Health related quality of life and its impacts by chronic diseases in urban community population, Shanghai, China in 2015.

This survey aimed to describe the health-related quality of life (HRQoL) and to explore the relationship between chronic diseases and HRQoL among urban residents in Shanghai, China. A cross-sectional study of 9 426 adults was conducted in Xuhui District of Shanghai, China in 2015. The EuroQol five-dimension three-level (EQ-5D-3 L) was used to measure HRQoL. The average age of subjects was 55.6 ± 17.4 years and 53% were female. Their mean values of utility and visual analogue scale (VAS) were 0.974 ± 0.099 and 80.00 ± 12.36, respectively, which were above the Chinese norm values. Women had lower scores compared with men. The utility value decreased with age, which accelerated after the age of 55 years. Chronic conditions including diabetes, tumor, cardiovascular disease, and respiratory disease, were significantly related to HRQoL, and the reported proportions of problems in the five dimensions increased with the number of chronic diseases (p < 0.05). Chronic diseases except for respiratory disease had a negative effect on HRQoL utility value and VAS score after the adjustment for covariates (p < 0.05). Chronic diseases had a negative impact on both EQ-5D-3 L utility and VAS scores, although the health-related quality of life for the study was above the national average.

Near-infrared photoresponsive drug delivery nanosystems for cancer photo-chemotherapy.

Drug delivery systems (DDSs) based on nanomaterials have shown a promise for cancer chemotherapy; however, it remains a great challenge to localize on-demand release of anticancer drugs in tumor tissues to improve therapeutic effects and minimize the side effects. In this regard, photoresponsive DDSs that employ light as an external stimulus can offer a precise spatiotemporal control of drug release at desired sites of interest. Most photoresponsive DDSs are only responsive to ultraviolet-visible light that shows phototoxicity and/or shallow tissue penetration depth, and thereby their applications are greatly restricted. To address these issues, near-infrared (NIR) photoresponsive DDSs have been developed. In this review, the development of NIR photoresponsive DDSs in last several years for cancer photo-chemotherapy are summarized. They can achieve on-demand release of drugs into tumors of living animals through photothermal, photodynamic, and photoconversion mechanisms, affording obviously amplified therapeutic effects in synergy with phototherapy. Finally, the existing challenges and further perspectives on the development of NIR photoresponsive DDSs and their clinical translation are discussed.

Norovirus shedding among symptomatic and asymptomatic employees in outbreak settings in Shanghai, China.

BACKGROUND: Norovirus (NoV) is recognized as a leading cause of acute gastroenteritis (AGE) outbreaks in settings globally. Studies have shown that employees played an important role in the transmission mode during some NoV outbreaks. This study aimed to investigate the prevalence of NoV infection and duration of NoV shedding among employees during NoV outbreaks, as well as factors affecting shedding duration. METHODS: Specimens and epidemiological data were collected from employees who were suspected of being involved in the transmission or with AGE symptoms during NoV outbreaks in Xuhui District, Shanghai, from 2015 to 2017. Specimens were detected using real-time RT-PCR to determine whether or not employees had become infected with NoV. Specimens were collected every 3-7 days from NoV-infected employees until specimens became negative for NoV. RESULTS: A total of 421 employees were sampled from 49 NoV outbreaks, and nearly 90% of them (377/421) were asymptomatic. Symptomatic employees showed significantly higher prevalence of NoV infection than asymptomatic ones (70.5% vs. 17.0%, P < 0.01). The average duration of NoV shedding was 6.9 days (95% confidence interval: 6.1-7.7 days) among 88 NoV-infected individuals, and was significantly longer in symptomatic individuals than in asymptomatic ones (9.8 days vs. 5.6 days, P < 0.01). In Cox proportional-hazards model, after adjusting age and gender, symptoms was the only factor associated with duration of NoV shedding. CONCLUSIONS: Compared with asymptomatic employees, symptomatic employees had higher prevalence of NoV infection and longer durations of NoV shedding. Since NoV shedding duration among NoV-infected employees tends to be longer than their isolation time during outbreaks, reinforcement of hygiene practices among these employees is especially necessary to reduce the risk of virus secondary transmissions after their return to work.

Changes in epidemiological features of vaccine preventable infectious diseases among three eras of national vaccination strategies from 1953 to 2018 in Shanghai, China.

BACKGROUND: Recurring outbreaks of infectious diseases highlight the importance of population vaccination strategies. We aimed to assess the impact of national vaccination strategies on vaccine-preventable infectious diseases (VPDs) in Shanghai, China and to identify vulnerable groups that may benefit from future vaccination policies. METHODS: Infectious disease data from 1953 to 2018 was obtained from Xuhui District Center for Disease Control and Prevention, Shanghai China. We used joinpoint regression to show incidence, mortality and fatality trends and to determine annual percent change in incidence of 12 VPDs among three eras of national immunization strategies: (1)1953-1977, (2)1978-2007, and(3)2008-2018. FINDINGS: Incidence, mortality, and fatality from VPDs have decreased drastically over the three eras, despite the inclusion of more diseases over time. Strikingly, the overall yearly incidence of VPDs shows an increasing trend from 2000 to 2018 in Shanghai (annual percentage changes, APC:7.7, p = 0.025). In the third era (2008-2018), the three VPDs with the highest incidence were varicella (80.2 cases/100,000), hand, foot, and mouth disease (HFMD) (73.6 cases/100,000), and hepatitis (43.5 cases/100,000). A significant upward trend was also observed in hepatitis (APC:24.9, p<0.001), varicella (APC:5.9, p = 0.006), and HFMD (APC:11.8, p = 0.003) from 2008-2018. Hepatitis and tuberculosis are the only VPDs with fatality cases in this period. INTERPRETATION: Focus is needed in controlling adult hepatitis and tuberculosis, either by introducing adult booster vaccines or by research into more effective vaccines. Varicella and HFMD are on the rise, but vaccines for these are not included in national programs. Strategies funded by government agencies or encouraged by research incentives are needed for varicella and HFMD, such as two-dose and novel multi-valent vaccines, respectively. FUNDING: Chinese Ministry of Education, Shanghai Municipal Government.

Factors Influencing the Size and Duration of School Varicella Outbreaks in Shanghai, China, in the Era of Voluntary Single-Dose Vaccination.

Varicella outbreaks continue to occur in schools. We assessed potential factors associated with the size and duration of 560 school-based outbreaks in Shanghai, China. Outbreaks occurring in primary and middle schools involved more cases and had longer durations, and conducting postexposure prophylaxis campaigns was an effective strategy for outbreak control.

Lung cancer incidence in female rises significantly in urban sprawl of Shanghai after introduction of LDCT screening.

OBJECTIVES: LDCT screening for lung cancer has been widely used in China since the release of the NLST trial data in 2011, but little is known about its impact on the incidence and mortality rates of lung cancer in China. METHODS: Official cancer registry data of lung cancer incidence and mortality were collected by Shanghai Municipal Center for Disease Control and Prevention from 2005 to 2014. Two districts (Xuhui and Songjiang Districts) were selected to represent populations with different levels of accessibility to LDCT. Incidence and mortality age-standardized rates (ASRs) were calculated using the Segi/Doll 1960 world standard population. Trends in lung cancer incidence and mortality rate over time, the average annual percent change (APC) and the corresponding 95% confidence interval (CI) were calculated using Joinpoint. RESULTS: In Shanghai, lung cancer incidence rate in men did not change significantly between 2005 and 2014 (APC = 0.76%; 95% CI: -0.27%, 1.80%; P = 0.127); while lung cancer incidence in women increased significantly (APC: 5.50%; 95% CI: 2.94%, 8.13%; P = 0.001). In Xuhui district, where eight tertiary hospitals was located, including Shanghai Cancer Center and Shanghai Chest Hospital, both of which provided LDCT lung cancer screening for eligible patients, the incidence rate of lung cancer increased significantly in women only since 2011(APC: 19.84%, P < 0.001). Overall mortality rate of lung cancer showed a significantly decreasing trend from 2005 to 2014 in men (APC = -2.68%, P = 0.009) but not in women (APC = -0.91%, P = 0.305). In Songjiang district, where limited access to LDCT was provided, lung cancer incidence in women increased significantly between 2005 and 2014 (APC: 5.42%, P = 0.001). Lung cancer incidence rates did not change significantly in men in either district from 2005 to 2014. Mortality rate of lung cancer did not change significantly from 2005 to 2014 in both men (APC = -0.51%, P = 0.259) and women (APC = -1.46%, P = 0.186). CONCLUSION: There is a steady increase in the incidence of lung cancer in women, especially after the wide use of LDCT screening, but without a clear mortality reduction.

Varicella outbreak trends in school settings during the voluntary single-dose vaccine era from 2006 to 2017 in Shanghai, China.

OBJECTIVE: To investigate varicella outbreak trends among schoolchildren during the voluntary single-dose varicella vaccine (VarV) era in Shanghai, China. METHODS: Trends in school varicella outbreaks from 2006 to 2017 were assessed using joinpoint regression models. The impacts of changes in single-dose VarV coverage among schoolchildren and implementation of post-exposure prophylaxis (PEP) strategies on outbreak trends were further analyzed. RESULTS: In total, 265 varicella outbreaks involving 3263 cases were reported in Shanghai from 2006 to 2017. The number of outbreaks showed an increasing trend from 2006 to 2017 (t=2.62, p=0.026), especially in kindergartens. The proportion of breakthrough varicella cases among all outbreak-related cases showed an increasing trend from 30.4% in 2008 to 85.7% in 2017 (t=7.45, p<0.001). Single-dose VarV coverage among schoolchildren was 88.1%, and showed a significant increase from the 1996 to the 2008 birth cohorts, followed by a non-significant decline from the 2008 to the 2014 birth cohorts. During school outbreaks in which PEP campaigns were conducted, the varicella attack rate was significantly lower than those in outbreaks without PEP campaigns (1.2% vs. 1.4%; Chi-square=23.35, p<0.001). CONCLUSIONS: Even with high coverage, single-dose VarV is insufficient to prevent school outbreaks. The administration of VarV as PEP is an appropriate intervention for varicella outbreak control prior to implementing a two-dose VarV schedule.

Changes in smoking prevalence after the enforcement of smoking control regulations in urban Shanghai, China: Findings from two cross-sectional surveys.

INTRODUCTION: The Smoking Control Regulation in Public Places (hereafter, the 'regulations') has been implemented in Shanghai since 2010. This study explores the changes in smoking prevalence and its influencing factors among urban Shanghai residents. METHODS: Two rounds of household investigations (the Health Status and Health Service Utilization Survey) were carried out using a multistage probability proportionate-to-size sampling method in an urbanized district in 2010 and 2015. Descriptive and logistic regression analyses were applied to the statistics. RESULTS: From 2010 to 2015, the standardized current smoking rate fell from 24.8% to 19.1% (38.3% to 32.0% among men, and 1.9% to 1.4% among women). Meanwhile, the standardized smoking cessation rate increased from 18.1% to 23.3%. Smoking prevalence in respondents aged 45 to 59 years was still higher than that of other age groups. Changes in smoking prevalence and cessation rates were more obvious in respondents aged 30-44 and over 75 years. Sex, age, education, marital status, and alcohol use were influencing factors of current smoking, while sex, age and alcohol use were influencing factors of smoking cessation. CONCLUSIONS: The implementation of smoking control regulations may be beneficial for reducing smoking and increasing smoking cessation, especially among middle-aged and older men. Nevertheless, tobacco control in urban Shanghai still faces huge challenges. Therefore, more targeted and comprehensive measures should be taken.