Wen Ren

Validation of the mainland chinese version of the inflammatory bowel disease questionnaire (IBDQ) for ulcerative colitis and Crohn's disease

Background: Inflammatory bowel disease affects the quality of a patients life in many ways, but no validated instrument for measuring disease‐specific quality of life in these patients is available for use in Mainland China. The aim of our study was to develop and validate the Mainland Chinese translation of the Inflammatory Bowel Disease Questionnaire for ulcerative colitis (UC) and Crohns disease (CD) by assessing its construct validity, discriminant ability, reliability, and sensitivity to change. Methods: We administered a developed Mainland Chinese version of the Inflammatory Bowel Disease Questionnaire (IBDQ). Ninety‐two Mainland Chinese patients (52 with UC and 40 with CD) completed the Mainland Chinese version of the IBDQ, the Chinese version of SF‐36, and the global scale for general well‐being. A subgroup of 71 patients also completed the Mainland Chinese version of the IBDQ and the global scales for general well‐being on a second occasion. Clinical activity was assessed by the Walmsley and Harvey–Bradshaw simple indices. Results: The Mainland Chinese IBDQ scores correlated well with the related SF‐36 dimensional scores for all 4 domains (r = 0.51–0.82), SF‐36 total scores (r = 0.58–0.87), the colitis activity index (r = −0.56–0.74), and the CD activity index (r = −0.64–0.78) as well as with the global scales. The Mainland Chinese IBDQ was able to discriminate between active and inactive disease. Cronbachs &agr; was 0.95 in UC and 0.94 in CD. Test–retest reliability was excellent (intraclass correlation coefficient 0.69–0.93) when it was repeated in patients whose clinical activity index was stable. In contrast, there was a significant difference between the baseline and follow‐up measurements in patients whose clinical activity index was changed. Conclusions: The Mainland Chinese IBDQ proved to be a valid, discriminative, and reliable instrument for assessing health‐related quality of life in patients with UC and CD in Mainland China. (Inflamm Bowel Dis 2007)

Immunological effects of a 10-μg dose of domestic hepatitis B vaccine in adults

ObjectiveTo evaluate the immunological effects of three types of domestic 10-μg/dose hepatitis B vaccines in adults compared with a foreign vaccine, and to provide scientific evidence in support of adult hepatitis B vaccination.MethodsAdults from five counties (Deqing, Changxing, Nanxun, Wuxing, Anji) in Huzhou City, Shaoxing County and Tongxiang County, Zhejiang Province, China were selected. Blood samples were taken to assess serum HBsAg, anti-HBs, and anti-HBc using a chemiluminescence immunoassay. Adults, aged 16 to 49 years and who were anti-HBs negative at baseline, received hepatitis B immunizations at 0, 1, and 6 months. Anti-HBs levels were assessed one month after the third and final vaccination.ResultsA total of 1 872 adults were immunized and the average positive rate was 89.5%. Four types of hepatitis B vaccine were used, including three from Chinese companies (Shenzhen Kangtai, Dalian High-Tech, and North China Pharmaceutical) and one from a UK company (GlaxoSmithKline). Their seroconversion rates were 81.67%, 95.05%, 89.64%, and 86.81%, respectively. There was a significant difference between the anti-HBs positive conversion rates of the four types (P<0.005) but the seroconversion rates among the different vaccines were not significantly different (χ2=2.123, P=0.145). The average anti-HBs geometric mean titers (GMTs) of non-immune adults immunized with each of the four vaccines were 177.28, 473.23, 246.13, and 332.20 mIU/ml, respectively. There were no statistically significant differences in the GMTs between the three types of domestic vaccine and the foreign vaccine (t=−1.575, P=0.116).ConclusionsDomestic recombinant hepatitis B vaccines can achieve immunization effects comparable to those of a foreign vaccine.

The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China

Background Mobile phones and mobile phone apps have expanded new forms of health professionals’ work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs’ current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice.

Prevalence and influencing factors of hepatitis B among a rural residential population in Zhejiang Province, China: a cross-sectional study.

Objectives To reveal the prevalence and associated influencing factors of hepatitis B among a rural residential population in Zhejiang, China, in order to help develop specific control strategies. Methods We conducted a cross-sectional study among a rural residential population in Zhejiang, China. Stratified multistage cluster sampling was utilised in five districts; a structured questionnaire was used to collect the information such as age, gender, education, occupation, living status, and other health related information of the participants by trained local staff; and the hepatitis B virus (HBV) infection status of the participants was determined by the chemiluminescence immunoassay test. Univariate and multivariate analyses were applied to evaluate the influencing factors of HBV infection. The odds ratio of each related factor was assessed with or without adjustment separately. Results The mean age of the 16 601 participants (7881 males and 8720 females) who completed the survey was 40.28±19.47 years. The positive rate of hepatitis B surface antigen (HBsAg) was 4.04% (95% CI 3.74% to 4.35%), and 3.85% when standardised by age and gender. Univariate analysis showed that age, educational level, occupation, living status, history of hepatitis B examinations, history of blood transfusion, vaccination, family history, coastal living, and district were the potential influencing factors. Multivariate logistic regression indicated that occupation, living status, history of hepatitis B examinations, vaccination and district were the influencing factors. Undertaking a service-based tertiary industry job (ORa 1.19, 95% CI 0.94 to 1.51) and non-single living (ORa 2.84, 95% CI 2.17 to 3.70) might be risk factors, while vaccination (ORa 0.43, 95% CI 0.34 to 0.53) and history of hepatitis B examinations (ORa 0.71, 95% CI 0.48 to 1.03) were potential protective factors. Conclusions The prevalence of hepatitis B is at an intermediate epidemic level in a rural residential population in Zhejiang, China. Raising vaccination coverage, especially in adults, is a suitable strategy for the prevention and control of hepatitis B.

Responses to hepatitis B vaccine in isolated anti-HBc positive adults

ABSTRACT Immune responses of isolated anti-HBc subjects are not well characterized in populations in China. This study aimed to evaluate immune responses to hepatitis B vaccination in isolated anti-HBc positive subjects. A cohort of 608 subjects were selected and separated into isolated anti-HBc (negative for HBsAg and anti-HBs, positive for anti-HBc) and control (negative for HBsAg, anti-HBs, and anti-HBc) groups, who were matched by age and sex. All subjects received 3 doses of hepatitis B vaccine (20μg) at months 0, 1, and 3, followed by testing for serological responses 1 month after the third vaccination. The positive seroprotection rate and geometric mean titer (GMT) for hepatitis B surface antibody (anti-HBs) of isolated anti-HBc subjects were significantly lower than those in the control group(86.2% vs.92.1%, P = 0.02; 47.26 vs.97.81 mIU/mL, P < 0.001). When stratified by age, positive seroprotection rate in the isolated anti-HBc group were 92%, 88.5% and 79.4% in the 20–34, 35–49, and 50–60 y old subgroups, respectively (χ2 = 5.919, P = 0.04). Additionally, the GMT level for anti-HBs in the isolated anti-HBc group for different age subgroups were 104.43, 47.87 and 31.79 mIU/mL respectively (χ2 = 19.44, P < 0.001). The GMT level for anti-HBc before vaccination were negatively correlated with GMT for anti-HBs after 3 doses of hepatitis B vaccine (r = −0.165, P < 0.001). In conclusion, isolated anti-HBc positive subjects can achieve good immune responses after hepatitis B vaccination, and the positive seroprotection rate and GMT level for anti-HBs were lower than the control group. Better responses could be observed in young adults, and significant negative correlations were found between GMT of anti-HBc before vaccination and GMT of anti-HBs after vaccination.

Optimal vaccination program for healthy adults in China

There is still no suitable routine hepatitis B immunization strategy for adults in China. To establish an optimal vaccination schedule for healthy adults, we investigated various schedules in healthy adults. In this randomized 5143 healthy adults received 10 μg hepatitis B vaccine at 0, 1 and 3 months(group A), 0, 1 and 6 months(group B), or 0, 1 and 12 months(group C). Blood samples were collected after 1 month and 12 months after the third dose. The geometric mean titer (GMT), seroconversion rate (levels of anti-HBs ≥10 mIU/mL) and high response rate (levels of anti-HBs ≥100 mIU/mL) were assayed. In our study, 2438 healthy adults finished the full vaccination program and follow-up. The seroconversion/sero-protective rate of groups A–C at one and 12 month after administration of the third vaccine dose was 100%, 99.9% and 97.9% verse 64.9%, 75.7% and 79.0%, respectively. GMT for anti-HBs tested in group A to C within 1 or 12 month after the third vaccination was 213.16, 432.58 and 451.47 mIU/ml verse 22.07, 46.70 and 56.18 mIU/ml, respectively. There were significant differences of seroconversion/sero-protective rate and GMT among the 3 groups (p < 0.01). Given the high anti-HBs seroconversion rate and GMT in all 3 groups, a flexible schedule for Hepatitis B vaccine should be recommended to adults, but 0-1-12 schedule is a better choice.

Internet-Based and Mobile-Based General Practice: Cross-Sectional Survey

Background Globally, mHealth is increasing as a promising technology for promoting the quality of health care. Thus, a growing number of internet hospitals have been established in China to avail all its advantages. However, no study has investigated the service scope and patient satisfaction of the internet hospital to date. Objective The objective of our study was to explore the features of outpatients in general practice, the disease information, and the satisfaction through an internet rating site. Methods We collected data from the internet hospital of the First Affiliated Hospital, Zhejiang University between February 2016 and February 2017. Patients visited Web-based clinic via a computer or smartphone. The data included patients’ demographic characteristics, disease information, and patients’ comments. Results We enrolled 715 patients with 365 health-related problems. All health conditions involved diseases ranging from internal medicine, surgery, gynecology and obstetrics, pediatrics, dermatology, ophthalmology, stomatology to emergency. Among them, 63.1% patients (451/715) visited traditional hospitals for further management, 25.3% (181/715) had prescriptions, laboratory, or imaging examination appointment, 1% (9/715) used emergency service, and 10% (74/715) needed routine follow-up. All patients received health education. Almost all patients gave positive feedback and 4-5-star rating. Conclusions The internet hospital is suitable for all health conditions with high satisfaction only when patients have the access to internet via a computer or smartphone.

How to Clear HBV cccDNA: CRISPR/Cas9 Might Be Promising

BACKGROUND: Chronic hepatitis B infected with Hepatitis B virus remains a major health concern worldwide. Despite standard interferon-α and nucleotide analogues have been shown to reduce the deterioration of liver disease among chronic hepatitis B patients, covalently closed circular DNA was still difficult to eradicate. METHODS: A literature search of Pubmed and Web of science was performed with the following key words: ‘CRISPR’, ‘CRISPR/Cas9’, ‘hepatitis B’, ‘HBV’, ‘chronic hepatitis B’ and ‘HBV cccDNA’. The information about CRISPR/Cas9 for the treatment of HBV cccDNA or hepatitis B was reviewed. RESULTS: CRISPR/Cas9 could treat hepatitis B through suppressing or clearing HBV cccDNA with different gRNAs. CONCLUSION: With the emergence of CRISPR/Cas9 (the RNA-guided clustered regulatory interspaced short palindromic repeats, CRISPR) editing technology, clearance of hepatitis B virus and better prevention of liver carcinoma seemed to be possible.

Motivations and Training Needs of General Practitioner Preceptors

Background: General practitioner (GP) preceptors play an important role in the cultivation of GPs. Many problems exist in the training of GP preceptors. This study aimed to explore the willingness and training needs of GP preceptors and compare the differences between preceptors from general practice and other specialties. Methods: A total of 375 questionnaire forms were sent to 375 GP preceptors from 11 different provinces, and 344 completed forms were returned. The main outcome included general information, teaching motivations, and training needs of GP preceptors. Results: The study showed that about 89.2% of GP preceptors were willing to be teachers. The majority of respondents strongly agreed that the motivation for becoming a GP supervisor was to learn from teaching. The most important capability they should master was clinical teaching (92.2%), followed by lecture (83.1%) and doctor–patient communication (83.1%). The top three preferred methods of GP preceptors training were case discussion (78.8%), workshop (57.6%), and classroom teaching (56.4%). The domains in which most GP preceptors wanted to acquire knowledge and skill were mental health (59.3%), rehabilitation (47.1%), pediatrics (41.0%), and obstetrics (37.5%). No significant differences were found in the willingness to train GPs (&khgr;2 = 3.34, P > 0.05) and whether they would become or continue to become a GP supervisor after the training (&khgr;2 = 1.106, P > 0.05). Conclusions: Although most preceptors were under on-the-job training, they were glad to train GPs. To be qualified, preceptors should be trained according to the actual needs of GP preceptors.

The application of digital technology in community health education

With the rapid development of the internet and information technologies, coupled with a variety of digital media, the digital technology has become a conventional method of health education for the general public and has the potential to influence health behaviors. Our aim was to conduct a review of how digital technology projects have been used in the health education and health promotion, as well as the disadvantages and barriers in the process.