in magnitude of effect and statistical significance to the unadjusted estimates. CONCLUSION: Black and Latino community-dwelling patients with moderate to severe dementia have a higher prevalence of dementia-related behaviors than whites. Therefore, as the aging minority population grows, it will be especially important to target caregiver education, in-home support, and resources to minority communities.     

中国卒中患者医院感染相关因素的Meta分析

目的通过对中国囡内卒中医院感染相关文献的Meta分析,探讨卒中患者医院感染的常见危险因素和病死率。方法以中国学术期刊全文数据库（1994年1月-2009年4月）、万方数据库（1999年1月-2009年4月）和Medline—Pubmed（1965年1月-2009年4月）为文献检索源,对符合标准的文献进行Meta分析。结果①共纳入29篇文献,均为中文文献。其中,3篇为前瞧性研究,26篇为回顾性研究,均未没市病例对照。②出血性卒中（OR=1．93,95％CI：1．59～2．36）、老年（〈60／≥60岁：OR=0．44,95％CI：0．40～0．49;≤60／〉60岁：OR=0．52,95％C1：0．43～0．63）、吸烟史（OR=1,54,95％CI：1．25～1．90）、饮酒史（OR=1．43,95％CI：1．15～1．77）、心脏病史（OR=4．92,95％CI．3．54～7．01）、糖尿病史（OR=3．69,95％C1：2．86～4．76）、意识障碍（OR=6．21,95％CI：4．51～8．55）、吞咽障碍（OR=6．43,95％CI：3．34～12．35）、气管插管（OR=19．48,95％CI：9．84～38．56）、气管切开（OR=33．35,95％CI：14．46～76．96）、机械通气（OR=26．70,95％CI：8．53～83．60）、留置胄管（OR=5．84,95％CI：2．56～13．29）、留置尿管（OR=6．38,95％CI：1．82～22．37）、预防性应用抗生素（OR=5．93,95％CI：2．81～12．49）及H2受体拈抗剂（OR=4．34,95％CI：2．21～8．52）是影响卒中患者医院感染的相关因素。②有医院感染的书中患者病死率较无感染者增加4．44倍。结论出血性卒中患者较缺血性卒中有更大的医院感染的风险;老年、既往有不良生活习惯和慢性疾病史,病程中有意识障碍、吞咽障碍,行侵袭性操作和预防性使用抗生素的卒中患者,更易发生医院感染;有医院感染卒中患普的死亡风险较无感染者显著增加。     

Epidemiological characteristics and associated factors of acute hepatitis A outbreak among HIV‐coinfected men who have sex with men in Taiwan,June 2015‐December 2016

In Taiwan, an outbreak of acute hepatitis A (AHA) infection has been identified since June 2015. Approximately half of the cases occurred in HIV‐infected men who have sex with men (MSM). We used the Taiwan Centers for Disease Control (TCDC)‐operated National Disease Surveillance Systems (NDSS) to identify the incidence of AHA during 2011‐2016. Between June 2015 and December 2016, a total of 1268 AHA cases were documented, and 601 cases (47.4%) were co‐infected with HIV; the majority of whom were MSM (98.4%). Each AHA case was matched to two HIV‐infected controls without AHA reported in the NDSS on age (± 5 years), risk factor of HIV infection, HIV diagnosis date (± 30 days) and county/city of residence at HIV diagnosis. Three hundred forty‐three HIV/AHA cases were matched to 686 controls. In multivariable conditional logistic regression analysis, a previous gonorrhoea (adjusted OR=1.77, 95% CI 1.16‐2.70) and recent (aOR=6.77, 95% CI 4.34‐10.55) or remote syphilis report (aOR=3.56, 95% CI 2.48‐5.13) were independently associated with AHA. The epidemic persisted till December 2016, and the cases with a new diagnosis of HIV infection after AHA (28/301, 9.3%) increased after July 2016 (P = .001). HIV/AHA cases were centralized in northern and central metropolitan areas and HIV‐infected MSM with a recent history of sexually transmitted diseases in Taiwan. We recommend surveillance of associated behavioural and virologic characteristics and HAV counselling and testing for HIV‐infected men.