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Background: Vulvovaginal candidiasis (VVC) is frequent in women of reproductive age, but very limited data are available on the epidemiology in cases of VVC in China. Objectives: The current study has been conducted to reveal the prevalence, species distribution of yeast causing VVC and molecular genetics of Candida albicans in China. Methods: Vaginal swabs were collected from 543 VVC outpatients recruited in 12 hospitals in China between September 2017 and March 2018. They were preliminarily incubated on Sabouraud dextrose agar and then positive subjects of which were then transmitted to our institute for further identification. CHROMagar™ was used to isolate Candida species, and all isolates were finally identified by DNA sequencing. Multilocus sequence typing (MLST) was used to analyse phylogenetic relationships of the various C. albicans isolates. Results: Eleven different yeast species were identified in 543 isolates, among which C. albicans (84.7%) was the most frequent, followed by C. glabrata (8.7%). We obtained 117 unique diploid sequence types from 451 clinical C. albicans isolates and 92 isolates (20.4%) belonged to a New Clade. All the strains appearing in the New Clade were from northern China and they were isolated from non‐recurrent VVC. Conclusions: Our findings suggest that C. albicans are still the main cause of VVC in China and the majority of C. albicans isolates belongs to Clade 1 with DST 79 and DST 45 being two most common. Moreover, the New Clade revealed in our study seems to be specific to northern China. [ABSTRACT FROM AUTHOR]

We describe the epidemiology of hepatitis B virus ( HBV) infection among women of reproductive age residing in areas of China that are highly endemic for chronic HBV, and provide evidence useful for decision-makers to guide strategies for preventing mother-to-child transmission of HBV, and assess the impact of perinatal transmission PMTCT by projecting HBsAg prevalence trends without interventions. We conducted a cross-sectional HBV serological survey of women, 15-49 years of age, residing in Fujian, Guangdong, Guangxi and Hainan provinces. Demographic and other subject-level data were collected in face-to-face interviews, after which we obtain blood specimens. Specimens were tested for HBV sero-markers by ELISA (Beijing Wantai Biological Pharmacy), and HBV DNA was tested with PCR (Hunan Sansure Biotech). Weighted HBsAg and HBV (either HBsAg+ or anti- HBc+ indicating either present or past infection) prevalences were 11.82% and 57.16%, respectively. Among the HBsAg-positive women, 27% were also HBeAg positive. The proportion of individuals with HBV DNA loads >105IU/mL declined with increasing age. Among HBsAg-negative women, 0.9% had occult HBV infection. The prevalence of chronic HBV infection among reproductive women in these highly endemic provinces is high, posing a threat to maternal health and risk of mother-to-child transmission. Prevention of mother-to-child transmission remains critically important. [ABSTRACT FROM AUTHOR]

A nationwide survey of hepatitis B virus ( HBV)-associated economic burden has not previously been performed in China. The purpose of this study was to examine the direct, indirect, and intangible costs of HBV-related diseases within the span of one year. A random sample was taken from specialty and general hospitals across 12 cities in six provinces of China. Intangible costs were estimated based on willingness to pay or open-ended answers provided by patients. The results showed that 27 hospitals were enrolled, with a sample population of 4726 patients (77.7% response rate). The average annual costs were $4454.0 (direct), $924.3 (indirect), and $6611.10 (intangible), corresponding to 37.3%, 7.7%, and 55.1% of the total costs, respectively. The direct medical fees were substantially greater than the non-medical fees. Annual indirect costs were divided into outpatient ($112.9) and inpatient ($811.40) loss of income. The intangible costs of chronic HBV were notably higher than either the direct or indirect costs, consistent with the social stigma in China. The comparison amongst individual cities for the average ratio of direct to indirect costs revealed that the sizes of ratios were negatively correlated with the socioeconomic status of the regions. This study suggested that as a whole in China, the HBV-related diseases caused a heavy financial burden which was positively associated with disease severity. Although the intangible costs coincided with a high prevalence of discrimination against CHB patients in Chinese society, our study may serve as future reference for detailed exploration. [ABSTRACT FROM AUTHOR]

Background The epidemiology, diagnosis, and treatment of motor neuron disease ( MND) in Chinese patients are ill known. Methods A registered study of 461 MND patients was conducted across 10 facilities in 7 Chinese cities from February 2009 to March 2010. Results Patients were classified as amyotrophic lateral sclerosis ( ALS) (84.4%), progressive bulbar palsy ( PBP) (4.1%), progressive muscular atrophy ( PMA) (10.4%), or primary lateral sclerosis ( PLS) (0.9%). MND was predominant in men (men/women; 1.6:1.0). Mean onset age was 52.6 years, with the highest incidence being observed between 51 and 60 years. Notably, 26.0% of MND patients were employed in forestry, fishery, or animal husbandry industries. Ten cases (2.7%) reported family history of MND, and 54.2% exhibited cervical onset. MND was also associated with head/neck trauma. Non-invasive positive pressure ventilation was the most common supportive therapy. Conclusion As a novel comprehensive report of a Chinese population, this study reveals that epidemiological characteristics of MND patients were similar to those observed in international populations. MND is age-related, male gender predominant, and may be associated with both environmental and genetic risk factors. [ABSTRACT FROM AUTHOR]

Objectives:Many complex mechanisms responsible for the pathogenesis of pressure ulcers (PUs) currently remain poorly understood. The objective of this study was to discover the major roles for inflammatory cytokines, growth factors and several apoptosis-related signal molecules in chronic PU wound.Methods:We investigated expression of inflammatory cytokines, growth factors and their corresponding receptors, and the apoptosis signal of caspase-3 in chronic stage III/IV chronic PU wound, acute wounds as well as normal skin controls. Tissues were stained by hematoxylin and eosin (HE) for histopathology and Masson's trichrome for collagen. Vascular endothelial growth factor (VEGF), fibroblast growth factors 2 (bFGF) and caspase-3 were detected by immunohistochemical analysis. Expression of mRNAs for interleukin (IL)-1β, tumor necrosis factor-α (TNF-α), VEGF, KDR, bFGF and FGFR1 was determined by real-time reverse transcription PCR.Results:Stage III and IV chronic PUs stained had increased inflammatory cell infiltration and decreased collagen compared with controls. Levels of mRNAs for inflammatory cytokines IL-1β and TNF-α were elevated in PUs compared with acute wounds and normal skin. VEGF and bFGF, together with their receptors KDR and FGFR1, respectively, were significantly decreased compared with controls. However, the expression levels of caspase-3 were elevated in the PUs.Conclusion:Our series of studies have shown that chronic PUs displayed high levels of inflammation and disruption of the collagen matrix, along with increased indications of apoptosis and decreased levels of growth factors and their receptors. These characteristics can be used to comprehensively evaluate the etiology and treatment of chronic PUs. [ABSTRACT FROM AUTHOR]

A comprehensive review of the current water pollution status in China has indicated that the urban lakes in Chinese cities have suffered from serious pollution and are in high risk of eutrophication, although the pollution sources have been largely controlled. The objective of this study lies in exploring a long term restoration of the aquatic ecosystem in Chinese city lakes using treatment wetland, an environmentally friendly and cost-effective technology. Trials from a subsurface horizontal flow constructed wetland (CW) have demonstrated that the treatment wetland can be used for a purpose such as lake water quality control. Average removal of 84.2% for COD, 53.8% for NH3-N, 47.9% for TN, 73.3% for TP and 86.6% for SS can be achieved. Relatively, low removal of nitrogen lies in the lack of nitrification and denitrification process. Accordingly, improved configuration of the treatment wetland system has been proposed and discussed. Finally, the importance of the integrated constructed wetland especially for the application of urban lake water treatment is highlighted. [ABSTRACT FROM AUTHOR]

Landfill leachates are composed of a complex mixture of organic matter, including a wide range of potentially fluorescent organic compounds. The fluorescence excitation-emission matrix (FEEM) of leachates during treatment processes is investigated. Particular attention is paid to the fluorescence evolution of leachates during treatment processes. Two typical types of landfill, landfill A (a direct municipal solid waste (MSW) landfill) and landfill B (disposal of bottom ashes from MSW incinerators), in a city in Southern China were selected. The results show that two characteristic and intense excitation-emission peaks located at Ex/Em = 310-330 nm/395-410 nm (peak α) and Ex/Em = 250-260 nm/450-460 nm (peak α') are observed. As the aromatic chemicals, capable of emitting fluorescence, are more recalcitrant to biodegradation than aliphatic chemicals, enhancement of the dissolved organic carbon normalized fluorescence intensities is demonstrated during treatment processes of leachate A and leachate B. This is confirmed by the variation of ultraviolet absorptivity of leachates at 254 nm. Peak α' and peak α are attributed to a mixture of xenobiotic organic compounds with low molecular weight and relatively stable aromatic fulvic-like matters with high molecular weight, respectively. Humic substances are more resistant to biodegradation than xenobiotic organic compounds, so a significant reduction in the Iα'/Iα values (fluorescence intensity ratios of peak α' and peak α) of leachate A was observed during treatment processes. However, no evident variation for the Iα'/Iα values of leachate B was found during treatment processes owing to the low concentrations of xenobiotic organic compounds in leachate B after incineration. [ABSTRACT FROM AUTHOR]

The article reports on the progress in hepatitis B prevention through universal infant vaccination in China for the period of 1997-2006. The incidence of hepatitis B virus (HBV) infection in China is discussed. The efforts to make hepatitis B vaccine (HepB) more affordable and free in China are described. The estimated number of chronic HBV infections and HBV-related deaths prevented during 2003-2006 is given.

In most parts of China, mosquitoes have been subjected to organophosphate (OP) insecticide treatments since the mid-1960s, and resistance gene monitoring in the Culex pipiens complex (Diptera: Culicidae) started in only a few locations from the end of the 1980s. Many resistant alleles at the Ester locus have been found in field populations, including those commonly found around the world ( Ester B1 and Ester 2), and those endemic to China ( Ester B6, Ester B7, Ester 8, and Ester 9). This situation is atypical, and may represent a complex situation for the evolution of insecticide resistance genes in China. To increase our understanding of the Chinese situation and our ability to manage resistance in the C. pipiens complex, a large study was performed. Twenty field populations were sampled from Beijing to Guangzhou. Bioassays with five insecticides (dichlorvos, parathion, chlorpyrifos, 2-sec-butylphenyl methyl carbamate, and propoxur) disclosed resistance levels variable according to the geographic origin, and up to 85-fold for dichlorvos. Six overproduced esterases were identified, including two that have not been previously described. Most of them were found in all samples, although at variable frequencies, suggesting variable selection or a transient situation, e.g., each one was recently restricted to a particular geographic area. The results are discussed in the context of recent alterations to insecticide campaigns, and of the evolution of resistance genes in Chinese C. pipiens populations. [ABSTRACT FROM AUTHOR]

The China GAVI Hepatitis B Immunization Project was initiated in 2002 with the signing of a Memorandum of Understanding between GAVI and the Government of China. The Project was one of the three (China, India, and Indonesia) GAVI-initiated special projects done to support countries too large to receive full GAVI support for hepatitis B vaccine and safe injections. The Project in China was designed by the Chinese Government and partners to deliver free hepatitis B vaccine and safe injections to all newborns in the 12 Western Provinces and Poverty Counties in 10 Provinces of Central China (1301 Counties with approximately 5.6 million births per year), eliminating the gap in immunization coverage between wealthier and poorer regions of China. The project budget (USD 76 million) was equally shared by GAVI and the Chinese Government. Initially planned for 5 years, two no cost extensions extended the project to 2011. Although China produced hepatitis B vaccine, before the project the vaccine was sold to parents who were also charged a “user fee” for the syringe and vaccine administration. Basic Expanded Program on Immunization (EPI) vaccines such as BCG, DTP, Polio, and measles vaccines were provided free to parents, although they were charged a user fee. Vaccines were sold by China CDC Offices at provincial, prefecture, county level and township hospitals, and village doctors received a substantial portion of their income from the sale of hepatitis B and other vaccines. The result of charging for hepatitis B vaccine was that coverage was relatively high in Eastern and wealthier counties in Central China (∼80–90%), but was much lower (∼40%) in Western China and Poverty Counties where parents could not afford the vaccine. The Project was administered by the China MOH and China CDC EPI program, and two Project Co-managers, one from the Chinese Government and the other an international assignee, were chosen. The project had an oversight Operational Advisory Group composed of the Chinese Government, WHO, UNICEF, and GAVI. The initial targets of the project as delineated in the initial MOU for the Project areas (HepB3 coverage will reach 85% at the county level, >75% of newborns at the county level will receive the first dose of hepatitis B within 24 h of birth, and all immunization injections will be with auto disable [AD] syringes) were substantially exceeded. The differential in vaccine coverage between wealthier and poorer parts of China was eliminated contributing to a great improvement in equity. With additional contributions of the Chinese Government the Project was accomplished substantially under budget allowing for additional catch up immunization of children under 15 years of age. More than 5 million health workers were trained in how to deliver hepatitis B vaccine, timely birth dose (TBD), and safe injections, and public awareness of hepatitis B and its prevention rose significantly. TBD coverage was expedited by concurrent efforts to have women deliver in township clinics and district hospitals instead of at home. The effective management of the Project, with a Project office sitting within the China EPI and an Operational Advisory Group for oversight, could serve as a model for other GAVI projects worldwide. Most importantly, the carrier rate in Chinese children less than 5 years of age has fallen to 1%, from a level of 10% before the inception of the Project. Liver cancer, one of the major cancer killers in China (250,000–300,000 annual estimated deaths), will dramatically decline as immunized cohorts of Chinese children age. While hepatitis C and non-alcoholic liver disease also exist in China and can lead to liver cancer and cirrhosis, the majority of liver disease in China is hepatitis B related and therefore preventable. The authors believe that China's success in preventing hepatitis B is one of the greatest public health achievements of the 21st century. Work remains to be done in several key areas. There are still pockets of home births in rural provinces where a TBD is difficult to deliver, and China is strengthening its policy of screening pregnant women for HBsAg and delivering HBIG plus vaccine to newborns of HBV carrier mothers. Approximately 10% of the adult population of China remain chronic carriers of hepatitis B virus and cannot be helped by the vaccine, so prevention of liver cancer and cirrhosis in those groups remains a future challenge for China. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of momentary intervention on the willingness and actual uptake of influenza vaccination among the elderly in China., Methods: A cross-sectional study assessed the willingness of the elderly to receive influenza vaccination, and an momentary intervention aimed to increase vaccination willingness among those initially unwilling. The elderly reporting a willingness were offered free influenza vaccination through a community intervention program., Results: A total of 3138 participants were recruited in this study, and 61.3 % (95 % CI 59.6 %-63.0 %) were willing to receive influenza vaccination at baseline. The willingness rate of influenza vaccination increased to 79.8 % (95 % CI 78.4 %-81.2 %), with an increase of 18.5 % (95 % CI 16.3 %-20.7 %) after momentary intervention. The influenza vaccination rate was 40.4 % (95 % CI 38.5 %-42.3 %) before and 53.9 % (95 % CI 52.0 %-55.8 %) after momentary intervention with an increase of 13.5 % (95 % CI 10.9 %-16.2 %). There was no significant difference in influenza vaccination rates between the initially willing people and those who changed to be willing to receive influenza vaccination after momentary intervention (vaccination rates: 78.0 % vs. 81.3 %)., Conclusion: Momentary intervention has been shown to effectively enhance the willingness of the elderly to receive influenza vaccination, thereby facilitating the translation of this intention into actual behavior., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Freshwater systems near highly urbanized areas are extremely susceptible to emerging contaminants (ECs), yet their stereoscopic persistence in aquatic ecosystems and related risks remain largely unknown. Herein, we characterized the multi-mediums distribution of 63 ECs in Baiyangdian Lake, the biggest urban lake in the North of China. We identified variations in the seasonal patterns of aquatic EC levels, which decreased in water and increased in sediment from wet to dry seasons. Surprisingly, higher concentrations and a greater variety of ECs were detected in reeds than in aquatic animals, indicating that plants may contribute to the transferring of ECs. Source analysis indicated that human activity considerably affected the distribution and risk of ECs. The dietary risk of ECs is most pronounced among children following the intake of aquatic products, especially with a relatively higher risk associated with fish consumption. Besides, a comprehensive scoring ranking method was proposed, and 9 ECs, including BPS and macrolide antibiotics, are identified as prioritized control pollutants. These findings highlight the risks associated with aquatic ECs and can facilitate the development of effective management strategies., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Xiyan Mu reports financial support was provided by Key Laboratory of Healthy Freshwater Aquaculture, Ministry of Agriculture and Rural Affairs. Yingren Li reports financial support was provided by Chinese Academy of Fishery Sciences Central Public-interest Scientific Institution Basal Research Fund. Xiyan Mu reports financial support was provided by Central Public-interest Scientific Institution Basal Research Fund. Jing Qiu reports financial support was provided by Science and Technology Innovation Program of the Chinese Academy of Agricultural Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third doses is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from the Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28 and 61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61 and 214 days after the second dose 87,067 (64.1%) infants were vaccinated with the third dose between 151 and 180 days after the second dose. The time interval distribution varied across the four provinces or municipalities ( p  < .001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine and training for obstetricians and related personnel.

Few studies focused on human papillomavirus (HPV) in male patients. This study aimed to explore the detection rate and genotyping of HPV among male patients in Beijing to provide a reference for formulating prevention strategies for HPV infection. The cross-sectional study was conducted in Beijing Chaoyang Hospital from November 2015 to March 2023. It covered male patients from the urology and dermatology departments. Fifteen high-risk HPV genotypes were detected by the multiplex real-time polymerase chain reaction method. The overall detection rate of HPV was 25.19% (1288/5114, 95% confidence interval [CI] 24.00%-26.38%), of which the single infection rate was 16.99% (869/5114, 95% CI 15.97%-18.05%) and the co-infection rate was 8.19% (419/5114, 95% CI 7.46%-8.98%). The detection rate of HPV was 40.77% (521/1278), 35.58% (58/163), 32.69% (101/309), 31.91% (60/188), 12.63% (299/2367), and 32.35% (131/405) among male patients with balanitis, warts, rash, urethritis, prostatitis, and other urinary inflammation, respectively ( P  < 0.001). The top five HPV genotypes were HPV-52, HPV-58, HPV-16, HPV-51, and HPV-66. After the first positive HPV test, the proportion of male patients who turned negative was 22.47% within 3 months, 26.40% within 3-6 months, 24.72% within 6-12 months, 17.98% within 12-24 months, and 8.43% more than 24 months. The detection rate of HPV was high among male patients from the urology and dermatology departments in Beijing, which should be considered to develop HPV vaccines with better prevention effects.

Numerous studies have explored the health impacts of individual metal exposures, yet the effects of metal mixtures on human endogenous metabolism remain largely unexplored. We aimed to assess the serum metabolic signatures of people exposed to metal mixtures. Serum and urine samples were collected from 186 workers at a steel factory in Anhui, China, in September 2019. Inductively coupled plasma mass spectrometry was used to analyze the concentrations of 23 metal elements. The serum metabolome was determined by liquid chromatography-mass spectrometry (LC-MS). A metabolome-wide association study (MWAS) was performed across the metal exposures and metabolism using quantile g-computation modeling. Pathway enrichment analysis was performed using MetaboAnalyst. We identified 226 metabolites associated with metal mixtures, primarily involving lipid metabolism (glycerophospholipids, sphingolipids), amino acid metabolism (arginine and proline, alanine, aspartate and glutamate metabolism) and caffeine metabolic pathways. Exposure to metal mixtures is mainly associated with alterations in lipid metabolism and amino acid metabolism, particularly in the glycerophospholipid and arginine and proline metabolism pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Telemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine., Methods: We collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations., Results: From 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration., Conclusions: In China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital., (© 2024. The Author(s).)

Wastewater monitoring may be a valuable early surveillance tool for studying mpox virus (MPXV) circulation in China, a country with high population density and very few mpox patients. To evaluate the effectiveness of wastewater monitoring for MPXV in detecting local hidden transmission of the epidemic in the early period, the Chinese Center for Disease Control and Prevention initiated a wastewater monitoring program for MPXV in China in July 2023. To enhance the monitoring sensitivity of the program, an MPXV monitoring point was established in a gathering place of high-risk mpox population. Three different concentration methods, PEG precipitation, ultrafiltration, and magnetic beads method were evaluated and compared. Due to its high recovery efficiency, low limit of detection, and high degree of automation, the magnetic beads method was selected for the daily surveillance of MPXV in wastewater. On September 5, 2023, MPXV DNA was detected at the MPXV monitoring point in Zibo City, marking the first instance of MPXV detection of MPXV in wastewater in China. Next-generation sequencing was conducted on the MPXV genome obtained from the positive wastewater, positive environmental samples, and the single case of mpox in Zibo in September. The results showed that the genotypes of these three genomes were different but all belong to the IIb branch of the C.1 lineage, indicating a probably hidden transmission of mpox. Wastewater monitoring is potentially an effective early surveillance tool for tracking the spread of MPXV in areas with high population density and very few mpox patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Xu Jin reports financial support was provided by National Institute of Environmental Health, China CDC. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Under the system of health decentralization, there are differences in the level of expenditure decentralization at different levels of government, and their impact on residents' health may also be different. This paper is one of the first to evaluate the effect of decentralization of health services at the municipal level from a multi-dimensional health perspective., Data and Methods: This paper uses the data of expenditure decentralization of health services at the municipal level to match the panel data from the China Household Panel Survey (CFPS) from 2010 to 2018, and uses the logit model, ordered logit model and two-way fixed effects model to empirically analyze the impact of health decentralization at the municipal level on health outcomes., Results: Based on the perspective of multi-dimensional health, from the three aspects of physical health, depression status and cognitive ability, the six sub-indicators of self-rated health, BMI standards, depression scores (summation method), depression scores (factor method), phrase test scores and mathematics test scores are discussed separately. The results show that the decentralization of health services at the municipal level has a significant promotion effect on the multi-dimensional health of residents., Conclusion: The decentralization of health services at the municipal level has important theoretical significance for promoting the reasonable division of medical and health powers and expenditure responsibilities between provincial and municipal governments, improving the efficiency of health expenditure funds, and establishing a fiscal system that matches financial resources., 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 © 2024 Cui and Wang.)

This study aims to analyze the epidemiological and pathogenic characteristics of an outbreak primarily caused by respiratory syncytial virus (RSV), human rhinovirus (HRV), and human metapneumovirus (HMPV) in a kindergarten and primary school. The outbreak was investigated by field epidemiological investigation, and the common respiratory pathogens were screened by RT-PCR detection technology. The attack rate of this outbreak was 63.95% (110/172). Main symptoms included cough (85.45%), sore throat (60.91%), and sneezing (60.00%). Multifactorial logistic regression analysis revealed that continuous handwashing and mouth and nose covering when sneezing were protective factors. All 15 collected throat swab specimens tested positive for viruses, with HMPV as the predominant pathogen (80.00%), followed by HRV (53.33%), and two cases of positive respiratory syncytial virus (13.33%). Among them, six samples showed coinfections of HMPV and HRV, and one had coinfections of HMPV and RSV, resulting in a coinfection rate of 46.67%. Genetic sequencing indicated that the HMPV genotype in this outbreak was A2c, and the HRV genotype was type A, resulting in a coinfection outbreak of HMPV, HRV, and RSV in schools and kindergartens, suggesting that multi-pathogen surveillance of respiratory tract infections should be strengthened.

Background: The impact of residential greenness on incident idiopathic pulmonary fibrosis (IPF) is unknown. We aimed to assess the association between residential greenness and incident IPF, identify underlying pathways, and further evaluate the effect among different genetic subgroups., Methods: 469,348 participants in the UK Biobank were included and followed until December 2020. Normalized difference vegetation index (NDVI) within 300-, 500-, 1000-, and 1500-m buffers (NDVI 300m , NDVI 500m , NDVI 1000m , and NDVI 1500m ) were employed as indicators of greenness. The polygenic risk score (PRS) was constructed based on 13 independent SNPs. Cox models were fitted to assess the association of residential greenness with incident IPF. Casual mediation analyses were applied to evaluate potential mediators., Findings: After a median follow-up of 11.85 years, 1574 IPF cases were identified. We found residential greenness inversely associated with incident IPF. The HRs (95%CIs) for each interquartile increase of NDVI 300m , NDVI 500m , NDVI 1000m , NDVI 1500m were 0.93 (0.87, 0.99), 0.92 (0.86, 0.98), 0.89 (0.83, 0.95), and 0.89 (0.83, 0.95), respectively. The association was stronger among individuals with intermediate or high genetic risk. In mediation analyses, the main mediators identified were PM 2.5 and NO 2 , with proportion mediated estimated to be 31.92% and 40.61% respectively for NDVI 300m ., Interpretation: Residential greenness was associated with reduced risk of incident IPF., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

To assess the associations of ambient specific-size PM with brachial-ankle pulse wave velocity (baPWV) and the progression of arterial stiffness. Participants were included from the Kailuan study, the cross-sectional study involved 36,486 participants, while the longitudinal study enrolled 16,871 participants. PM exposures was assessed through satellite-based random forest approaches at a 1 km resolution. Initial observations indicated a link between baseline baPWV and heightened levels of PM 1 , PM 2.5 , and PM 10 exposure, and greater effects were observed for PM 1 (β: 22.52, 95% CI: 18.14-26.89), followed by PM 2.5 (β: 9.76, 95% CI: 7.52-12.00), and PM 10 (β: 8.88, 95% CI: 7.32-10.45). Furthermore, the growth rate of baPWV was higher in participants exposed to high levels of PM 1 exposure (β: 2.77, 95% CI: 1.19-4.35), succeeded by PM 2.5 and PM 10 . Throughout a median follow-up period of 4.04 years, arterial stiffness was diagnosed in 1709 subjects. Long-term exposure to PM was linked with an increased risk of incident arterial stiffness, estimated HR for fixed 10 µg/m 3 increments in annual average PM 1 was 2.20 (95% CI: 2.01-2.42), PM 2.5 was 1.48 (95% CI: 1.41-1.55), and PM 10 1.32 (95% CI: 1.27-1.36). PM had a greater impact on men and older individuals (P for interaction <0.001). Long-term exposures to ambient PM 1 , PM 2.5 , and PM 10 were positively associated with baPWV and an increased risk of arterial stiffness. Higher estimated effects were observed for PM 1 than PM 2.5 and PM 10 ., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Both extreme temperature events (ETEs) and air pollution affected human health, and their effects were often not independent. Previous studies have provided limited information on the interactions between ETEs and air pollution., Methods: We collected data on deaths (non-accidental, cardiovascular, and respiratory) in Zibo City along with daily air pollution and meteorological data from January 2015 to December 2019. Distributed lag non-linear model was used to explore the health effects of ETEs on deaths. Non-parametric binary response model, hierarchical model and joint effect model were used to further explore the interaction between ETEs and air pollution in different seasons. Meanwhile, subgroup analysis by gender and age (≥ 65 years old and < 65 years old) was conducted to identify the vulnerable population., Results: ETEs increased death risk, especially for cardiovascular and respiratory deaths. Heat waves had a stronger impact than cold spells. Cold spells had a longer lag and fluctuating trend. Heat waves had a short-term impact, followed by a decrease. Females and those aged ≥ 65 were more affected, but subgroup differences were not significant. During ETEs and non-ETEs, there were different effects on deaths with per IQR increase in air pollutant concentrations. Joint effect models revealed that there was a significant interaction between ETEs and air pollution on non-accidental deaths. The interaction between PM 2.5 and cold spells was antagonistic in the cold season. In the warm season, the health effects of heat waves and high O 3 concentration were enhanced. The relative excess risk due to interaction (RERI) of cold spells and PM 2.5 in total population was -0.09 (95 % CI: -0.17, -0.01), and 9 % (95 % CI: 1 %, 17 %) of the total effect was attributable to interaction. Subgroup analysis confirmed the interactions in females and those aged ≥ 65., Conclusions: Significant association observed between ETEs and deaths. Females and ≥ 65 age groups were vulnerable. There were interactions between ETEs and air pollution. The effect of PM 2.5 on deaths decreased during cold spells, while the effect of O 3 increased during heat waves. In addition to improving air quality, it is necessary to further strengthen the prevention and control of ETEs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Plant viruses are a group of intracellular pathogens that persistently threaten global food security. Significant advances in plant virology have been achieved by Chinese scientists over the last 20 years, including basic research and technologies for preventing and controlling plant viral diseases. Here, we review these milestones and advances, including the identification of new crop-infecting viruses, dissection of pathogenic mechanisms of multiple viruses, examination of multilayered interactions among viruses, their host plants, and virus-transmitting arthropod vectors, and in-depth interrogation of plant-encoded resistance and susceptibility determinants. Notably, various plant virus-based vectors have also been successfully developed for gene function studies and target gene expression in plants. We also recommend future plant virology studies in China., (© 2023 The Authors. Journal of Integrative Plant Biology published by John Wiley & Sons Australia, Ltd on behalf of Institute of Botany, Chinese Academy of Sciences.)

Reducing hepatitis B virus (HBV) mother-to-child transmission (MTCT) is a fundamental step toward the HBV elimination goal. The multicentred, multilevel SHIELD program aimed to use an intense intervention package to reduce HBV MTCT in China. This study was conducted in diverse health settings across China, encompassing 30,109 pregnant women from 178 hospitals, part of the interim analysis of stage II of the SHIELD program, and 8,642 pregnant women from 160 community-level health facilities in stage III of the SHIELD program. The study found that the overall MTCT rate was 0.23% (39 of 16,908; 95% confidence interval (CI): 0.16-0.32%) in stage II and 0.23% (12 of 5,290; 95% CI: 0.12-0.40%) in stage III. The MTCT rate was lower among participants who were compliant with the interventions (stage II: 0.16% (95% CI: 0.10-0.26%); stage III: 0.03% (95% CI: 0.00-0.19%)) than among those who were noncompliant (3.16% (95% CI: 1.94-4.85%); 1.91% (95% CI: 0.83-3.73%); P < 0.001). Our findings demonstrate that the comprehensive interventions among HBV-infected pregnant women were feasible and effective in dramatically reducing MTCT., (© 2024. The Author(s).)

Background: Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals., Objective: We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions., Methods: We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education., Results: Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals., Conclusions: Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions., (©Xianying He, Fangfang Cui, Minzhao Lyu, Dongxu Sun, Xu Zhang, Jinming Shi, Yinglan Zhang, Shuai Jiang, Jie Zhao. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.01.2024.)

Objective: This study evaluated job burnout among primary healthcare workers (PHCWs) in China during the COVID-19 pandemic, explored its influencing factors, and examined PHCWs' preferences for reducing job burnout., Method: We conducted a multicenter cross-sectional study in Heilongjiang, Sichuan, Anhui, Gansu, and Shandong Provinces. An electronic questionnaire survey was conducted through convenience sampling in communities from May to July 2022. We collected sociodemographic characteristics, job burnout level, job satisfaction, and preferred ways to reduce job burnout among PHCWs., Results: The job burnout rate among PHCWs in China was 59.87% (937/1565). Scores for each dimension of job burnout were lower among PHCWs who had a better work environment (emotional exhaustion OR: 0.60; depersonalization OR: 0.73; personal accomplishment OR: 0.76) and higher professional pride (emotional exhaustion OR: 0.63; depersonalization OR: 0.70; personal accomplishment OR: 0.44). PHCWs with higher work intensity (emotional exhaustion OR: 2.37; depersonalization OR: 1.34; personal accomplishment OR: 1.19) had higher scores in all job burnout dimensions. Improving work environments and raising salaries were the preferred ways for PHCWs to reduce job burnout., Conclusion: Strategies should be developed to improve job satisfaction among PHCWs, enhance their professional identity, and alleviate burnout to ensure the effective operation of the healthcare system, especially during periods of overwork., 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 © 2023 Cai, Zhao, Chen, Zhang, Yu, Sun, Gao, Zhang, Wang, Du, Liu, Lu and Cui.)

Seasonal influenza leads to a significant disease burden, and older people infected with influenza are susceptible to various complications. Influenza immunization can prevent infection effectively and significantly reduce the risk of complications and severe cases. Creating a supportive environment for vaccination is crucial in advancing the influenza vaccination rate among the elderly population. In China, the present environment for supporting influenza vaccinations among the elderly is primarily comprised of policies for free vaccination and expense reimbursement, which exhibit noteworthy regional variations across cities and regions. This study systematically analyses the supportive environment and regional disparities associated with influenza vaccination among the elderly in China. It aims to comprehend the opportunities for influenza prevention and control resulting from the current background of influenza vaccination and to identify potential health inequality challenges caused by regional differences. The findings should inform the introduction of relevant national policies and programs to protect the health and well-being of the elderly population.

With the acceleration of urbanization and industrialization, the increasingly prominent contradiction between urban industrial development and urban land supply and demand highlights the need to explore the intricate interplay between the green transformation of urban construction land (GTUCL) and industrial transformation and upgrading (ITU). This exploration carries significant practical implications for fostering the harmonious development of industry and land use and achieving sustainable urban growth. In this study, we constructed evaluation indicator systems for GTUCL and ITU, drawing on the analytical frameworks of "dominant-recessive" transformation theory and "dynamic structure benefit" theory, respectively. We employed an enhanced entropy method, an improved coupling coordination model, and a geographic detector to unveil the coupling coordination relationship, the spatiotemporal evolution patterns, and the driving mechanisms of GTUCL and ITU within the urban agglomeration of the mid-Yangtze River region. The results are as follows: (1) during the research period, the comprehensive index of ITU exhibited substantial growth, increasing from 0.159 to 0.408, reflecting a remarkable 157% surge. Simultaneously, the comprehensive index of GTUCL witnessed an increase from 0.171 to 0.285, signifying a 66.66% upswing, lagging behind that of ITU. (2) The degree of coupling coordination between ITU and GTUCL demonstrated a consistent upward trajectory. It rose from 0.402 to 0.579 by 2020, marking a significant 44.2% increase. The overall development now resides within the stage of coordinated progress, although it remains at a relatively modest level, and the pace of development has moderated somewhat. Regional disparities within the urban agglomeration consistently manifest a trend of initial reduction followed by amplification, accentuating the polarization effect of internal coupling relationships. (3) The spatial differentiation pattern centered around "Wuhan, Changsha, and Nanchang" has become increasingly pronounced. The radiation linkage model following the "core-periphery" paradigm has stabilized further. Nevertheless, the relatively loose spatial connection structure has led to a more conspicuous inadequacy in radiation impact. (4) The core driving factors have transitioned from emphasizing economic development to focusing on technological support. The composition structure has shifted from the initial stage of an "economically sensitive" driving model, which centers on economic development, to the second stage of an "ecologically sensitive" driving model, which prioritizes ecological development., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The transmissibility is a crucial feature for norovirus, yet its quantitative estimation has been limited. Our objective was to estimate the basic reproduction number (R 0 ) of norovirus and investigate its variation characteristics. Norovirus outbreaks reported from September 2016 to August 2021 in Beijing were analyzed. The susceptible-infected-removed compartment model was established to estimate R 0 . Linear regression models and logistic regression models were used to explore the factors affecting the transmissibility of norovirus. The overall median R 0 of norovirus was estimated as 2.1 (interquartile range [IQR] 1.8-2.5), with 650 norovirus outbreaks. The transmissibility of norovirus varied by year, outbreak setting and genotype. The R 0 of norovirus during September 2019 to August 2020 (median 2.1, IQR 1.8-2.4) and September 2020 to August 2021 (median 2.0, IQR 1.7-2.3) was lower than that of September 2016 to August 2017 (median 2.3, IQR 1.8-2.7) (β = 0.94, p = 0.05; β = 0.93, p = 0.008). The R 0 of norovirus for all other settings was lower than that for kindergarten (median 2.4, IQR 2.0-2.9) (primary school: median 2.0, IQR 1.7-2.4, β = 0.94, p = 0.001; secondary school: median 1.7, IQR 1.5-2.0, β = 0.87, p < 0.001; college: median 1.7, IQR 1.5-1.8, β = 0.89, p = 0.03; other closed settings: median 1.8, IQR 1.5-2.0, β = 0.90, p = 0.004). GⅡ.2[P16] outbreaks had a median R 0 of 2.2 (IQR 1.8-2.7), which was higher than that for GⅡ.6[P7] outbreaks (median 1.8, IQR: 1.8-2.0, odds ratio = 0.19, p = 0.03; GⅡ.2[P16] as reference) and mixed-genotype outbreaks (median 1.7, IQR: 1.5-1.8, β = 0.92, p = 0.02; mixed-genotype as reference). In kindergartens and primary schools, norovirus shows increased transmissibility, emphasizing the vulnerable population and high-risk settings. Furthermore, the transmissibility of norovirus may change over time and with virus evolution, necessitating additional research to uncover the underlying mechanisms., (© 2023 Wiley Periodicals LLC.)

In China, adverse events following immunization (AEFI) are reported by the China AEFI Surveillance System (CNAEFIS). Serious AEFI, including deaths, are mandatorily reported and are evaluated for causality by province-or prefecture-level panels of experts. Yeast-derived HepB is the most widely used HepB in China for infants. However, the information about the death of infants caused by HepB is unclear. The CNAEFIS data on deaths following HepB from 2013 to 2020 were used for analyses. Descriptive analysis of epidemiologic characteristics was used to report death cases following HepB. We used administered doses to calculate denominators to estimate the risk of death after vaccination. During 2013-2020, there were 161 deaths following the administration of 173 million doses of HepB, for an overall incidence of 0.9 deaths per million doses. One hundred fifty-seven deaths were categorized as coincidental, and four deaths were accompanied by an abnormal reaction determined to be unrelated to the cause of death. The most common causes of death were neonatal pneumonia and foreign body asphyxia. These data provide reliable evidence on the safety of HepB among infants in China and can enhance public confidence in HepB immunization. To ensure public confidence in infants' HepB vaccination, monitoring and scientifically evaluating AEFI-related deaths of HepB is necessary., 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 © 2023 Zhang, Zhao, Chen, Xie, Lu, Du, Zeng, Huang, Liu, Wang and Cui.)

Gastric cancer is one of the most common lethal malignancies in the world, especially in China. Due to the ineffective screening of early gastric cancer and drug resistance of the advanced, the prognosis of gastric cancer remains dismal. Based on bioinformatics and tissue microarray analyses, FBXO5 was selected for analysis in this study. Here, we report the function of FBXO5 in gastric cancer, showing for the first time that it contributes to tumor cell proliferation, clone formation, invasion and migration. In these preliminary findings, FBXO5 promoted the transition of the cell cycle from the G0/G1 to the G2/M phase, which likely resulted from FBXO5 interacting with CDK1 and NCAPG proteins. The relevant mechanism needs to be explored. In addition, FBXO5 participated in the tumor microenvironment and was negatively related to immune activation. FBXO5, an oncogene, plays a role in tumor initiation and progression, and is expected to be a potential target for gastric cancer treatment., Competing Interests: Declaration of competing interest None of the authors have potential conflicts of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Human papillomavirus (HPV) infection is the most common sexually transmissible infection worldwide. Although the prevalence of cervical HPV infection has been extensively reported in women worldwide, few epidemiological studies have examined the prevalence of non-cervical HPV infection among both women and men, especially in China., Methods and Analysis: PROGRESS-Plus is a national, multisite, cross-sectional study that aims to estimate the prevalence of non-cervical HPV infection in women and men aged 18-60 years residing in mainland China. More specifically, PROGRESS-Plus will estimate the prevalence rate of HPV DNA in oral samples from both women and men, and that of anogenital samples from men. The secondary study objectives are to (1) report the aforementioned prevalence rates by HPV genotype, age and geographical region, (2) examine the concordance (ie, prevalence of the same HPV genotype) between the oral and anogenital samples among men, (3) explore risk factors associated with oral (in both women and men) and anogenital (in men only) HPV infection and (4) describe study participants' health-related quality of life, health behaviour, sexual behaviour and health status., Ethics and Dissemination: The study protocol and all required documents have been submitted for review and approval to the Independent Ethics Committees of all the participating sites. All participants will provide their written informed consent on study entry, and all the recorded data will be treated as confidential., Competing Interests: Competing interests: The PROGRESS-Plus study is sponsored by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study aimed to explore the association between air pollutants and outpatient visits for influenza-like illnesses (ILI) under the coronavirus disease 2019 (COVID-19) stage in the subcenter of Beijing. The data on ILI in the subcenter of Beijing from January 1, 2018 to December 31, 2020 were obtained from the Beijing Influenza Surveillance Network. A generalized additive Poisson model was applied to examine the associations between the concentrations of air pollutants and daily outpatient visits for ILI when controlling meteorological factors and temporal trend. A total of 171 943 ILI patients were included. In the pre-coronavirus disease 2019 (COVID-19) stage, an increased risk of ILI outpatient visits was associated to a high air quality index (AQI) and the high concentrations of particulate matter less than 2.5 (PM 2.5 ), particulate matter 10 (PM 10 ), sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and carbon monoxide (CO), and a low concentration of ozone (O 3 ) on lag0 day and lag1 day, while a higher increased risk of ILI outpatient visits was observed by the air pollutants in the COVID-19 stage on lag0 day. Except for PM 10 , the concentrations of other air pollutants on lag1 day were not significantly associated with an increased risk of ILI outpatient visits during the COVID-19 stage. The findings that air pollutants had enhanced immediate effects and diminished lag-effects on the risk of ILI outpatient visits during the COVID-19 pandemic, which is important for the development of public health and environmental governance strategies., (© 2023 Wiley Periodicals LLC.)

Combination vaccines can reduce the vaccination visit, simplify the vaccination schedule and efficiently improve management. This study was primarily designed to evaluate the economic impact of integrating the diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine into the China National Immunization Program. A cost-minimization analysis (CMA) compared the costs associated with direct medical, direct nonmedical, and indirect social costs in four schemes was conducted. A budgetary impact analysis assessed the alternative schemes' financial impact on the healthcare budget. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct nonmedical (cost for transportation) and indirect costs (loss of productivity) were derived from parents' questionnaires. Replacement of the current vaccination scheme with DTaP-IPV-Hib combination vaccine, resulted in net increases in direct medical costs of 77.64% for alternative scheme 1, 146.54% for alternative scheme 2, and 294.67% for alternative scheme 3, respectively. However, the direct nonmedical and indirect costs and the cost of the alternative schemes were 18.18%, 36.36%, and 63.64% lower than the current scheme for alternative scheme 1, alternative scheme 2, and alternative scheme 3, respectively. From the societal perspective, when compared with the current scheme, the budgetary impact of the three alternative schemes were +66 million Chinese Yuan (CNY) (4.81%), +103 million CNY (7.53%), and +305million CNY (22.35%), respectively. The CMA considered a broader perspective of social costs and indicated that the alternative schemes would result in an overall saving of parents' transportation and work loss costs to bring their children for vaccination, translating into a total cost saving of 18.18%, 36.36%, 63.64%, comparing to the current scheme. Thus, fully or partly using the DTaP-IPV-Hib combination vaccine is cost-saving in the context of China., (© 2022 Wiley Periodicals LLC.)

We aimed to investigate the hesitancy and willingness of parents to vaccinate themselves and their children with a booster dose against severe acute respiratory syndrome coronavirus 2 and related factors. We conducted a cross-sectional study in Puyang city, China. The information was collected, including demographic characteristics, willingness to receive a booster dose of coronavirus disease 2019 (COVID-19) vaccine, and attitudes and concerns toward COVID-19 and vaccines. Vaccine hesitancy was assessed in individuals completing the first two doses and booster eligible, while vaccine willingness was assessed in those completing the first two doses and not yet booster eligible. Among the participants completing two primary doses while not meeting the booster criteria, 95.4% (1465/1536) and 95.0% (1385/1458) had a willingness to a booster dose of COVID-19 vaccine for themselves and their children, respectively. Among the participants who met the booster criteria, 40.3% had vaccine hesitancy. Vaccine hesitancy and unwillingness tended to occur in people who were younger, less educated, less healthy, and with unsureness of vaccines' efficacy and adverse events (AE). The younger age of children, children in poorer health, and concern about the efficacy and AE of vaccines contributed to the participants' unwillingness to vaccinate their children. We observed a high willingness to the booster dose of COVID-19 vaccine both for the parents and their children, regardless of the eligibility to a booster dose. However, 40% of people had delayed vaccination behaviors. The promotion of scientific knowledge of vaccines' effectiveness and safety is needed, especially for people in poor health and parents with young children. Timely disclosure of AE caused by COVID-19 vaccines and proper aiding offered to people encountering AE are suggested., (© 2022 Wiley Periodicals LLC.)

Background: We conducted an evaluation on the potential data resources for the elimination of hepatitis B virus (HBV) mother-to-child transmission in China, so as to provide reference for WHO and other countries in the validation of HBV elimination of mother-to-child transmission (EMTCT) in a real-world large country setting., Methods: We used the indicators set out in WHO Interim guidance for country validation of viral hepatitis elimination as the benchmark to evaluate the availability of data and progress against indicators for the elimination validation in China. We used descriptive analysis to illustrate the status of all indicators and parameters., Results: According to the indicators which are recommended by WHO for HBV EMTCT validation, the national data in China are attainable, though not for HBV DNA testing for the HBsAg-positive mothers and their subsequent management. The remaining challenges for China are to consider how the national serosurvey might be conducted in future in the context of low HBV prevalence among children under 5 years; to collect systematically the programmatic impact data; to strengthen multi-sectoral collaboration among immunization, maternal and child health, hospital services, as well as other stakeholders., Conclusion: The available data on HBV EMTCT are sufficient to support the validation of the elimination of HBV mother-to-child transmission in China., (© 2022. Asian Pacific Association for the Study of the Liver.)

Objective: As the variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, periodic vaccine booster immunization may become a normal policy. This study investigated the changes and factors associated with vaccination intentions in various epidemic situations, which can provide suggestions for the construction and modification of routine vaccination program strategies., Methods: Two cross-sectional online surveys were conducted in January and June of 2021. The willingness and confidence of the coronavirus disease 2019 (COVID-19) vaccination were measured following propensity score matching (PSM) treatment. The difference in the willingness for COVID-19 Vaccination in the two surveys was analyzed by single or multi-factor analyses., Results: The willingness to accept the SARS-CoV-2 vaccine was higher in the second survey than that in the first survey (90.5% vs. 66.6%, p < 0.001). Concerns about the vaccine's safety declined (71.0% vs. 47.6%, p < 0.001), but concerns about the efficacy increased (22.4% vs. 30.9%, p < 0.001). Confidence in the SARS-CoV-2 vaccine had an important impact on the increased uptake willingness (odds ratio = 3.19, 95% confidence interval: 2.23-4.58, p < 0.001)., Conclusions: There has been a significant increase in attitudes towards the SARS-CoV-2 vaccine which was associated with higher vaccine confidence. Vaccine effectiveness received more concerns from respondents rather than safety after nearly 6 months' utilization of the SARS-CoV-2 vaccine. It indicates that aggressive communication and timely disclosure of vaccine data can build vaccine confidence., (© 2022 Wiley Periodicals LLC.)

Mutations in the SH3TC2 gene cause Charcot-Marie-Tooth disease type 4C (CMT4C), characterized by inherited demyelinating peripheral neuropathy. CMT4C is a common form of CMT4/autosomal recessive (AR) CMT1. This study examined the SH3TC2 variants, investigated genotype-phenotype correlations and explored the frequency of CMT4C in Chinese patients. A total of 206 unrelated patients of Chinese Han descent clinically diagnosed with CMT were recruited. All patients underwent detailed history-taking, neurological examination, laboratory workups, and electrophysiological studies. Genetic analysis was performed via high-throughput target sequencing (NGS). Three patients, one male and two females, were found to carry five SH3TC2 mutations: patient 1 (c.3154C > T, p.R1054X; c.929G > A, p.G310E); Patient 2 (c.2872&#95;2872del, p.S958fs; c.3710C > T, p.A1237V) and Patient 3 (c.2782C > T, p.Q928X; c.929G > A, p.G310E). The c.2872&#95;2872del, c.3710C > T and c.2782C > T variants were not reported before. CMT4C caused by SH3TC2 mutation is a very common type of CMT4/AR CMT1. Three novel mutations, c.2872&#95;2872del, c.3710C > T and c.2782C > T, were found in this study. Combination of clinical phenotype, nerve conduction studies, genetic analysis and bioinformatics analysis are of vital importance in patients suspected as CMT., (© 2021. Belgian Neurological Society.)

Objective: To explore health care professionals' usage and perceptions of telemedicine, including their experience, evaluation and attitude towards telemedicine, and the factors affecting their satisfaction, using intention, and willingness to recommend telemedicine., Methods: A nationwide and web-based survey was conducted. Statistical charts were used to describe the usage and perceptions of telemedicine by health care professionals. And the ordinal logistic regression was applied to analyze the influencing factors., Results: A total of 1349 valid questionnaires were collected. In the survey, 74.0 % of Chinese health care professionals used telemedicine once a week. The average duration of participating in telemedicine services lasted mainly 11-30 min (64.0 %). More than half (52.5 %) of participants' hospitals adopted fee subsidy measures, followed by the award for excellent evaluation (36.4 %). The majority (92.5 %) believed that telemedicine could reduce patient referral rates. More than 95 % were satisfied with telemedicine, were willing to continue, and would recommend telemedicine for patients, respectively. The main problems existing were: incomplete system equipment, insufficient timeliness, high costs, inability to reimburse medical insurance, non-standardized medical records, inadequate publicity, cumbersome processes and long waiting time. Ordinal logistic regression showed that too short service duration (≤10 min) could significantly reduce medical professionals' overall satisfaction, using intention and willingness to recommend (P = 0.026, P = 0.017 and P = 0.040 respectively), while the convenience of the operating system had a significant positive impact (P = 0.005, P = 0.003 and P = 0.001 respectively). And cost subsidy incentive and the promotion of professional titles could significantly enhance their overall satisfaction(P = 0.006, P = 0.030), using intention (P = 0.011, P = 0.001), and willingness to recommend (P = 0.040, P = 0.004)., Conclusions: The usage of telemedicine is relatively insufficient. Most health care professionals have fairly positive opinions toward telemedicine. The most mentioned issues and expectations for telemedicine can be roughly divided into four categories: infrastructure, service process, charge and cost, and popularity. It is possible to improve their evaluation by improving system convenience, enhancing service punctuality, avoiding excessively short service duration and adopting incentive measures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Hepatitis B vaccine (HepB) has been routinely recommended as part of the immunization program in China and has had a satisfactory safety and effectiveness profile in protecting infants from hepatitis B virus infection. We evaluated the surveillance sensitivity and changes over time of AEFI reports related to HepB among infants based on the consistent national data before and after the introduction of vaccine administration law (LAW) from 2013 to 2020 in China., Methods: AEFI records were extracted from the Chinese National AEFI Surveillance System from 2013 to 2020. According to the proportion of different kinds of HepB vaccines distributed, the annual administration data of the most distributed HepB produced by Bio-Kangtai and its corresponding adverse reaction reports were collected and analyzed. We categorized the time interval into the pre-LAW period (2013 to 2017), transition period (2018 to 2019), and LAW period (2020) to demonstrate the impact of LAW on the surveillance patterns of AEFIs., Results: The annual AEFI rates increased from 3.1/100,000 to 14.8/100,000 over this period in total. The rate ratio for the post-LAW period and pre-LAW period was 2.19 (95%CI: 2.10, 2.29). Common reactions occupied 87.6% of the total reported AEFIs whose rate was recorded as 7.9/100,000. Rare reactions occupied 9.1% of the total AEFIs showing an average rate of 0.8/100,000, of which anaphylaxis accounted for over 80%, with the rate ratio of the transition period and LAW period as 1.36 (95%CI:1.22, 1.52) and 1.14 (95%CI:0.95, 1.35), respectively. Children receiving more than one vaccine showed a higher proportion of fever, anaphylaxis, and febrile convulsions, which were suggested to be a result of vaccine co-administration vaccines, such as the DPT and Polio vaccine., Conclusion: Most reactions were mild and self-limited and the rates of rare more serious events remained stable. The LAW has largely increased the surveillance capability and sensitivity on AEFIs of HepB and also contributes to enhancing public confidence in HepB immunization. Hepatitis B vaccination is a safe and effective means of preventing the complications of hepatitis B disease and continuous standardized AEFI investigation and assessment of causal association should be maintained., 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, Huang, Lu, Black, Liang and Cui.)

Background: The safety and immunogenicity of the coadministration of an inactivated SARS-CoV-2 vaccine (Sinopharm BBIBP-CorV), quadrivalent split-virion inactivated influenza vaccine (IIV4), and 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults in China is unknown., Methods: In this open-label, non-inferiority, randomised controlled trial, participants aged ≥ 18 years were recruited from the community. Individuals were eligible if they had no history of SARS-CoV-2 vaccine or any pneumonia vaccine and had not received an influenza vaccine during the 2020-21 influenza season. Eligible participants were randomly assigned (1:1:1), using block randomization stratified, to either: SARS-CoV-2 vaccine and IIV4 followed by SARS-CoV-2 vaccine and PPV23 (SARS-CoV-2 + IIV4/PPV23 group); two doses of SARS-CoV-2 vaccine (SARS-CoV-2 vaccine group); or IIV4 followed by PPV23 (IIV4/PPV23 group). Vaccines were administered 28 days apart, with blood samples taken on day 0 and day 28 before vaccination, and on day 56., Results: Between March 10 and March 15, 2021, 1152 participants were recruited and randomly assigned to three groups (384 per group). 1132 participants were included in the per-protocol population (375 in the SARS-CoV-2 + IIV4/PPV23 group, 380 in the SARS-CoV-2 vaccine group, and 377 in the IIV4/PPV23 group). The seroconversion rate (100 % vs 100 %) and GMT (159.13 vs 173.20; GMT ratio of 0.92 [95 % CI 0.83 to 1.02]) of SARS-CoV-2 neutralising antibodies in the SARS-CoV-2 + IIV4/PPV23 group was not inferior to those in the SARS-CoV-2 vaccine group. The SARS-CoV-2 + IIV4/PPV23 group was not inferior to the IIV4/PPV23 group in terms of seroconversion rates and GMT of influenza virus antibodies for all strains except for the seroconversion rate for the B/Yamagata strain. The SARS-CoV-2 + IIV4/PPV23 group was not inferior to the IIV4/PPV23 group regarding seroconversion rates and GMC of Streptococcus pneumoniae IgG antibodies specific to all serotypes. All vaccines were well tolerated., Conclusions: The coadministration of the inactivated SARS-CoV-2 vaccine and IIV4/PPV23 is safe with satisfactory immunogenicity. This study is registered with ClinicalTrials.gov, NCT04790851., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Xiaoming Yang is the employee of the China National Biotec Group, receives the grant from National Program on Key Research Project of China (2020YFC0842100) during the conduct of the study, and has four authorized patents of ZL202010559132.3, ZL202010645875.2, ZL202010537733.4 and ZL202010537730.0. Yuntao Zhang is the employee of the China National Biotec Group, receives the grant from The National Key Research and Development Project of China (2020YFC0842100) during the conduct of the study. Hui Wang is the employee of the Beijing Institute of Biological Products, receives the grants from The National Key Research and Development Project of China (2020YFC0842100) and the Beijing Municipal Science & Technology Commission (Z201100005420014) during the conduct of the study and has three authorized patents of ZL202010645875.2, ZL202010537733.4 and ZL202010537730.0, two pending patents of 202110052921.2 and 202110052933.5. Rui Ma is the employee of the Beijing Institute of Biological Products, receives the grant from The National Key Research and Development Project of China (2020YFC0842100) during the conduct of the study. Haiping Chen, Yanhui Xiao, Shasha Han, Min Zhang, Shengyi Wang and Linyun Luo are the employees of the China National Biotec Group. Yonghong Ge and Lei Zhang are the employees of the Chengdu Institute of Biological Products. Yong Zou and Xue Guo are the employees of the Changchun Institute of Biological Products. All other authors report no potential conflicts., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: Charcot-Marie-Tooth disease (CMT) comprises a group of clinically and genetically heterogeneous inherited neuropathies with an estimated prevalence of 1 in 2500. This study aimed to analyze the clinical and mutational characteristics of Chinese CMT patients with MFN2, BSCL2 and LRSAM1 variants. Methods: In this study, genetic analysis was performed in 206 Chinese patients at Chinese PLA General Hospital from December 2012 to March 2020 with clinical diagnosis of CMT, and reported variants of MFN2, BSCL2 and LRSAM1 related to CMT2. Results: We reported ten MFN2 mutations in ten unrelated patients (7 male, 3 female), two of whom had positive family history. Three novel mutations were detected including c.475-2A>G (splicing); c.687dupA (p.E230Rfs*16) and c.558dupT (p.S186fs). We reported three BSCL2 mutations of four unrelated patients, including c.461C>G (p.S154W), c.461C>T(p.S154L), and novel variants of c.1309G>C (p.A437P) and c.845C>T (p.A282V). Furthermore, two novel variants of LRSAM1, including c.1930G>T (p.G644C) and c.1178T>A (p.L393Q) were detected in two unrelated patients. Conclusion: Mutational spectrum of MFN2-, BSCL2-and LRSAM1-related CMT disease is expanded with the identification of novel variants in Chinese patients.

Background: To explore the development of central nervous system (CNS) symptoms and clinical application in predicting the clinical outcomes of SARS-COV-2 patients., Methods: A retrospective cohort study was performed on the hospitalized patients with SARS-COV-2 recruited from four hospitals in Hubei Province, China from 18 January to 10 March 2020. The patients with CNS symptoms were determined. Data regarding clinical symptoms and laboratory tests were collected from medical records., Results: Of 1268 patients studied, 162 (12.8%) had CNS symptoms, manifested as unconsciousness (71, 5.6%), coma (69, 5.4%), dysphoria (50, 3.9%), somnolence (34, 2.7%) and convulsion (3, 0.2%), which were observed at median of 14 (interquartile range 9-18) days after symptom onset and significantly associated with older age (OR = 5.71, 95% confidence interval [CI] 2.78-11.73), male (OR = 1.73, 95% CI 1.22-2.47) and preexisting hypertension (OR = 1.78, 95% CI 1.23-2.57). The presence of CNS symptoms could be predicted by abnormal laboratory tests across various clinical stages, including by lymphocyte counts of <0.93 × 10 9 /L, LDH≥435 U/L and IL-6≥28.83 pg/L at 0-10 days post disease; by lymphocyte count<0.86 × 10 9 /L, IL-2R ≥ 949 U/L, LDH≥382 U/L and WBC≥8.06 × 10 9 /L at 11-20 days post disease. More patients with CNS symptoms developed fatal outcome compared with patients without CNS symptoms (HR = 33.96, 95% CI 20.87-55.16)., Conclusion: Neurological symptoms of COVID-19 were related to increased odds of developing poor prognosis and even fatal infection., Competing Interests: Declaration of competing interest The authors declared that they have no conflicts of interest to this work., (Copyright © 2021. Published by Elsevier B.V.)

Maximizing or improving residents' subjective well-being is one of the basic purposes of public expenditure. As an important component of public expenditure, the impact of public health investment on residents' subjective well-being receives considerable attention. Regarding the empirical evidence, this paper measures residents' subjective well-being from the perspectives of overall cognitive happiness, life satisfaction, positive emotions and negative emotions, on the basis of a multi-level structural model of subjective well-being. Factor analysis is used to estimate the subjective well-being of residents at the province level in China, based on the China Family Panel Studies of 2018. In addition, structural equation modeling is employed to explore the impact of public health investment and its regional disparity on the subjective well-being of residents. The empirical results show that public health investment has a significant positive effect on residents' subjective well-being. Moreover, there is an inverted U-shaped relationship between the regional disparity of public health investment and residents' subjective well-being. Further study illustrates that the effects of public health investment and its regional disparity on residents' subjective well-being are heterogeneous by group. Public health investment has a greater impact on the well-being of low- and middle-income, eastern and urban residents than high-income, midwest and rural residents.

Competing Interests: We declare no competing interests.

Background: The first wave of the COVID-19 epidemic in China was brought under with 3 months-from mid-January 2020 to the end of March 2020. Less studies examined dynamic psychological effect and behaviors during COVID-19 pandemic. This study aims to examine perceived risk, anxiety, and behavioral response of the general public related to the outbreak of COVID-19 in four cross-sectional surveys conducted throughout China. Methods: In 2020, four cross-sectional, population-based online survey were conducted from January 28 to February 3, from February 10 to 12, from February 20 to 22, and from March 1 to 10, respectively. Convenience sampling was used for easy recruiting survey participants under the long-term impact of the COVID-19 epidemic. The four independent online questionnaires were sent from the same approach (WeChat and MicroBlog), and anyone who receives the questionnaire on the Internet or mobile phone and meets the inclusion criteria could fill in it. The same questionnaires repeatedly used in the four surveys. Socio-demographic information and individual protective practice were collected and the state-trait anxiety inventory (STAI) was used for measuring anxiety. Propensity score matching was used to adjust for differences in baseline characteristics among the four surveys. Wilcoxon signed ranks test was used to compare people's perceived risk, anxiety and protective behaviors changes in four stages. General linear model was used to identify associations between some demographic factors and perceived risk, anxiety scores, and protective behaviors. Results: The proportion of high perceived risk has dropped from 24.7 to 4.7%. The proportion of severe anxiety has declined from 12.2 to 1.2%. The proportion of people wore masks when they went out has increased from 97.0 to 98.3%. Women were more likely to develop anxiety (OR = 1.5, 95%CI: 1.4-1.6) and more positively adopted recommended behaviors (OR = 2.1, 95%CI: 1.3-3.4) than men. People at age 30-39 years, with high-degree education, with married status, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Perceived risk was significantly associated with anxiety over the entire periods. Anxiety levels had stronger associations with adoption of protective behaviors (wearing mask and avoiding crowed place) in the early epidemic periods than in the late epidemic periods. Conclusions: The levels of perceived risk and anxiety showed a trend of rising first and then falling. Gradually upward trend on initiative preventive behaviors including wearing mask and avoiding visiting crowded places also was observed through scanning data at four stages. People at age 30-39 years, with high-degree education, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Our findings showed that people simultaneously presented both high-level risk perception and anxiety across the four wave surveys, leading to their positive self-prevention and protective behavior., 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 Liu, Liu, Han, Zhao, Sun, Tan and Cui.)