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BackgroundCOVID-19 has posed a global threat due to substantial morbidity and mortality, and health education strategies need to be adjusted accordingly to prevent a possible epidemic rebound. ObjectiveThis study aimed to evaluate the perceptions of COVID-19 among individuals coming to, returning to, or living in Jiangsu Province, China, and determine the impact of the pandemic on the perceptions of the public. MethodsIn this study, an online questionnaire was distributed to participants between February 15 and April 21, 2020. The questionnaire comprised items on personal information (eg, sex, age, educational level, and occupation); protection knowledge, skills, and behaviors related to COVID-19; access to COVID-19–related information; and current information needs. Factors influencing the knowledge score, skill score, behavior score, and total score for COVID-19 were evaluated using univariate and multivariate analyses. The time-varying reproduction number (Rt) and its 95% credible interval were calculated and compared with the daily participation number and protection scores. ResultsIn total, 52,066 participants were included in the study; their average knowledge score, skill score, behavior score, and total score were 25.58 (SD 4.22), 24.05 (SD 4.02), 31.51 (SD 2.84), and 90.02 (SD 8.87), respectively, and 65.91% (34,315/52,066) had a total protection score above 90 points. For the knowledge and skill sections, correct rates of answers to questions on medical observation days, infectiousness of asymptomatic individuals, cough or sneeze treatment, and precautions were higher than 95%, while those of questions on initial symptoms (32,286/52,066, 62.01%), transmission routes (37,134/52,066, 71.32%), selection of disinfection products (37,390/52,066, 71.81%), and measures of home quarantine (40,037/52,066, 76.90%) were relatively low. For the actual behavior section, 97.93% (50,989/52,066) of participants could wear masks properly when going out. However, 19.76% (10,290/52,066) could not disinfect their homes each week, and 18.42% (9589/52,066) could not distinguish differences in initial symptoms between the common cold and COVID-19. The regression analyses showed that the knowledge score, skill score, behavior score, and total score were influenced by sex, age, educational level, occupation, and place of residence at different degrees (P

Background Methods Results Conclusions Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV.A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non‐narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses.Of 4012 participants, the majority were women with low VH. Only loss‐framing exerted a direct effect on advocacy (p = .036). Initial VH negatively moderated this effect (p = .027). Except for narrative evidence (p = .068), message framings showed significant small effects in low‐hesitant participants (p = .032). An incentive policy negatively moderated the initial VH's effect on advocacy (p = .042). Persuasion was evident only among low‐hesitant participants not receiving incentives (p = .002). In contrast, for highly hesitant individuals without incentive policies, loss‐framing (p = .024) and collectivism perspective (p = .033) produced counterintuitive effects.Message framing is effective among low‐hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non‐narrative evidence and loss‐framing messages should be prioritized over narrative evidence and gain‐framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents. [ABSTRACT FROM AUTHOR]

Pregnant women's influenza vaccination uptake was low, although being recommended as a priority. We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect vaccine hesitancy; response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played as a moderator. Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [βindirect = 0.142 (95% confidence interval (CI): 0.084, 0.206), P < 0.001], subjective norms [βindirect = 0.568 (95%CI: 0.424, 0.754), P < 0.001], perceived behavioral control [βindirect = 0.070 (95%CI: 0.025, 0.118), P = 0.004] and vaccine hesitancy. Further, indirect effect differences between the two dimensions of attitude (P < 0.001), perceived behavioral control (P < 0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P = 0.679), subjective norms (P = 0.645), and hesitancy. The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history was limited to reduce hesitancy. [ABSTRACT FROM AUTHOR]

Background Epidemiological studies have shown that some factors other than smoking may affect the risk of lung cancer in women, but the results are controversial. We conducted a meta-analysis to summarize the influencing factors of lung cancer in nonsmoking women. Methods Both English and Chinese databases were searched for publications from 1990 to 2020. All included studies were assessed according to the Newcastle-Ottawa Scale (NOS). The pooled odds ratios (ORs) and 95% confidence interval (CI) of influential factors were analyzed using the meta-analysis method, and the publication bias and sensitivity were analyzed. Results Among the five categories, the pooled OR of cooking factors category was the highest. Among 42 influencing factors, there were frequent fried food (OR = 2.42, 95% CI: 1.73–3.38) and long menstrual cycle (0.54, 95% CI: 0.39–0.75). A positive association of history of lung diseases/family lung/all cancer with lung cancer among Asian nonsmoking women (1.82, 95% CI: 1.60–2.07). Unlike other regions, cooking factors were the main risk factor for lung cancer in Asian. Conclusion The meta-analysis suggests that cooking habits, diet, passive smoking, history of cancer and lung disease, and female reproduction are related to lung cancer in nonsmoking women. However, additional studies are warranted to extend this finding. [ABSTRACT FROM AUTHOR]

Background There are currently no studies synthesizing the screening rate and influential factors of low-dose computed tomography (LDCT)-screened lung cancer in Asian population. Methods A systematic review was conducted, using both English and Chinese language databases on March, 2019. The pooled screening rate and estimated odds ratios (ORs) of influential factors were analyzed using random effects models. Subgroup and meta-regression analyses were also employed to explore the heterogeneity. Results The pooled LDCT lung cancer screening rate was 1.12% (95% confidence interval (CI): 0.94%, 1.32%), and increased with age. Adenocarcinoma and stage I lung cancer had higher screening rates. Analysis of influential factors in the general population showed that female and elder age (≥50 years) were significantly influencing LDCT lung cancer screening rate (for female, OR = 1.32, 95% CI: 1.15–1.52; for adults ≥ 50 years, OR = 1.94, 95% CI: 1.52–2.49). Meta-regression analysis indicated that the heterogeneity maybe significantly correlated with the sample size, risk population and source of population. Conclusions Unlike European and American populations, female and adults > 50 years rather than smoking adults were positively associated with screening rate in Asian populations. It is important to further study the benefits of lung cancer screening with LDCT in Asian populations. [ABSTRACT FROM AUTHOR]

Aims: There are knowledge gaps regarding STEC and EPEC strains in livestock in Jiangsu, China. This study aimed to evaluate the potential public health significance of STEC and EPEC strains isolated from livestock by determining the serotypes, virulence profiles, and genetic relationship with international STEC strains. Methods and Results: A total of 68 STEC and 37 EPEC strains were obtained from 231 faecal sheep samples and 70 faecal cattle samples. By using whole‐genome sequencing (WGS) analysis, all STEC belonged to 15 O: H serotypes, and the most prevalent serotypes were O6:H10 (19.1%), O155:H21 (14.7%), and O21:H25 (10.3%). The main Shiga toxin gene subtypes detected were stx1c (41.2%), stx1a (26.5%), stx2b (14.7%), and stx2k (14.7%). Only the STEC from cattle carried eae gene. Other adherence‐associated or toxin‐related genes, including lpfA (70.6%), iha (48.5%), subA (54.4%), and ehxA (33.8%), were found in STEC. All EPEC strains were bfpA‐negative, and the predominant eae variants were eae‐β1 (62.2%), eae‐ζ (21.6%), and eae‐θ (8.1%). The core‐genome multi‐locus sequence typing (cgMLST) analysis revealed nine scattered clusters in STEC and one dominant cluster in EPEC. The strains with the same serotypes, including O22:H8 and O43:H2 in the two towns, possessed a closely genomic distance. The core genome single‐nucleotide polymorphism (cgSNP) showed that part of STEC strains in this study was clustered with isolates possessing the same serotypes from the Netherlands, Sweden, and Xinjiang of China. Five serotypes of STEC isolates were associated with the clinical STEC strains from databases. Conclusion: This study provided the diverse serotypes and the virulence genes profiles in STEC and EPEC strains. Local strains possessed widely diverse and scattered clusters by cgMLST. Closely genomic correlation with clinical isolates displayed that part of the STEC strains may threaten to public health. Significance and Impact of the Study: Non‐O157 STEC strains act as important pathogens for human infections. This study supports the increased surveillance work of non‐O157 STEC rather than just O157 STEC in this region. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is one of the top ten health threats. We aimed to (1) assess parental Category B vaccines hesitancy and associated sociodemographic factors in China, and (2) explore the association between attitude toward vaccines and self-reported hesitant behavior. A cross-sectional study was performed through a web-based anonymous online questionnaire survey between 9 February and 7 April 2021. Chinese parents aged ≥ 18 years with one child aged < 6 years were included to assess vaccine hesitancy using the vaccine-hesitancy scale (VHS). Structural equation model was used to determine relationships between variables. Of 2952 Chinese parents included in the analysis, 17.5% were highly hesitant in Category B vaccines. Parents who were younger, less educated, engaged in health-related occupations, and had been vaccinated against influenza in the past year were more hesitant when vaccinating their children (P < 0.001). VHS score accuracy to identify vaccine-hesitant behavior was acceptable, and the optimal cutoff was 37.50 (with 61.96% parental vaccine hesitancy). Parents who lack confidence or believe vaccines were risk were more likely to show vaccine hesitant behavior (P < 0.001). In China, effective interventions need to be implemented to eliminate parental Category B vaccines hesitancy. [ABSTRACT FROM AUTHOR]

This study aimed to examine childhood vaccination delay, explore the association between vaccination delay and parental vaccine hesitancy, and assess childhood vaccination delays during the coronavirus disease (COVID)-19 pandemic in China. This cross-sectional survey was conducted in Wuxi City. Participants were recruited from local vaccination clinics. Questionnaires were used to collect information about socio-demographics, vaccine hesitancy, and immunization clinic evaluations. Vaccination records were obtained from the Jiangsu Information Management System of Vaccination Cases. Overall, 2728 participants were included. The coverage for seven category A vaccines (Expanded Program on Immunization (EPI)) was more than 95% at 24 months. The proportion of children vaccinated in a timely manner was the highest for the first dose of the hepatitis B vaccine (91.6%) and the lowest for the Bacillus-Calmette-Guerin vaccine (44.6%). More than 50% of the planned vaccinations were delayed in February and March 2020. The Vaccine Hesitancy Scale scores were not associated with vaccination delay (P = 0.842). Children's vaccination delays were negatively associated with parents who reported convenient access to clinics and satisfaction with immunization services (P = 0.020, P = 0.045). EPI is highly successful in China. Despite vaccination delays due to the COVID-19 pandemic, coverage was recovered after lockdown restrictions were eased. [ABSTRACT FROM AUTHOR]

To understand the characteristics and influencing factors related to cluster infections in Jiangsu Province, China, we investigated case reports to explore transmission dynamics and influencing factors of scales of cluster infection. The effectiveness of interventions was assessed by changes in the time-dependent reproductive number (Rt). From 25th January to 29th February, Jiangsu Province reported a total of 134 clusters involving 617 cases. Household clusters accounted for 79.85% of the total. The time interval from onset to report of index cases was 8 days, which was longer than that of secondary cases (4 days) (χ2 = 22.763, P < 0.001) and had a relationship with the number of secondary cases (the correlation coefficient (r) = 0.193, P = 0.040). The average interval from onset to report was different between family cluster cases (4 days) and community cluster cases (7 days) (χ2 = 28.072, P < 0.001). The average time interval from onset to isolation of patients with secondary infection (5 days) was longer than that of patients without secondary infection (3 days) (F = 9.761, P = 0.002). Asymptomatic patients and non-familial clusters had impacts on the size of the clusters. The average reduction in the Rt value in family clusters (26.00%, 0.26 ± 0.22) was lower than that in other clusters (37.00%, 0.37 ± 0.26) (F = 4.400, P = 0.039). Early detection of asymptomatic patients and early reports of non-family clusters can effectively weaken cluster infections. [ABSTRACT FROM AUTHOR]

We investigated an outbreak of COVID‐19 infection, which was traced back to a bathing pool at an entertainment venue, to explore the epidemiology of the outbreak, understand the transmissibility of the virus and analyse the influencing factors. Contact investigation and management were conducted to identify potential cases. Epidemiological investigation was carried out to determine the epidemiological and demographic characteristics of the outbreak. We estimated the secondary attack rate (SAR), incubation time and time‐dependent reproductive number (Rt) and explored the predisposing factors for cluster infection. The incubation time was 5.4 days and the serial interval (SI) was 4.4 days, with the rate of negative‐valued SIs at 24.5%. The SAR at the bathing pool (3.3%) was relatively low due to its high temperature and humidity. The SAR was higher in the colleagues' cluster (20.5%) than in the family cluster (11.8%). Super‐spreaders had a longer isolation delay time (p =.004). The Rt of the cluster decreased from the highest value of 3.88 on January 27, 2020 to 1.22 on February 6. Our findings suggest that the predisposing factors of the outbreak included close contact with an infected person, airtight and crowded spaces, temperature and humidity in the space and untimely isolation of patients and quarantine of contacts at the early stage of transmission. Measures to reduce the risk of infection at these gatherings and subsequent tracking of close contacts were effective. [ABSTRACT FROM AUTHOR]

In spring 2013, a novel avian‐origin influenza A (H7N9) virus emerged in mainland China. The burden of H7N9 infection was estimated based on systematic review and meta‐analysis. The systematic search for available literature was conducted using Chinese and English databases. We calculated the pooled seroprevalence of H7N9 infection and its 95% confidence interval by using Freeman‐Tukey double arcsine transformation. Out of 16 890 records found using Chinese and English databases, 54 articles were included in the meta‐analysis. These included studies of a total of 64 107 individuals. The pooled seroprevalence of H7N9 infection among humans was 0.122% (95% CI: 0.023, 0.275). In high‐risk populations, the highest pooled seroprevalence was observed among close contacts (1.075%, 95% CI: 0.000, 4.357). The seroprevalence among general population was (0.077%, 95% CI: 0.011, 0.180). Our study discovered that asymptomatic infection of H7N9 virus did occur, even if the seroprevalence among humans was low. [ABSTRACT FROM AUTHOR]

Background: This review aimed to provide constructive suggestions for the control and management of avian influenza through quantitative and qualitative evaluation of the impact of different live poultry market (LPM) interventions.Methods: Both English and Chinese language databases were searched for articles that were published on or before 9 November 2018. After extraction and assessment of the included literature, Stata14.0 was applied to perform a meta-analysis to explore the impacts of LPM interventions.Results: A total of 19 studies were identified. In total, 224 human, 3550 poultry, and 13 773 environment samples were collected before the intervention; 181 people, 4519 poultry, and 9562 environments were sampled after LPM interventions. Avian influenza virus (AIV) detection rates in the LPM environment (odds ratio [OR], 0.393; 95% confidence interval [CI], 0.262-0.589) and the incidence of AIV infection (OR, 0.045; 95% CI, 0.025-0.079) were significantly lower after LPM interventions, while interventions were not significantly effective in reducing AIV detection in poultry samples (OR, 0.803; 95% CI, 0.403-1.597).Conclusions: LPM interventions can reduce AIV human infections and the detection rate of AIV in market environments. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to (1) assess parental hesitancy about category A (Expanded Program on Immunization (EPI)) and B (non-EPI) vaccines, (2) assess parental willingness for COVID-19 and influenza vaccinations, and (3) explore the association of vaccination hesitancy of parents and healthcare workers (HCWs). Methods: The study was performed in Wuxi, eastern China between 21 September 2020 and 17 October 2020. Parents of children aged <18 years and HCWs were recruited from the selected immunization clinics. Vaccine hesitancy was assessed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy survey (VHS) by summing the total score for 10 items (maximum 50 points). Results: A total of 3009 parents and 86 HCWs were included in the analysis. The category A VHS scores were significantly higher than the category B VHS scores (p = 0.000). Overall, 59.3% and 52.4% of parents reported willingness to avail COVID-19 and influenza vaccination for their children, respectively; 51.2% of the HCWs wanted to be vaccinated against COVID-19. Parental category B VHS scores were associated with HCW category B VHS scores (r = 0.928, p = 0.008). Conclusions: In China, parents are more hesitant about category B vaccines than category A vaccines. More than 40% of parents showed hesitancy and a refusal to use COVID-19 and influenza vaccines. [ABSTRACT FROM AUTHOR]

Background: Parental acceptance of HPV vaccination remains low. This study investigates the influence of different message framing on Chinese parental intentions to vaccinate their daughters against HPV., Methods: A 2 (appeal framing: gain vs. loss) × 2 (cultural value: individualism vs. collectivism) × 2 (evidence type: narrative vs. non-narrative) factorial design was used in an online experiment. Parents of unvaccinated junior high school girls were recruited and included in the experiment. The primary outcome assessed was the reduction in HPV vaccine hesitancy (VH). The analysis of variance tests (ANOVAs) and hierarchical regression analyses were conducted to test the hypotheses., Results: Of 4012 participants, the majority were women with low VH. Only loss-framing exerted a direct effect on advocacy (p = .036). Initial VH negatively moderated this effect (p = .027). Except for narrative evidence (p = .068), message framings showed significant small effects in low-hesitant participants (p = .032). An incentive policy negatively moderated the initial VH's effect on advocacy (p = .042). Persuasion was evident only among low-hesitant participants not receiving incentives (p = .002). In contrast, for highly hesitant individuals without incentive policies, loss-framing (p = .024) and collectivism perspective (p = .033) produced counterintuitive effects., Conclusions: Message framing is effective among low-hesitant parents of female adolescents in improving HPV vaccination decisions without economic incentives. Non-narrative evidence and loss-framing messages should be prioritized over narrative evidence and gain-framing messages. Nonetheless, caution is warranted when engaging with highly hesitant parents., (© 2024 British Psychological Society.)

Background: Increasing evidence has shown the relationship between sleep and the recurrence of atrial fibrillation (AF). However, the association of different sleep patterns with AF recurrence after catheter ablation was rarely studied. We aimed to assess the role of different sleep behaviors in the risk of AF recurrence after catheter ablation., Methods and Results: A total of 416 consecutive participants from Zhongda hospital of Southeast University were finally analyzed. Sleep patterns were defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. A total of 208 patients (50.0%) had a healthy sleep pattern within a mean follow-up of 32.42 ± 18.18 months. The observed number of patients with AF recurrence was 10 (50.0%), 80 (42.6%), and 40 (19.2%) in unhealthy, intermediate and healthy sleep groups, respectively (p < .01). After adjusting covariates, unhealthy sleep pattern was significantly associated with AF recurrence [hazard ratio = 3.47 (95% confidence interval CI: 1.726-6.979, p < .001)]. Sleep disorders such as inadequate sleep time (time <7 h or >8 h), insomnia and excessive sleepiness during daytime were associated with a higher risk of recurrence. Otherwise, improvement in sleep seemed to be associated with decreased risk of AF recurrence., Conclusion: This retrospective study indicates that adherence to a healthy sleep pattern is associated with a lower risk of AF recurrence. Also, improved sleep before ablation is associated with a lower risk of AF recurrence., (© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Background: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death., Objective: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the "3Cs" (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators., Methods: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway's coefficients., Results: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=-0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=-0.071; P=.02) and lower vaccine hesitancy., Conclusions: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy., (©Liuqing Yang, Lili Ji, Qiang Wang, Guoping Yang, Shixin Xiu, Tingting Cui, Naiyang Shi, Lin Zhu, Xuepeng Xu, Hui Jin, Shiqi Zhen. Originally published in JMIR Formative Research (https://formative.jmir.org), 07.02.2023.)

Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases., Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices., Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior-in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation-to test the validity of the theoretical framework., Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (β=-0.052, P<.001) and subjective norms (β=-0.028, P=.006) with perceived behavioral control were significant., Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior., (©Liuqing Yang, Lili Ji, Qiang Wang, Yan Xu, Guoping Yang, Tingting Cui, Naiyang Shi, Lin Zhu, Shixin Xiu, Hui Jin, Shiqi Zhen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 20.06.2022.)

Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic., Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China., Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness., Results: Overall, 2881, 1038, and 1183 participants were included in the survey's three waves. Using the Vaccine Hesitancy Scale, 7.8% (225/2881), 15.1% (157/1038), and 5.5% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3% (1709/2881), 64.6% (671/1038), and 92% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, "concerns about vaccine safety and side effects" was the most common reason for refusal., Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety., (©Qiang Wang, Shixin Xiu, Liuqing Yang, Ying Han, Tingting Cui, Naiyang Shi, Minqi Liu, Youqin Yi, Chang Liu, Xuwen Wang, Guoping Yang, Lili Ji, Weijie Zhou, Hui Jin, Shiqi Zhen, Leesa Lin. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.05.2022.)

This study aimed to assess the cost-effectiveness of various public health measures in dealing with coronavirus disease 2019 (COVID-19) in China. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (imported one case) and scenario II (imported four cases) with a series of public health measures. The main outcomes included the avoided infections and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to assess uncertainty. The results indicated that isolation-and-quarantine averted the COVID-19 outbreak at the lowest ICERs. The joint strategy of personal protection and isolation-and-quarantine averted one more case than only isolation-and-quarantine with additional costs. The effectiveness of isolation-and-quarantine decreased with lowering quarantine probability and increasing delay time. The strategy that included community containment would be cost-effective when the number of imported cases was >65, or the delay time of the quarantine was more than 5 days, or the quarantine probability was below 25%, based on current assumptions. In conclusion, isolation-and-quarantine was the most cost-effective intervention. However, personal protection combined with isolation-and-quarantine was the optimal strategy for averting more cases. The community containment could be more cost-effective as the efficiency of isolation-and-quarantine drops and the imported cases increases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Shi, Huang, Yang, Cui, Ai, Ji, Xu, Ahmad, Bao and Jin.)

BACKGROUND This retrospective study aimed to investigate the factors associated with disease severity and patient outcomes in 631 patients with COVID-19 who were reported to the Jiangsu Commission of Health between January 1 and March 20, 2020. MATERIAL AND METHODS We conducted an epidemiological investigation enrolling 631 patients with laboratory-confirmed COVID-19 from our clinic from January to March 2020. Patients' information was collected through a standard questionnaire. Then, we described the patients' epidemiological characteristics, analyzed risk factors associated with disease severity, and assessed causes of zero mortality. Additionally, some key technologies for epidemic prevention and control were identified. RESULTS Of the 631 patients, 8.46% (n=53) were severe cases, and no deaths were recorded (n=0). The epidemic of COVID-19 has gone through 4 stages: a sporadic phase, an exponential growth phase, a peak plateau phase, and a declining phase. The proportion of severe cases was significantly different among the 4 stages and 13 municipal prefectures (P<0.001). Factors including age >65 years old, underlying medical conditions, highest fever >39.0°C, dyspnea, and lymphocytopenia (<1.0×10⁹/L) were early warning signs of disease severity (P<0.05). In contrast, earlier clinic visits were associated with better patient outcomes (P=0.029). Further, the viral load was a potentially useful marker associated with COVID-19 infection severity. CONCLUSIONS The study findings from the beginning of the COVID-19 epidemic in Jiangsu Province, China showed that patients who were more than 65 years of age and with comorbidities and presented with a fever of more than 39.0°C developed more severe disease. However, mortality was prevented in this initial patient population by early supportive clinical management.

Evaluation of the validity and applicability of published prognostic prediction models for coronavirus disease 2019 (COVID-19) is essential, because determining the patients' prognosis at an early stage may reduce mortality. This study was aimed to utilize the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) to report the completeness of COVID-19-related prognostic models and appraise its effectiveness in clinical practice. A systematic search of the Web of Science and PubMed was performed for studies published until August 11, 2020. All models were assessed on model development, external validation of existing models, incremental values, and development and validation of the same model. TRIPOD was used to assess the completeness of included models, and the completeness of each item was also reported. In total, 52 publications were included, including 67 models. Age, disease history, lymphoma count, history of hypertension and cardiovascular disease, C-reactive protein, lactate dehydrogenase, white blood cell count, and platelet count were the commonly used predictors. The predicted outcome was death, development of severe or critical state, survival time, and length-of-hospital stay. The reported discrimination performance of all models ranged from 0.361 to 0.994, while few models reported calibration. Overall, the reporting completeness based on TRIPOD was between 31% and 83% [median, 67% (interquartile range: 62%, 73%)]. Blinding of the outcome to be predicted or predictors were poorly reported. Additionally, there was little description on the handling of missing data. This assessment indicated a poorly-reported COVID-19 prognostic model in existing literature. The risk of over-fitting may exist with these models. The reporting of calibration and external validation should be given more attention in future research., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-6933). The authors have no conflicts of interest to declare., (2021 Annals of Translational Medicine. All rights reserved.)