Objective To analyze the changing trend and influencing factors of anemia among primary and middle school students from the pilot areas of the “Nutrition Improvement Plan for Rural Compulsory Education Students” （shorten as “Program”） in Hainan Province. Methods From 2014 to 2017, primary and middle school students were selected from the key monitoring counties implementing the “Program” through stratified cluster random sampling method. The biochemical indicators such as hemoglobin were detected and questionnaire survey was carried out. Analysis of variance was used to compare the mean values of multiple groups, chi-square test was used to compare the rates, and the influencing factors of anemia were analyzed by binary Logistic regression. Results From 2014 to 2017, 2 590 students were selected, the students’ average hemoglobin levels were （138.1±12.0）, （136.4±13.4）, （138.1±12.4） and （138.1±15.4） g/L, respectively, and the differences were no statistical significance （P>0.05）. In 4 years, the anemia rates were 5.4%, 5.4%, 4.5% and 6.7%, respectively, there was no obvious change trend （P>0.05）. In 2015, the anemia rate of junior high school students was higher than the primary school students, and the difference was statistically significant （P< 0.05）. But in other years, there were no significant difference in anemia rates between primary and junior high school students, and between boys and girls （both P>0.05）. Logistic regression analysis showed that the ethnic minority students （OR=6.947） and vitamin A subclinical deficiency or deficiency students （OR=2.030） had a higher risk in anemia. Conclusion The anemia status of students from the pilot area of “Program” in Hainan Province is not significantly improved, and the ethnic minority students and vitamin A subclinical deficiency or deficiency students are the key intervention targets.

Objective To analyze the investigation results of knowledge, attitude, and practice （KAP） of community management of stroke among primary medical staff in Wuxi area, and analyze the influencing factors of KAP. Methods The research object was the medical staff who were responsible for chronic disease management in the primary medical service center in Wuxi City. Using the method of multi-stage stratified cluster sampling, medical staff （including general practitioners, public health physicians, nursing staff, traditional Chinese physicians, etc.） engaged in chronic disease management in 8 community health service centers were selected at a proportion of 10% in May 2021 to conduct a questionnaire survey on KAP of stroke. The descriptive analysis method was used to analyze the KAP of medical staff in stroke, and univariate and multivariate analysis methods were used to analyze the influencing factors of KAP in stroke community management. Results A total of 512 primary medical staff were included for analysis, including 154 general practitioners, 54 public health physicians, 227 nursing staff, and 77 traditional Chinese physicians. The knowledge score, attitude score, and practice score of primary medical staff for stroke community management were （29.68±9.23）, （31.02±4.32）, and （33.63±2.67）, respectively. Multiple linear regression analysis showed that the location of the community health service center was in the economically developed area （β'=0.137）, the general practitioners （β'=0.523） had higher knowledge scores of stroke management; the location of the community health service center was in the economically developed area （β'=0.324）, the general practitioners （β'=0.203）, and medical staff with high knowledge scores （β'=0.553） had higher attitude scores of stroke management; the location of the community health service center was in the economically developed area （β'=0.506）, the general practitioners （β'=0.434）, and medical staff with high knowledge scores （β'=0.619） and high attitude scores （β'=0.719） had higher practice scores of stroke management. Conclusion The primary medical staff in this area have a certain level of knowledge of stroke health management, but the recognition and participation of this management need to be improved, and the depth and breadth of relevant management work carried out in the community are also insufficient. Relevant departments need to make adjustments at the policy level, change the existing working mode and provide correct guidance to primary medical staff.

Objective To explore the status of drug resistance in patients with chronic hepatitis B （CHB） and gene mutation sites of common nucleoside （acid） drug resistance. Methods From January 1, 2020, to September 30, 2021, patients with CHB in Kaifeng Infectious Diseases Hospital and Huaihe Hospital, Henan University were selected as the research objects. The case data were collected retrospectively and gene mutation sites of common nucleoside （acid） drug resistance were detected. The results were analyzed by the descriptive analysis method. Results A total of 2 141 CHB patients were included in this study, including 1 635 males and 506 females, aged 20-42 years, with an average of （31.5±10.5） years old, and HBV DNA load of （4.88±1.54）×10⁷ U/mL. The drug resistance rate of CHB patients aged 30-42 years was significantly higher than that of patients aged 20-29 years （P<0.01）. CHB patients were highly resistant to lamivudine and were more sensitive to tenofovir disoprox and adefovir dipivoxil. Among 2 141 CHB patients, 788 cases of HBV drug resistance gene mutation were detected, accounting for 36.81%. M204I, M204V, and M250I+M250L were the top three HBV drug resistance mutation sites, accounting for 22.08%, 13.20%, and 9.64%, respectively. B genotype patients were mainly （62.20%）. The gene mutation rate of C genotype and B+C mixed genotype patients was significantly higher than that of B genotype patients, and the multi-gene mutation rate of B genotype patients was significantly higher than that of C genotype and B+C mixed genotype patients （P<0.01）. There was no significant difference in the mutation rate of drug resistance genes between the single-drug therapy group and the multiple-drug sequential therapy group （P>0.05）. The mutation rate of the drug resistance gene in the drug withdrawal group was higher than that in the non-drug withdrawal group （P<0.01）. Conclusion Long-term common nucleoside （acid） drugs often appear clinical resistance, which can lead to various forms of HBV polymerase denaturation, which is the main obstacle to the treatment of HBV infection. Clinical detection of drug-resistant mutation sites is conducive to the formulation of treatment plans and guides the selection of therapeutic drugs and long-term prevention and treatment.

Objective To explore the influencing factors of infection after cesarean section, and analyze the pathogenic characteristics and drug resistance of infection after cesarean section. Methods Taking parturients who underwent cesarean section from January 1, 2018, to December 31, 2021, in a hospital in Haikou as the research object, retrospective data collection and postpartum monitoring to discharge were conducted for all cesarean section parturients during the study period. The monitoring content was whether there were postoperative complications. The descriptive epidemiological analysis method was used to analyze postoperative infection and pathogenic bacteria and their drug resistance, and the multivariate Logistic regression analysis method was used to analyze the influencing factors of infection after cesarean section. Results A total of 3 012 cesarean section parturients were included in the study, of which 2 015 cases were ≤35 years old, accounting for 66.90%; 16.70% had a history of cesarean section. Postoperative infection occurred in 146 cases, with an incidence rate of 4.85%. A total of 178 strains of pathogenic bacteria were isolated and cultured, mainly Escherichia coli （52 strains, 29.21%）, Klebsiella pneumoniae （24 strains, 13.48%）, and Staphylococcus aureus （39 strains, 21.91%）, and all of them had low resistance to levofloxacin, amikacin, and imipenem. Multivariate Logistic regression analysis showed that age ≥35 years old （OR=1.871）, gestational diabetes mellitus （OR=2.532）, malnutrition （OR=4.952）, more than 2 surgical indications （OR=2.305）, indwelling catheter time>24 h （OR=2.161）, and no antibiotics （OR=1.767） were risk factors for postoperative infection in cesarean section parturient. Conclusion There are many risk factors for infection after cesarean section, and the pathogenic bacteria are mainly Gram-negative bacteria. In case of abnormal conditions, clinical prophylactic drugs can be given reasonably according to the pathogenic bacteria and drug resistance in the hospital, effectively controlling the incidence of postoperative infection.

Objective To explore the status of untreated patients with multidrug-resistant tuberculosis （MDR-TB） in Guangdong Province and its influencing factors. Methods The MDR-TB patients diagnosed in 10 designated medical institutions in 9 prefecture-level cities in Guangdong Province from 2018 to 2019 were selected, and they were divided into the treatment group and the non-treatment group according to whether they received treatment. The questionnaire was used to collect individual and area-related factors. The two-level Logistic regression model was used to explore the influencing factors of whether MDR-TB patients received treatment. Results Among 530 MDR-TB patients, 398 cases （75.1%） were included in the treatment group, and 132 cases （24.91%） were in the non-treatment group, with a male to female ratio of 2.4∶1. The two-level Logistic regression model showed that MDR-TB patients with junior high school, senior high school and above education （OR=4.302, 15.858）, agricultural workers, retired or other workers （OR=5.246, 16.662, 5.244） were more likely to receive treatment. MDR-TB patients with registered residence in other provinces （OR=0.365） were not easy to receive treatment. Conclusion The education, occupation, and registered residence location are the influencing factors of untreated patients with MDR-TB in Guangdong Province, which indicated feasible prevention and control measures should be taken for these high-risk groups to improve the inclusion rate of MDR-TB patients in Guangdong Province.

Objective To explore the cognition of early detection, early diagnosis and treatment and its influencing factors in the high-risk population of gastric cancer. Methods From January 1, 2020, to August 30, 2021, people aged ≥ 40 years old who had undergone physical examination and completed the determination of Hp by 13C-uBT method were recruited in the physical examination center of a tertiary hospital in Beijing. Hypertrophic gastritis, chronic atrophic gastritis, pernicious anemia, gastric ulcer, postoperative remnant stomach, and other high-risk factors for gastric cancer or first-degree relatives of gastric cancer patients were selected as the subjects to conduct a questionnaire survey for cognition of early detection, early diagnosis and treatment. The descriptive analysis method was used to analyze the cognition of early detection, early diagnosis and treatment, and the multivariate Logistic regression analysis method was used to analyze the influencing factors. Results A total of 9 852 cases of the high-risk population for gastric cancer were included in this study. The age group was 40-76 years old, 35.48% were 60-76 years old, 62.51% were male, and 52.46% were urban residents. The proportion of college degrees and above was higher, accounting for 52.38%. The cognitive level of early detection, early diagnosis and treatment was generally low, with 5 052 cases （51.28%） of low-level, 1 910 cases （19.39%） of middle-level, and 2 890 cases （29.33%） of high-level. Among the risk factors of gastric cancer-related knowledge, the highest-scoring rate was irregular diet, with a scoring rate of 52.05%, followed by frequent eating of preserved food and smoked food, with scoring rates of 51.08% and 50.02%. The higher scoring rates of early warning symptoms were gastrointestinal hemorrhage and epigastric mass, which were 40.35% and 33.76% respectively. Multivariate Logistic regression analysis showed that educational level （OR=3.165）, gender （OR=2.303）, family history of gastric cancer （OR=3.327）, the initial symptom of vomiting （OR=1.840） and abdominal pain （OR=2.445）, living location （OR=8.069）, and the time of the first visit to a medical institution with symptoms （OR=2.171） were the influencing factors for the cognitive level of early detection, early diagnosis and treatment of the high-risk population of gastric cancer. Conclusion The high-risk population of gastric cancer has an insufficient understanding of the risk factors of gastric cancer and the early diagnosis of related symptoms. The medical staff should carry out individualized guidance in combination with the different demographic characteristics of the risk population. The medical resources in rural areas still need to be strengthened, at the same time, we should reduce taking medicine without medical advice, improve the knowledge level of high-risk populations of gastric cancer, promote healthy behavior and reduce the risk of gastric cancer.

Objective To investigate the symptoms of patients with esophageal cancer 3 months after operation in Zhengzhou and explore the types of symptoms, analyze the influencing factors of postoperative symptoms, and guide the formulation of symptom management and intervention measures. Methods Patients with esophageal cancer who underwent surgery in the Fifth Affiliated Hospital of Zhengzhou University from January 1, 2018, to December 31, 2020, were included in the study. Based on the Chinese Version of the M.D. Anderson Symptom Inventory （MDASI-C）, a self-made questionnaire was used to evaluate the severity of postoperative symptoms of patients who completed the follow-up visit as required 3 months after the operation. Exploratory factor analysis method was used to explore the type and composition of symptom groups. Univariate and multivariate linear regression analysis methods were used to analyze the influencing factors of symptom groups of patients with esophageal cancer 3 months after operation in Zhengzhou. Results The complete data of 293 patients with esophageal cancer were collected in the study. The highest incidence of symptoms was anorexia （95.90%）, fatigue （89.42%）, reflux （79.86%）, and eating difficulty （78.16%）. The most severe symptoms was fatigue （6.05±1.49）, reflux （5.92±1.62）, anorexia （5.87±1.53）, and disturbed sleep （5.56±1.38）. Three symptom groups were obtained by exploratory factor analysis, which were gastrointestinal related symptom group, fatigue-related symptom group, and eating difficulty-pain symptom group, the symptom scores were （20.19±3.56）, （18.24±3.10）, and （23.92±4.07） points, respectively. Univariate and multivariate linear regression analysis showed that age （β’=0.361）, esophageal cancer staging （β’=0.152）, therapeutic modalities （β’=0.378）, and anastomotic site （β’=-0.089） were the influencing factors of gastrointestinal related symptoms; gender （ β’=0.086 ）, age （ β’=2.011 ）, esophageal cancer staging （ β’=1.562 ）, and therapeutic modalities （ β’=0.104 ） were the influencing factors of fatigue-related symptoms; gender （ β’=1.127 ）, esophageal cancer staging （ β’=0.413 ）, therapeutic modalities （ β’=0.459 ）, and anastomotic site （β’=0.518 ） were the influencing factors of eating difficulty-pain symptoms. Conclusion Three months after surgery, patients with esophageal cancer in Zhengzhou have gastrointestinal-related symptoms, fatigue-related symptoms, and eating difficulty-pain symptoms. The occurrence of symptoms is affected by gender, age, esophageal cancer staging, therapeutic modalities, and anastomotic site. It is necessary to establish efficient and individualized management and intervention strategies according to symptoms and their influencing factors.

Objective To explore the cognition and demand of labor analgesia in pregnant women. Methods Pregnant women undergoing prenatal examinations in various hospitals in Xi’an were selected as the research objects. From April to July 2021, the convenience sampling method was used to conduct a questionnaire survey on the cognition and demand of labor analgesia among pregnant women who underwent a prenatal examination in the obstetric clinics of 5 hospitals （3 tertiary hospitals and 2 secondary hospitals） in Xi’an. The descriptive analysis method was used to analyze the willingness of labor analgesia and related influencing factors. Results A total of 675 pregnant women were included in this study, and 351 pregnant women expressed little understanding of labor analgesia, accounting for 52.00%. The proportion of pregnant women who learned about labor analgesia through relatives and friends was the highest, with 388 people, accounting for 57.48%. 116 pregnant women believed that labor analgesia was painless, accounting for 17.19%. The main effects that pregnant women hope to achieve by using labor analgesia were to reduce the pain of waiting （85.63%） and delivery （73.78%）. The family members of 629 pregnant women were willing to use labor analgesia, accounting for 93.19%. Pregnant women wanted to obtain knowledge about labor analgesia in terms of sequelae and risks （61.78%） and methods of labor analgesia （55.11 %）. The results of multivariate analysis showed that the age of pregnant women （OR=2.486）, family monthly income （OR=1.440, 1.523, 2.396）, educational level （OR=2.232, 2.675）, nature of work （OR=2.731） and spouse’s willingness （OR=4.716） were the influencing factors affecting the development of labor analgesia. Conclusion The pregnant women in Xi’an have a relatively low level of cognition of labor analgesia. The family members of pregnant women have good support for labor analgesia, but both pregnant women and family members have some concerns. The popularization and use of labor analgesia are affected by many factors. It is necessary to continue to strengthen publicity and improve people’s cognition.

Objective To analyze the cost-effectiveness of three kinds of different insulin intensive treatment regimes, and to provide a reference for the selection of clinical treatment regimens. Methods Patients with newly diagnosed type 2 diabetes mellitus （T2DM） were randomly divided into three groups. Group A, continuous subcutaneous insulin infusion （CSII） alone; group B, CSII combined with metformin and pioglitazone; group C, CSII combined with sitagliptin. Fasting blood glucose （FPG） and 2-hour postprandial blood glucose （2hPG） before and after treatment, the days of reaching the target of blood glucose, the hospitalization days, the frequency of hypoglycemia, and the costs of the different regimes were recorded, and the cost-effectiveness of the three regimes was compared. Results All groups showed significantly decreased FPG and 2hPG post-treatment （all P<0.01）, and the days of reaching the target of blood glucose, the hospitalization days, and the frequency of hypoglycemia among the three groups were statistically significant （all P<0.01）. The cost-effectiveness ratio of the effective rate was 139.37, 134.29, and 135.66, respectively. Compared with group A, the incremental cost-effectiveness ratios for group B and group C were 25.52 and 53.85, respectively. The results of sensitivity analysis supported the results of basic analysis. Conclusion CSII combined with metformin and pioglitazone therapy is the most cost-effective treatment for newly diagnosed T2DM. For patients with a high risk of hypoglycemia, CSII combined with sitagliptin is available.

Objective To investigate the physical development and nutritional status of infants under 6 months of age in Xi'an, and analyze the relevant influencing factors. Methods The convenience sampling method was used to randomly select 10 communities or villages in Xi'an （5 belong to urban sub-district offices and 5 belong to village and town governments）, and randomly select 1 community health service center in each community or village. Infants under 6 months of age who were vaccinated by the immunization program at the selected community health service center from June to August 2021 were selected as the research subjects. The infants were subjected to physical examination （length and weight） and hemoglobin level detection, and infant mothers were subjected to a questionnaire survey. The descriptive analysis method was used to analyze infant malnutrition, and univariate and multivariate analysis methods were used to analyze the influencing factors of infant malnutrition. Results A total of 11 714 infants were included in this study, including 5 951 male infants, accounting for 50.80%, and 5 763 female infants, accounting for 49.20%. Infants under 3 months of age accounted for 45.65%, and 4-6 months of age accounted for 54.35%. A total of 1 972 infants under 6 months of age were malnutrition, and the incidence of malnutrition was 16.83%. The incidence of growth retardation, underweight, wasting, and anemia was 1.15%, 0.96%, 1.47%, and 14.90% respectively. Multivariate Logistic regression analysis showed that the feeding situation （partial breastfeeding OR=1.440, artificial feeding OR=1.523）, the location of household registration （OR=2.396）, the number of complementary food categories added > 2 （OR=1.690）, and the intake of egg yolks （OR=1.657） and fruits （OR=1.355） were the influencing factors of malnutrition in infants under 6 months of age. Conclusion There is a certain risk of malnutrition in infants under 6 months of age in Xi'an, among which anemia is the main malnutrition. Location of household registration, feeding patterns, the number of complementary food categories, and intake of egg yolks and fruits are the influencing factors of malnutrition in infants under 6 months of age, and targeted interventions can be given.