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Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It's concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future. [ABSTRACT FROM AUTHOR]

Paeonia (Paeoniaceae), a culturally and economically important plant genus, has an isolated taxonomy while the evolution of this genus is unclear. A plant species endemic to southwest China, Paeonia mairei is precious germplasm for evolution-related research and cultivar improvement, and its conservation is urgent. However, little is known about its patterns of habitat distribution and responses to climate change. Using 98 occurrence sites and data of 19 bioclimatic variables, we conducted principal component analysis and hierarchical cluster analysis to delineate different climatic populations. Maximum entropy algorithm (MaxEnt) was applied to each population to evaluate the importance of environmental variables in shaping their distribution, and to identify distribution shifts under different climate change scenarios. We also applied MaxEnt to all of the P. mairei presence sites (P_Whole) to evaluate the need to construct separate species distribution models for separate populations rather than a common approach by treating them as a whole. Our results show that local adaptation exists within the distribution range of P. mairei and that all presence sites were clustered into a western population (P_West) and an eastern population (P_East). Two variables (precipitation of the driest month and temperature seasonality) are important when shaping the distribution of P_West, and another two variables (mean diurnal range and mean temperature of the wettest quarter) are important for P_East. Both populations are likely to shift upward under climate change, while P_East may lose most current suitable areas while P_West may not. P_Whole produced a narrower area compared to the combination of P_West and P_East but a suitable area (south Chongqing) may have been missed in the prediction. Accordingly, a population-based approach in constructing a species distribution model is needed to provide a detailed appreciation of the distribution of P. mairei , allowing for a population-based conservation strategy. In this case, it could include assisted migration to new and suitable distribution areas for P_West and in situ conservation in high elevation regions for P_East. The results of our study could be a useful reference for implementing the long-term conservation and further research of P. mairei. [ABSTRACT FROM AUTHOR]

This study employed a data envelopment analysis (DEA) by using slacks-based measure (SBM) with undesirable outputs to assess the industrial environmental efficiency of western China during the period of 2001–2015. The Malmquist index was further used to examine the changes in the industrial environmental efficiency of the analyzed region. The result showed that western China presented a low industrial environmental efficiency throughout the period of 2001–2015. Chongqing City was the only province that exhibited strong economic and environmental coordination. The level of technical development was identified as a key determinant of industrial environmental efficiency. This study provided policy implications on emissions reduction and the improvement of industrial efficiency. Limitations of the approach were provided to lay foundation for future studies. [ABSTRACT FROM AUTHOR]

The major obstacles to strengthening the primary care system in China are shortages of finance and workforce, especially in rural and low-income areas. To address these barriers, in 2009, Pengshui County (Chongqing, China), implemented a reform on its primary care delivery system, with a focus on horizontal integration and financing mechanisms. We aimed to analyse the horizontal integrated-care model and evaluate the effect of the reform in the past 10 years. We analysed the reform to the primary care delivery system in Pengshui County, focusing on the design and implementation of the horizontal integrated-care model, as well as its financial mechanisms. A descriptive, explanatory, evaluative case study was conducted based on analysis of national and local policy documents, in-depth interviews with local policy makers and institution managers in March, 2019, and analysis of pre-reform and post-reform administrative data from provincial and local health administrative departments. Implementation of the reform was characterised by establishment of a commission of primary care and a policy-coordinating board, which was charged with managing all horizontally integrated primary care providers and strengthening strategic planning and management of Pengshui County's primary care system. Additionally, a primary care funding pool was developed to support facility purchasing, professional development, and financial incentives. The reform was also characterised by performance assessments, with equal emphasis on public health care and basic medical services, and an enhanced compensation system to encourage uptake of grassroots medical posts by the primary care workforce. From 2009 to 2018, the number of primary care health professionals increased by 125% (from 1113 to 2510). The proportion of outpatients who sought first-contact care in rural community health centres or township health centres increased from 29% (522 700 of 1 817 600) in 2009 to 40% (849 900 of 2 147 800) in 2018 (the national average in 2018 was 23%). From 2009 to 2018, the proportion of inpatients in primary medical institutions decreased slightly from 67% (30 528 of 45 450) to 60% (93 273 of 156 166), marking a decline rate that was 6 percentage points lower than the national average (the national average decreased from 31% to 17%). However, numbers of inpatients tripled in the same period. The mean annual payment to primary care staff was ¥120 800 (SD 25 615) in 2018, which was five times higher than in 2009. Our study suggests that a high priority of Pengshui County's reform strategy was the mobilisation of enough resources to finance efficient and equitable provision of primary care. The horizontal integrated-care model established a clear division of responsibilities and governance structure. The policy of fundraising and mutual aid-sharing of compulsory payment improved the financing and compensation mechanism and made up for the problem of insufficient investment. Many positive results have been achieved through the reform, including advanced medical facilities, more qualified medical professionals, better capability of primary health care, and improved patients' trust of public health and primary medical services. Pengshui County's experience represents a successful experiment in the development of integrated-care reform, especially for rural and low-income regions. World Bank China and Science and Technology Department of Chongqing. [ABSTRACT FROM AUTHOR]