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Abstract Background Primary health-care workers (PHWs) managed increased workloads and pressure during the COVID-19 pandemic. This study conducted a national survey examining burnout among PHWs at the end of the COVID-19 pandemic, and identifies related factors. By doing so, it addresses the gap in understanding the burnout situation among PHWs at a national level, taking into account urban-rural disparities. Methods We conducted a nationwide cross-sectional survey of PHWs in China from May to October 2022, covering 31 provinces. The MBI-HSS was used to measure overall burnout and emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). We used multivariable logistic regression to identify risk factors, and subgroup analyses to identify differences between rural and urban areas. Results 3769 PHWs from 44 primary health-care institutions completed the survey. Overall, 16.6% reported overall burnout, and the prevalence of EE, DP, and reduced PA was 29.7%, 28.0%, and 62.9%, respectively. The prevalence of overall burnout (17.6% vs. 13.7%, P = 0.004) and EE (31.5% vs. 24.8%, P

Abstract Objective To assess the influence of supply and demand factors on the contract behavior of occupational populations with general practitioner (GP) teams. Methods We employed a system dynamics approach to assess and predict the effect of the general practitioner service package (GPSP) and complementary incentive policies on the contract rate for 2015–2030. First, the GPSP is designed to address the unique needs of occupational populations, enhancing the attractiveness of GP contracting services, including three personalized service contents tailored to demand-side considerations: work-related disease prevention (WDP), health education & counseling (HEC), and health-care service (HCS). Second, the complementary incentive policies on the supply-side included income incentives (II), job title promotion (JTP), and education & training (ET). Considering the team collaboration, the income distribution ratio (IDR) was also incorporated into supply-side factors. Findings The contract rate is predicted to increase to 57.8% by 2030 after the GPSP intervention, representing a 15.4% increase on the non-intervention scenario. WDP and HEC have a slightly higher (by 2%) impact on the contract rate than that from HCS. Regarding the supply-side policies, II have a more significant impact on the contract rate than JTP and ET by 3–5%. The maximum predicted contract rate of 75.2% is expected by 2030 when the IDR is 0.5, i.e., the GP receives 50% of the contract income and other members share 50%. Conclusion The GP service package favorably increased the contract rate among occupational population, particularly after integrating the incentive policies. Specifically, for a given demand level, the targeted content of the package enhanced the attractiveness of contract services. On the supply side, the incentive policies boost GPs’ motivation, and the income distribution motivated other team members.

Abstract BackgroundAfter strict COVID-19–related restrictions were lifted, health systems globally were overwhelmed. Much has been discussed about how health systems could better prepare for future pandemics; however, primary health care (PHC) has been largely ignored. ObjectiveWe aimed to investigate what combined policies PHC could apply to strengthen the health care system via a bottom-up approach, so as to better respond to a public health emergency. MethodsWe developed a system dynamics model to replicate Shanghai’s response when COVID-19–related restrictions were lifted. We then simulated an alternative PHC-based integrated health system and tested the following three interventions: first contact in PHC with telemedicine services, recommendation to secondary care, and return to PHC for recovery. ResultsThe simulation results showed that each selected intervention could alleviate hospital overwhelm. Increasing the rate of first contact in PHC with telemedicine increased hospital bed availability by 6% to 12% and reduced the cumulative number of deaths by 35%. More precise recommendations had a limited impact on hospital overwhelm (

Abstract An enzyme-free sandwich amperometric immunosensor based on bimetallic Pt/Ag nanoparticle (Pt/AgNPs)-functionalized chitosan (Chi)-modified multiwalled carbon nanotubes (MWCNTs) as dual signal amplifiers and Chi-modified MWCNTs (MWCNTs-Chi) as substrate materials was developed for ultrasensitive detection of fowl adenovirus group I (FAdV-I). MWCNTs have a large specific surface area, and many accessible active sites were formed after modification with Chi. Hence, MWCNTs-Chi, as a substrate material for modifying glassy carbon electrodes (GCEs), could immobilize more antibodies (fowl adenovirus group I-monoclonal antibody, FAdV-I/MAb). Multiple Pt/AgNPs were attached to the surface of MWCNTs-Chi to generate MWCNTs-Chi-Pt/AgNPs with high catalytic ability for the reaction of H2O2 and modified active sites for fowl adenovirus group I-polyclonal antibody (FAdV-I/PAb) binding. Amperometric i–t measurements were employed to characterize the recognizability of FAdV-I. Under optimal conditions, and the developed immunosensor exhibited a wide linear range (100.93 EID50 mL−1 to 103.43 EID50 mL−1), a low detection limit (100.67 EID50 mL−1) and good selectivity, reproducibility and stability. This immunosensor can be used in clinical sample detection.

Abstract Avian parvoviruses cause several enteric poultry diseases that have been increasingly diagnosed in Guangxi, China, since 2014. In this study, the whole-genome sequences of 32 strains of chicken parvovirus (ChPV) and 3 strains of turkey parvovirus (TuPV) were obtained by traditional PCR techniques. Phylogenetic analyses of 3 genes and full genome sequences were carried out, and 35 of the Guangxi ChPV/TuPV field strains were genetically different from 17 classic ChPV/TuPV reference strains. The nucleotide sequence alignment between ChPVs/TuPVs from Guangxi and other countries revealed 85.2–99.9% similarity, and the amino acid sequences showed 87.8–100% identity. The phylogenetic tree of these sequences could be divided into 6 distinct ChPV/TuPV groups. More importantly, 3 novel ChPV/TuPV groups were identified for the first time. Recombination analysis with RDP 5.0 revealed 15 recombinants in 35 ChPV/TuPV isolates. These recombination events were further confirmed by Simplot 3.5.1 analysis. Phylogenetic analysis based on full genomes showed that Guangxi ChPV/TuPV strains did not cluster according to their geographic origin, and the identified Guangxi ChPV/TuPV strains differed from the reference strains. Overall, whole-genome characterizations of emerging Guangxi ChPV and TuPV field strains will provide more detailed insights into ChPV/TuPV mutations and recombination and their relationships with molecular epidemiological features.

ObjectiveTo explore the prevalence and influencing factors of early-onset scoliosis (EOS, which appears before the age of 10) and adolescent scoliosis (manifesting at the age of 10 and above) among primary and secondary school students in Qinghai province. MethodsTotally 3 582 students aged 5 – 18 years were recruited in 24 primary and secondary schools in 2 municipalities of Qinghai province with stratified cluster sampling. A scoliosis screening was conducted among the students during October 2020 – February 2021 using national standard method (GB/T 16133 – 2014); whole spine X-ray examination was recommended to the students with the angle of trunk rotation (ATR) of ≥ 5° measured with Bunnell Scoliometer. Relevant information of the students were collected from their guardians with a self-designed questionnaire. Detect rates of EOS and juvenile-type scoliosis among the students were compared in statistical analysis and unconditional multivariate logistic regression model was adopted to explore influencing factors of scoliosis. ResultsThe overall detection rate of scoliosis in the students was 5.6% (201/3 582) and the detection rate of EOS was significantly lower than that of adolescent scoliosis (2.9% [58/1 549] vs. 9.3% [143/2 033], P < 0.05). The results of unconditional multivariate logistic regression analysis showed that for adolescent scoliosis, age increment (odd ratio [OR] = 1.23), paternal occupation (herder versus farmer: OR = 5.89), maternal occupation compared to being farmer (herder: OR = 59.85, doing business: OR = 10.62, being self-employed: OR = 19.41) were significant risk factors; but higher body mass index (OR = 0.75) and higher maternal education (OR = 0.55) were significant protective factors against scoliosis; while for EOS, age increment was a significant risk factor (OR = 1.88) and significant protective factors including higher parity number ( ≥ 2 versus 1: OR = 0.27), being born in summer (OR = 0.27) and in autumn (OR = 0.19) in contrast to being born in spring. ConclusionAmong 5 – 18 years old primary and secondary school students in Qinghai province, the detection rate of adolescent scoliosis is higher than that of EOS; the prevalence of adolescent scoliosis is influenced significantly by body mass index, maternal education and parental occupation but that of EOS is affected by parity and birth season.

Chicken parvovirus (ChPV) infection can cause runting-stunting syndrome (RSS) in chickens. There is currently no commercially available vaccine for controlling ChPV, and ChPV infection in chickens is widespread globally. The rapid detection of ChPV is crucial for promptly capturing epidemiological data on ChPV. Two monoclonal antibodies (mAbs), 1B12 and 2B2, against the ChPV NS1 protein were generated. A double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) was developed for detecting ChPV based on the mAb 1B12 and an anti-chicken polyclonal antibody against the ChPV NS1 protein. The detection limit for the ChPV recombinant pET32a-NS1 protein was approximately 31.2 ng/mL. A total of 192 throat and cloaca swab samples were analyzed for ChPV by the established DAS-ELISA and nested PCR methods. The concordance rate between the DAS-ELISA and the nested PCR method was 89.1%. The DAS-ELISA can detect the ChPV antigen without any cross-reaction with FAdV-4, FAdV-1, NDV, AIV, MS, CIAV, aMPV, EDSV, IBV, or AGV2. The method also has high repeatability, with a coefficient of variation (CV) of less than 5%. These findings indicate that the DAS-ELISA exhibits high accuracy, good sensitivity, and specificity, making it suitable for viral detection, field surveillance, and epidemiological studies.

Interferon-alpha inducible protein 6 (IFI6) is an important interferon-stimulated gene. To date, research on IFI6 has mainly focused on human malignant tumors, virus-related diseases and autoimmune diseases. Previous studies have shown that IFI6 plays an important role in antiviral, antiapoptotic and tumor-promoting cellular functions, but few studies have focused on the structure or function of avian IFI6. Avian reovirus (ARV) is an important virus that can exert immunosuppressive effects on poultry. Preliminary studies have shown that IFI6 expression is upregulated in various tissues and organs of specific-pathogen-free chickens infected with ARV, suggesting that IFI6 plays an important role in ARV infection. To analyze the function of avian IFI6, particularly in ARV infection, the chicken IFI6 gene was cloned, a bioinformatics analysis was conducted, and the roles of IFI6 in ARV replication and the innate immune response were investigated after the overexpression or knockdown of IFI6 in vitro. The results indicated that the molecular weight of the chicken IFI6 protein was approximately 11 kDa and that its structure was similar to that of the human IFI27L1 protein. A phylogenetic tree analysis of the IFI6 amino acid sequence revealed that the evolution of mammals and birds was clearly divided into two branches. The evolutionary history and homology of chickens are similar to those of other birds. Avian IFI6 localized to the cytoplasm and was abundantly expressed in the chicken lung, intestine, pancreas, liver, spleen, glandular stomach, thymus, bursa of Fabricius and trachea. Further studies demonstrated that IFI6 overexpression in DF-1 cells inhibited ARV replication and that the inhibition of IFI6 expression promoted ARV replication. After ARV infection, IFI6 modulated the expression of various innate immunity-related factors. Notably, the expression patterns of MAVS and IFI6 were similar, and the expression patterns of IRF1 and IFN-β were opposite to those of IFI6. The results of this study further advance the research on avian IFI6 and provide a theoretical basis for further research on the role of IFI6 in avian virus infection and innate immunity.

Abstract Among the common methods used for antibody immobilization on electrode surfaces, which is the best available option for immunosensor fabrication? To answer this question, we first used graphene-chitosan-Au/Pt nanoparticle (G-Chi-Au/PtNP) nanocomposites to modify a gold electrode (GE). Second, avian reovirus monoclonal antibody (ARV/MAb) was immobilized on the GE surface by using four common methods, which included glutaraldehyde (Glu), 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide/N-hydroxysuccinimide (EDC/NHS), direct incubation or cysteamine hydrochloride (CH). Third, the electrodes were incubated with bovine serum albumin, four different avian reovirus (ARV) immunosensors were obtained. Last, the four ARV immunosensors were used to detect ARV. The results showed that the ARV immunosensors immobilized via Glu, EDC/NHS, direct incubation or CH showed detection limits of 100.63 EID50 mL−1, 100.48 EID50 mL−1, 100.37 EID50 mL−1 and 100.46 EID50 mL−1 ARV (S/N = 3) and quantification limits of 101.15 EID50 mL−1, and 101.00 EID50 mL−1, 100.89 EID50 mL−1 and 100.98 EID50 mL−1 ARV (S/N = 10), respectively, while the linear range of the immunosensor immobilized via CH (0–105.82 EID50 mL−1 ARV) was 10 times broader than that of the immunosensor immobilized via direct incubation (0–104.82 EID50 mL−1 ARV) and 100 times broader than those of the immunosensors immobilized via Glu (0–103.82 EID50 mL−1 ARV) or EDC/NHS (0–103.82 EID50 mL−1 ARV). And the four immunosensors showed excellent selectivity, reproducibility and stability.

Abstract Avian influenza virus H9 subtype (AIV H9) has contributed to enormous economic losses. Effective diagnosis is key to controlling the spread of AIV H9. In this study, a nonenzymatic highly electrocatalytic material was prepared using chitosan (Chi)-modified graphene sheet (GS)-functionalized Au/Pt nanoparticles (GS-Chi-Au/Pt), followed by the construction of a novel enzyme-free sandwich electrochemical immunosensor for the detection of AIV H9 using GS-Chi-Au/Pt and graphene–chitosan (GS-Chi) nanocomposites as a nonenzymatic highly electrocatalytic material and a substrate material to immobilize capture antibodies (avian influenza virus H9-monoclonal antibody, AIV H9/MAb), respectively. GS, which has a large specific surface area and many accessible active sites, permitted multiple Au/Pt nanoparticles to be attached to its surface, resulting in substantially improved conductivity and catalytic ability. Au/Pt nanoparticles can provide modified active sites for avian influenza virus H9-polyclonal antibody (AIV H9/PAb) immobilization as signal labels. Upon establishing the electrocatalytic activity of Au/Pt nanoparticles on graphene towards hydrogen peroxide (H2O2) reduction for signal amplification and optimizing the experimental parameters, we developed an AIV H9 electrochemical immunosensor, which showed a wide linear range from 101.37 EID50 mL−1 to 106.37 EID50 mL−1 and a detection limit of 100.82 EID50 mL−1. This sandwich electrochemical immunosensor also exhibited high selectivity, reproducibility and stability.

Interferon-inducible transmembrane protein 3 (IFITM3) is an antiviral factor that plays an important role in the host innate immune response against viruses. Previous studies have shown that IFITM3 is upregulated in various tissues and organs after avian reovirus (ARV) infection, which suggests that IFITM3 may be involved in the antiviral response after ARV infection. In this study, the chicken IFITM3 gene was cloned and analyzed bioinformatically. Then, the role of chicken IFITM3 in ARV infection was further explored. The results showed that the molecular weight of the chicken IFITM3 protein was approximately 13 kDa. This protein was found to be localized mainly in the cytoplasm, and its protein structure contained the CD225 domain. The homology analysis and phylogenetic tree analysis showed that the IFITM3 genes of different species exhibited great variation during genetic evolution, and chicken IFITM3 shared the highest homology with that of Anas platyrhynchos and displayed relatively low homology with those of birds such as Anser cygnoides and Serinus canaria. An analysis of the distribution of chicken IFITM3 in tissues and organs revealed that the IFITM3 gene was expressed at its highest level in the intestine and in large quantities in immune organs, such as the bursa of Fabricius, thymus and spleen. Further studies showed that the overexpression of IFITM3 in chicken embryo fibroblasts (DF-1) could inhibit the replication of ARV, whereas the inhibition of IFITM3 expression in DF-1 cells promoted ARV replication. In addition, chicken IFITM3 may exert negative feedback regulatory effects on the expression of TBK1, IFN-γ and IRF1 during ARV infection, and it is speculated that IFITM3 may participate in the innate immune response after ARV infection by negatively regulating the expression of TBK1, IFN-γ and IRF1. The results of this study further enrich the understanding of the role and function of chicken IFITM3 in ARV infection and provide a theoretical basis for an in-depth understanding of the antiviral mechanism of host resistance to ARV infection.

H5, H7 and H9 are the most important subtypes of avian influenza viruses (AIVs), and nine neuraminidase (NA) subtypes (N1–N9) of AIVs have been identified in poultry. A method that can simultaneously detect H5, H7, H9 and the nine NA subtypes of AIVs would save time and effort. In this study, 13 pairs of primers, including 12 pairs of subtype-specific primers for detecting particular subtypes (H5, H7, H9 and N1–N9) and one pair of universal primers for detecting all subtypes of AIVs, were designed and screened. The 13 pairs of primers were mixed in the same reaction, and the 13 target genes were simultaneously detected. A GeXP assay using all 13 pairs of primers to simultaneously detect H5, H7, H9 and the nine NA subtypes of AIVs was developed. The GeXP assay showed specific binding to the corresponding target genes for singlet and multiplex templates, and no cross-reactivity was observed between AIV subtypes and other related avian pathogens. Detection was observed even when only 102 copies of the 13 target genes were present. This study provides a high-throughput, rapid and labor-saving GeXP assay for the simultaneous rapid identification of three HA subtypes (H5, H7 and N9) and nine NA subtypes (N1–N9) of AIVs.

Abstract Background Rapid mutation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is sweeping the world and delaying the full reopening of society. Acceleration of the vaccination process may be the key element in winning the race against this virus. We examine factors associated with personal considerations of and accessibility to the corona virus disease 2019 (COVID-19) vaccination in metropolises of China. Methods This multi-center, cross-sectional research was conducted using online questionnaires from April 1 to June 1, 2021, in community health service centers of Shanghai, Chengdu and Fuzhou. 9,047 vaccinated participants were included and data for 8,990 individuals were eligible for analysis. Chi-square test was conducted to find potential predictors, which were included in the logistic regressions. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the influence of region, socio-economic status (SES), and attitudes on vaccination process. Results In consideration phase, participants in Fuzhou (OR:2.26, 95%CI: 1.90 to 2.68) and Chengdu (OR: 2.48, 95%CI: 2.17 to 2.83) were more likely than those in Shanghai to consider longer than one month. These odds increased for participants with master or above degree (reference: illiteracy and primary school), higher monthly household income (reference:

The GX2020-019 strain of fowl adenovirus serotype 4 (FAdV-4) was isolated from the liver of chickens with hydropericardium hepatitis syndrome in Guangxi Province, China, and was purified by plaque assay three times. Pathogenicity studies showed that GX2020-019 can cause typical FAdV-4 pathology, such as hydropericardium syndrome and liver yellowing and swelling. Four-week-old specific pathogen-free (SPF) chickens inoculated with the virus at doses of 103 median tissue culture infectious dose (TCID50), 104 TCID50, 105 TCID50, 106 TCID50, and 107 TCID50 had mortality rates of 0, 20, 60, 100, and 100%, respectively, which were lower than those of chickens inoculated with other highly pathogenic Chinese isolates, indicating that GX2020-019 is a moderately virulent strain. Persistent shedding occurred through the oral and cloacal routes for up to 35 days postinfection. The viral infection caused severe pathological damage to the liver, kidney, lung, bursa of Fabricius, thymus, and spleen. The damage to the liver and immune organs could not be fully restored 21 days after infection, which continued to affect the immune function of chickens. Whole genome analysis indicated that the strain belonged to the FAdV-C group, serotype 4, and had 99.7–100% homology with recent FAdV-4 strains isolated from China. However, the amino acid sequences encoded by ORF30 and ORF49 are identical to the sequences found in nonpathogenic strains, and none of the 32 amino acid mutation sites that appeared in other Chinese isolates were found. Our research expands understanding of the pathogenicity of FAdV-4 and provides a reference for further studies.

Retirement has a heterogeneous impact depending on gender and occupation. This study aimed to analyze and evaluate the heterogeneity and potential mechanism of retirement on the biomedical risk factors for cardiovascular and metabolic diseases. Physical examination data from 2017 to 2020 were extracted from a hospital database in Shanghai. The fluctuation tendency of biomedical risk factor indicators for cardiovascular and metabolic diseases was evaluated by gender and occupation shortly after retirement using fuzzy regression discontinuity design and was analyzed for internal mechanism. Retirement had a significantly negative influence on body weight (β = −3.943), body mass index (β = −2.152), and diastolic blood pressure (β = −5.180) in women working in public institutions or state-owned enterprises, but a positive influence on their blood glucose level (β = 0.696). Retirement had a significantly positive effect on high-density lipoprotein in men (β = 0.138), particularly those employed in private enterprises (β = 0.339). The internal influencing mechanism of retirement showed that the health attention effect after retirement among women in government or public institutions on diastolic blood pressure reduction was better than that before retirement. The body weight, body mass index, and diastolic blood pressure of women in public institutions or state-owned enterprises were reduced at retirement; however, they were exposed to higher risks of elevated blood glucose level. Conversely, high-density lipoprotein level, which is protective against cardiovascular disease, was increased in men at retirement. Retirement has a heterogeneous effect on cardiovascular and metabolic health among people of different genders or occupational experiences. Retirees with low health awareness should be targeted for behavioral interventions and monitored conscientiously by health providers during retirement adaptation.

Avian reovirus (ARV) infection is prevalent in farmed poultry and causes viral arthritis and severe immunosuppression. The spleen plays a very important part in protecting hosts against infectious pathogens. In this research, transcriptome and translatome sequencing technology were combined to investigate the mechanisms of transcriptional and translational regulation in the spleen after ARV infection. On a genome-wide scale, ARV infection can significantly reduce the translation efficiency (TE) of splenic genes. Differentially expressed translational efficiency genes (DTEGs) were identified, including 15 upregulated DTEGs and 396 downregulated DTEGs. These DTEGs were mainly enriched in immune regulation signaling pathways, which indicates that ARV infection reduces the innate immune response in the spleen. In addition, combined analyses revealed that the innate immune response involves the effects of transcriptional and translational regulation. Moreover, we discovered the key gene IL4I1, the most significantly upregulated gene at both the transcriptional and translational levels. Further studies in DF1 cells showed that overexpression of IL4I1 could inhibit the replication of ARV, while inhibiting the expression of endogenous IL4I1 with siRNA promoted the replication of ARV. Overexpression of IL4I1 significantly downregulated the mRNA expression of IFN-β, LGP2, TBK1 and NF-κB; however, the expression of these genes was significantly upregulated after inhibition of IL4I1, suggesting that IL4I1 may be a negative feedback effect of innate immune signaling pathways. In addition, there may be an interaction between IL4I1 and ARV σA protein, and we speculate that the IL4I1 protein plays a regulatory role by interacting with the σA protein. This study not only provides a new perspective on the regulatory mechanisms of the innate immune response after ARV infection but also enriches the knowledge of the host defense mechanisms against ARV invasion and the outcome of ARV evasion of the host’s innate immune response.

Abstract Low pathogenic avian influenza viruses (LPAIVs) have been widespread in poultry and wild birds throughout the world for many decades. LPAIV infections are usually asymptomatic or cause subclinical symptoms. However, the genetic reassortment of LPAIVs may generate novel viruses with increased virulence and cross-species transmission, posing potential risks to public health. To evaluate the epidemic potential and infection landscape of LPAIVs in Guangxi Province, China, we collected and analyzed throat and cloacal swab samples from chickens, ducks and geese from the live poultry markets on a regular basis from 2016 to 2019. Among the 7,567 samples, 974 (12.87%) were LPAIVs-positive, with 890 single and 84 mixed infections. Higher yearly isolation rates were observed in 2017 and 2018. Additionally, geese had the highest isolation rate, followed by ducks and chickens. Seasonally, spring had the highest isolation rate. Subtype H3, H4, H6 and H9 viruses were detected over prolonged periods, while H1 and H11 viruses were detected transiently. The predominant subtypes in chickens, ducks and geese were H9, H3, and H6, respectively. The 84 mixed infection samples contained 22 combinations. Most mixed infections involved two subtypes, with H3 + H4 as the most common combination. Our study provides important epidemiological data regarding the isolation rates, distributions of prevalent subtypes and mixed infections of LPAIVs. These results will improve our knowledge and ability to control epidemics, guide disease management strategies and provide early awareness of newly emerged AIV reassortants with pandemic potential.

ObjectivesChaxugeju is a very special Chinese culture following a self-centered and outward expanding social network, which might be a significant culture factor for vaccination behavior. This study aimed to identify the motivation pattern in China, and paid special focus on socio-economic status (SES), region, and migration.MethodsWe used a latent class analysis, with a sample of 12,432 participants collected in China from April to June, to identify the COVID-19 vaccination motivation patterns. Multinomial logistic regression models were utilized to separately explore associations between SES, migration, region, and COVID-19 vaccination motivation patterns.ResultsThree COVID-19 vaccination motivation patterns were identified: Self-protection (41.9%), Trust and Self-protection (38.5%), and Trust and Differential Protection (19.6%). Participants with higher income were more likely to be Trust and Self-protection, and when income is more than 50,000 CNY per month, they are more likely to be self-protection. Professional/white collar were more likely to be Self-protection. Participants from Shenzhen were more likely to be Trust and Differential protection. The moderating effects of gender were found for income and region. Gender does not moderate the associations of occupation or migration and COVID-19 vaccination motivation patterns.ConclusionThree motivational patterns were identified in which the Trust & Differential Pattern followed the traditional self-family-community Chaxu circle. However, the Chaxu motivation pattern was not the dominant one which might be weakened by SES. Migration and Shenzhen preserved the traditional social network, keeping in the trust and differential pattern. All of these factors in various cultural contexts should be considered when promoting vaccines.

Objectives In this study, we aimed to identify concerns and stimuli regarding COVID-19 vaccination acceptance and to compare the findings by occupation.Methods We conducted a cross-sectional study of individuals vaccinated against COVID-19 between 1 April and 30 June 2021 in four metropolitan areas of China. A total of 20 863 participants completed questionnaires, 20 767 of which were eligible for analysis. We used ordered logistic regression to assess the association of vaccination concerns and stimuli with vaccination hesitancy according to occupation.Results Farmers were mainly concerned about the quality of vaccines (adjusted OR (aOR): 3.18, 95% CI (CI): 1.83 to 5.54). Among civil servants, media publicity reduced hesitancy (aOR: 0.44, 95% CI: 0.21 to 0.92). Among medical staff, concerns about a short duration of protective effects increased hesitancy (aOR: 8.31, 95% CI: 2.03 to 33.99). For most occupations, concerns about side effects, poor protective effects and health status increased hesitancy. In contrast, protecting oneself and protecting others acted as a stimulus to decrease hesitancy. Interestingly, ‘people around me have been vaccinated’ was associated with higher vaccination hesitancy among farmers (aOR: 2.19, 95% CI: 1.20 to 4.00).Conclusion The association of vaccination concerns and stimuli with vaccination hesitancy varied by occupation. The characteristics and concerns of specific target audiences should be considered when designing informational campaigns to promote vaccination against COVID-19.

ObjectiveWe investigated regional disparities in rates of scoliosis among adolescents in western and eastern China and the dominant factors underlying these disparities.MethodsThis cross-sectional study used data from a school scoliosis screening program conducted in two typical areas: Yangpu District of Shanghai (eastern China) and Tianzhu Tibetan Autonomous County of Gansu Province (western China), during October 2020 to February 2021. Participants included adolescents aged 12–16 years (4,240 in Shanghai and 2,510 in Gansu Province). School scoliosis screening data were obtained on age, sex, height, weight and BMI, and region as well. We screened angles of trunk rotation in level of proximal thoracic (T1–T4), main thoracic (T5–T12), and lumbar (T12–L4) by the forward bend test with scoliometer. An angle of trunk rotation ≥5° was used as the criterion to identify suspected scoliosis.ResultsThe proportion of suspected scoliosis was lower in Shanghai (6.9%) than in Gansu (8.6%). Angle of trunk rotation tended to increase with age in Shanghai, peaking at 15 years, but decreased with age in Gansu, and bottomed at 15 years. The angle of trunk rotation in the proximal thoracic, main thoracic, and lumbar part of the spine appeared to be larger in Gansu adolescents and in Shanghai female adolescents. Age was a relevant factor in angle trunk rotation in regression models and interacted with region as well.ConclusionWe found regional and age- and sex-related disparities in rates of suspected scoliosis.

ObjectiveAfter emergence of the COVID-19 pandemic and subsequent restrictions, countries worldwide have sought to reopen as quickly as possible. However, reopening involves the risk of epidemic rebound. In this study, we investigated the effective policy combination to ensure safe reopen.MethodsOn the basis of the classical SEIR epidemic model, we constructed a COVID-19 system dynamics model, incorporating vaccination, border screening, and fever clinic unit monitoring policies. The case of China was used to validate the model and then to test policy combinations for safe reopening.FindingsVaccination was found to be crucial for safe reopening. When the vaccination rate reached 60%, the daily number of newly confirmed COVID-19 cases began to drop significantly and stabilized around 1,400 [1/1,000,000]. The border screening policy alone only delayed epidemic spread for 8 days but did not reduce the number of infections. Fever clinic unit monitoring alone could reduce the peak of new confirmed cases by 44% when the case identification rate rose from 20 to 80%. When combining polices, once the vaccination rate reached 70%, daily new confirmed cases stabilized at 90 [0.64/1,000,000] with an 80% case identification rate at fever clinic units and border screening. For new variants, newly confirmed cases did not stabilize until the vaccination rate reached 90%.ConclusionHigh vaccination rate is the base for reopening. Vaccination passport is less effective compared with a strong primary care monitoring system for early detection and isolation of the infected cases.

Avian reovirus (ARV) infection can lead to severe immunosuppression, complications, and secondary diseases, causing immense economic losses to the poultry industry. In-depth study of the mechanism by which the innate immune system combats ARV infection, especially the antiviral effect mediated by interferon, is needed to prevent and contain ARV infection. In this study, ARV strain S1133 was used to artificially infect 7-day-old specific pathogen–free chickens. The results indicated that ARV rapidly proliferated in the immune organs, including the spleen, bursa of Fabricius, and thymus. The viral load peaked early in the infection and led to varying degrees of pathological damage to tissues and organs. Real-time quantitative PCR revealed that the mRNA levels of interferon and multiple interferon-stimulated genes (ISGs) in the spleen, bursa of Fabricius, and thymus were upregulated to varying degrees in the early stage of infection. Among the ISGs, IFIT5, and Mx were the most upregulated in various tissues and organs, suggesting that they are important ISGs for host resistance to ARV infection. Further investigation of the role of IFIT5 in ARV infection showed that overexpression of the IFIT5 gene inhibited ARV replication, whereas inhibition of the endogenously expressed IFIT5 gene by siRNA promoted ARV replication. IFIT5 may be a positive feedback regulator of the innate immune signaling pathways during ARV infection and may induce IFN-α production by promoting the expression of MAD5 and MAVS to exert its antiviral effect. The results of this study help explain the innate immune regulatory mechanism of ARV infection and reveal the important role of IFIT5 in inhibiting ARV replication, which has important theoretical significance and practical application value for the prevention and control of ARV infection.

BackgroundA new wave of Coronavirus disease 2019 (COVID-19) infection driven by Omicron BA.2 subvariant hit Shanghai end of February 2020. With higher transmissibility and milder symptoms, the daily new confirmed cases have soared to more than 20 K within one and a half months. The greatest challenge of Omicron spreading is that the rapidly surging number of infected populations overwhelming the healthcare system. What policy is effective for huge cities to fight against fast-spreading COVID-19 new variant remains a question.MethodsA system dynamics model of the Shanghai Omicron epidemic was developed as an extension of the traditional susceptible-exposed-infected-susceptible recovered (SEIR) model to incorporate the policies, such as contact tracing and quarantine, COVID-19 testing, isolation of areas concerned, and vaccination. Epidemic data from Shanghai Municipal Health Commission were collected for model validation.ResultsThree policies were tested with the model: COVID-19 testing, isolation of areas concerned, and vaccination. Maintaining a high level of COVID-19 testing and transfer rate of the infected population can prevent the number of daily new confirmed cases from recurring growth. In the scenario that 50% of the infected population could be transferred for quarantine on daily bases, the daily confirmed asymptomatic cases and symptomatic cases remained at a low level under 100. For isolation of areas concerned, in the scenario with most isolation scope, the peak of daily confirmed asymptomatic and symptomatic cases dropped 18 and 16%, respectively, compared with that in the scenario with least isolation. Regarding vaccination, increasing the vaccination rate from 75 to 95% only slightly reduced the peak of the confirmed cases, but it can reduce the severe cases and death by 170%.ConclusionsThe effective policies for Omicron include high level of testing capacity with a combination of RAT and PCR testing to identify and quarantine the infected cases, especially the asymptomatic cases. Immediate home-isolation and fast transfer to centralized quarantine location could help control the spread of the virus. Moreover, to promote the vaccination in vulnerable population could significantly reduce the severe cases and death. These policies could be applicable to all metropolises with huge population facing high transmissible low severity epidemic.

ObjectiveAs a heavily populated megacity, Shanghai faces major epidemic risks. However, Shanghai's control of COVID-19 has been successful owing to both the strict government policy and wide community participation. Here, we investigated the impact of these stakeholders and examined who played a major role across different epidemic stages.DesignWe extended the classic susceptible-exposed-infectious-recovered (SEIR) model considering the heterogeneous contact structure in four social sceneries, i.e., school, workplace, public entertainment venues, and neighborhood community, which could reflect the impact of lockdown policy and wide participation of residents happened at the community level.ResultThe simulation results showed that without lockdown policy and only with community participation, the daily new confirmed cases would gradually increase to more than 7,000 [292/1,000,000] at the end of Sep. However, without community participation and only with a lockdown policy, the daily new confirmed cases sharply decreased to 30 [1.2/1,000,000] at the end of the 1st month and remained low for several months. However, when a lockdown policy was gradually lifted, the new confirmed cases increased exponentially, eventually reaching more than 17,000 [708/1,000,000]. Therefore, a government lockdown policy was necessary for the rapid control of COVID-19 during the outbreak stage while community participation is more important in keeping the number of new confirmed cases low during the reopening stage.ConclusionGovernment lockdown policy and community participation play different roles in the control of COVID-19 at different stages of the epidemic: although the government played a leading role in setting up policies, the broader participation of community fever clinics (CFCs) and the general public were especially crucial in winning the battle against COVID-19 in the long run.

Abstract Background The family doctor system is a vital part of China’s national medical and health system reform. Evidence of the degree of implementation of the family doctor system is required to assist managers and policy makers in Pudong with resource allocation planning. This study analyzed changes in indicators (family doctor team construction, contracted medical services, health management services and so on) over time to evaluate the progress of the family doctor system in Pudong. Methods We used a cross-sectional design with an online questionnaire survey to collect 3-year (2013–2016) consecutive data. The online questionnaires were completed by the doctors responsible for information reporting in each community health service center of Pudong. The data were sorted, and the indices calculated and analyzed using descriptive statistics and statistical tests. Results The proportion of registered general practitioners increased each year, from 50.8% in 2013 to 66.5% in 2016; this difference was statistically significant (P = 0.000). The number of family doctors per 10,000 permanent residents rose each year, from 1.7 in 2013 to 2.1 in 2016. The rate of contracted household residents was 55.7% in 2013 and increased to 71.7% in 2016, with the difference being significant in different years (P = 0.012). Analysis of referral services showed the people times of contracted residents transferring to higher-level hospitals from family doctors increased each year, from 172,734 in 2013 to 341,615 in 2016; differences among different regions were statistically significant for 2013–2016. The rate of health screening for contracted residents also increased each year, with statistically significant differences in different years (P = 0.000). The rate of health assessment interventions for contracted residents rose each year, with statistically significant differences in different years (P = 0.003). Conclusions The family doctor signing service in Pudong made headway in general practitioner availability, contract service rate of household residents, and providing health management services. However, problems included family doctor shortages and limited supporting policies, especially in rural and suburban areas compared with urban divisions. Increasing the enrollment rate of family doctors and speeding up the implementation of “contract service fees” are key tasks for the sustainable development of the family doctor system in Pudong.

ObjectivesTo determine the influence of ethnic disparities, socioeconomic status (SES) and hukou on the incidence of scoliosis.MethodsWe enrolled 2,445 junior high school students (Han: 1,153; ethnic minorities: 1,292) aged 12–16 years from two schools in Tianzhu Tibetan Autonomous County, Gansu Province from November 2020 to February 2021. We measured the angle of trunk rotation (ATR) using a scoliometer. Two-factor analysis of variance was used to comparatively analyze differences in the ATR according to ethnicity, age, sex, body mass index (BMI), and SES between the groups. Associations between risk factors and scoliosis were estimated using odds ratios and 95% confidence intervals with an unconditional multivariate logistic regression model for the two groups.ResultsAdolescents with Han ethnicity were more likely to have scoliosis than their ethnic minority counterparts (10.8% vs. 7.1%, P < 0.05). The ATR value in the Han group decreased with age whereas the minority group showed an upward trend (P < 0.05). The difference between ethnic groups was not significant, only at level 3. In particular, the ATR values among Han girls were significantly higher than those of ethnic minority girls (P < 0.05). Compared with Han adolescents, the BMI of ethnic minorities had a greater impact on the ATR. A statistically significant difference in SES was found between the two ethnic groups (P < 0.05). Hukou and parents' occupation had an important influence on the onset of scoliosis.ConclusionsHan adolescents had higher ATR values and were more likely to have scoliosis than ethnic minority adolescents in our study. Growth and development indicators (height and BMI) and differences in SES between the two groups played an important role.

BackgroundA lack of physical activity (PA) is a threat to public health. However, for the elderly, most PA abilities are limited. By focusing on the types and intensity of PA that the elderly can bear, this study aimed to reveal whether preferences regarding types of PA (including housework, transportation, and recreational activities) and their intensity were associated with health status. The main forms of PA include shopping, cooking, cleaning, walking, cycling, various fitness activities and other activities with a certain intensity.MethodsSurveillance data on chronic diseases and their risk factors were collected from one district of Shanghai in 2017-2018. A Kish table was used for sampling 500 older adults, including the diagnosed group (chronic diseases diagnosed by physicians, n = 119), the abnormal group (not diagnosed but abnormal indicators detected in this investigation, n = 287) and the healthy group (n = 94). Multiple regressions were used to test the relationship between the various types, durations and intensities of PA the elderly individuals participated in and their health status.ResultsAll three groups included a large proportion of older adults who participated in housework- and transport-related PA. The diagnosed group had the largest proportion (63.06% for housework-related PA; 87.39% for transport-related PA) and median minutes (17.14 min of housework-related PA per day; 30.00 min of transport-related PA per day). The diagnosed group had more metabolic equivalents (METs) of moderate-intensity PA than the two other groups (H = 33.01, P < 0.01), and more people met the WHO recommendation (χ2 = 34.71, P < 0.01). Diagnosis was associated with performing housework- and transport-related PA and moderate-intensity PA and with meeting the WHO's recommendation. Higher education levels were a positive factor for elderly individuals to participate in PA.ConclusionsTransportation and housework activities are good targets for increasing PA in older adults. Diagnosis is associated with older adults' more PA.

Abstract Background A key component of the 2009 medical reform in China was the change to family doctor (FD) policy practice. However, this led to an increased workload for primary health-care workers (PHCWs) at community health service centres. Their increasing workload may play a significant role in affecting PHCWs’ health. Methods A questionnaire survey was conducted in Hongkou district of Shanghai amongst PHCWs including family doctors (FDs), family nurses (FNs), public health doctors (PHDs), and other PHCWs in early 2019. Ordered logistic regression models (Models 1 to 3) were performed to explore the differing health status amongst PHCWs, and their respective influential factors were also tested (Models 4 to 7). Results Five hundred sixty-two valid questionnaires were collected with a response rate of 96.4%. Other PHCWs’ (OR = 2.03; 95% CI: 1.163–3.560) and FNs’ (OR = 1.98; 95% CI: 1.136–3.452) self-rated health (SRH) were significantly better than that of FDs. In terms of FNs, the OR of SRH for those who strongly perceived the extra workload brought by FD-contracted services was only 12.0% (95% CI: 0.018–0.815) of that of the no-pressure group. Similarly, FNs with stronger work pressure had worse SRH, i.e., compared with “no” pressure, the SRH ORs for “neutral,” “strong,” and “very strong” evaluations of work pressure were 0.002 (95% CI: 0.000–0.055), 0.001 (95% CI: 0.000–0.033), and 0.000 (95% CI: 0.000–0.006), respectively. Information technology (IT) systems and performance incentives were suggested to improve SRH for FNs, while the former was found to be negatively correlated with other PHCWs. After one unit increase in the PHDs’ team/department support, their OR was 10.7 times (95% CI: 1.700–67.352) higher. In addition, policy support had a negative effect on SRH for PHDs. The OR of “good” assessments of cultural environments was 25.98 times (95% CI: 1.391–485.186) higher than that of “very poor” for Other PHCWs. Conclusions The influences of FD policy practice on FNs’ SRH were the most significant amongst PHCWs, rather than FDs’ as expected. The significant factors of SRH were varied over different occupational categories, that is team/department support and policy support (though negative) for PHDs, IT system and incentive for FNs, facility and equipment for FDs, and culture environment for other PHCWs respectively.

Abstract Background Children are especially vulnerable to pneumonia and the effects of air pollution. However, little is known about the impacts of air pollutants on pediatric admissions for Mycoplasma pneumonia. This study was conducted to investigate the impacts of air pollutants on pediatric hospital admissions for Mycoplasma pneumonia in Shanghai, China. Methods A cross-sectional design was applied to explore the association between pediatric hospital admissions and levels of air pollutants (fine particulate matter, particulate matter, ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide). Data on hospital admissions for pneumonia and levels of ambient air pollutants were obtained for the period of 2015 to 2018. Associations between pediatric admissions for Mycoplasma pneumonia and ambient air pollutants were calculated using logistic regression and described by the odds ratio and relevant 95% confidence interval. The hysteresis effects of air pollutants from the day of hospital admission to the previous 7 days were evaluated in single-pollutant models and multi-pollutant models with adjustments for weather variables and seasonality. Lag 0 was defined as the day of hospital admission, lag 1 was defined as the day before hospital admission, and so forth. Results In the single-pollutant models (without adjustment for other pollutants), pediatric hospital admissions for pneumonia were positively associated with elevated concentrations of nitrogen dioxide and fine particulate matter. A 0.5% increase in daily admissions per 10-μg/m3 increase in the nitrogen dioxide level occurred at lag 1 and lag 2, and a 0.3% increase in daily admissions per 10-μg/m3 increase in fine particulate matter occurred at lag 1. In the multi-pollutant models, nitrogen dioxide and fine particulate matter remained significant after inclusion of particulate matter, ozone, sulfur dioxide, and carbon monoxide. Conclusions This study illustrated that higher levels of nitrogen dioxide and fine particulate matter increase the risk of pediatric hospitalization for Mycoplasma pneumonia in Shanghai, China. These findings imply that the high incidence of Mycoplasma pneumonia in children in Asia might be attributed to the high concentration of specific air pollutants in Asia.

Abstract Background Since 2000, China has been developing primary care institutions to serve as the gateway to the healthcare system. However, the investment of resources in primary care institutions is not based on the actual medical demands of the public. This study analysed primary care utilization to provide targeted guidance for the improvement of primary healthcare delivery in China. Methods We extracted outpatient visit data from all community healthcare centres in Shanghai from 2014 to 2018. Diseases were then classified according to ICD-10 codes. The disease spectrum (frequency, proportion, rank) was stratified by sex, age, and region. Results Most primary care outpatients were female (58.20%), 60–79 years old (57.91%), and in suburban regions (62.18%). Chronic diseases accounted for the majority (91.41%). Hypertension, chronic ischaemic heart disease, diabetes, and acute upper respiratory tract infections were the top four disorders for primary care visits regardless of sex. In the group aged 0–18 years, symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified accounted for 37.96% of the top 20 reasons. Acute upper respiratory tract infections were the most common diseases in the groups aged 0–18 (11.20%) and 19–39 (11.14%) years. However, hypertension was the most common disease in the group aged > 39 years old (> 20%). There were more outpatients with respiratory and digestive diseases in suburban areas than in urban areas. In addition, problems associated with medical equipment and other healthcare deficiencies were relatively more common in suburban areas (suburban: 4.13%, rank 5; urban: 2.29%, rank 10). Conclusions To meet the patients’ needs and to develop the primary care system, the Shanghai government should focus on diseases with regionally high proportions. Disease diagnosis and treatment should be improved in the younger and suburban populations.

Abstract The H3 subtype of avian influenza virus (AIV) is widespread in avian species and is frequently isolated in surveillance projects; thus, we have developed a more effective diagnostic approach of a monoclonal antibody (mAb)-based sandwich ELISA for the H3 AIV detection. First, we have produced the essential reagent of mAb against AIV H3 strains with the development of an mAb-Mouse immunization with a purified H3-subtype AIV strain and cell fusion to generate hybridoma cells. These cells were screened with hemagglutination inhibition (HI) tests, and optimal cells were subcloned. We chose a hybridoma cell line that steadily secreted a specific H3-subtype AIV mAb, designated 9F12, that belongs to the IgG1 subclass and has a K-type light chain. 9F12 was shown to bind specifically to the H3-subtype AIV antigen by both immunofluorescence assay and Western blot analysis. Finally, a 9F12-based sandwich ELISA was successfully developed and used to specifically test for this antigen. The sandwich ELISA conditions were optimized, and the specificity and sensitivity were validated. The results for clinical sample detection were consistent with viral isolation. Consequently, the 9F12-based sandwich ELISA is a specific, sensitive, robust, rapid and versatile diagnostic tool for H3-subtype AIV and provides a promising strategy for effective influenza virus prevention and control.

Loop-mediated isothermal amplification (LAMP) is a nucleic acid amplification technique that can be used to amplify target genes at a constant temperature, and it has several advantages, including convenience, specificity and sensitivity. However, due to the special interpretation methods of this technology for reaction results, all the previously reported LAMP detection methods have been restricted to identifying a single target, which limits the application of this technology. In this study, we modified conventional LAMP to include a quencher-fluorophore composite probe complementary to the F1c segment of the inner primer FIP; upon strand separation, a gain in the visible fluorescent signal was observed. The probes could be labeled with different fluorophores, showing different colors at the corresponding wavelengths. Therefore, this multiplex LAMP (mLAMP) assay can simultaneously detect 1-3 target sequences in a single LAMP reaction tube, and the results are more accurate and intuitive. In this study, we comprehensively demonstrated a single-reaction mLAMP assay for the robust detection of three cattle viruses without nonspecific amplification of other related pathogenic cattle viruses. The detection limit of this mLAMP assay was as low as 526-2477 copies/reaction for the recombinant plasmids. It is expected that this mLAMP assay can be widely used in clinical diagnosis.

For Chinese community pharmacists, there is a lack of guidance before and after the drug treatment process for community residents. This study aimed to investigate community pharmacists’ role in hypertension management. One hundred ninety-six hypertensive patients were randomly selected from the studied community. For patients in the intervention group, monthly meetings were scheduled with a community pharmacist. Patients in the non-intervention group received standard care from their physicians. In the intervention group, the percentage using information from pharmacists increased significantly, from 54.3% to 94.2% ( P

Abstract Background Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the “gatekeeper” role of the family doctor. Methods A cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction. Results Compared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P

Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (β 5 = 0.26, P .05). The model fit was acceptable (RMSEA = 0.033). A “cognition-behavior-outcomes (health and medical expense)” path of FD’s gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.

Objectives To enhance the understanding of non-communicable disease (NCD) multimorbidity in children who are inpatients by delineating the characteristics of and identifying patterns among paediatric inpatients with multimorbidity in China.Design Cross-sectional study.Setting Paediatric wards (n=17) in Pudong New Area, Shanghai, China.Participants A total of 193 432 paediatric inpatients in the electronic health record systems of 17 hospitals from 2011 to 2016 participated in the study, and 91 004 children with NCDs were extracted and classified based on International Classification of Diseases, 10th version codes.Main outcome measures Number of the NCDs and multimorbidity patterns of the paediatric inpatients.Results In total, 47.05% (95% CI 46.83 to 47.27) of the paediatric inpatients had one or more chronic diseases, and 16.30% (95% CI 16.14 to 16.46) had multimorbidity. Congenital anomalies accounted for 19.43% (95% CI 19.25 to 19.61) of the principal diagnoses among the paediatric inpatients. Five common multimorbidity patterns were identified: a neurological-respiratory cluster, a neurological-respiratory-ear cluster, a cardiovascular-circulatory cluster, a genitourinary cluster (boy group) and a musculoskeletal-connective cluster (10–18 years age group).Conclusions Multimorbidity in paediatric inpatients suggests that decisions about reasonable allocation of paediatric inpatient resources should be fully considered. Multimorbidity patterns in paediatric inpatients revealed that prevention, including innovative treatments targeting children, should be further studied.

Avian reovirus (ARV) can induce many diseases as well as immunosuppression in chickens, severely endangering the poultry industry. Interferons (IFNs) play an antiviral role by inducing the expression of interferon-stimulated genes (ISGs). The effect of ARV infection on the expression of host ISGs is unclear. Specific-pathogen-free (SPF) chickens were infected with ARV strain S1133 in this study, and real time quantitative PCR was used to detect changes in the dynamic expression of IFNs and common ISGs in joints of SPF chickens. The results showed that the transcription levels of IFNA, IFNB, and several ISGs, including myxovirus resistance (MX), interferon-induced transmembrane protein 3 (IFITM3), protein kinase R (PKR), oligoadenylate synthase (OAS), interferon-induced protein with tetratricopeptide repeats 5 (IFIT5), interferon-stimulated gene 12 (ISG12), virus inhibitory protein (VIPERIN), interferon-alpha-inducible protein 6 (IFI6), and integrin-associated protein (CD47), were upregulated in joints on days 1–7 of infection (the levels of increase of MX, IFIT5, OAS, VIPERIN, ISG12, and IFI6 were the most significant, at hundreds-fold). In addition, the expression levels of the ISGs encoding zinc finger protein 313 (ZFP313), and DNA damage–inducible transcript 4 (DDIT4) increased suddenly on the 1st or 2nd day, then decreased to control levels. The ARV viral load in chicken joints rapidly increased after 1 day of viral challenge, and the viral load remained high within 6 days of viral challenge. The ARV viral load sharply decreased starting on day 7. These results indicate that in SPF chicken joints, many ISGs have mRNA expression patterns that are basically consistent with the viral load in joints. IFNA, IFNB, and the ISGs MX, IFITM3, PKR, OAS, IFIT5, ISG12, VIPERIN, IFI6, and CD47 play important roles in defending against ARV invasion, inhibiting ARV replication and proliferation, and promoting virus clearance. These results enrich our understanding of the innate immune response mechanisms of hosts against ARV infection and provide a theoretical basis for prevention and control of ARV infection.

BackgroundChronic obstructive pulmonary disease (COPD), the most common chronic respiratory disease worldwide, not only leads to the decline of pulmonary function and quality of life consecutively, but also has become a major economic burden on individuals, families, and society in China. The purpose of this meta-analysis was to explore the risk factors for developing COPD in the Chinese population that resides in China and to provide a theoretical basis for the early prevention of COPD.MethodsA total of 2457 cross-sectional, case-control, and cohort studies published related to risk factors for COPD in China were searched. Based on the inclusion and exclusion criteria, 20 articles were selected. Stata 11.0 was used for meta-analysis. After merging the data, the pooled effect and 95% confidence intervals (CIs) were calculated to assess the association between risk factors and COPD. Heterogeneity between studies was assessed using I2 and Cochran's Q tests. Begg's test was used to assess publication bias.ResultsExposure to particulate matter less than 2.5 μm in diameter (PM2.5) (pooled effect = 1.73; 95%CI: 1.16~2.58; P ConclusionEarly prevention of COPD could be accomplished by quitting smoking, reducing exposure to air pollutants and biomass burning emissions, maintaining body mass index between 18.5 kg/m2 and 28 kg/m2, protecting children from respiratory infections, adopting active treatments to children with respiratory diseases, and conducting regular screening for those with family history of respiratory diseases.

Objectives This study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed.Setting We extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre.Participants Our data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong.Results We found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits—a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age.Conclusions Different from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.

A previously unidentified chicken parvovirus (ChPV) and turkey parvovirus (TuPV) strain, associated with runting-stunting syndrome (RSS) and poultry enteritis and mortality syndrome (PEMS) in turkeys, is now prevalent among chickens in China. In this study, a large-scale surveillance of parvoviruses in chickens and turkeys using conserved PCR assays was performed. We assessed the prevalence of ChPV/TuPV in commercial chicken and turkey farms in China between 2014 and 2019. Parvoviruses were prevalent in 51.73% (1,795/3,470) of commercial chicken and turkey farms in Guangxi, China. The highest frequency of ChPV positive samples tested by PCR occurred in chickens that were broiler chickens 64.18% (1,041/1,622) compared with breeder chickens 38.75% (572/1,476) and layer hens 38.89% (112/288), and TuPV was detected in 70/84 (83.33%). Native and exotic chicken species were both prevalent in commercial farms in southern China, and exotic broiler chickens had a higher positive rate with 88.10% (148/168), while native chickens were 50.00% (1,465/2,930). The environmental samples from poultry houses tested positive for ChPV and TuPV were 47.05% (415/874). Samples from open house flocks had higher prevalence rates of ChPV than those of closed house flocks (Table 5), among which those from the open house showed 84.16% (85/101) positivity, those from litter showed 62.86% (44/70) positivity, and those from drinking water showed 50.00% (56/112) positivity, whereas those from the closed house litter were 53.57% (60/112), those from swabs were 50.18% (138/275), and those from drinking water were 15.69% (32/204). Samples collected during spring were more frequently ChPV/ TuPV positive than those collected during other seasons. This study is the first report regarding the epidemiological surveillance of ChPV and TuPV in chicken/turkey flocks in Guangxi, China. Our results suggest that ChPV and TuPV are widely distributed in commercial fowl in Guangxi. These findings highlight the need for further epidemiological and genetic research on ChPV and TuPV in this area.

Objectives Since 2010, the Chinese government has gradually increased its investment in the training of general practitioners (GPs) to support their role as ‘gatekeepers’ in the healthcare system. However, this training is still organised from the perspective of specialist care. We aimed to assess the appropriateness of the principal GP admission training programme curricula in China, including Residents Training for GPs (RTGP), Residents Training for Assistant GPs (RTAGP) and Training for Specialists with General Practice interest (TSGP).Setting The study focussed on GP training programmes in Shanghai, China.Participants Data on disease competences developed in three GP clinical training programmes (RTGP, RTAGP and TSGP) were derived from official programme training manuals. Data on the proportion of outpatient visits for each disease were taken from the Shanghai community healthcare centres grassroots outpatient database.Primary and secondary outcome measures We first conducted a quantitative analysis by comparing the structure of current training curricula with actual outpatient utilisation patterns across all community healthcare institutions in Shanghai from 2014 to 2018. Qualitative analysis was then conducted to evaluate GP training programmes based on Donabedian’s model.Results Quantitative analysis showed that the distribution of diseases for which competences were taught did not match the composition of outpatient visits in community healthcare institutions. Concerns identified through qualitative analysis included teachers who were mostly specialists, lack of equipment for differential diagnosis in community healthcare institutions, insufficient teaching of referral standards and GP training in large hospitals that consistently neglected communication skills.Conclusions The establishment and implementation of admission training programmes for GPs in China lacks a focus on general practice training and may be improved by adopting an evidence-based general perspective aligned with the medical needs of the community.

Background: Hypertension and its complications represent major health problems worldwide and are distributed differently in different populations. This study aimed to reveal the differences between two populations of patients with hypertension who had atherosclerotic complications: local residents in and migrants to the city of Shanghai, China. Methods: We conducted a cross-sectional study among hospitalized patients with hypertension age 21–65 years in Pudong District. We compared the characteristics of local and migrant patients with hypertension, and analyzed the distribution and risk factors of atherosclerotic complications between these groups. Results: The proportion of young and uninsured patients with hypertension was higher among migrant than local participants. The rates of stroke (15.4% vs. 25.0%, p < 0.05) and coronary heart disease (8.6% vs. 11.7%, p < 0.05) were lower and the rates of other atherosclerotic diseases higher (8.5% vs. 7.9%, p = 0.429) among migrant than local participants. According to logistic regression analysis, age was an important risk factor in both the migrant and local groups for all three atherosclerotic complications investigated. Insurance, diabetes, and frequency of hospitalization could influence the incidence of atherosclerotic complications among local patients with hypertension. Among migrant patients, differences for sex, insurance, marital status, diabetes history, and frequency of hospitalization were not significant. Conclusions: Our study demonstrated differences in the characteristics, distribution, and risk factors of atherosclerotic complications among migrant and local patients with hypertension. Greater attention in needed for the increasing population of migrants.

Most disabled people have poor health status. They often have multiple diseases requiring continual medication. This study aimed to explore the factors associated with medication adherence among disabled people, with a particular focus on the factors associated with family and primary health care support. A questionnaire survey was conducted among 226 disabled individuals. The analysis was performed using an ordered logistic regression model, including 4 categories of predictor variables. We found that the community health service center played a positive role in improving medication adherence, whereas the role played by the participant’s family was more complicated. Specifically, those obtaining a brochure were more likely to have higher medication adherence (odds ratio [OR] = 2.732, 95% confidence interval [CI] = 1.349-5.532). Compared with those who were married, widowed participants (OR = 0.207, 95% CI = 0.069-0.620) and divorced participants (OR = 0.330, 95% CI = 0.057-1.914) had lower odds of having greater adherence, whereas the odds of having greater adherence for single participants were 1.679 times the same odds for married participants (OR = 1.679, 95% CI = 0.668-4.224). The odds of having greater medication adherence for participants receiving help with prescriptions from a family member were almost 60% lower than these odds for those who did not receive this kind of help (OR = 0.460, 95% CI = 0.216-0.979). Thus, the role played by participants’ family members was both protective and damaging, whereas the role of the community health service center was clearer. These findings merit further exploration.

To date, nine neuraminidase (NA) subtypes of avian influenza virus (AIV) have been identified in poultry and wild birds. Rapid and effective methods for differentiating these nine NA subtypes are needed. We developed and validated a rapid, sensitive, and robust method utilizing a GeXP analyzer-based multiplex RT-PCR assay and capillary electrophoresis for the simultaneous differentiation of the N1 to N9 subtypes in a single-tube reaction. Ten pairs of primers–nine subtype-specific pairs and one pan-AIV pair–were screened and used to establish the GeXP multiplex RT-PCR assay. A single subtype was detected using the developed GeXP assay; the N1 to N9 AIV subtypes individually generated two target peaks: the NA subtype-specific peak and the general AIV peak. Different concentrations of multiplexed subtypes were tested with this GeXP assay and the peaks of the corresponding NA subtypes were generated, suggesting that this GeXP assay is useful for identifying NA subtypes in mixed samples. Moreover, no peaks were generated for other important avian viruses, indicating negative results and validating the lack of cross-reactions between AIV subtypes and other avian pathogens. RNA templates synthesized through in vitro transcription were used to analyze the sensitivity of the assay; the limit of detection was 100 copies per reaction mixture. The results obtained from clinical samples using this GeXP method were consistent with the results of the neuraminidase inhibition (NI) test, and the ability of the GeXP assay to identify mixed infections was superior to amplicon sequencing of isolated viruses. In conclusion, this GeXP assay is proposed as a specific, sensitive, rapid, high-throughput, and versatile diagnostic tool for nine NA subtypes of AIV.

The public hospital reform has lasted 5 years in China; however, the operation development status and trends of public hospitals have not been systematically evaluated in Pudong New District. We first applied the technology of longitudinal index to assess the development of public hospitals there. The quantitative data were mainly gathered by taking health statistics database from 2009 to 2014. The results showed that overall operating index presented a down-up trend, with the highest point in 2014 and the lowest point in 2012. Overall operating index, development foundation index, and management condition index were found to be statistically different ( P = .010, P = .016, P = .031) in different years, whereas the service operation index and financial risk index were not so ( P = .543, P = .228). Moreover, the results demonstrated that no obvious difference was observed in the overall operating index between the general and specialized hospitals ( P = .327), which was the same in the 4 first-class indexes. However, there were statistical differences in the overall operating index and development foundation index among these 5 years ( P = .018, P = .036), but none in the service operation index, management condition index, and financial risk index ( P = .503, P = .062, P = .177). No interaction effects were discovered between year and hospital categories in the current study ( P = .673, P = .375, P = .885, P = .152, P = .288).

BackgroundChina adopted family doctor (FD) to help achieve "Healthy China 2030" through providing continuous, comprehensive, and life-cycle contract services. However, there is a disparity between actual and targeted FD use, as residents continue to visit specialists in large hospitals. The government implemented initiatives to improve residents' willingness to sign up with and visit their FDs. Factors that influence contract behavior are therefore significant for frontier policy research.MethodsTwo survey waves were conducted in Shanghai (2013 and 2016). The first wave included 2754 people and the second 1995 people. Exploratory factor analysis was used to synthesize "satisfaction" as a predictor of contract behavior. Pearson's chi-square, pooled and logistic regression models were used to estimate associations between influencing factors and contract behavior, and clarify variations in factors across the two waves.ResultsFour factors were extracted from 15 satisfaction items: "Treatment Environment," "Medical Technology," "Service Specification" and "Service Attitude". Consistent with descriptive analysis, longitudinal analysis showed sociodemographic characteristics (age, education, marital status, and hukou) were significant predictors of contract behavior. The odds ratio of non-communicable diseases (NCD) patients for contract behavior was 2.218 times that of residents without NCD. Contract behavior was positively correlated with awareness of FD services (OR = 21.674, 95%CI = 15.043-31.229), satisfaction with Service Attitude (OR = 1.210, 95%CI = 1.009-1.451), and visit compliance (OR = 1.959, 95%CI = 1.564-2.452). Over time, the odds ratios of the married, Shanghai hukou, NCD, and awareness of FD services declined from 0.456, 1.795, 2.492, 28.690 to 0.443, 1.678, 1.910 and 14.031 respectively, while those of age, and visit compliance increased from 1.027, 1.521 to 1.041 and 2.305 respectively. In 2016, an education-contract gradient had formed (the higher the education level, the higher probability of signing with a FD), whereas high school education had the highest odds ratio (OR = 1.163,95%CI = 0.740-1.827) in 2013. Service Attitude was the only significant satisfaction-related predictor (OR = 1.358, 95%CI = 1.001-1.842) in 2016, compared with "Treatment Environment" (OR = 1.224, 95%CI = 1.001-1.496) and "Service Specification" in 2013(OR = 1.270, 95%CI = 1.040-1.552).ConclusionsExcept for the socio-demographic variables, NCD, awareness of FD services, satisfaction and visit compliance were significant predictors of contract behavior with FDs. The effect of visit compliance had increased over time while NCD and awareness of FD services were losing impact over time. Significant satisfaction factors had also changed from "Treatment Environment" and "Service Specification" to "Service Attitude".

[This corrects the article DOI: 10.1371/journal.pone.0171287.].

Foot-and-mouth disease virus (FMDV), Bluetongue virus (BTV), Vesicular stomatitis Virus (VSV), Bovine viral diarrheal (BVDV), Bovine rotavirus (BRV), and Bovine herpesvirus 1 (IBRV) are common cattle infectious viruses that cause a great economic loss every year in many parts of the world. A rapid and high-throughput GenomeLab Gene Expression Profiler (GeXP) analyzer-based multiplex PCR assay was developed for the simultaneous detection and differentiation of these six cattle viruses. Six pairs of chimeric primers consisting of both the gene-specific primer and a universal primer were designed and used for amplification. Then capillary electrophoresis was used to separate the fluorescent labeled PCR products according to the amplicons size. The specificity of GeXP-multiplex PCR assay was examined with samples of the single template and mixed template of six viruses. The sensitivity was evaluated using the GeXP-multiplex PCR assay on serial 10-fold dilutions of ssRNAs obtained via in vitro transcription. To further evaluate the reliability, 305 clinical samples were tested by the GeXP-multiplex PCR assay. The results showed that the corresponding virus specific fragments of genes were amplified. The detection limit of the GeXP-multiplex PCR assay was 100 copies/μL in a mixed sample of ssRNAs containing target genes of six different cattle viruses, whereas the detection limit for the Gexp-mono PCR assay for a single target gene was 10 copies/μL. In detection of viruses in 305 clinical samples, the results of GeXP were consistent with simplex real-time PCR. Analysis of positive samples by sequencing demonstrated that the GeXP-multiplex PCR assay had no false positive samples of nonspecific amplification. In conclusion, this GeXP-multiplex PCR assay is a high throughput, specific, sensitive, rapid and simple method for the detection and differentiation of six cattle viruses. It is an effective tool that can be applied for the rapid differential diagnosis of clinical samples and for epidemiological investigation.

The objective of this study was to obtain the complete mitochondrial DNA sequence of chukar partridge, and to provide reference data for protection and utilization of these resources of chukar partridge. The complete mitochondrial genome sequence of the China chukar partridge was measured by PCR-based methods and analysed in detail. Our research findings reveal that the entire mitochondrial genome of the chukar partridge is a circular molecule consisting of 16,688 bp (GenBank accession number: KY829450). The contents of A, T, C, and G in the mitochondrial genome were found to be 30.44%, 24.43%, 31.57%, and 13.56%, respectively. The complete mitochondrial genome of the chukar partridge has a typical structure, including 13 protein-coding genes, two rRNA genes, 22 tRNA genes, and one control region (D-loop region). This complete mitochondrial genome sequence provides essential information in understanding phylogenetic relationships among Galliformes mitochondrial genomes.

We report a novel electrochemical immunosensor that can sensitively detect avian influenza virus H5 subtype (AIV H5) captured by graphene oxide-H5-polychonal antibodies-bovine serum albumin (GO-PAb-BSA) nanocomposite. The graphene oxide (GO) carried H5-polychonal antibody (PAb) were used as signal amplification materials. Upon signal amplification, the immunosensor showed a 256-fold increase in detection sensitivity compared to the immunosensor without GO-PAb-BSA. We designed a PAb labeling GO strategy and signal amplification procedure that allow ultrasensitive and selective detection of AIV H5. The established method responded to 2(-15) HA unit/50 µL H5, with a linear calibration range from 2(-15) to 2(-8) HA unit/50 µL. In summary, we demonstrated that the immunosenser has a high specificity and sensitivity for AIV H5, and the established assay could be potentially applied in the rapid detection of other pathogenic microorganisms.