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Systemic lupus erythematosus (SLE) is a severe complex rheumatic disease, but good estimate of its prevalence and risk factors is lacking in China. The aim of the study was to explore the prevalence of SLE and risk factors in rural areas of Anhui Province of China. Eleven counties were randomly selected in Anhui Province, and then, 15% of the villages in selected counties were randomly sampled as study sites. Patients with SLE were identified through two phases. Based on the cases identified, a population-based case-control study was designed to examine risk factors associated with SLE. A total of 1,253,832 individuals and identified 471 SLE cases were surveyed. Crude and age-standardized prevalence were estimated at 37.56 and 36.03 per 100,000 persons, respectively. Gender difference in the prevalence of SLE was significant (P = 4.62 × 10(-76)), and the age-standardized prevalence was 6.17 for males and 67.78 for females per 100,000 persons. The distribution of SLE prevalence was significant by age group (P = 1.78 × 10(-53)), and the peak prevalence was observed at 40-50 years. Multiple environmental factors were associated with SLE, including birth conditions, sweet food, cooking oil, taste, fruit consumption, sunlight exposure, quality of sleep, physical activities, drinking water, residence, negative life events, hepatitis B vaccine, age of menarche, and age at birth of first child (P < 0.05). Our large population-based epidemiological survey estimated the prevalence of SLE at 37.56 per 100,000 persons. Multiple environmental factors were associated with the development of SLE.

Background The shortage of primary care physicians in rural China is an enduring problem with serious implications for access to care. In response to the shortage in health workforce in rural areas, China government has launched the rural-oriented tuition-waived medical education (RTME) programme since 2010, aiming to train more general practitioners to address the rural health workforce requirements in middle and west areas. This study aims to investigate the prevalence of mental illness and the level of professional identity in the rural-oriented tuition-waived medical students (RTMSs), and to explore the impact of the RTMSs’ professional identity and related cognition and satisfaction with the RTME programme on mental health. Methods We conducted a descriptive, cross-sectional study. A total of 1103 RTMSs and 1095 non-oriented medical students from seven medical universities (colleges) in Anhui province completed a demographic questionnaire, the Depression, Anxiety, Stress Scales and the Professional Identity Questionnaire for Undergraduate Students. Cognition and satisfaction with the RTME programme of the RTMSs were collected. Multiple linear regression analysis was used to analyze the data. Results The prevalence of depression, anxiety, and stress in RTMSs were 11.8, 22.9 and 3.4%, respectively. The mean total scores of the Professional Identity Questionnaire for Undergraduate Students were 3.58 (SD = 0.61). Results of multiple linear regression model indicated that students who are dissatisfied with targeted primary healthcare institution are likely to suffer from depression and anxiety; moreover, students who enrolled in the rural-oriented tuition-waived medical education programme due to economic reason are more likely to suffer from anxiety. Furthermore, a significant positive correlation was found between professional identity and mental health. Conclusions Providing better information about the RTME programme prior to enrollment and improving the students’ cognition of the policy’s effectiveness and the social value of rural healthcare work may contribute to improving the professional identity of the RTMSs. Meanwhile, a significant positive association was found between professional identity and mental health. This is a new perspective that shows that developing and improving professional identity may help medical students reduce the risk of psychological illness.