Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.

Background We aim to describe the prevalence and trends of hypertension among 9–17 school-aged students from 2017 to 2019 in Yunnan, China. Methods We conducted a cross-sectional study by using data from the Students’ Health Surveillance Surveys of 2017, 2018 and 2019 in Yunnan. The Students’ Health Surveillance Surveys in Yunnan collected date on physical fitness and health status of students in Yunnan through multistage-stratified sampling in 3 prefectures. In each prefecture, the study population were classified by gender and region (urban or rural), and each group had an equal size. Diagnosing criteria of hypertension was set with reference to Chinese age-specific and height-specific blood pressure (BP), to identify the abnormal status of boys and girls separately. ANOVA test was adopted to measure the differences in the mean BP stratified by gender, age, prefecture and area, and Chi-square test was used to compare the percentages of hypertension in different areas. For comparability, the age-standard and gender-standard population prevalence was calculated by directly using China Census in 2010 as a standard population. Totally 24,890 participants aged 9–17 years were included in this study. Results From 2017 to 2019, there were 24,872 students completed physical examinations and included in the analysis, of which 3288 were diagnosed with hypertension. The total prevalence of hypertension was 13.72, 12.49 and 13.45% among 9–17 years school-aged population in Yunnan, respectively. The total age-standardized hypertension prevalence trended to decrease from 13.82 to 13.48%. For urban population, the age-standardized hypertension prevalence decreased slightly from 11.24 to 10.13%. While, for rural population, it increased from 17.58 to 19.16%. The average annual growth rate in rural population was 0.53%. Conclusions From 2017to 2019, there was a significant and continuous increase in the prevalence of hypertension in 9–17 years school-aged population in Yunnan. Hypertension is epidemic among children and adolescents in Yunnan. We should take effective and comprehensive intervention measures to reduce its prevalence among school-aged children.

ObjectivesThis study aimed to describe and quantify the relationship between body mass index (BMI) and tuberculosis (TB) incidence.DesignA population-based prospective cohort study.SettingTen randomly selected communities in the southwestern mountainous region of China.ParticipantsParticipants who had resided in study sites before screening for at least 6 months were eligible. Those who refused to participate or were temporary residents (who resided less than 6 months during three waves of screening) were excluded. The present research included 26 022 participants aged over 15 years for analyses.InterventionsThe cohort study conducted three rounds of TB screening from 2013 to 2015. Face-to-face surveys for participants were carried out. TB symptoms positivity suspects underwent chest X-ray and sputum smear test for diagnosis.Primary outcome measuresThe study outcome was the diagnosed active TB in the second and third rounds of screening.ResultsDuring the follow-up of 2.25 years, 43 cases developed TB in 44 574.4 person-years. The negative log-linear relationship between BMI and TB incidence was fitted (adjusted R2=0.76). Overweight or obese was associated with a lower risk of TB compared with normal weight (adjusted HR (aHR) 0.34, 95% CI 0.14 to 0.82). The inverse log-linear associations between continuous BMI and individual TB risk were evaluated. In subgroup analysis, the risk of TB reduced 78% in overweight or obese women (aHR 0.22, 95% CI 0.05 to 0.97), and a 64% reduction in the elderly (aHR 0.36, 95% CI 0.12 to 1.00) compared with those with normal weight, respectively.ConclusionsThe study provided evidence for a negative association between BMI and TB development in Chinese adults. It suggests the inverse dose–response relationship between BMI and TB incidence, and implies an optimal cut-off point of BMI for screening strategy.

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Background Many pieces of evidence presented the body mass index (BMI) was inversely associated with tuberculosis (TB). BMI was radically changed during the past decades in China. The aim of the study was to evaluate the contemporary relationship between BMI and tuberculosis incident. Methods A population-based prospective cohort included 26 022 community participants was conducted. Three rounds of tuberculosis screening were implemented between June 2013 and December 2015. The main exposure was defined as baseline BMI, and was categorized into 3 levels: underweight (< 18.5 kg/m2), normal (18.5 to 24.0 kg/m2), overweight or obese (≥ 24.0 kg/m2). The active tuberculosis incident in the second or third round screening was the study outcome. The dose-response relationship between BMI and tuberculosis incidence as well as tuberculosis risk were analyzed. Results During the followed up of 2.25 years, 43 cases developed tuberculosis in 44 574.4 person-years. The log-linear dose-response relationship between BMI and tuberculosis incidence was fitted (adjusted R2 = 0.95). In multivariable Cox proportional regression, overweight and obese was associated with a lower risk of incident tuberculosis compared with normal weight (adjusted hazard ratio [aHR], 0.34; 95% confidence interval [CI] 0.14–0.82, p < 0.01), the inverse dose-response association between BMI and tuberculosis risk was characterized by restricted cubic spline. In subgroups analysis, the risk of tuberculosis reduced 78% in overweight or obese (aHR, 0.22; 95% CI 0.05–0.97, p = 0.05) and 64% (aHR, 0.36; 95% CI 0.12-1.00, p = 0.05) compared with normal weight among female and elderly. Conclusion Our study revealed that high BMI was a protective factor in tuberculosis development. Precise dose-response relationship between BMI and the incident tuberculosis, as well as the risk of tuberculosis progression in contemporary Chinese adulthood, will benefit to disease control policy.

ObjectiveTo understand the trends of nutrition in children and adolescents, which may further help to prevent and control chronic diseases in younger ages.MethodsThe Chinese National Surveys on Students' Constitution and Health (CNSSCH) in Yunnan is a survey of growth conditions, physical fitness, and health status of students in Yunnan and uses a series of complex multistage stratified sampling of seven prefectures consisting of 16 counties. Sampling schools were held constant over 35 years. The participants were randomly selected among 7–18 aged students. We used data from 1985, 1991, 2000, 2005, 2010, 2014, and 2019 CNSSCH of Yunnan. According to body mass index (BMI) criteria of National Working Group for Obesity in China (WGOC-BMI criteria), a participant's nutrition (emaciation, overweight or obesity) was defined. This study is based on survey data from 129,520 participants in 1985 (n = 14,683), 1991 (n = 4,894), 1995 (n = 6,673), 2000 (n = 9,751), 2005 (n = 23,461), 2010 (n = 22,889), 2014 (n = 23,003) and 2019 (24,166).ResultsSince 1985, the trends of emaciation over 35 years were decreasing. Regardless of gender, area, and age, the prevalence of obesity and overweight were increased. The average annual growth rate of overweight and obesity was quicker in rural areas and boys than in urban areas and girls. In Yunnan, emaciation, overweight, and obesity disparity in children were common phenomena, with differences in areas and gender.ConclusionChildren in Yunnan faced the triple burden of malnutrition (emaciation, overweight, and obesity). We should take comprehensive policies and effective intervention measures to decrease the rate of nutrition deficiencies in school-aged children.

BackgroundThe Dulong people are one of the minorities in China with the lowest population. In recent years, the lifestyle of the Dulong people has also changed drastically due to income growth and urbanization. This study aims to identify cigarette smoking prevalence and potential risk factors among Dulong adults in China.MethodsThis study was conducted among 1,018 adults based on the Dulong Health Status Investigation and Evaluation (DHSIE) in Gongshan Dulong and Nu Autonomous County of Yunnan province, Southwest China. A cross-sectional design and face-to-face questionnaire were used to collect cigarette smoking habits and demographic information. Data were weighted by post-stratification weights according to the age and gender composition of Dulong resident. We also analyzed univariate and multivariate unconditional logistic regression to explore current smoking correlates.ResultsThe weighted prevalence of ever-smoking, currently smoking, and formerly smoking among Dulong adults is 31.3, 27.7, and 3.6%, respectively. The prevalence of ever-smoking and currently smoking among male participants (57.0 and 50.6%) is much higher than that of female participants (4.0 and 3.4%). Nearly 60% of ever-smokers and current smokers smoked more than 20 cigarettes per day, which are higher than former smokers (35.2%). Among current smokers, 33.1% relapsed, and 28.3% intend to quit smoking. By adjusting for potential confounding variables, multiple logistic regression analysis indicated that male participants (OR = 48.982, 95% CI: 25.026–95.869) and current drinkers (OR = 4.450, 95% CI: 2.556–7.746) are more likely to be current smokers. On the contrary, current smokers are also more likely to be exposed to secondhand smoke (OR = 4.269, 95% CI: 2.330–7.820) and have a higher risk of chronic respiratory disease (OR = 4.955, 95% CI: 1.669–14.706).ConclusionCigarette smoking is highly prevalent among the Dulong people in Southwest China. An appropriate and effective tobacco control strategy is an urgent need for this population.