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Currently, countries worldwide are embracing digital strategies, enabling enterprises to utilize digital technology, digital supply chains, blockchain, and additional digital measures to increase their competitiveness. This paper analyzed the correlation between the digital transformation of manufacturing export enterprises and their business and export performance, focusing on China's manufacturing export enterprises through empirical analysis. The study investigated the influence of digital transformation on enterprise performance. Using the Resource Based View theory and Trade theory, hypotheses were proposed and regression models were developed to analyze a sample of 1007 enterprises listed on the Shanghai and Shenzhen Stock markets from 2012 to 2019. The study conducted regression analysis, intermediate effect test, robustness test, stage lag, and heterogeneity analysis. The study found that (1) Manufacturing export enterprises listed in the stock market implemented digital transformation, leading to a significant positive impact on their overall performance. (2) Digital transformation led to cost reduction, improved R&D intensity, and enhanced human resources, among other benefits for enterprise performance. (3) According to the fractal analysis, non-state-owned enterprises exhibited more favorable effects on enterprise performance, and the digital transformation of manufacturing export companies in developed regions had a more significant impact on their performance. Finally, the study's empirical results yielded pertinent proposals for digital transformation. [ABSTRACT FROM AUTHOR]

In the era of innovation dividends, whether investors, as the main participants in the capital market, can tolerate enterprise innovation activities is the key to whether the capital market can help enterprises innovate. This paper takes the listed companies of Shanghai and Shenzhen A-shares in China that disclosed quantitative performance forecasts from 2016 to 2021 as samples, obtains the market reaction of performance forecasts through the event study method and uses them as proxy variables of investors' short-term performance expectations, and uses multiple regression analysis to explore the impact of corporate R&D on investors' short-term performance expectations. The results are as follows: (1) corporate R&D investment significantly reduces investors' short-term performance expectations (that is, investors have a significant tolerance effect on enterprises with higher R&D investment); (2) the increase in the shareholding ratio of institutional investors weakens the tolerance effect; and (3) with the implementation of China's innovation-driven strategy, the tolerance effect of its capital market on enterprise R&D gradually increases, especially for high-tech companies, but has a low tolerance effect on state-owned companies' R&D risk. The results show that investors in China's capital market are not completely rational in their response to corporate R&D, and investors are willing to bear more short-term performance losses for high R&D investment, which is consistent with prospect theory. [ABSTRACT FROM AUTHOR]

The majority of insurance investment funds are derived from policy liability debt funds. It differs from other institutional investors in a number of ways, including investment size, horizon, duration, risk, and so on. However, only a small portion of the extant literature focuses on in-depth and extensive analysis of Insurance Institutional Investors' holdings (IIIs). This study analyses the impact of shareholding by insurance institutions on the value of Shanghai and Shenzhen A-share listed companies in China's capital market. The paper offers three major contributions. First, we discovered that long-term equity-holding IIIs have both value selection and value creation functions. Second, the value creation function becomes more significant among long-term stock-holding IIIs with an increase in the period during which they retain the company's shares; Third, fast-in and fast-out (FIFO) IIIs have a value-inhibiting effect on the held company and serve a value selection role, rather than a value creation function. This study provides more insight on the lack of academic interest in insurance institutions and serves as a foundation and reference for the design of regulatory policies for insurance institutions' involvement in stock markets. It also gives empirical evidence for corporations to accurately analyze shareholding by insurance institutions. Furthermore, since this study concentrates on China's capital market, it can serve as a benchmark for other nations, particularly, those designated as developing market economies. [ABSTRACT FROM AUTHOR]

The pressure upon local governments to redeem their debt could affect government fiscal ability. It could consequently affect their fiscal policies on corporations, which might distort corporate innovation. Based on the data of Chinese Shanghai and Shenzhen A-share listed companies and the local government implicit short-term debt financed by local government financing vehicles (LGFVs) in 31 provinces, this paper shows that local government debt (LGD) negatively affects corporate R&D investment in China, thereby suggesting a strong crowding-out effect. The crowding-out effect is more pronounced when the firm is a non-state-owned enterprise (NSOE), the firm's size is small, the firm's age is young, or the firm is in the lower market competition. This paper provide evidence by interacting the terms that local government actions, such as consumption of fiscal resources, strengthening tax collection efforts, or consumption of credit resources, might partially account for the crowding-out effect. This study illustrates the innovation costs of local government debt. [ABSTRACT FROM AUTHOR]

National key rural tourism villages (NKRTVs) can lead to the high-quality development of rural tourism, and their spatial distribution is influenced by a variety of factors. However, existing studies have neglected the fact that influencing factors can have different directions and effects in different geographic spaces. This study investigates 156 NKRTVs in the Yangtze River Delta region of China as the research object and employs ArcGIS spatial analysis technology to examine their spatial distribution characteristics. Additionally, two new indicators of land and culture are introduced to enhance the index system of influencing factors. A geographically weighted regression model is utilized to identify the spatial heterogeneity of various factors that affect the spatial distribution of NKRTVs. The results of this study indicate the following: (1) The spatial distribution of NKRTVs in the Yangtze River Delta region is characterized by "small clustering and large dispersion." The spatial distribution exhibits strong spatial correlation, with Shanghai serving as the primary spatial clustering core and Huangshan city forming a secondary spatial clustering subcore. The distribution of NKRTVs is relatively scattered in other areas, with obvious differences in the spatial distribution of cold and hot spots. (2) The results of the geographically weighted regression model show that with the change in spatial location, the influence effect of each influencing factor on the spatial distribution of NKRTVs has obvious spatial differences. Based on the spatial heterogeneity of the influencing factors, this study proposes targeted suggestions for the development of rural tourism in different regions. [ABSTRACT FROM AUTHOR]

Environmental protection and social obligation fulfillment have become hot subjects as the "dual carbon" approach has been developed and deepened. The ESG system is consistent with China's current policies, abandoning the traditional business philosophy of economic supremacy in favor of comprehensively measuring corporate social responsibility and sustainable development capability across three dimensions: environmental (E), social (S), and corporate governance (G), which receive widespread attention from all sectors of society. Based on observational data from A-share listed businesses in Shanghai and Shenzhen from 2011 to 2020, this study empirically evaluates the influence and mechanism of ESG on government subsidies. The research results indicate that enterprises can receive more government subsidies by improving ESG performance. Mechanism analysis found that corporate transparency plays a positive mediating role in the process of ESG affecting government subsidies. Further research on political affiliation and property rights has found that companies without political affiliation are more inclined to receive more government subsidies by improving ESG performance, and the impact of political affiliation and ESG performance on government subsidies is mutually complementary. Enterprises with different property rights have different strengths of motivation to increase government subsidies by improving ESG performance. State owned enterprises (excluding central enterprises) are the strongest, followed by non-state-owned enterprises, and central enterprises are the weakest. Therefore, enterprises should be further encouraged to strengthen ESG construction, improve the quality of ESG information disclosure, improve resource allocation efficiency, and promote high-quality development of enterprises. [ABSTRACT FROM AUTHOR]

The Chinese government adheres to the innovation driven strategy and emphasizes that technological innovation is the strategic support for improving social productivity and comprehensive national strength. This paper discusses the mechanism of technological innovation and regional economic co-evolution, and constructs an index system to assess them based on the principles of synergy and systematics. The authors use a dynamic coupling model to study the law of the cooperative evolution of composite systems and geo-detector methods to reveal the main factors controlling the degree of coordination among them. The results show that the total factor productivity of China's high-tech industry showed a "W"-type trend of change from 2006 to 2016, and the other indices exhibited a volatile trend. The total factor productivity, technical efficiency, scale efficiency, pure technical efficiency, and technological progress increased by 37%, 13.3%, 3.9%, 9%, and 20.8%, respectively. There was a significant spatial difference in changes in total factor productivity, forming a core-edge spatial pattern with the middle and upper reaches of the Yangtze River as the center of concentration. Most of China's technological innovation and regional economic complex systems were in a state of interactive development from 2007 to 2016, except in the three northeastern provinces of Zhejiang, Shanghai, and the western part of the country. The degree of coupling of the other provinces showed an increasing trend, and the overall degree of coupling exhibited the spatial pattern of Central > Eastern > Western > Northeastern. The three most influential factors for the degree of coupling of China's provincial complex system were the gross domestic product, efficiency of technological innovation, and expenditure on research and development, whereas the three most important factors affecting the degree of coupling of complex systems were the efficiency of technological innovation, gross domestic product, and number of high-tech enterprises as well as research and development personnel, respectively, in the eastern, central, western, and northeastern regions. Finally, the paper puts forward the suggestions of regional innovation driven coordinated development, technology innovation and regional economic coordinated development, in order to provide reference for the high-quality economic development of developing countries. [ABSTRACT FROM AUTHOR]

The Yangtze River Delta urban agglomeration is the leading and demonstration area for the high-quality development of culture tourism (HDCT) in China. It is of great significance to study the spatiotemporal characteristics and impact mechanism of the HDCT for revealing the internal law of HDCT and promoting the collaborative innovation of culture tourism among cities. Based on the scientific construction of the evaluation system of HDCT, this paper made a quantitative analysis of 26 cities' HDCT by using coupling coordination degree model, Lisa spatiotemporal transition and spatial Durbin model (SDM). The results show that: The overall level of 26 cities' HDCT shows a fluctuating upward trend, and presents a "Z" pattern in space. More than 80% of the cities are at the medium and high level. Shanghai has obvious advantages in the primacy degree. There is a significant positive spatial autocorrelation among cities with high-quality of culture tourism development. The spatial clustering and proximity of the same kind are increasing, and the radiation effect is gradually obvious. The local spatial association patterns are mainly HH and LL agglomeration, and the characteristics of polarization are gradually prominent. The local spatial correlation structure of HDCT has strong stability, the transfer inertia between types is prominent, and the overall spatial evolution is lack of integration with obvious path dependence and lock-in effect. The spatiotemporal evolution of the HDCT is a complex process under the interaction of multiple factors, and there is a significant spatial spillover effect (0.256). The level of economic development, technological innovation, professional talent allocation are the three main factors. According to the dominant factor, it can be divided into economy stabilizing type, industry optimizing type, innovation driving type and traffic impacting type. These findings have implications for local governments and tourism management departments to achieve high-quality innovative development of cultural tourism. [ABSTRACT FROM AUTHOR]

Competitive strategy plays an important role in achieving superior profits, but there is still much to be explored in terms of the effect on firm growth. This study focuses on exploring the relationship between competitive strategy and firm growth in emerging economies. We focus on how the development zone policies moderate this relationship. This study uses a two-way fixed-effect model to analyze data for 527 manufacturing firms listed in China's Shanghai and Shenzhen A-shares from 2012-2021. Our empirical analysis showed that there is a significant positive relationship between low-cost strategy and firm growth and a significant negative relationship between differentiation strategy and firm growth. Compared with national development zones, firms in provincial development zones choose low-cost strategies that are more conducive to growth. Compared with provincial development zones, firms in national development zones choose differentiation strategies that are more conducive to growth. These findings contribute to understanding the mechanisms by which competitive strategy affects firm growth in different regional institutional contexts in emerging economies. The results of the study also have reference value for the government to optimize the development zone policies. [ABSTRACT FROM AUTHOR]

The intercity daily flow of long stay international visitors (LSIV) reflects the economic globalisation and regional integration of a region. We made the first attempt to use mobile phone data to identify international visitors who stayed longer than one month in the Yangtze River Delta (YRD) region in 2019, analysed the spatial patterns of LSIV, and revealed the impact factors associated with the daily intercity flow of LSIV. We discussed spatial dependence using multiscale geographically weighted regression (MGWR), and performed cluster analysis to understand the combination effects. The results show that enterprises have the largest effect, AQI and administrative hierarchy have relatively low effects, and income, imports and exports do not have any significant effect. Overall, the economically developed eastern regions of the YRD region are more attractive for daily travel by LSIV, with the Shanghai metropolitan area being the most attractive. Our findings provide new insights into the relationship between the intercity daily flow of LSIV and the urban economy and society in the delta region to help suggest planning recommendations to enhance the globalisation development strategy and provide a better environment for international visitors in the delta region. [ABSTRACT FROM AUTHOR]

Market competition is considered to have a significant impact on product diversification, but related issues are rarely discussed on a city scale. To analyze the diversification of export commodities and export market of 270 Chinese cities, this study uses data from 2000 to 2017 based on the commodity concentration index, market concentration index, export similarity index, spatial stratified heterogeneity, and the Almon lag model. The study's findings are: (1) The diversification of exports in most Chinese cities increased, which was higher in more developed cities in the southeast than in less developed ones in the northwest. With time, the degree of commodity and market diversification in some developed southeast Chinese cities (e.g., Shanghai) declined. This indicates the difference in and complexity of the evolution of export development in hundreds of Chinese cities between 2000 and 2017. (2) The export competition between cities became increasingly fierce, which effectively urged most of them to improve their export diversification levels. Facing increasing export competition pressure, 81.11% of the total number of cities will enhance the diversification of export commodities to cope with challenges posed by other cities. But only 56.67% will further expand the export market when the pressure of export competition increases. The biggest contribution of this study is the finding that for most Chinese cities, when export competition from other domestic cities increases, increasing diversification of products becomes a wise choice. However, the influence of competition on the diversification degree of the city's export market is relatively weak. This study provides not only a new perspective for existing research on urban export trade, but also valuable information for cities to form a more profitable and robust trading system. [ABSTRACT FROM AUTHOR]

Migrant workers greatly contributing to China's industrialization and urbanization are confronted with increasing health risks. This study empirically investigates the effects of public employment services on the self-rated health of migrant workers in Shanghai China, by using data from the National Bureau of Statistics from 2015 to 2020. The estimation results under the Ordered Probit model illustrate that public employment services significantly improve the self-rated health of migrant workers, and vocational training, job development and other related services show an apparently positive correlation with the self-rated health. The marginal effect analysis reveals that public employment services obviously reduce the probability of health satisfaction as "average", "relatively satisfied" and "relatively dissatisfied", which translate into a significant increase in the probability of "very satisfied". The mechanism analysis verifies that public employment services enhance the self-rated health by increasing the proportion of medical insurance and injury insurance of migrant workers. The results are still reliable by adopting the methods of subsample regression, Propensity Score Matching and variable substitution to conduct robustness checks. This study further enriches the literature on public employment services and the health status of migrant workers, and provides policy implications on improving the health status of migrant workers and the public employment service system of China under the impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Research indicates that Staphylococcus aureus colonization in the elderly with predisposing risks is associated with subsequent infection. However, the molecular epidemiology and risk factors for S. aureus colonization among residents and staff in nursing homes (NHs) in China remain unclear. A multicenter study was conducted in three NHs in Shanghai between September 2019 and October 2019. We explored the prevalence, molecular epidemiology, and risk factors for S. aureus colonization. All S. aureus isolates were characterized based on antimicrobial resistance, virulence genes, multilocus sequence typing (MLST), staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. NH records were examined for potential risk factors for S. aureus colonization. S. aureus and methicillin-resistant S. aureus (MRSA) isolates were detected in 109 (100 residents and 9 staff, 19.8%, 109/551) and 28 (24 residents and 4 staff, 5.1%, 28/551) subjects among 496 residents and 55 staff screened, respectively. Compared to methicillin-susceptible S. aureus isolates, all 30 MRSA isolates had higher resistance rates to most antibiotics except minocycline, rifampicin, linezolid, vancomycin, and teicoplanin. Sequence type (ST) 1 (21.3%) was the most common sequence type, and t127 (20.5%) was the most common spa type among 122 S. aureus isolates. SCCmec type I (70%) was the dominant clone among all MRSA isolates. CC1 (26/122, 21.3%) was the predominant complex clone (CC), followed by CC398 (25/122, 20.5%), CC5 (20/122, 16.4%) and CC188 (18/122, 14.8%). Female sex (OR, 1.70; 95% CI, 1.04–2.79; P = 0.036) and invasive devices (OR, 2.19; 95% CI, 1.26–3.81; P = 0.006) were independently associated with S. aureus colonization. [ABSTRACT FROM AUTHOR]

Many studies have explored the relationship between housing prices and environmental characteristics using the hedonic price model (HPM). However, few studies have deeply examined the impact of scene perception near residential units on housing prices. This article used house purchasing records from and open access geolocation data (including massive street view pictures, point of interest (POI) data and road network data) and proposed a framework named “open-access-dataset-based hedonic price modeling (OADB-HPM)” for comprehensive analysis in Beijing and Shanghai, China. A state-of-the-art deep learning framework and massive Baidu street view panoramas were employed to visualize and quantify three major scene perception characteristics (greenery, sky and building view indexes, abbreviated GVI, SVI and BVI, respectively) at the street level. Then, the newly introduced scene perception characteristics were combined with other traditional characteristics in the HPM to calculate marginal prices, and the results for Beijing and Shanghai were explored and compared. The empirical results showed that the greenery and sky perceptual elements at the property level can significantly increase the housing price in Beijing (RMB 39,377 and 6011, respectively) and Shanghai (RMB 21,689 and 2763, respectively), indicating an objectively higher willingness by buyers to pay for houses that provide the ability to perceive natural elements in the surrounding environment. This study developed quantification tools to help decision makers and planners understand and analyze the interaction between residents and urban scene components. [ABSTRACT FROM AUTHOR]

Background: Knowledge of drug safety in the pediatric population of China is limited. This study was designed to evaluate ADRs in children reported to the spontaneous reporting system (SRS) of Shanghai in 2009. Methodology and Principal Findings: Crude ADR reports submitted to Shanghai SRS in 2009 for individuals aged from birth to 17 years (including 17 years) were included. Data were analyzed with respect to age, gender, category of ADR (System Organ Class [SOC]), the severity of reports and type of reporter. Results: A male overrepresentation was observed regarding the total number of reports. The most frequently reported group of drugs were vaccines (42.15%). Skin rash and fever were the commonest symptoms reported in the total pediatric dataset. The proportion of children that suffered from a serious ADR was 2.16% and that for drug related deaths was 0.34%. And we found that the multiple drug exposure experienced a high proportion of serious ADRs compared with the single drug use (χ2 = 15.99, P<0.0001). Sixty-five percent of ADRs were for children less than 6 years of age. And more than half of reports were from doctors. Conclusions: In our study, consumers were more likely to report new ADRs though they appear to contribute a relatively small percentage of total reports. We propose that patients would take an active role in reporting ADRs. More researches are needed in order to achieve better understanding the characteristics of ADRs in pediatric population of China. [ABSTRACT FROM AUTHOR]

Objective: Voluntary counseling and testing (VCT) plays an important integral role in response to the HIV/AIDS epidemic. However, VCT service has not been effectively utilized among rural migrants, a high risk group in China. In this study, we developed a community based intervention to examine if community mobilization with comprehensive VCT is more effective than current HIV preventions with routine VCT service in promoting VCT acceptability among rural migrants in Shanghai, China. Methods: A comprehensive intervention with community mobilization and comprehensive VCT services including community-based VCT and mobile VCT was implemented during 2007–2009. Three communities in Minhang District of Shanghai were randomly selected and were designed to receive community mobilization and comprehensive VCT, traditional VCT and none intervention, respectively. After 24 months intervention, effects were evaluated by comparing outcome indicators between the baseline (2,690 participants) and follow-up surveys (1,850 participants). Findings: A substantial increase in VCT acceptance was observed among community mobilization group (94.9% vs. 88.5%, P<0.001), whereas the reverse effect was seen in the traditional VCT group (86.1% vs. 94.6%, P<0.001) and control group (69.0% vs. 91.7%, P<0.001). Rural migrants from community mobilization group were more likely to accept VCT (OR = 2.91, 95% CI 1.69–4.97). Rural migrants from community mobilization group also showed significant increase in HIV/AIDS knowledge, positive attitude towards HIV positive individuals and condom use. Conclusion: Community mobilization with comprehensive VCT has significant impact on promotion of VCT acceptance and utilization among rural migrants in Shanghai. These findings provide evidence to support community mobilization as a suitable strategy for VCT promotion among rural migrants in Shanghai, China. [ABSTRACT FROM AUTHOR]

Drinking water chlorination plays a pivotal role in preventing pathogen contamination against water-borne disease. However, chemical disinfection leads to the formation of halogenated disinfection by products (DBPs). Many DBPs are highly toxic and are of health concern. In this study, we conducted a comprehensive measurements of DBPs, including iodoacetic acid (IAA), iodoform (IF), nine haloacetic acids and four trihalomethanes in drinking waters from 13 water plants in Shanghai, China. The results suggested that IAA and IF were found in all the water treatment plants, with maximum levels of 1.66 µg/L and 1.25 µg/L for IAA and IF, respectively. Owing to deterioration of water quality, the Huangpu River has higher IAA and IF than the Yangtze River. Our results also demonstrated that low pH, high natural organic matter, ammonia nitrogen, and iodide in source waters increased IAA and IF formation. Compared to chlorine, chloramines resulted in higher concentration of iodinated DBP, but reduced the levels of trihalomethanes. This is the first study to reveal the widespread occurrence of IAA and IF in drinking water in China. The data provide a better understanding on the formation of iodinated disinfection byproducts and the findings should be useful for treatment process improvement and disinfection byproducts controls. [ABSTRACT FROM AUTHOR]

Pre-existing immunity is an important factor countering the pandemic potential of an emerging influenza virus strain. Thus, studying of pre-existing immunity to the 2009 pandemic H1N1 virus (2009 H1N1) will advance our understanding of the pathogenesis and epidemiology of this emerging pathogen. In the present study, sera were collected from 486 individuals in a hospital in Shanghai, China, before the 2009 H1N1 influenza pandemic. The serum anti-hemagglutinins (HA) antibody, hemagglutination inhibition (HI) antibody and neutralizing antibody against the 2009 H1N1 were assayed. Among this population, 84.2%, 14.61% and 26.5% subjects possessed anti-HA antibody, HI antibody and neutralizing antibody, respectively. Although neutralizing antibody only existed in those sera with detectable anti-HA antibody, there was no obvious correlation between the titers of anti-HA and neutralizing antibody. However, the titers of anti-HA and neutralizing antibody against seasonal H1N1 virus were highly correlated. In the same population, there was no correlation between titers of neutralizing antibody against 2009 H1N1 and seasonal H1N1. DNA immunization performed on mice demonstrated that antibodies to the HA of 2009 pandemic and seasonal H1N1 influenza viruses were strain-specific and had no cross-neutralizing activity. In addition, the predicted conserved epitope in the HA of 2009 H1N1 and recently circulating seasonal H1N1 virus, GLFGAIAGFIE, was not an immunologically valid B-cell epitope. The data in this report are valuable for advancing our understanding of 2009 H1N1 influenza virus infection. [ABSTRACT FROM AUTHOR]

Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD), in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2–3 years. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI) comparing the highest with the lowest quintiles were 1.18 (1.02–1.35) and 0.92 (0.82–1.03), respectively. This sex difference was statistically significant (P = 0.01). Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05–1.89) and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45–0.87). There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red meat intake and mortality. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence and risk factors associated with idiopathic epiretinal membranes (iERM) in a Chinese population aged 60 years or older in Beixinjing Blocks, Shanghai. Methods: This population-based study consisted of 3727 participants (89.7% of the eligible). It was performed to describe the prevalence of iERM and possible demographic, systemic, and ocular factors associated with iERM. Each participant underwent a standardized interview and comprehensive ophthalmic examination. iERM was identified and graded from retinal photographs. Then, a case-control study comparing the participants with vs. without iERM was performed to further study the associations between iERM and blood biochemical test results (including fasting plasma glucose, serum creatinine, total cholesterol, and triglyceride), ocular biological parameters (including the axial length, corneal curvature, refractive diopter, intraocular press, and anterior chamber depth), and the data of optical coherence tomography. Results: The prevalence of iERM was 1.02%. iERM was significantly associated with diabetes (OR: 2.457; 95% CI: 1.137, 5.309) and a higher level of education (OR: 1.48; 95% CI: 1.123, 1.952). Blood biochemical test results and ocular biological parameters showed no significant differences between the iERM and control groups, whereas the incidence of posterior vitreous detachment in the iERM group was much higher than in the control group (26.5% vs. 8.8%), but this difference was not statistically significant. Moreover, the eyes with iERM had poorer visual acuity than the eyes without iERM (P<0.05). Conclusions: In Beixinjing Blocks, Shanghai, iERM was relatively rare, was associated with diabetes and a higher level of education, and caused a substantial decrease in visual acuity. [ABSTRACT FROM AUTHOR]

Land cover data represent a fundamental data source for various types of scientific research. The classification of land cover based on satellite data is a challenging task, and an efficient classification method is needed. In this study, an automatic scheme is proposed for the classification of land use using multispectral remote sensing images based on change detection and a semi-supervised classifier. The satellite image can be automatically classified using only the prior land cover map and existing images; therefore human involvement is reduced to a minimum, ensuring the operability of the method. The method was tested in the Qingpu District of Shanghai, China. Using Environment Satellite 1(HJ-1) images of 2009 with 30 m spatial resolution, the areas were classified into five main types of land cover based on previous land cover data and spectral features. The results agreed on validation of land cover maps well with a Kappa value of 0.79 and statistical area biases in proportion less than 6%. This study proposed a simple semi-automatic approach for land cover classification by using prior maps with satisfied accuracy, which integrated the accuracy of visual interpretation and performance of automatic classification methods. The method can be used for land cover mapping in areas lacking ground reference information or identifying rapid variation of land cover regions (such as rapid urbanization) with convenience. [ABSTRACT FROM AUTHOR]

Background: Upper respiratory tract infection (URTI) is a major reason for hospitalization in childhood. More than 80% of URTIs are viral. Etiological diagnosis of URTIs is important to make correct clinical decisions on treatment methods. However, data for viral spectrum of URTIs are very limited in Shanghai children. Methods: Nasopharyngeal swabs were collected from a group of 164 children aged below 3 years who were hospitalized due to acute respiratory infection from May 2009 to July 2010 in Shanghai. A VRDAL multiplex PCR for 10 common respiratory viruses was performed on collected specimens compared with the Seeplex® RV15 ACE Detection kit for 15 respiratory viruses. Results: Viruses were detected in 84 (51.2%) patients by VRDAL multiplex PCR, and 8 (4.9%) of cases were mixed infections. Using the Seeplex® RV15 ACE Detection kit, viruses were detected in 129 (78.7%) patients, 49 (29.9%) were co-infected cases. Identified viruses included 37 of human rhinovirus (22.6% of cases), 32 of influenza A virus (19.5%), 30 of parainfluenzavirus-2 (18.3%), 23 of parainfluenzavirus-3 (14.0%), 15 of human enterovirus (9.1%), 14 each of parainfluenzavirus-1, respiratory syncytial virus B and adenovirus (8.5%), 8 of coronavirus 229E/NL63 (4.9%), 6 of human bocavirus (3.7%), 5 each of influenza B virus and respiratory syncytial virus A (3.0%), 3 of parainfluenzavirus-4 (1.8%), 2 of coronavirus OC43/HKU1 (1.2%), and 1 human metapneumovirus (0.6%). Conclusions: A high frequency of respiratory infections (78.7%) and co-infections (29.9%) was detected in children with acute respiratory infection symptoms in Shanghai. The Seeplex® RV15 ACE detection method was found to be a more reliable high throughput tool than VRDAL method to simultaneously detect multiple respiratory viruses. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effect of an intervention on fall induced injuries of elderly people in a safe-community in Shanghai and to discuss an intervention model that is proper for the community to generalize. Methodology/Principal Findings: Five neighborhood areas in a Safe Community were purposively selected. All individuals aged 60 years or over in five neighborhoods were prospective participants. From randomly selected prospective households with elders, 2,889 (pre intervention) and 3,021 (post intervention) elderly people were included in the study. Knowledge, Attitude and Practice Model (KAP) questionnaires were used at the pre- and post-intervention phase for fall-induced injury prevention in the community. Descriptive statistics and chi-square tests were used. After the intervention, knowledge about the prevention of fall-induced injuries increased, as did attitudes, beliefs and good behaviors for fall prevention. Behavior modification was most notable with many behavior items changing significantly (p value<0.0001). Conclusions/ Significance: The integrated program for reducing fall-related injuries in the community was effective in improving fall prevention among the elderly, but the intervention still needs further improvement. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the associations of age at menarche and the leg length-to-sitting-height ratio, markers of adolescent growth, with risk of diabetes in later life. Materials and Methods: Information from 69,385 women and 55,311 men, aged 40-74 years from the Shanghai Women's Health Study and Shanghai Men's Health Study, were included in the current analyses. Diabetes status was ascertained through biennial in person follow-up. Cox models, with age as the time scale, were used. Results: There were 2369 cases of diabetes (1831 women; 538 men) during an average of 7.3 and 3.6 years of follow-up of the women and men, respectively. In females, menarche age was inversely associated with diabetes risk after adjustment for birth cohort, education, and income (HR = 0.95, 0.92-0.98). In both genders, leg length-to-sitting-height ratio was inversely related to diabetes (HR = 0.88, 0.80-0.97 for men; HR = 0.91, 0.86-0.96 for women) after adjustment for birth cohort, education, and income. Further adjustment for adult BMI at study enrollment completely eliminated the associations of age at menarche (HR = 0.99, 0.96-1.02) and the leg length-to-sitting-height ratio (HR = 1.00, 0.91-1.10 for men; HR = 1.01, 0.96- 1.07 for women) with diabetes risk. Conclusions: Our study suggests that markers of an early age at peak height velocity, i.e. early menarche age and low leglength- to-sitting height ratio, may be associated with diabetes risk later in life and this association is likely to be mediated through obesity. [ABSTRACT FROM AUTHOR]

Objectives: To determine the length of delay in initial health-seeking in new pulmonary tuberculosis (PTB) cases among migrant population in the eastern part of China, and factors associated with it. Methods: A cross-sectional study was conducted using a structured questionnaire in six counties in Shanghai, Guangdong and Jiangsu from May to October, 2008, to estimate the extent and factors responsible for delayed initial health-seeking of the new PTB cases. The interval between self-reported onset of TB symptoms and date of first attendance at any medical institution was determined. More than the median duration was defined as delayed health-seeking. Results: A total of 323 new migrant PTB patients participated in the study. Only 6.5% had medical insurance. The median and mean durations to initial health-seeking were respectively 10 and 31 days. There was no significant association between socio-demographic factors and delayed initial health-seeking. Average monthly working days >24 (AOR, 1.61; 95% CI, 1.03-2.51), and hemoptysis or bloody sputum (AOR, 0.48; 95% CI, 0.28-0.85) were significantly associated with delayed initial health-seeking. Conclusions: Interventions to improve health seeking behavior among the migrant population in China must focus on strengthening their labor, medical security and health education. [ABSTRACT FROM AUTHOR]

Human parvovirus 4 (PARV4) has been detected in blood and diverse tissues samples from HIV/AIDS patients who are injecting drug users. Although B19 virus, the best characterized human parvovirus, has been shown to co-infect patients with hepatitis B or hepatitis C virus (HBV, HCV) infection, the association of PARV4 with HBV or HCV infections is still unknown. The aim of this study was to characterise the association of viruses belonging to PARV4 genotype 1 and 2 with chronic HBV and HCV infection in Shanghai. Serum samples of healthy controls, HCV infected subjects and HBV infected subjects were retrieved from Shanghai Center for Disease Control and Prevention (SCDC) Sample Bank. Parvovirus-specific nested-PCR was performed and results confirmed by sequencing. Sequences were compared with reference sequences obtained from Genbank to derive phylogeny trees. The frequency of parvovirus molecular detection was 16-22%, 33% and 41% in healthy controls, HCV infected and HBV infected subjects respectively, with PARV4 being the only parvovirus detected. HCV infected and HBV infected subjects had a significantly higher PARV4 prevalence than the healthy population. No statistical difference was found in PARV4 prevalence between HBV or HCV infected subjects. PARV4 sequence divergence within study groups was similar in healthy subjects, HBV or HCV infected subjects. Our data clearly demonstrate that PARV4 infection is strongly associated with HCV and HBV infection in Shanghai but may not cause increased disease severity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that marital status is associated with mortality, but few studies have been conducted in China where increasing aging population and divorce rates may have major impact on health and total mortality. Methods: We examined the association of marital status with mortality using data from the Shanghai Women's Health Study (1996-2009) and Shanghai Men's Health Study (2002-2009), two population-based cohort studies of 74,942 women aged 40-70 years and 61,500 men aged 40-74 years at the study enrollment. Deaths were identified by biennial home visits and record linkage with the vital statistics registry. Marital status was categorized as married, never married, divorced, widowed, and all unmarried categories combined. Cox regression models were used to derive hazard ratios (HR) and 95% confidence interval (CI). Results: Unmarried and widowed women had an increased all-cause HR = 1.11, 95% CI: 1.03, 1.21 and HR = 1.10, 95% CI: 1.02, 1.20 respectively) and cancer (HR = 1.17, 95% CI: 1.04, 1.32 and HR = 1.18, 95% CI: 1.04, 1.34 respectively) mortality. Never married women had excess all-cause mortality (HR = 1.46, 95% CI: 1.03, 2.09). Divorce was associated with elevated cardiovascular disease (CVD) mortality in women (HR = 1.47, 95% CI: 1.01, 2.13) and elevated all-cause mortality (HR = 2.45, 95% CI: 1.55, 3.86) in men. Amongst men, not being married was associated with excess all-cause (HR = 1.45, 95% CI: 1.12, 1.88) and CVD (HR = 1.65, 95% CI: 1.07, 2.54) mortality. Conclusions: Marriage is associated with decreased all cause mortality and CVD mortality, in particular, among both Chinese men and women. [ABSTRACT FROM AUTHOR]

Background: Personality traits such as novelty seeking (NS) are associated with substance dependence but the mechanism underlying this association remains uncertain. Previous studies have focused on the role of the dopamine pathway. Objective: Examine the relationships between allelic variants of the catechol-O- methlytransferase (COMT) gene, NS personality traits, and age of onset of drug use in heroin-dependent subjects in China. Methods: The 478 heroin dependent subjects from four drug rehabilitation centers in Shanghai who were genotyped for eight tagging single nucleotide polymorphisms (SNP) on the COMT gene completed the NS subscale from the Temperament and Character Inventory. Multivaritate analyses were used to assess the potential mediating role of NS personality traits in the association between COMT gene variants and the age of onset of heroin use. Principal Findings and Conclusions: In the univariate analysis the COMT rs737866 gene variants were independently associated with both NS and age of onset of drug use: those with the TT genotype had higher NS subscale scores and an earlier onset age of heroin use than individuals with CT or CC genotypes. In the multivariate analysis the inclusion of the NS subscore variable weakened the relationship between the COMT rs737866 TT genotype and an earlier age of onset of drug use. Our findings that COMT is associated with both NS personality traits and with the age of onset of heroin use helps to clarify the complex relationship between genetic and psychological factors in the development of substance abuse. [ABSTRACT FROM AUTHOR]

Perceived facial age has been proposed as a biomarker of ageing with 'looking young for one's age' linked to physical and cognitive functioning and to increased survival for Caucasians. We have investigated the environmental and lifestyle factors associated with perceived facial ageing in Chinese women. Facial photographs were collected from 250 Chinese women, aged 25-70 years in Shanghai, China. Perceived facial age was determined and related to chronological age for each participant. Lifestyle and health information was collected by questionnaire. Bivariate analyses (controlling for chronological age) identified and quantified lifestyle variables associated with perceived facial age. Independent predictors of perceived age were identified by multivariate modelling. Factors which significantly associated with looking younger for one's chronological age included greater years of education (p,0.001), fewer household members (p = 0.027), menopausal status (p = 0.020), frequency of visiting one's doctor (p = 0.013), working indoors (p,0.001), spending less time in the sun (p = 0.015), moderate levels of physical activity (p = 0.004), higher frequency of teeth cleaning (p,0.001) and more frequent use of facial care products: cleanser (p,0.001); moisturiser (p = 0.016) or night cream (p = 0.016). Overall, 36.5% of the variation in the difference between perceived and chronological age could be explained by a combination of chronological age and 6 independent lifestyle variables. We have thus identified and quantified a number of factors associated with younger appearance in Chinese women. Presentation of these factors in the context of facial appearance could provide significant motivation for the adoption of a range of healthy behaviours at the level of both individuals and populations. [ABSTRACT FROM AUTHOR]

Background: Human rhinoviruses (HRVs) are a highly prevalent cause of acute respiratory infection in children. They are classified into at least three species, HRV-A, HRV-B and HRV-C, which are characterized by sequencing the 59 untranslated region (UTR) or the VP4/VP2 region of the genome. Given the increased interest for novel HRV strain identification and their worldwide distribution, we have carried out clinical and molecular diagnosis of HRV strains in a 2-year study of children with acute respiratory infection visiting one district hospital in Shanghai. Methodology/Findings: We cloned and sequenced a 924-nt fragment that covered part of the 59UTR and the VP4/VP2 capsid genes. Sixty-four HRV-infected outpatients were diagnosed amongst 827 children with acute low respiratory tract infection. Two samples were co-infected with HRV-A and HRV-B or HRV-C. By comparative analysis of the VP4/VP2 sequences of the 66 HRVs, we showed a high diversity of strains in HRV-A and HRV-B species, and a prevalence of 51.5% of strains that belonged to the recently identified HRV-C species. When analyzing a fragment of the 59 UTR, we characterized at least two subspecies of HRV-C: HRV-Cc, which clustered differently from HRV-A and HRV-B, and HRV-Ca, which resulted from previous recombination in this region with sequences related to HRV-A. The full-length sequence of one strain of each HRVCa and HRV-Cc subspecies was obtained for comparative analysis. We confirmed the close relationship of their structural proteins but showed apparent additional recombination events in the 2A gene and 39UTR of the HRV-Ca strain. Double or triple infections with HRV-C and respiratory syncytial virus and/or bocavirus were diagnosed in 33.3% of the HRV-infected patients, but no correlation with severity of clinical outcome was observed. Conclusion: Our study showed a high diversity of HRV strains that cause bronchitis and pneumonia in children. A predominance of HRV-C over HRV-A and HRV-B was observed, and two subspecies of HRV-C were identified, the diversity of which seemed to be related to recombination with former HRV-A strains. None of the HRV-C strains appeared to have a higher clinical impact than HRV-A or HRV-B on respiratory compromise. [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are global health problems. We sought to determine the characteristics, prevalence, and relative frequency of transmission of MDR and XDR TB in Shanghai, one of the largest cities in Asia. Methods: TB is diagnosed in district TB hospitals in Shanghai, China. Drug susceptibility testing for first-line drugs was performed for all culture positive TB cases, and tests for second-line drugs were performed for MDR cases. VNTR-7 and VNTR- 16 were used to genotype the strains, and prior treatment history and treatment outcomes were determined for each patient. Results: There were 4,379 culture positive TB cases diagnosed with drug susceptibility test results available during March 2004 through November 2007. 247 (5.6%) were infected with a MDR strain of M. tuberculosis and 11 (6.3%) of the 175 MDR patients whose isolate was tested for susceptibility to second-line drugs, were XDR. More than half of the patients with MDR and XDR were newly diagnosed and had no prior history of TB treatment. Nearly 57% of the patients with MDR were successfully treated. Discussion: Transmission of MDR and XDR strains is a serious problem in Shanghai. While a history of prior anti-TB treatment indicates which individuals may have acquired MDR or XDR TB, it does not accurately predict which TB patients have disease caused by transmission of MDR and XDR strains. Therefore, universal drug susceptibility testing is recommended for new and retreatment TB cases. [ABSTRACT FROM AUTHOR]

Background:The Shanghai Public Places Smoking Control Legislation was implemented in March 2010 as the first provincial-level legislation promoting smoke-free public places in China. Objective:To evaluate the compliance with this policy as well as its impact on exposure to secondhand smoke (SHS), respiratory symptoms, and related attitudes among employees in five kinds of workplaces (schools, kindergartens, hospitals, hotels, and shopping malls). Methods:A cross-sectional survey was conducted six months before and then six months after the policy was implemented. Five types of occupational employees from 52 work settings were surveyed anonymously using multistage stratified cluster sampling. Results:Six months after implementation, 82% of the participants agreed that “legislation is enforced most of the time”. The percentage of self-reported exposure to secondhand smoke declined from round up to 49% to 36%. High compliance rates were achieved in schools and kindergartens (above 90%), with less compliance in hotels and shopping malls (about 70%). Accordingly, prevalence of exposure to SHS was low in schools and kindergartens (less than 10%) and high in hotels and shopping malls (40% and above). The prevalence of respiratory and sensory symptoms (e.g., red or irritated eyes) among employees decreased from 83% to 67%. Conclusions:Initial positive effects were achieved after the implementation of Shanghai Smoking Control legislation including decreased exposure to SHS. However, compliance with the policies was a considerable problem in some settings. Further evaluation of such policy implementation should be conducted to inform strategies for increasing compliance in the future. [ABSTRACT FROM AUTHOR]