A Quickly Organized Response to a COVID-19 Positive Case Comeback After Clearance for over 2 Months in Shenzhen, China.

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic has spread quickly throughout the world. So far, there are no standard measures in terms of quick and effective control of new COVID-19 positive patient comeback after COVID-19 clearance for a certain time. Here, we report a quickly organized response from Luohu Hospital Group to a COVID-19 positive case comeback after clearance for over 2 months in Shenzhen, China. METHODS: After 2 months with no new COVID-19 cases in Shenzhen, on August 14, 2020, a supermarket employee living in the Luohu district of Shenzhen was tested positive in a nearby city. She has no any symptoms and signs, with unremarkable laboratory testing and radiological image, so she was soon diagnosed as asymptomatic COVID-19 positive case. Rapid contact tracing revealed that three of her relatives in Shenzhen were infected with COVID-19 and all of them were diagnosed as asymptomatic COVID-19 positive cases. To ensure residents' safety, Luohu hospital group (LHG) mounted a rapid organized response focusing on four measures: local environment management and residents' health monitoring, guidance for resumption of work, education and psychological counseling, and management of patients with fever in outpatient clinics. RESULTS: The LHG being structured as a people-centered, integrated organization responded to residents' medical and psychological needs rapidly, provided 6-hour results for COVID-19 testing, and recleared the city of COVID-19, as evidenced by the processing of 459,381 community samples within 15 days, with universally negative results beyond the originally identified case and her three close relatives. CONCLUSIONS: A quick and effective response from local organization to a new comeback COVID-19 positive case after clearance for a certain time is necessary in terms of ensuring the physical and psychological health of residents, as well as guarantying normal social work.

People-centred integrated care in urban China.

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.

Dans la plupart des pays, la demande de soins intégrés pour les personnes atteintes de maladies chroniques augmente à mesure que la population vieillit. Cette demande nécessite une réorientation majeure des systèmes de soins de santé vers des dispositifs de prestation de services plus intégrés. Pour effectuer cette réorientation en Chine, l'Organisation mondiale de la Santé, la Banque mondiale et le gouvernement chinois ont proposé un système de soins de santé à plusieurs niveaux selon un dispositif de soins intégrés axés sur l'être humain. Cette approche a été utilisée pour la première fois dans le district de Luohu de la ville de Shenzhen de 2015 à 2017 en tant que modèle de pratique. En septembre 2017, le ministère chinois de la Santé a appliqué à l'ensemble du pays ce dispositif de soins intégrés axés sur l'être humain. Nous décrivons les caractéristiques du modèle de Luohu par rapport aux principaux domaines d'action et aux stratégies de mise en œuvre proposées et nous résumons les données extraites d'une évaluation des deux premières années du programme. Nous examinons les difficultés rencontrées lors de la mise en œuvre et les leçons tirées de ces difficultés pour d'autres systèmes de soins de santé. Nous réfléchissons aux moyens d'améliorer la collaboration entre les institutions, de changer le comportement de la population concernant l'utilisation des services de santé des collectivités comme premier point de contact et de gérer efficacement les ressources pour éviter les déficits budgétaires. Enfin, nous décrivons les prochaines étapes à suivre dans le cadre du modèle de Luohu et son application potentielle pour renforcer les soins de santé dans d'autres systèmes urbains de soins de santé.

En la mayoría de los países, la demanda de atención integrada para las personas con enfermedades crónicas aumenta a medida que la población envejece. Esta demanda requiere un cambio fundamental de los sistemas de atención sanitaria hacia modelos de prestación de servicios más integrados. Para lograr este cambio en China, la Organización Mundial de la Salud, el Banco Mundial y el gobierno chino propusieron un sistema escalonado de prestación de servicios sanitarios de acuerdo con un modelo de atención integrada centrada en las personas. El enfoque se introdujo en el distrito de Luohu de la ciudad de Shenzhen de 2015 a 2017 como modelo para la práctica. En septiembre de 2017, el Ministerio de Salud de China introdujo este enfoque de atención integrada centrada en las personas en todo el país. Se describen las características del modelo de Luohu en relación con las áreas centrales de acción y las estrategias de implementación propuestas y se resumen los datos de una evaluación de los dos primeros años del programa. Se exponen los desafíos enfrentados durante la implementación y las lecciones aprendidas de la misma para otros sistemas de atención sanitaria. Se considera cómo mejorar la colaboración entre las instituciones, cómo cambiar el comportamiento de la población sobre el uso de los servicios sanitarios comunitarios como primer punto de contacto y cómo gestionar eficazmente los recursos para evitar déficits de presupuesto. Por último, se esbozaron los próximos pasos del modelo de Luohu y su posible aplicación para fortalecer la atención sanitaria en otros sistemas urbanos de atención sanitaria.

A study on the performance and cost-effectiveness of robots in replacing manual nucleic acid collection method: Experience from the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led nucleic acid collection and detection became a measure to ensure normal life in China. Considering the huge detection demand, it has emerged that robots replace manual sample collection. However, the cost-effectiveness of nucleic acid collection by robots instead of humans remain unknown. METHODS: This study was approved by the Ethics Committee of the Shenzhen Luohu District People's Hospital, number 2021-LHQRMYY-KYLL-031a. All participants signed the written informed consent of this study. 273 volunteers were recruited on December 1st 2021 from Shenzhen and divided into six groups: one group to be sampled by robots and the others to be sampled manually with varying specifications for swab rotation and insertion time. Questionnaires were distributed to the robot group to ask them sampling feeling. The effectiveness and safety of sampling were evaluated through the sampling efficiency, adverse events and sampling feeling of different groups. The economics of the different methods were judged by comparing the sampling cost for each. RESULTS: The sampling efficiency of the robot group was 96.9%, and there was no statistically significant difference between the other five manually sampled groups (p = 0.586). There were no serious adverse events in any of the six groups, but nasal soreness and tearing did occur in all group. Of the volunteers who underwent robotic sampling, 85.94% reported that the experience was either no different or more comfortable than the manual sampling. In economic terms, a single robot used to replace medical staff for sample collection becomes economically advantageous when the working time is ≥ 455 days. If multiple robots are used to replace twice the number of manual collections, it becomes more economical at 137 days and remains so as long as the robot is used. CONCLUSIONS: It appears safe and effective for robots to replace manual sampling method. Implementation of robotic sampling is economical and feasible, and can significantly save costs when working over a long term.

Economic evaluation of the screening for Alzheimer's disease in China.

Background: We evaluated the cost-effectiveness of the screening in mainland China for Alzheimer's disease (AD) patients aged over 60. Methods: Individuals in mainland China, received an initial screening by questionnaire on mental state, and those with scores deemed suspicious for AD were referred to diagnostic tests. A 9-state Markov model was developed to simulate the disease progression of a cohort of 100,000 subjects aging from 60 to 80. In addition, several scenarios were analyzed to assess the robustness under different screening frequency, starting age, the duration of drug effects, and the health status of subjects. Results: The ICER of AD screening was 26413.77 USD per QALY [quality-adjusted life-year (QALY)] compared with no screening. The number of deaths and severe AD cases who did not receive treatment averted by screening accounted for 0.076 and 0.006% of the total population, respectively, and the net monetary benefit was 128.29 USD per capita. Under the thresholds of one and three times the gross domestic product per capita, the probability of screening being cost-effective was approximately 18 and 77%, respectively. The ICER decreased to 18132.96USD per QALY when the drug effect was prolonged, and increased when the frequency of screening was increased, the starting age was postponed, and patients suffering from comorbidities were more. However, the number of severe AD cases and deaths declined when the screening frequency increased. Conclusion: Screening for AD in individuals over 60 can reduce the numbers of severe AD cases and deaths and may be cost-effective, depending on factors such as screening frequency, starting age of screening, and duration of drug effects. Additionally, mild cognitive impairment (MCI) is an important stage at which the burden of progression to AD may be reduced and the cost-effectiveness of screening may be improved.

Prevention and Control Measures for Imported SARS-CoV-2 Transmission During the Postpandemic Period in Shenzhen, China.

In China, most cities have gradually controlled the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and brought coronavirus disease 2019 (COVID-19) under control locally. This means that crucial work has shifted from internal management of the pandemic to external prevention and control, especially management of international travelers and imported goods. There is much uncertainty about variants of concern for SARS-CoV-2, which pose challenges to the steady resumption of social and economic life once the mutant strains begin to spread. The sporadic outbreaks of COVID-19 in different provinces of China caused by these mutant strains emphasizes the need for both prevention and control measures. Therefore, we introduce China's experience with preventing and controlling COVID-19 in the postpandemic period, which may serve as a reference in various settings.

Transition from Nurses to Medicalized Elderly Caregivers: Comparison on Willingness between Traditional and Modern Regions in China.

As China is transitioning to an aging society, the Chinese government has proposed an eldercare pattern, called medicalized elderly care, to help solve the rapid aging and health care problems together. However, the shortage of elderly caregivers is a critical issue, with deficiency both in quantity and quality. This study aims to survey nurses' willingness to transition into medicalized elderly caregivers and compare it between modern and traditional regions. Nurses working in Guangdong (modern region) and Jilin (traditional region) were investigated using a self-administered questionnaire in October 2021. We analyzed the influencing factors through χ²-test, t-test a and binary logistic regression model and further explored the influence of region using propensity score matching (PSM). A total of 1227 nurses were included, with 726 (59.2%) of them showing willingness to transition. Nurses from traditional regions showed a significantly higher willingness to transition after PSM (p = 0.027). Other factors influencing nurses' willingness were age, education, lived with older adults, participated in voluntary activities related to older adults, visited eldercare institutions, attitudes toward older adults, knowledge about older adults, hospice care attitudes and death attitudes. The willingness of nurses to transition was not high enough. To have more willing and skillful human resources for eldercare, we need a more "intimate society for older adults" in the first place.

Cost-effectiveness analysis of colonoscopy and fecal immunochemical testing for colorectal cancer screening in China.

Objective: This study aimed to evaluate the cost-effectiveness of the colorectal cancer screening in China, and that when the screening was implemented in a specific region. Methods: A 13-state Markov model was established to compare four screening protocols, including annual fecal immunochemical testing (FIT1), biennial fecal immunochemical testing (FIT2), electronic colonoscopy every 10 years (e-CSPY10), and electronic colonoscopy every 5 years (e-CSPY5), with no screening from the perspective of Chinese healthcare system. The model simulated the health states of a cohort of 100,000 average-risk individuals aging from 50 to 75. Additionally, scenarios including the implementation in a specific region, starting from 40, and incompletely successful treatment of cancer were also analyzed. Results: Annual and biennial FIT could save 8.13USD (US Dollar) and 44.96USD per person, and increase 0.0705QALYs (Quality-Adjusted Life Years) and 0.2341 QALYs compared with no screening, respectively. Annual FIT could decrease costs by 36.81USD per person and increase 0.1637 QALYs in comparison to biennial FIT. The results showed that both annual and biennial FIT for screening were dominant over no screening, and annual FIT was dominant over biennial FIT. The ICER (Incremental Cost-Effectiveness Ratio) for e-CSPY10 were 1183.51USD/QALY and 536.66USD/QALY compared with FIT1 and FIT2. The ICER for e-CSPY5 were 1158.16USD/QALY and 770.85USD/QALY compared with FIT1 and FIT2. And the ICER for e-CSPY5 relative to e-CSPY10 was 358.71USD/QALY. All the ICER values were lower than the economic threshold of 2021 Chinese GDP (Gross Domestic Product) per capita in 2021(12554.42USD). Conclusions: It is worthwhile to popularize CRC screening in mainland China, as FIT always saving costs and colonoscopy is cost-effective. Regions with high income can take electronic colonoscopy every 10 years, or even every 5 years into consideration when determining the specific strategies.

A Large-Scale Screening Responding Sporadic Epidemic of COVID-19 in China by an Integrated Health-Care System.

Introduction: In the post-pandemic period of COVID-19, the majority of cities in China try to balance the normalization of epidemic prevention and social-economic development. However, the appearance of asymptomatic infected patients poses threats to public health, which might be infectious without clinical symptoms and only be detected by testing approaches. Methods: Along with the appearance of one symptomatic case, a regional large-scale screening program was carried out in Shenzhen City charged by a regionally integrated healthcare system. After describing the screening program, a retrospective cross-sectional study for the screening outcome and efficacy was conducted. Discussion: According to the screening results, the asymptomatic case was infectious and their close contacts should be quarantined cautiously as the close contacts of symptomatic cases. Besides, after integrating medical resources in Luohu district of Shenzhen, the medical capability of Luohu district improved greatly which could be demonstrated in inspection and organization abilities in this screening program. Conclusion: The large-scale screening contributed to preventing epidemic transmission. In the post-pandemic period, regular surveillance of asymptomatic cases and rapid response capability for emergent screening program are both crucial for the prevention and control of COVID-19 epidemic. The integrated healthcare system coordinating regional medical institutions and optimizing regional medical recourse has advantages to address public health emergencies.

Integrated Healthcare Systems Response Strategies Based on the Luohu Model During the COVID-19 Epidemic in Shenzhen, China.

COVID-19 has affected primary health-care delivery in metropolitan areas. An integrated health-care system offers advantages in response to the community outbreak and transmission of highly infectious diseases. On the basis of practitioner experience with a pioneering integrated health-care system in Shenzhen, China, this article presents the following effective strategies in response to the epidemic: (1) enhance the public workforce in primary health care; (2) integrate resources to allow regional sharing and efficient use; (3) employ teams centered on general practitioners for community containment; and (4) adopt e-health and telemedicine for health-care delivery. An integrated health-care system is usually very specific to a particular regional context; however, the core strategies and mechanisms based on the Luohu model can contribute to improving the public health capacity in emergency responses; they can transform health-care delivery in the COVID-19 epidemic. The experience in Shenzhen may help other cities in enhancing and coordinating the preparedness of their health-care systems in dealing with future public health emergencies.

Detection of the level of DNMT1 based on self-assembled probe signal amplification technique in plasma.

DNA (cytosine-5)-methyltransferase1 (DNMT1) is the most abundant DNA methyltransferase in somatic cells, and it plays an important role in the initiation, occurrence, and rehabilitation of tumors. Herein, we developed a novel strategy for the detection of the level of DNMT1 in human plasma using the self-assembled nucleic acid probe signal amplification technology. In this method, the DNMT1 monoclonal antibody (McAbDNMT1) was immobilized on carboxyl magnetic beads to form immunomagnetic beads and then captured DNMT1 specifically. After that, DNMT1 polyclonal antibody (PcAbDNMT1) and biotinylated sheep anti-rabbit IgG (sheep anti rabbit IgG-Biotin) were sequentially added into the system to react with DNMT1 and form biotinylated double antibody sandwich immunomagnetic beads. In the presence of the bridging medium streptavidin, the biotinylated double antibody sandwich immunomagnetic beads would form a complex with biotinylated poly-fluorescein (Biotin-poly FAM), and the fluorescence intensity of the complex was proportional to the concentration of DNMT1. Immunomagnetic beads can capture the target DNMT1 in the sample, and Biotin-poly FAM can realize signal amplification. Using these strategies, we got a linear range of the system for DNMT1 level detection was from 2 nmol/L to 200 nmol/L, and the limit of detection (LOD) was 0.05 nmol/L. The method was successfully applied for the determination of DNMT1 in human plasma with the recovery of 101.3-106.0%. Therefore, this method has the potential for the detection of DNMT1 level in clinical diagnosis.

The Luohu Model: A Template for Integrated Urban Healthcare Systems in China.

INTRODUCTION: Emerging from the epidemiological transition and accelerated aging process, China's fragmentated healthcare systems struggle to meet the demands of the population. On Sept 1st 2017, China's National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges. In this paper, we study the integration process, analyze the core mechanisms, and conduct preliminary evaluations of integrated policy development in the Luohu model. POLICY DEVELOPMENT: The Luohu hospital group was established in Aug 2015, consists of five district hospitals, 23 community health stations and an institute of precision medicine. The group adopted a series of professional, organizational, system, functional and normative strategies for integrated care, which was provided for the residents of Luohu, especially for the elderly population and patients with chronic conditions. According to a preliminary evaluation of the past two years, the Luohu model showed improvement in the structure and process towards integrated care. New preventive programs conducted in the hospital group resulted in changes of disease incidence. Residents were more satisfied with the Luohu model. However, spending exceeded the global budget for health insurance because of short-term increases in the demand for health care. LESSONS LEARNED: First, engagement of multiple stakeholders is essential for the design and implementation of reform. Second, organizational integration is a prerequisite for integrated care in China. Third, effective care integration requires alignment with payment reforms. Fourth, normative integration could promote collaboration in an integrated healthcare system. CONCLUSION: Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges. However, it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care.

[Effect of semi-fixed Twin-block appliance on temporomandibular joint remodeling].

PURPOSE: To evaluate quantitatively the effect of semi-fixed Twin-block appliance on the temporomandibular joint remodeling during the Class II malocclusion treatment. METHODS: Twenty two Class II division 1 patients treated with semi-fixed Twin-block appliance were included. Pre- and post-orthopedic treatment cephalometric data were analyzed with SPSS13.0 software package for paired t test. RESULTS: The mandibular condylar growth was directed superiorly(2.7mm) and posteriorly (3.6mm) (P<0.01), the glenoid fossa was displaced in a inferior(1.5mm) (P<0.01) and posterior (0.8mm)(P<0.05) direction, the effective TMJ changes showed a pattern similar to condylar growth in a superior(4.2mm) and posterior(2.7mm) direction(P<0.01), the mandibular rotation was slightly clockwise(P>0.05). CONCLUSIONS: The application of semi-fixed Twin-block appliance shows its effectiveness on patients' compliance and the remodeling in temporomandibular joint, contributing to the correction of sagittal jaw relationship discrepancy.

[A comparison of rapid palatal expansion and Damon appliance on non-extraction correction of dental crowding].

PURPOSE: To compare the effect of rapid palatal expansion (RPE) and Damon technique on the correction of dental crowding with non-extraction approach. METHODS: 19 adolescent patients with non-extraction orthodontic treatment were reviewed. They had Class I skeletal pattern and moderate crowding. Nine subjects were treated with RPE followed by straight wire appliance, and 10 subjects were treated with Damon appliance only. The dental casts and cephalometric radiophotographs were measured before and after the treatment. The difference between two groups was analyzed for Student's t test with SPSS15.0 software package. RESULTS: Upper and lower inter-canine width increased 2.9mm and 1.3mm respectively in RPE group (P<0.05), while there was no significant change in Damon group. A significant posterior expansion of upper and lower arch width was noted in both RPE and Damon groups (P<0.05). The increase in upper inter-bicuspid width and lower inter-molar width was comparable in two groups. The upper inter-molar width in RPE group expanded 5.3mm, which was significantly larger than that of 3.1mm in Damon group(P<0.05). The increase in lower inter-bicuspid width in Damon group, on the other hand, was larger than that of RPE group (4.5mm vs. 1.5mm). (P<0.05) Both groups showed buccal tipping of bicuspids and molars, with more extend of bicuspid tipping in Damon group (P<0.05). The maxillary base width increased 2.1mm in RPE group, which was significantly larger than that of 0.6mm in Damon group (P<0.05). The upper and lower incisors in Damon group were tipped forward by 9.2 degrees and 7.5 degrees respectively, while the change in RPE group was not significant (P<0.05). CONCLUSION: Both RPE and Damon technique can successfully increase the arch width and correct moderate dental crowding with non-extraction approach. Damon appliance protrudes the upper and lower incisors and expands the dental arch by buccal tipping of bicuspids and molars. RPE expands the maxillary base along with the whole upper dental arch and could maintain the incisors in upright position.

[The preliminary study of the treatment timing for rapid maxillary expansion].

PURPOSE: The aim of this study was to find the treatment timing of rapid maxillary expansion by investigating the relationship among the chronologic age, dental age, skeletal age and treatment effect of rapid maxillary expansion. METHODS: A sample of thirty patients who required rapid maxillary expansion was selected. The patients ranged in age from 11 to 14 years, with the mean age being 12.30 years. Assessment of the skeletal age was made with a hand radiograph before treatment. The posteroanterior cephalograms, occlusal radiograph of the maxilla were taken at the time of pretreatment and post-treatment. Paired t test and multiple regression analysis were used for statistical analysis. RESULTS: The results showed that the effects of rapid maxillary expansion were different even though the chronologic ages were similar. A negative correlation was found between the skeletal age and the expansive effect. Regressive coefficient was -6.440, P value was 0.045. There was a significant negative correlation between the dental age and the expansive effect. The regressive coefficient was -1.289, P value was 0.000. The expansive effect was on the decrease while the second maxillary molars erupted continuously. CONCLUSION: It is proposed that rapid maxillary expansion could be used successfully before the second maxillary molars erupt. The optimal orthopedic effect could be attained.

[A clinical study of the changes of condylar position in class division 2 deep-bite patients after orthodontic treatment].

OBJECTIVE: To observe the effects of orthodontic treatment on the changes of condylar position in Class division 2 deep-bite patients. METHODS: 11 patients with Class division 2 deep-bite malocclusion were orthodontically treated, the changes of condylar position were evaluated by means of 3D-CT and Sam-diagnostic articulator. RESULTS: With the increase of inclination of upper incisors and opening bite, there were statistically significant changes of condylar longitudinal distance and condylar height in both sides, and retruded contact position-intercuspal position(RCP-ICP) discrepancy was significantly reduced. CONCLUSION: The condylar position in division 2 deep-bite patients could be orthodontically changed, moving anterior-inferiorly and approaching RCP.

[Non-extraction approach using RPE to correct Angle Class I malocclusion with moderate crowding: A cephalometric study].

PURPOSE: To study cephalometric changes in Angle Class I malocclusion with moderate crowding treated orthodontically without extraction using rapid palatal expansion (RPE). METHODS: 9 patients with Angle Class I moderate crowding were orthodontically treated with a non-extraction approach using RPE and fixed edgewise appliances.The cephalometric analysis was performed at T1(pretreatment), T2(3 months after RPE) and T3(fixed retention period after active treatment). RESULTS: Lateronasal width, maxillary width, upper and lower first molar width significantly increased after rapid expansion (T1-T2) and after active treatment (T1-T3) with the significant difference in upper first molar width between T2 and T3. Total facial height, upper anterior facial height, the inclination of palatal plane and Y axis increased significantly (T1-T2, T1-T3). There were significant differences in the inclination of mandibular plane among T1, T2 and T3. CONCLUSION: Maxillary transverse width could increase using RPE. Rapid palatal expansion might not result in the anteroposterior changes.