Inequality of opportunity in health service utilization among middle-aged and elderly community-dwelling adults in China.

BACKGROUND: The inequality caused by circumstances is known as "inequality of opportunity" (IOp). Many scholars have studied IOp in the health field, but few studies have quantified contributors to the IOp of health service utilization among middle-aged and elderly people. This study measured the IOp of health service utilization and decomposed the contributors to IOp present among Chinese middle-aged and elderly people. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018. A mean-based regression method was adopted to measure the IOp of health service utilization. Shapley-Shorrocks decomposition was used to analyze the main contributors to IOp seen among the middle-aged and elderly. RESULTS: Although the absolute IOp of health service utilization decreased over time, IOp still explains the total inequality to a large extent. The absolute IOp and relative IOp were greatest in the areas of self-treatment and inpatient care utilization, respectively. Shapley decomposition results showed that the out-of-pocket (OOP) ratio contributed most to the IOp of outpatient care utilization; and the residence area highly explains the IOp of inpatient service utilization. Meanwhile, social and economic factors such as work status and income contribute more to the IOp of inpatient care utilization than outpatient and self-treatment. CONCLUSIONS: Strategies aimed at achieving equal opportunities remain necessary to ensure the fairness of health service utilization. Policies and measures should further adjust the medical insurance compensation policies, and pay more attention to the middle-aged and elderly residents in rural areas, optimize health resource allocation, improve the social security systems, and narrow the socioeconomic gap between urban and rural areas in China.

Prevalence, antimicrobial resistance and genetic characterization of Vibrio parahaemolyticus isolated from retail aquatic products in Nanjing, China.

Vibrio parahaemolyticus, is one of the most frequently reported pathogenic microorganisms that causes foodborne illnesses worldwide. The aims of the current study were to determine the prevalence, virulence genes, antimicrobial resistance, biofilm formation ability (BFA) and genetic characterization of V. parahaemolyticus recovered from retail aquatic products in Nanjing, China. There were 131 samples (71.6%) that tested positive for V. parahaemolyticus. The thermostable direct hemolysin-related hemolysin (trh) gene was found in two isolates (1.5%). Antimicrobial susceptibility tests showed that 46.6% of isolates were multidrug resistant. High resistance was observed to ampicillin (100%), cephalosporin (99.2%), trimethoprim/sulfamethoxazole (38.2%) and tetracycline (16.0%). Ten resistance patterns were found. The crystal violet staining assay showed that 35.1% had strong BFA, and 52.7% had intermediate BFA; notably, five (3.8%) extremely strong BFA strains were obtained from wet markets. According to whole genome sequencing analysis of 59 randomly selected isolates, 46 sequence types (STs) were identified, including 22 novel STs, and ST1042 was the dominant sequence type. It is clear that the V. parahaemolyticus population exhibits a high level of genetic variation. Our findings provide comprehensive insight into the prevalence and phylogenetic relationship of V. parahaemolyticus in aquatic products, suggesting potential hazards to consumers in Nanjing.

Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey.

Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. However, few studies have analyzed the concentration or persistence of medical expenses among Chinese residents or vulnerable groups with longitudinal survey data. Based on the data of CHARLS (China Health and Retirement Longitudinal Study), this study sought to identify characteristics associated with the concentration and persistence of medical expenses among Chinese middle-aged and elderly adults and to help alleviate medical spending and the operational risk of social medical insurance. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling. The results show that total medical expenses were concentrated among a few adults and the concentration increased over time. People in the high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. Lagged medical expenses had a persistent positive effect on current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Policy efforts should focus on preventive management, more efficient care systems, improvement of serious illness insurance level, and strengthening the persistent protection effect of social medical insurance to reduce the high medical financial risk and long-term financial healthcare burden in China.

Multiplex and on-site PCR detection of swine diseases based on the microfluidic chip system.

BACKGROUND: At present, the process of inspection and quarantine starts with sampling at the customs port, continues with transporting the samples to the central laboratory for inspection experiments, and ends with the inspected results being fed back to the port. This process had the risks of degradation of biological samples and generation of pathogenic microorganisms and did not meet the rapid on-site detection demand because it took a rather long time. Therefore, it is urgently needed to develop a rapid and high-throughput detection assay of pathogenic microorganisms at the customs port. The aim of this study was to develop a microfluidic chip to rapidly detect swine pathogenic microorganisms with high-throughput and higher accuracy. Moreover, this chip will decrease the risk of spreading infection during transportation. RESULTS: A series of experiments were performed to establish a microfluidic chip. The resulting data showed that the positive nucleic acid of four swine viruses were detected by using a portable and rapid microfluidic PCR system, which could achieve a on-site real-time quantitative PCR detection. Furthermore, the detection results of eight clinical samples were obtained within an hour. The lowest concentration that amplified of this microfluidic PCR detection system was as low as 1 copies/µL. The results showed that the high specificity of this chip system in disease detection played an important role in customs inspection and quarantine during customs clearance. CONCLUSION: The microfluidic PCR detection system established in this study could meet the requirement for rapid detection of samples at the customs port. This chip could avoid the risky process of transporting the samples from the sampling site to the testing lab, and drastically reduce the inspection cycle. Moreover, it would enable parallel inspections on one chip, which greatly raised the efficiency of inspection.

Rapid and accurate detection of Escherichia coli O157:H7 in beef using microfluidic wax-printed paper-based ELISA.

Escherichia coli O157:H7 is a severe foodborne pathogen that causes lots of life-threatening diseases. In the search for a rapid, sensitive, portable and low-cost method to detect this pathogen, we developed a wax-printed paper-based enzyme-linked immunosorbent assay (P-ELISA) based on microfluidic paper-based analytical devices (µPADs), with the whole operation time being less than 3 h and only needing 5 µl samples for detection. The limit of detection (LOD) of E. coli O157:H7 reached 104 CFU ml-1, which is an order of magnitude higher than that of conventional ELISA (C-ELISA). The LOD in artificially contaminated beef samples is 1 CFU per 25 g after enriching the culture for 8 h. This method is superior to the molecular biology method in detection sensitivity and superior to C-ELISA and the national standard method in detection time and cost. Thus, the established P-ELISA method has good sensitivity, specificity and repeatability. It can be suitable for point-of-care testing without expensive and bulky instruments and can also provide a platform for detecting other pathogens, especially in areas that lack advanced clinical equipment.

Selected microRNA-192 mutant indicates association with several function genes in bovine cells.

MicroRNAs are implicated in many cellular processes such as cell differentiation and development, tumorigenesis, and immune regulation. In this study, miR192 was detected using quantitative real-time polymerase chain reaction (qRT-PCR) when MDBK cells were exposed to Escherichia coli. Cells with malfunction of bta-miR-192 were established using transcription activator-like effector nuclease (TALEN) technology. Finally, bta-miR-192 mutant cells were screened for differentially expressed genes using RNA-sequencing (RNA-seq). The results showed that miR192 significantly decreased in cells exposed to E. coli F18ac and E. coli K88ac. The RNA-seq results showed that 1673 differentially expressed transcripts were identified; 890 genes were upregulated and 775 genes were downregulated. With the gene ontology enrichment analysis, 431 differentially expressed genes (DEGs) were classified into 937 gene ontology terms. The pathway enrichment analysis showed that 535 genes were involved in 254 pathway terms. Interestingly, most of these DEGs were associated with the pathways in cancers or infectious diseases. When the selected DEGs (n = 162) in these pathways were intersected with 120 differential transcripts, 11 DEGs were identified. Subsequently, several genes associated with regulation, cancers, or viral infections, such as LEF1, AXIN2, MX1, and FCGR2B, were identified among the DEGs using functional analysis. Furthermore, associations between bta-miR-192 and DEGs were detected by intersecting the bta-miR-192's target genes with the DEGs, indicating that three genes including CBL, DICER1 and TRERF1 were involved in this relationship. These findings provided useful guidance for investigating the role played by bta-miR-192 in cellular functionality in bovine cells.

Phenotypic Characters and Molecular Epidemiology of Campylobacter Jejuni in East China.

In this study, we investigated the distribution, phenotypic and molecular typing characters of Campylobacter jejuni in domestic fowl, and livestock populations in East China, to provide some reference for researches on its molecular epidemiology. A total of 1250 samples were collected from different animal sources, and C. jejuni strains were then isolated and tested for antibiotic sensitivity. Antibiotics-resistance gene and pathogenic genes were detected by polymerase chain reaction. Phylogenic analysis on the C. jejuni strains was performed by multilocus sequence typing (MLST) method. The results showed that 108 out of the 1250 samples (mean 8.64%) were C. jejuni positive. These 108 C. jejuni strains were highly sensitive to antibiotics such as chloramphenicol, amoxicillin, amikacin, cefotaxime, and azithromycin, whereas they were highly resistant to antibiotics such as cefoperazone, cotrimoxazole, cefamandole, sulfamethoxazole, and cefradine. Pathogenicity related gene identification indicated that the mean carrying rate of adhesion related gene cadF and racR, flagellin gene flaA, toxin regulating gene cdtA, cdtB, cdtC, wlaN and virB11, heat shock proteins and transferring proteins related genes dnaJ and ceuE, CiaB and pldA were 92.45%, 38.69%, 73.58%, 71.70%, 52.83%, 96.23%, 12.26%, 1.89%, 0.94%, 65.09%, 39.62% and 9.43%, respectively. A total of 58.82% of these strains contained more than 6 pathogenicity-related genes. MLST typed 58 ST types from the 108 isolated C. jejuni strains, including 24 new types, and ST-21 was the major type, accounting for 39.3% of the total strains.

Oxalate-degrading capacities of lactic acid bacteria in canine feces.

In this study, lactic acid bacteria in canine feces were isolated and identified, and their oxalate-degrading capacities were evaluated. The oxalate-degrading capacities were determined for 24 of 47 (51.06%) lactic acid bacteria isolates. Of these, 8 isolates [Leuconostoc mesenteroides (RL75), Lactococcus garvieae (CD2), Lactococcus subsp. lactis (CS21), Enterococcus faecium (CL71 and CL72), and Enterococcus faecalis (CD14, CS62, and CD12)] degraded more than 5% of the oxalate present, while the others degraded less than 5% of the oxalate in vitro. Isolates that degraded more than 5% of the oxalate present were selected for further examination. The oxalate-degrading capacities of individual isolates, a mixture of Enterococcus, a mixture of Lactococcus, and a mixture of the eight isolates were evaluated in media containing different concentrations of glucose (sufficient, insufficient, or no glucose). In comparison with the control medium, all of the individual isolates and mixtures of isolates could degrade oxalate in all three groups (P<0.05). In most cases, the isolates growing in medium with 20 g/L of glucose had higher oxalate-degrading capacities than those growing in medium with 2.5 g/L of glucose or no glucose. The mixture of all isolates showed higher oxalate-degrading capacity than the individual isolates and other mixtures. The oxalate-degrading capacities of the isolates were isolate dependent.

[Rapid detection of salmonella in food by using fluorescently labeled phage O-I].

OBJECTIVE: To develop a rapid detection method for Salmonella in food by using specific Salmonella-phage O-I. METHODS: One hundred bacteria strains and 120 food sample isolates were infected using fluorescently labeled O-I phage genome with SYBR gold stain (a nucleic acid dye, 1 x working solution), then were observed under epi-fluorescence microscopy. The sensitivity of the method was tested. RESULTS: Among the 100 strains infected with O-I/SYBR gold stain, 40 Salmonella strains exhibited rod fluorescence. Other bacteria including 10 Proteus, 20 Shigella, 20 E. coli and 10 Staphylococcus did not exhibit this feature The sensitivity of detecting Salmonella was 10 CFU/100 microL. The detection for 120 food samples by using the O-I/SYBR gold stain had similar results to those by using the biochemical method. CONCLUSION: Fluorescent-labeled O-I phage could rapidly, sensitively and specifically detect Salmonella species in food samples.

Application of real-time PCR for quantitative detection of Vibrio parahaemolyticus from seafood in eastern China.

Vibrio parahaemolyticus is recognized as a leading human food-borne pathogen. A TaqMan PCR assay based on the gyrase B gene (gyrB) sequence of V. parahaemolyticus was developed for quantitative detection of V. parahaemolyticus in seafood. The study involving 27 V. parahaemolyticus and 10 strains of other species indicated that the real-time PCR test was highly specific. The sensitivity of the assay was approximately a single CFU per PCR in pure culture and six to eight CFU per PCR in spiked raw oyster, respectively. Real-time PCR values of artificially inoculated oyster homogenates correlated well with plate counts determined using culture methods. A total of 300 seafood samples were analyzed and 78 (26%) of these samples were positive for V. parahaemolyticus using a conventional culture method and 97 (32.3%) using the real-time PCR assay. All culture-positive samples were PCR-positive. However, 19 samples positive by PCR were culture-negative. The results show that retail seafood is commonly contaminated with V. parahaemolyticus in harvest season in eastern China. These data also indicate that real-time PCR can provide sensitive species-specific detection and quantification of V. parahaemolyticus in seafood without prior isolation and characterization of the bacteria by traditional microbiological methods.

[Quantitative detection of Vibrio parahaemolyticus by real-time TaqMan PCR].

Vibrio parahaemolyticus is one of important human food pathogens. Traditional diagnostic tests for V. parahaemolyticus are laborious and always present false negative results. Therefore, it is important to develop a nucleic acid-based test for quantitative detection of V. parahaemolyticus. A TaqMan PCR assay was presented for quantitative detection of V. parahaemolyticus in pure cultures and oysters. The primers and probe were designed according to the gyrase B gene (gyrB) sequence of V. parahaemolyticus strains. Amplification of DNAs from 12 bacterial strains comprising 9 genera showed that all of the strains of V. parahaemolyticus tested (n = 4) were positive and all other species of strains tested (n = 8) were negative. The results of the TaqMan PCR with raw oysters inoculated with V. parahaemolyticus were comparable to those of pure cultures. The sensitivity of the assay was 1 CFU PCR Mixture(-1) and 10 CFU PCR Mixture(-1) in pure culture and inoculated raw oyster, respectively. The correlation rate was 0.99 (gamma2 = 0.99). The assay could be completed within 1h. The Real-time PCR can be used as a rapid screening tool for the presence of V. parahaemolyticus in seafood without prior isolation and characterization of the bacteria by traditional microbiological methods.