[Understanding the behavioural and social drivers of vaccine uptake: introduction and implications of World Health Organization Position Paper, 2022].

On May 20, 2022, World Health Organization (WHO) Position Paper on Understanding the Behavioural and Social Drivers of Vaccine Uptake (BeSD) was published. This review introduced the BeSD toolkit, interventions to increase vaccine uptake, and offered WHO's position and recommendation. Based on immunization practice, this position paper had some implications for improving the vaccination coverage in China: (1) To promote the BeSD toolkit localization; (2) To integrate the measurement and monitoring of BeSD into multisectoral routine efforts; (3) To enhance the diversity and professionalization of immunization practitioners; (4) To design and carry out implementation research scientifically.

[Progress in research of safety, efficiency and vaccination status of influenza vaccine in populations at high risk].

This paper reviews the domestic and foreign studies published in 2020 on the application of influenza vaccine in populations at high risk. The importance of influenza vaccination in population at high risk has been proved by larger sample, multicentre, high-quality evidence-based studies. Influenza vaccination is the most cost-effective measure to prevent influenza. However, the coverage rate of influenza vaccine is very low in China, it is necessary to strengthen the health education to promote influenza vaccination in different populations. It is recommended to give influenza vaccination to the population in whom influenza vaccination has been proven safe and effective before influenza season. Research of the safety, efficiency and cost-effectiveness of influenza vaccine should be accelerated for the populations in whom such data are lacking or insufficient.

[Financing strategies and cost estimates of influenza vaccination for the elderly in China: explore a multi-party co-payment mechanism].

The disease burden and economic burden of seasonal influenza is substantial in China, and the Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges to the prevention and control of influenza. As a priority group of influenza vaccination, the elderly are at higher risk of influenza-associated severe symptoms and deaths, and they are more price-sensitive vaccine users with better cost-effectiveness of vaccination program. Therefore, a reasonable financing mechanism of influenza vaccination should be designed for the elderly to increase their vaccination rate. This study proposes three financing strategies of influenza vaccination for the elderly in China, trying to explore the distribution of vaccination costs among individuals, central government and local governments under different financing strategies, including the individual-central-local mechanism (strategy 1), the central-local mechanism (strategy 2), and the local payment mechanism (strategy 3). Strategy 1 is feasible and sustainable for most regions in the short term. Strategy 2 is conducive to further increasing the vaccine coverage rate of the elderly. Strategy 3 encourages local fiscal payments to help relieve the financial pressure of the central government. The results revealed a relatively heavy financial burden of influenza vaccination for the elderly, and it is recommended to promote the development of a multiparty co-payment mechanism gradually based on local conditions.

[Cost-effective analysis of seasonal influenza vaccine in elderly Chinese population].

Objective: To evaluate the cost-effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. Methods: A static life-time Markov model is conducted to simulate the Chinese elderly population aged ≥60 years old. Taking the health care system perspective, one-year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality-adjusted life year (QALY) (193 932/QALY), the incremental cost-effectiveness ratio (ICER) was calculated to compare the cost-effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. Results: The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Conclusion: Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost-effective compared to no vaccination in elderly Chinese population.

[Cost-effectiveness of potential government fully-funded influenza vaccination in population with diabetes in China].

Objective: To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country. Methods: From the societal perspective, a decision tree model was developed to compare outcomes (including impact on the influenza-related outpatient consultation, hospitalization and excess mortality, and quality-adjusted life years (QALY), as well as incremental cost-effectiveness ratio (ICER)) of a national fully-funded vaccination programme in the population with diabetes and status quo (i.e., vaccinated with out-of-pocket payment, with a uptake rate of zero), using the published data with regarding to influenza related ILI (influenza-like illness) consultation rate, hospitalization rate and excess mortality rate, health-related quality of life and economic burden, diabetes prevalence, population size, health seeking behaviour, vaccine uptake rate, vaccine efficacy/effectiveness, etc. A time horizon of 1 year was used in the present analysis, and all costs were expressed in CNY in 2016 using the consumer price index. All results are presented in M (P(25), P(75)). Results: In the scenario of 40% vaccination coverage in the population with diabetes, government fully-funded vaccination programme was estimated to cost 1.71 (1.67, 1.75) billions CNY, and expected to prevent 110 000 (81 000, 143 000) influenza-related ILI consultations, 36 000 (28 000, 44 000) influenza-related SARI hospitalizations and 12 000 (9 000, 16 000) influenza-related deaths due to respiratory and cardiovascular diseases. A total of 108 000 (82 000, 142 000) QALY were estimated to be gained. The ICER was 10 088 (7 365, 14 046) CNY per QALY gained. The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1% at a threshold of 53 680 CNY per QALY gained (GDP per capita in 2016). Conclusion: Government fully-funded influenza vaccination in population with diabetes is cost-effective, and thus is recommended as the key strategy of diabetes prevention and control.

[A systematic review of the economic burden of influenza in China].

Objectives: To understand the status of studies about influenza economic burden in mainland China and summarize their major results. Methods: The words of influenza, flu, cost, economic, burden, effectiveness, benefit, utility, China, and Chinese, were used as search keywords. Journal papers published during 2000-2018 were searched from Chinese electronic databases (CNKI and Wanfang) and English electronic databases (PubMed, Web of science, EconLit and Cochrane Library). The language of literature was restricted to Chinese and English. A total of 23 effective documents were included, and the descriptive characteristics, research indexes and methods included in the literature were analyzed. The monetary unit used in this review is Chinese Yuan (CNY). Results: The 23 study sites were mainly in the relatively developed and populous regions. The total cost per capita of laboratory-confirmed influenza,of all age-group was reported in 6 literatures, and only 4 literatures reported it in out-patients (range: 768.0-999.9 CNY), Only one study reported this indicator in inpatients (9 832.0 CNY). One literature reported the total cost per capita of influenza-like illness,, which was 205.1 CNY. And one literature reported that the direct medical cost of inpatients per capita in children under 5 years of age was 6 072.0 CNY while two literature reported this index for the elderly over 60 years of age, ranging from 14 250.0 to 19 349.1 CNY. Four articles reported the economic burden of influenza in urban and rural areas, one of which showed that the related expenses of urban influenza inpatients accounted for 31% of the average annual income, while which for the rural flow was 113%. Conclusion: The average economic burden of lab-confirmed influenza case is higher than that of influenza-like illness, and there are differences in outpatient indirect expenses and inpatients direct medical expenses. The direct medical burden for the hospitalized 60-years-and-beyond influenza case group is heavier thar other age group. By region, the influenza associated individual economic burden in rural area is higher than that of urban area..

A forced-choice preferential looking task for the assessment of vision in dogs: pilot study.

OBJECTIVES: To describe preliminary use of a forced-choice preferential looking task for the clinical assessment of vision in dogs. MATERIALS AND METHODS: The vision of 18 pet dogs was investigated in two separate studies using a forced-choice preferential looking task: multiple observers watched eye, head and body movements on video recordings to identify cues suggesting when a dog had seen the feature of interest. Human observer reliability was determined using eight dogs and computer-generated stimuli. Visual acuity was assessed using computer-generated grating stimuli: in real-time, an observer watched each dog's eye movement patterns and behaviour to decide whether each grating was seen. Stimuli were presented in a step-wise manner and were controlled by the observer. Acuity was estimated as the highest spatial frequency the dog was determined to have seen. RESULTS: Median estimated visual acuity was better at 1 m compared to that at 3 m. Average test time was longer at a 3-m distance than at 1 m. Inter- and intra-observer reliability was better from 1 m than from 3 m. CLINICAL SIGNIFICANCE: Preliminary use of a forced-choice preferential looking task for measurement of visual acuity in dogs has potential use as a clinical tool for the assessment of vision in dogs.

[Current situation and related policies on the implementation and promotion of influenza vaccination, in China].

Influenza can be prevented through annual appropriate vaccination against the virus concerned. In China, influenza vaccine is categorized as "Class Ⅱ" infectious diseases which the cost is paid out of the user's pockets. The annual coverage of influenza vaccination had been 2%-3%. The main reasons for the low coverage would include the following factors: lacking awareness on both the disease and vaccine, poor accessibility of vaccination service, and the cost of vaccination. To reduce the health and economic burden associated with influenza, comprehensive policies should be improved, targeting the coverage of seasonal influenza vaccination. These items would include: ① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups, as young children, elderly, people with underlying medical conditions; ② to ameliorate equality of vaccination services; ③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines; ④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines, pathway and consensus of experts; ⑤ to provide more convenient, accessible and normative vaccination service system; ⑥ to strengthen research and development as well as marketing on novel influenza vaccines; ⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women, stated in the Chinese Pharmacopoeia.

Tea consumption and physical function in older adults: a cross-sectional study.

BACKGROUND: Tea consumption has been reported to be associated with lowered risk of cardiovascular disease, stroke and osteoporosis that cause functional disability, but its association with physical function has not been investigated directly. OBJECTIVE: We examined the association between tea consumption and performance in gait and balance, instrumental and basic activities of daily living (IADL and BADL) in a cross-sectional study of community-living older persons. METHOD: Baseline data of 2398 adults aged ≥ 55 years in the Singapore Longitudinal Ageing Studies who completed self-reported current tea consumption, Performance Oriented Mobility Assessment (POMA) of gait and balance, and self reports of BADL and IADL were analyzed. RESULTS: In multivariate analyses controlling for age, gender, education, housing type, co-morbidities, hospitalization, arthritis and hip fracture, GDS depression score, MMSE cognitive score, body mass index, creatinine, serum albumin, haemoglobin, physical activities score and coffee consumption, tea consumption was positively associated with better balance (ß=0.06, p<0.01), gait (ß=0.01, p=0.02), IADL (ß=0.03, p=0.01) and BADL (ß=0.01, p=0.05). Strongly positive associations were observed for black/oolong tea in multivariate analyses, and for green tea consumption only in univariate analysis, whereas coffee consumption was not associated at all. CONCLUSIONS: Tea consumption was associated with better physical functional performances in community-living older adults.

Diagnostic performance of the Chinese Frontal Assessment Battery in early cognitive impairment in an Asian population.

BACKGROUND: The Frontal Assessment Battery (FAB) has been shown to be useful in evaluating frontal dysfunction. There is a paucity of studies validating cutoffs in the early cognitive impairment. We aim to validate the Chinese FAB in Asian subjects with mild cognitive impairment (MCI) and early dementia. METHODS: Eighty subjects with MCI and mild dementia and 100 cognitively healthy community subjects were studied. ROC analysis was done to determine the Chinese FAB's optimal cutoff scores for age- and education-adjusted subgroups. RESULTS: Chinese FAB scores were significantly lower in early cognitive impairment compared with cognitively normal controls. The optimal cutoff score was 12/13 (sensitivity 92%, specificity 78.7%). A similar cutoff score was obtained following age-adjustment and for subjects with <6 years' education. Of note, the optimal cutoff for subjects with ≥6 years' education was 13/14 (sensitivity 91.8%, specificity 70.3%), an improved diagnostic performance compared to the earlier reported 11/12 cutoff. In comparison, the Mini-Mental Status Examination (MMSE) had lower rule-out accuracy (77% sensitivity, 91.2% specificity). The combination of the Chinese FAB and MMSE was superior to either test in isolation. CONCLUSION: The education-adjusted Chinese FAB has good diagnostic performance, which can supplement the MMSE in early cognitive impairment evaluation with construct differences observed between the Chinese FAB and MMSE.

The mobile hospital--an experimental telemedicine system for the early detection of disease.

To detect early disease, especially lung disease, we created a new telemedicine system, called the Mobile Hospital. It consists of a satellite or ground communication system using a large vehicle in which is installed a whole-body spiral computerized tomography scanner and a multimedia telecommunications system. The Mobile Hospital goes to small villages and carries out mass screening for early lung disease, especially lung cancer. It travelled over 8000 km from May 1996 to March 1997. In this period 6358 persons aged 50-85 years and younger heavy smokers were screened in the Matsumoto area. As a result, 37.7% of the subjects were suspected of having various latent lung diseases. The cost of medical treatment for the lung cancers detected by the Mobile Hospital was 44% of that for a conventional medical care group, and the length of hospital treatment with surgical operation was 30% of that of the conventional group.

Changes in China's fertility rate in the 1980s and an analysis of the related social and economic factors.

PIP: In the 1980s, the government reform policy exerted a profound impact on Chinese society and the economy, including the fertility rate. A sample survey of two thousandths of the total population was conducted in mid-1988. Social and economic factors were investigated primarily using the total fertility rate (TFR). The new Marriage Act was adopted in 1988 setting marriage age at 20; previously, early marriage and childbearing before age 18 had occurred often. Early marriage had declined from 47.89% in 1970 to 12.53% in 1979. In rural areas more than half of marriages were early marriages, dropping to 16.90% by 1979 and increasing to 25% in 1987. Consequently, the cumulative fertility rate in the 15-20 age group rose 88% from 1980 to 1988. Mature-age marriage, at age 23 or older, became more common both in urban and rural areas, with a 80.0% and 42.26% rate, respectively, in 1979. However, by 1987 it declined to 66.84% and 20.71%, respectively. The age at first childbearing had grown to 24.45 in 1980 (23.89 in rural areas); however, it was reversed to 23.04 in 1987 (22.56 in rural areas). The cumulative fertility in the 15-24 age group shot up between 1980 and 1987. THe cumulative fertility rate in terms of TFR in this group grew from 35.21% in 1980 to 47.74% in 1987. Single-child cumulative fertility rates in the age groups of 15-19 and 20-24 had declined to below 1 in the late 1970s and 1980, but these were merely postponed childbearing. In 1987 many rural women began to have their second child. Multiple births in rural areas declined from 59.80% in 1970 to 20.86% in 1987, while total number of births increased 41.78% in 1987. In urban areas the TFR was 1.98 after 1974 and declined to 1.24 in 1980 and then rose to 1.36, a little below the planned TFR of 1.25. In rural areas, low per capita income and its irrational distribution favor less educated people, while transformation into the household-based economy requires child labor, factors which have impeded the family planning program.^ieng

A survey on the costs in the upbringing of new labor forces.

PIP: The authors analyze human capital investment, with a focus on the cost of raising a child to age 16 in China. Results indicate that investment in children increases with family income, parents' educational level, and smaller family size.^ieng

A comparative study of the modes of transference of surplus labor in China's countryside.

PIP: The problems posed by the recent development of a surplus labor force in rural areas of China are examined. Separate consideration is given to ways to absorb this surplus both within and outside the agricultural sector, agricultural labor migration to other rural areas, and rural-urban migration. The implications for urbanization and migration policy are reviewed.^ieng

[Survey and analysis of family planning work at Xindian Brigade].

PIP: Through personal interviews, it was found that the success of family planning at Xindan Brigade can be attributed in part to the Brigade party's contribution to family planning education, with the party members acting as family planning models. Moreover, economic objectives are used to secure the results desired. Devoted members are recruited to promote family planning, while economic rewards and restrictions reinforce planning goals. Family planning work in the village of Sung Chuang was reasserted in late 1983 with party leaders acting as family planning models. The results were significant and in 1984, 18 out of 24 brigades fulfilled projected goals by 100% with the average for the entire Sung Chung village being 98.5%. A single-child family rate was obtained in 12 brigades with the average rate in the village for single-child families being 95.9% overall. It is thought that the role of agricultural production must be correctly analyzed and family planning modified to adjust to the "new" type of farming village. Furthermore, a long-lasting contradiction must be forseen between the viewpoints of these 2 sectors of society (i.e., agricultural and political). The policy of the party will be to implement the program and to correctly handle any objections or problems that may arise. Finally, collective management methods must be adopted by the authorities in order to effectively control population growth, especially that seen in the farming village.^ieng