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Background: The construction of a robust healthcare information system is fundamental to enhancing countries' capabilities in the surveillance and control of hepatitis B virus (HBV). Making use of China's rapidly expanding primary healthcare system, this innovative approach using big data and machine learning (ML) could help towards the World Health Organization's (WHO) HBV infection elimination goals of reaching 90% diagnosis and treatment rates by 2030. We aimed to develop and validate HBV detection models using routine clinical data to improve the detection of HBV and support the development of effective interventions to mitigate the impact of this disease in China. Methods: Relevant data records extracted from the Family Medicine Clinic of the University of Hong Kong-Shenzhen Hospital's Hospital Information System were structuralized using state-of-the-art Natural Language Processing techniques. Several ML models have been used to develop HBV risk assessment models. The performance of the ML model was then interpreted using the Shapley value (SHAP) and validated using cohort data randomly divided at a ratio of 2:1 using a five-fold cross-validation framework. Results: The patterns of physical complaints of patients with and without HBV infection were identified by processing 158,988 clinic attendance records. After removing cases without any clinical parameters from the derivation sample (n=105,992), 27,392 cases were analysed using six modelling methods. A simplified model for HBV using patients' physical complaints and parameters was developed with good discrimination (AUC = 0.78) and calibration (goodness of fit test p-value >0.05). Conclusions: Suspected case detection models of HBV, showing potential for clinical deployment, have been developed to improve HBV surveillance in primary care setting in China. (Word count: 264) [ABSTRACT FROM AUTHOR]

Early school leavers cannot access school-based sex education programmes, increasing their vulnerability to sexual health issues. This study evaluated a culturally-sensitive and target-orientated sex education programme involving this group. Early school leavers were recruited from two branches of the Chinese Young Men's Christian Association in Hong Kong. These potential peer educators (PEs) attended five three-hour workshops providing comprehensive sex and sexuality education. They then provided peers with sex education, whilst receiving continuing support and attending additional training and activities. The Safer Choice Student Health Questionnaire, Mathtech Student Course Evaluation and Student Assessment of Course Impact questionnaires and Behavioral Intent Questionnaire were used to assess attitudes towards the programme and changes in knowledge, attitudes, practices regarding sex and sexual health. Of 60 PEs, 97% completed the workshop course. Seven months post intervention, changes in attitude towards contraception (p = 0.01) and a lower likelihood of having sex (p less than 0.001) were found amongst PEs. At 14 months, PEs were less likely to have sex (p less than 0.001) and were more comfortable talking about sex with friends and family (p = 0.01) but no difference was observed in pre-training and post-training tests among 545 targeted peers. The intervention successfully engaged the heavily involved PEs, and had some positive effects on their willingness to discuss sexual health issues, their perceived likelihood of having and their attitude towards sexual intercourse. (Contains 5 tables.)

Objective: This study investigated the prevalence of child maltreatment as perpetrated by parents, its associated health outcomes, and its resilient factors among high school students in China. Methods: A multi-level stratified random school-based survey was conducted in 2005. Twenty four high schools were randomly chosen from eight districts in Guangzhou, South China (three from each district). Two classes were randomly selected from each of Form 1 to Form 3 (aged 12-16) in each selected school. Data from 6,593 students were analyzed. A number of locally validated tools were used to measure various types of maltreatment as well as physical and psychological conditions of students. Results: The half-year prevalence of psychological aggression, minor physical maltreatment, severe physical maltreatment, and very severe physical maltreatment were 78.3%, 23.2%, 15.1%, and 2.8% respectively; while the half-year prevalence of sexual abuse was .6%. Maltreated students were more likely to report physical and psychological problems, and a positive relationship was also found between the severity of maltreatment and the likelihood of negative health outcomes. Male gender or having higher levels of social support and life satisfaction were identified as resilient factors to physical health of maltreated students. Conclusions: Child maltreatment as perpetrated by parents is common among high school students in Guangzhou, China. More public education programs are needed to raise public awareness of this problem. Intervention programs that target at improving social support and life satisfaction of students are potentially beneficial. (Contains 5 tables.)

China has more than 300 million cigarette smokers and 1 million deaths every year attributed to smoking. Despite its huge economic implications, the lack of smoking and associated lifestyle-related data on China's outpatients makes it difficult for health care professionals to provide individualized assessments and targeted interventions. This study aimed to identify factors to inform nurse-led smoking behavioral assessments and cessation interventions. Clinical data from new patients attending the family medicine outpatient department from a large tertiary hospital in a major Southern China city were collected between March and December 2015. Data including basic demographics, medical history, vaccination history, current medication, and information on lifestyle risk factors were collected by frontline nurses during nursing assessment on their initial visit. Chi-square and Student's t tests were used as univariate analysis and post hoc regression analysis to explore which factors contributed toward smoking cessation. Of 7913 eligible visits, smokers and ex-smokers accounted for 13.5% and 2.4% of new patients, respectively, with a majority of them being young and male (gender ratio of 8:1) smokers. Multiple behavioral risks and comorbidities such as hypertension and diabetes mellitus in smokers were common; for example, 17.9% of smokers were also current drinkers, making alcohol users 8.5 to 16.7 times more likely to have smoked. Ex-smokers were more likely to be divorced, to be ex-drinkers, or to have higher diastolic blood pressure and concurrent hypertension. Smoking and associated lifestyle risk assessments run by registered nurses should be incorporated into current outpatient health histories and in targeted smoking cessation intervention programs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the long‐term cost‐effectiveness of a Patient Empowerment Programme (PEP) for type 2 diabetes mellitus (DM) in primary care. Materials and Methods: PEP participants were subjects with type 2 DM who enrolled into PEP in addition to enrolment in the Risk Assessment and Management Programme for DM (RAMP‐DM) at primary care level. The comparison group was subjects who only enrolled into RAMP‐DM without participating in PEP (non‐PEP). A cost‐effectiveness analysis was conducted using a patient‐level simulation model (with fixed‐time increments) from a societal perspective. We incorporated the empirical data from a matched cohort of PEP and non‐PEP groups to simulate lifetime costs and outcomes for subjects with DM with or without PEP. Incremental cost‐effectiveness ratios (ICER) in terms of cost per quality adjusted life year (QALY) gained were calculated. Probabilistic sensitivity analysis was conducted with results presented as a cost‐effectiveness acceptability curve. Results: With an assumption that the PEP effect would last for 5 years as shown by the empirical data, the incremental cost per subject was US $197 and the incremental QALYs gained were 0.06 per subject, which resulted in an ICER of US $3290 per QALY gained compared with no PEP across the lifetime. Probabilistic sensitivity analysis showed 66% likelihood that PEP is cost‐effective compared with non‐PEP when willingness‐to‐pay for a QALY is ≥US $46 153 (based on per capita GDP 2017). Conclusions: Based on this carefully measured cost of PEP and its potentially large benefits, PEP could be highly cost‐effective from a societal perspective as an adjunct intervention for patients with DM. [ABSTRACT FROM AUTHOR]

To investigate the prevalence and the associated risk factors of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and sexually transmitted infections (STIs) among men who have sex with men (MSM) in Kunming, 300 MSM were recruited through community-based organizations between September 2014 and January 2015. The prevalence of HIV, HBsAg, syphilis, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were 17.0%, 7.7%, 11.3%, 18.2% and 13.2%, respectively. In the three different anatomic sites (urethra, rectum and pharynx), the prevalence of rectal CT was the highest (15.5%), whereas NG was most commonly found in the pharynx (8.1%). Low education level, homosexuality, inconsistent condom use and drug use in the previous six months were significantly associated with HIV infection, whereas the former three factors were also associated with HBV infection.Older people (aged ≥ 40 years) and those who lacked knowledge of STIs, and younger people (aged <30 years) as well as inconsistent condom users were more at risk of syphilis and CT infections, respectively. NG infection was only associated with reported dating venues. Our study revealed a heavy disease burden and multiple risk factors of HIV/STIs among MSM in Kunming. It is necessary to promote regular screening and proactive treatment of HIV/STIs among MSM. [ABSTRACT FROM AUTHOR]