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ObjectivesThis study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China.DesignA cross-sectional study with respondent-driven sampling (RDS).SettingA multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014.Participants1245 middle-aged female sex workers who were over 35 years old (about 400 per study site).Main outcome measuresUnprotected commercial sex, and syphilis and HIV infection were biologically tested and measured.ResultsThe RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases.ConclusionsIn contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.

Background: Existing studies exploring the association between low birth weight (LBW) and maternal fine particulate matter (aerodynamic diameter<2.5μm, PM2.5) exposure have presented equivocal results, and one of the possible reasons for this finding might be due to relatively low maternal exposures. In addition, relatively narrow maternal exposure windows to PM2.5 have not been well established for LBW.Methods: We employed a nested matched case-control design among 43,855 term births in a large maternity and child care hospital in Jinan, China. A total of 369 cases were identified, and four controls per case matched by maternal age were randomly selected among those with normal birth weight (n=1,476) from 2014 to 2016. Ambient air monitoring data on continuous measures of PM2.5, nitrogen dioxide (NO2), and sulfur dioxide (SO2) (24-h average concentrations) from 2013 to 2016 were collected from thirteen local monitoring stations. An inverse distance weighting method based on both home and work addresses was adopted to estimate the individual daily exposures to these air pollutants during pregnancy by weighting the average of the twelve nearest monitoring stations within 30km of each 100m×100m grid cell by an inverse squared distance, and then the average exposure concentrations for gestational months, trimesters and the entire pregnancy were calculated. Adjusted conditional logistic regression models were used to estimate the odds ratios (ORs) per 10μg/m3 increment in PM2.5 and by PM2.5 quartiles during different gestational periods.Results: In this study, the estimated mean values of PM2.5, NO2, and SO2 exposure during the entire pregnancy were 88.0, 54.6, and 63.1μg/m3, respectively. Term low birth weight (TLBW) increased in association with per 10μg/m3 increment in PM2.5 for the 8th month [OR=1.13, 95% confidence interval (CI): 1.04, 1.22], the 9th month (OR=1.06, 95% CI: 0.99, 1.15), the third trimester (OR=1.17, 95% CI: 1.05, 1.29), and the entire pregnancy (OR=1.38, 95% CI: 1.07, 1.77) in models adjusted for one pollutant (PM2.5). In models categorizing the PM2.5 exposure by quartiles, comparing the second, third, and highest with the lowest PM2.5 exposure quartile, the PM2.5 was positively associated with TLBW during the 8th month (OR: 1.77, 95% CI: 1.09, 2.88; OR: 1.77, 95% CI: 1.03, 3.04; OR: 1.92, 95% CI: 1.04, 3.55, respectively) and for the 9th month, only association for exposure in the third versus the lowest quartile was significant (OR: 1.91, 95% CI: 1.02, 3.58).Conclusions: The study provides evidence that exposure to PM2.5 during pregnancy might be associated with the risk of TLBW in the context of very high pollution level of PM2.5, and the 8th and 9th months were identified as potentially relevant exposure windows. [ABSTRACT FROM AUTHOR]

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The study reported here sought to understand the rationales of safer sex practices adopted by newly diagnosed HIV-positive men who have sex with men (MSM). Guided by a socio-ecological framework, an ethnography was conducted among newly diagnosed HIV-positive MSM. In-depth interviews and participant observation were employed to produce an account of the social and cultural settings that was faithful to the perspectives of participants. A total of 31 participants with diverse backgrounds were recruited in a southern city of China. Participant observation was conducted in local healthcare settings, MSM venues, and NGO offices. Most participants (24/31) reported stopping unprotected anal intercourse (UAI) immediately after being diagnosed as HIV-positive. Factors associated with safer sex practices were identified at both individual and environmental levels, including self-protection, establishment of self-esteem, dignity, altruism and reciprocity, disease experience as a source of personal growth, and organizational culture and values. Newly diagnosed HIV-positive MSM navigate their sexual practices within the context of multiple competing factors. Implications for sustained behaviour change enabling safer sex practices include stimulating survival instinct, facilitating safer sex decision making, motivating and facilitating personal growth, and encouraging volunteerism to promote intentional activities for safer sex practices. [ABSTRACT FROM AUTHOR]

Abstract Background Little information about the effects of floods on typhoid fever is available in previous studies. This study aimed to examine the relationships between floods and typhoid fever and to identify the vulnerable groups in Yongzhou, China. Methods Weekly typhoid fever data, flood data and meteorological data during the flood season (April to September) from 2005 to 2012 were collected for this study. A Poisson generalized linear model combined with a distributed lag non-linear model was conducted to quantify the lagged and cumulative effects of floods on typhoid fever, considering the confounding effects of long-term trend, seasonality, and meteorological variables. The model was also used to calculate risk ratios of floods for weekly typhoid fever cases among various subpopulations. Results After adjusting for long-term trend, seasonality, and meteorological variables, floods were associated with an increased number of typhoid fever cases with a risk ratio of 1.46 (95% CI: 1.10–1.92) at 1-week lag and a cumulative risk ratio of 1.76 (95% CI: 1.21–2.57) at lag 0–1 weeks. Males, people aged 0–4 years old, people aged 15–64 years old, farmers, and children appeared to be more vulnerable than the others. Conclusions Our study indicates that floods could significantly increase the risks of typhoid fever with lag effects of 1 week in the study areas. Precautionary measures should be taken with a focus on the identified vulnerable groups in order to control the transmission of typhoid fever associated with floods. Highlights • Floods significantly increased the number of typhoid fever cases with lagged effects of 1 week. • Vulnerable groups of typhoid fever after floods were identified. • Results will assist in reducing the risk of typhoid fever associated with floods. • Confounders were controlled in the model. [ABSTRACT FROM AUTHOR]

Background Understanding the health consequences of continuously rising temperatures—as is projected for China—is important in terms of developing heat-health adaptation and intervention programs. This study aimed to examine the association between mortality and daily maximum (T max ), mean (T mean ), and minimum (T min ) temperatures in warmer months; to explore threshold temperatures; and to identify optimal heat indicators and vulnerable populations. Methods Daily data on temperature and mortality were obtained for the period 2007–2013. Heat thresholds for condition-specific mortality were estimated using an observed/expected analysis. We used a generalised additive model with a quasi-Poisson distribution to examine the association between mortality and T max /T min /T mean values higher than the threshold values, after adjustment for covariates. Results T max /T mean /T min thresholds were 32/28/24 °C for non-accidental deaths; 32/28/24 °C for cardiovascular deaths; 35/31/26 °C for respiratory deaths; and 34/31/28 °C for diabetes-related deaths. For each 1 °C increase in T max /T mean /T min above the threshold, the mortality risk of non-accidental-, cardiovascular-, respiratory, and diabetes-related death increased by 2.8/5.3/4.8%, 4.1/7.2/6.6%, 6.6/25.3/14.7%, and 13.3/30.5/47.6%, respectively. Thresholds for mortality differed according to health condition when stratified by sex, age, and education level. For non-accidental deaths, effects were significant in individuals aged ≥65 years (relative risk=1.038, 95% confidence interval: 1.026–1.050), but not for those ≤64 years. For most outcomes, women and people ≥65 years were more vulnerable. Conclusion High temperature significantly increases the risk of mortality in the population of Jinan, China. Climate change with rising temperatures may bring about the situation worse. Public health programs should be improved and implemented to prevent and reduce health risks during hot days, especially for the identified vulnerable groups. [ABSTRACT FROM AUTHOR]