Development and validation of a Chinese outpatient satisfaction questionnaire: evidence from 46 public general hospitals and 5151 outpatients.

OBJECTIVE: To develop and test a reliable and practical self-administrated questionnaire in Chinese to evaluate outpatient satisfaction in China. DESIGN: In order to ensure content validity, the 19 items of this questionnaire were generated based on literature review, interview and group discussion. Acceptability was tested by the percentage of missing item responses and the time and operability of administration. Construct validity was evaluated using principal component exploratory factor analysis and item-total correlations. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient and inter-subscale correlation. SETTING: This study was conducted in 46 public general hospitals that report directly to the Provincial Health Department in Hunan Province, China. SUBJECTS: In total, 5151 outpatients were selected at random and asked to complete the questionnaire after they finished their medical procedures in the outpatient area. RESULTS: The extremely low rate of missing data (0-0.04%) suggested good acceptability of the questionnaire. Factor analysis generated six dimensions, and all item-total coefficients were >0.8. Cronbach's alpha exceeded 0.7 for all dimensions, and the inter-subscale correlation coefficients were all lower than the Cronbach's alpha coefficients of the corresponding scale. According to the results, outpatients were least satisfied with waiting time (86.8%) and most satisfied with the quality of medical care (90.1%). CONCLUSION: The Chinese outpatient satisfaction questionnaire has good acceptability, validity and reliability. It was effective and efficient for measuring outpatient satisfaction in a Chinese population.

Maternal and paternal factors associated with congenital syphilis in Shenzhen, China: a prospective cohort study.

Maternal and paternal factors create considerable obstacles to the elimination of congenital syphilis (CS). A clear understanding of maternal and paternal factors is important in order to define interventions in every community. This study aimed to investigate the maternal and paternal factors associated with CS. A prospective cohort study was conducted from April 25, 2007 to October 31, 2012 at the Shenzhen Center for Chronic Disease Control and Prevention (SCCDC) in China. We screened 279,334 pregnant women and identified 838 women with syphilis. Finally, a total of 360 women with syphilis were included for analysis. At the end of follow-up, 34 infants [9.4 %, 95 % confidence interval (CI): 6.8-12.9 %] were diagnosed with CS. Following adjustment for confounders, maternal history of syphilis [adjusted risk ratio (aRR) = 0.21], prenatal care (aRR = 0.12), and complete treatment (aRR = 0.22) reduced the risk of infants being infected. Every two-fold increase of titer of non-treponemal antibodies (aRR = 1.88), early stage of syphilis (aRR = 9.59), a shorter length of time between the end of the first treatment to childbirth (aRR = 5.39), and every week of delay in treatment (aRR = 2.25) for maternal syphilis as well as paternal history of cocaine use (aRR = 6.28) and positive (aRR = 3.30) or unknown (aRR = 2.79) status of syphilis increased the risk of infants being infected. CS also increased the risk (aRR = 8.02) of neonatal death. Maternal and paternal factors constituted two separate profiles associated with CS. To become more effective, future strategies for the prevention of CS should be targeted to each profile.

Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China.

The purpose of this investigation was to assess the effectiveness of an intervention program on mother-to-child transmission (MTCT) of syphilis and investigate determinants of congenital syphilis (CS) and adverse pregnancy outcomes (APOs). The Shenzhen local government initiated an intervention program of MTCT of syphilis in 2001. Based on this program, maternal and paternal factors associated with CS and APOs among syphilitic women were investigated from 2007 to 2012 by a prospective cohort study. From 2002 to 2012, 2,441,237 pregnant women were screened and screening coverage reached 97.2 % in 2012. In the background of continuing growth of CS in China, CS in Shenzhen significantly decreased from 109.3 cases in 2002 to 9.9 cases in 2012 per 100,000 live births. Maternal education (adjusted odds ratio [aOR]CS = 0.65; aORAPOs = 0.79) and history of syphilis (aORCS = 0.28; aORAPOs = 0.61), as well as paternal age (aORCS = 0.62; aORAPOs = 0.86) and education (aORCS = 0.66; aORAPOs = 0.86) were negatively associated with CS and APOs, but maternal unmarried status (aORCS = 1.95; aORAPOs = 2.61), inadequate antenatal care (ANC) (aORCS = 3.61; aORAPOs = 1.79), more sexual partners (aORCS = 1.51; aORAPOs = 1.39), every week of delay in treatment (aORCS = 2.82; aORAPOs = 1.27), higher baseline titers of nontreponemal antibodies (aORCS = 5.65; aORAPOs = 1.47), early syphilis (aORCS = 23.24; aORAPOs = 26.95), and non-penicillin treatment (aORCS = 3.00; aORAPOs = 2.16), as well as paternal history of cocaine use (aORCS = 2.70; aORAPOs = 2.44) and positive (aORCS = 4.14; aORAPOs = 1.50) or unknown (aORCS = 2.37; aORAPOs = 2.06) status of syphilis increased the risk of CS and APOs. Condom use (aOR = 0.70) decreased MTCT of syphilis. A ten-year program consisting of screening and treatment, early ANC, health education, partners tracking, detection, and treatment, follow-up visits, and information management is an effective means to block MTCT of syphilis. Maternal and paternal factors constituted two separate profiles associated with MTCT of syphilis.

Development and evaluation of loop-mediated isothermal amplification (LAMP) for rapid detection of Clonorchis sinensis from its first intermediate hosts, freshwater snails.

Clonorchiasis, caused by Clonorchis sinensis, is a key foodborne zoonosis, which is mainly found in China, Korea and Vietnam. Detection of this parasite from the second intermediate host, the freshwater fish is the common method for epidemiological surveys of this parasite, but is time consuming, labour intensive and easily leads to misdiagnosis. In this study, we have developed a rapid, sensitive and reliable molecular method for the diagnosis of C. sinensis from its first intermediate hosts, freshwater snails, based on a loop-mediated isothermal amplification (LAMP) method. The specific amplified fragment from genomic DNA of C. sinensis did not cross-react with those from other relevant trematodes and a range of hosts (freshwater fish, shrimps and snails) of C. sinensis living in similar environments. The detection limit of the LAMP method was as low as 10 fg which was 1000 times more sensitive than conventional PCR, which was also demonstrated by successful application to field samples. These results show that the LAMP method is a more sensitive tool than conventional PCR for the detection of C. sinensis infection in the first intermediate hosts and, due to a simpler protocol, is an ideal molecular method for field-based epidemiological surveys of this parasite.

Toxoplasma gondii infection in pregnant women in China.

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasitic infections in humans. Primary infection in pregnant women can be transmitted to the fetus leading to miscarriage or congenital toxoplasmosis. Carefully designed nationwide seroprevalence surveys and case-control studies of risk factors conducted primarily in Europe and America, have shaped our view of the global status of maternal and congenital infection, directing approaches to disease prevention. However, despite encompassing 1 in 5 of the world's population, information is limited on the status of toxoplasmosis in China, partly due to the linguistic inaccessibility of the Chinese literature to the global scientific community. By selection and analysis of studies and data, reported within the last 2 decades in China, this review summarizes and renders accessible a large body of Chinese and other literature and aims to estimate the seroprevalence in Chinese pregnant women. It also reviews the prevalence trends, risk factors, and clinical manifestations. The key findings are (1) the majority of studies show that the overall seroprevalence in Chinese pregnant women is less than 10%, considerably lower than a recently published global analysis; and (2) the few available appropriate studies on maternal acute infection suggested an incidence of 0·3% which is broadly comparable to studies from other countries.

Parasitic diseases of cultured marine finfishes and their surveillance in China.

More than 40 species of marine fishes are cultured in China and a wide variety of parasites are reported as lethal pathogens of these fishes in culture conditions. In the case of net cages, the culture facilities provides a good substrate for monogenean eggs to become entangled and the intensive aggregation of fishes facilitates the transmission of parasites between hosts. Relatively thorough studies on parasitic pathogens of marine fishes in China predominately concern the ciliate Cryptocaryon irritans and capsalid monogeneans (mainly Benedenia sp. and Neobenedenia sp.). Although nearly all such reports are related to treatment procedures, no single method has proved to be adequate for the effective control of these parasitic pathogens in marine cultured fishes. The National Fisheries Technology Extension Center (NFTEC) has established surveillance systems to monitor the diseases of aquaculture, including the parasitic diseases of maricultured fishes. The national monitoring stations for diseases of cultured marine fishes are distributed in the coastal counties or cities and provide remote in situ diagnoses of diseased fishes. International cooperation and effort are required for the control of parasitic diseases of marine finfish because of both the increasing international trade of eggs (seed) and larvae and commercial products in terms of live marine finfishes, which can readily result in the transmission of pathogens.

Genetic analyses of Chinese isolates of Toxoplasma gondii reveal a new genotype with high virulence to murine hosts.

A great deal of evidence demonstrates that a strongly clonal population structure of Toxoplasma gondii strains exists in humans and animals in North America and Europe, while the strains from South America are genetically separate and more diverse. Potential differences in virulence between different strains mean that an understanding of strain diversity is important to human and animal health. However, to date, only one predominant genotype, ToxoDB#9 (Chinese I), and a few other genotypes, including ToxoDB#205, have been identified in China. By using DNA sequence-based phylogenetic analyses, we have re-evaluated the population structure of T. gondii strains collected from China and compared them with other global strains. Based on phylogenetic analysis of restriction fragment length polymorphisms, multilocus sequence typing and intron sequences from T. gondii, we propose that the Chinese isolates described as Chinese I are divided into two groups called Chinese I and Chinese III. Our results demonstrate that significant differences were found in mouse mortality caused by some Chinese strains, and also the archetypal I, II, III strains in mice. Furthermore, a comparison of cyst loading in the brains of infected rats showed some Chinese strains to be capable of a high degree of cyst formation. Furthermore we show that genotyping using neutral genetic markers may not be a useful predictor of pathogenic phenotypes.

[Detection of anti-dsDNA-F(AB')2 antibody and evaluation of its clinical significance].

Purified anti-dsDNA antibody was obtained from the serum of patients with systemic lupus erythematosus by affinity-column chromatography. Anti-dsDNA-F(ab')2 fragment (idiotype) was prepared from digested anti-dsDNA antibody with pepsin. We have developed a sensitive and specific method for detection anti-dsDNA-F(ab')2 antibody. Our result revealed that low titer of anti-dsDNA was observed in patients with active stage of systemic lupus erythematosus.

The effect of a disastrous flood on the quality of life in Dongting lake area in China.

We carried out an epidemiological study to assess the impact of flood on the quality of life (QOL) of residents in the affected areas in China. We used a natural experiment approach, randomly selected 494 adults from 18 villages, which suffered from flooding as a result of embankments collapsing, 473 adults from 16 villages, which suffered from, soaked flood, and 773 adults from 11 villages without flood (control group). We used the Generic QOL Inventory-74 (GQOLI-74), social support scale, and questionnaires to assess the QOL of all study participants. The QOL was significantly poorer in soaked group (58.4) and (especially) in collapsed group (55.1) than in control group (59.5, p<0.001). Adjustment for potential confounding factors did not change the results. The impact of flood on QOL was stronger among farmers, seniors, persons with introvert personality, and residents with adverse life-events, whereas social support and extrovert personalities offset the negative impact of flood on QOL.

Practical PCR tools for the delineation of Contracaecum rudolphii A and Contracaecum rudolphii B (Ascaridoidea: Anisakidae) using genetic markers in nuclear ribosomal DNA.

Using genetic markers defined previously in the internal transcribed spacers (ITS-1 and ITS-2) of nuclear ribosomal DNA (rDNA), PCR-coupled restriction fragment length polymorphism (PCR-RFLP) and specific PCR assays were established for the specific detection of each of two morphologically indistinguishable operational taxonomic units (Contracaecum rudolphii A and Contracaecum rudolphii B) within Contracaecum rudolphii (s.l.) and their differentiation from Contracaecum septentrionale, a closely related congener. Application of these tools to C. rudolphii (s.l.) adults from Phalacrocorax carbo sinensis (the Eurasian subspecies of the great cormorant) from Qinghai Lake in China, revealed C. rudolphii B to infect this host. This is the first report of C. rudolphii B in P. carbo sinensis outside of Europe (where it was originally detected), supporting the proposal that this species has a broad geographical distribution. Together with other methods, each of these molecular tools will be useful for investigating the ecology of C. rudolphii A and C. rudolphii B as well as C. septentrionale.

Preparation and identification of specific and high-affinity monoclonal antibodies against morphine.

A C6-hemisuccinate derivative of morphine was prepared and conjugated to bovine serum albumin and ovalbumin. High titer antibody producing spleen cells were removed and fused with myeloma cells of SP2/0 origin. Using a conventional immunization protocol generated twenty-six stable murine monoclonal antibodies (MAbs) producing cell lines to morphine. The donor mouse produced antiserum with a high titer of 1/640,000. Twelve MAbs were selected for further characterization since they showed high sensitivities (53 pg/well to inhibit 50% of the tracer) in improved group-selective immunoassay (IGSI). The assay, which maintains high sensitivity, high precision, and a wide range of optical density (OD) values, was developed using the conjugate M-6-S-OVA to screen and characterize the anti-morphine MAbs. After four successive limiting dilutions, antibodies produced by 12 clones had high affinities ranging from 10(9) to 10(10) M(-1). These clones were found to be of Ig(G) class and IgM class with kappa and lambda light chain. Subclass determination showed that the clones produced IgG1, IgG2a, IgG3, and IgM types of antibody. One clone (2F8B11F2A12) was used to establish the calibration curve with a sensitivity of 400 pg/mL covering up to 25.6 ng/mL in urine.